Evidência científica e experiência clínica: aspectos transculturais

Uchôa, Elizabeth; Corin, Ellen

doi:10.1590/1415-47142002004008

Resumos

A psiquiatria contemporânea tem se empenhado em desenvolver classificações psiquiátricas voltadas principalmente para a padronização de critérios diagnósticos e para a replicação de dados. À medida que estas classificações se impõem cada vez mais à observação clínica, efeitos colaterais já se fazem sentir. Entre eles, nos parece particularmente problemático o estreitamento do campo de observação e suas repercussões sobre a concepção de tratamentos e políticas de saúde mental. Neste artigo nossa reflexão sobre as relações entre “Evidências científicas e experiência clínica” encontra seu ponto central em uma interrogação sobre as conseqüências de uma padronização e objetivação do diagnóstico em psiquiatria tanto para a clínica quanto para as pesquisas transculturais. A questão da depressão na África servirá de ponto de partida para nossa reflexão sobre estas questões.

África; depressão; psiquiatria transcultural

La psiquiatría contemporánea se ha empeñado en desarrollar clasificaciones psiquiátricas volcadas principalmente para la estandarización de ciertos diagnósticos y para la refutación de datos. En la medida que estas clasificaciones se imponen cada vez más en la observación clínica, efectos colaterales ya se hacen sentir. Entre ellos, nos parece particularmente problemático, el estrechamiento del campo de observación y sus repercusiones sobre la concepción de tratamientos y políticas de salud mental. En este artículo nuestra reflexión sobre las relaciones entre “evidencias científicas y experiencia clínica” encuentra su punto central en la interrogación sobre las consecuencias de la estandarización y objetivización del diagnóstico en psiquiatría tanto para la clínica como para las investigaciones transculturales. La cuestión de la depresión en África servirá de punto de partida para nuestra reflexión sobre estos asuntos.

África; depresión; psiquiatría transcultural

La psychiatrie actuelle se caractérise par le développement de classifications psychiatriques tournées vers la standardisation des critères et la reproduction de données. Dans la mesure oú ces classifications s’imposent à la clinique, des effets collatéraux se font déjà sentir; parmi eux la réduction du champ de l’observation et ses repércussions sur la conception des traitements et des politiques de santé mentale nous paraissent particulièrement problématiques. Dans cet article notre réflexion sur les relations entre évidences scientifiques et expérience clinique est tissée autour d’une interrogation sur les conséquences de la standardisation e de l’objectivation du diagnostic autant pour la clinique psychiatrique que pour les recherches transculturelles. La question de la dépression en Afrique servira de point de départ pour nos réflexions sur cette question.

Afrique; dépression; psychiatrie transculturelle

Contemporary psychiatry is committed to developing psychiatric classifications that are geared principally towards the standardization of diagnostic criteria and the replication of data. Side effects can be felt to the extent that these classifications are ever more present in clinical observations. Among these effects, especially problematic are the narrowing of the field of observation and the consequent repercussions on the development of mental health treatment and policies. This narrowing of the field of observation leads us to a positivist model of science and to a belief in the objectivity of knowledge and, specifically, of psychiatric categories. In this article our reflection on the relations between “Scientific proof and clinical experience” is based essentially on a discussion of the consequences of standardization and objectivity in psychiatric diagnosis for both clinical and transcultural research. The theme of depression in Africa will serve as a starting point for our reflection on these questions.

Africa; depression; transcultural psychiatry

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Referências

CORIN, E. At the Margins of Culture in Psychosis. Paper presented in the session “The Edge of Experience: Culture, Schizophrenia and Subjectivity”. American Anthropological Association Conference, Washington: 1997.
CORIN, E. The Tickness of Being: Intentional Worlds, Strategies of Identity, and Experience Among Schizophrenics. Psychiatry v. 61, p. 133-46, 1998.
DIOP, M. La dépression chez le noir Africain, Psychopathologie Africaine v. 3, p. 183-94, 1967.
GERMAN, G.A. Mental health in Africa I: the extend of mental health in Africa today. British Journal of Psychiatry v. 151, p. 435-9, 1987.
GERMAN, G.A. Mental health in Africa II: the extend of mental disorder in Africa today, some clinical observations. British Journal of Psychiatry v. 151, 1987, p. 440-6.
GOOD, B., DELVECCHIO, M.J., MORADI, R. The interpretation of Iranian depressive illness and dysphoric affect. In: KLEINMAN, A. & GOOD, B. (ed.). Culture and Depression: Studies in Anthropology and Cross-Cultural Psychiatry of Affect and Disorder. Berkeley: University of California Press, 1985, p. 369-428.
KLEINMAN, A. Rethinking Psychiatry. From Cultural category to Personal Experience New York: The Free Press, 1988.
KLEINMAN, A. Anthropology and Psychiatry. The Role of Culture in Cross-Cultural Research on Illness. British Journal of Psychiatry v. 151, p. 447-54, 1987.
KLEINMAN, A., GOOD, B. Introduction In: KLEINMAN, A. & GOOD, B. (ed.). Culture and Depression: Studies in Anthropology and Cross-Cultural Psychiatry of Affect and Disorder Berkeley: University of California Press, 1985, p. 1-40.
KLERMAN, G.L. The advantages of DSM-III. The American Journal of Psychiatry. v. 141, n. 4, p. 539-42, 1984.
KUHN, T. A estrutura das revoluções científicas São Paulo: Perspectiva, 1975.
LANTÉRI-LAURA, G. Sémiologie et critique de la connaissance. L’évolution psychiatrique v. 51, n. 4, p. 825-33, 1986.
MARSELLA, A.J., SARTORIUS, N., JABLENSKY, A., FENTON, F.R. Cross-Cultural Studies of Depressive Disorder: An Overview, In: KLEINMAN, A. & GOOD, B. (ed.). Culture and Depression: Studies in Anthropology and Cross-Cultural Psychiatry of Affect and Disorder. Berkeley: University of California Press, 1985. p. 299-324.
ODEJIDE, A.O., OYEWUNMI, L.K., OHAERI, J.U. Psychiatry in Africa: An overview. American Journal of Psychiatry, v. 46, 6, p. 708-16, 1989.
ORTIGUES, M.C. & ORTIGUES, E. Oedipe Africain Paris: Plon, 1973.
PRINCE, R. The changing picture of depressive syndromes in Africa: is it fact or diagnostic fashion? Canadian Journal of African Studies Montréal. v. 1, p. 17792, 1968.
UCHÔA, E. Epidemiologia e Antropologia. Contribuições a uma abordagem dos aspectos transculturais da depressão. In: CANESQUI, A (org.). Ciências sociais e saúde São Paulo: Hucitec-Abrasco, 1997, p. 87-112.
UCHÔA, E. Les femmes de Bamako (Mali) et la santé mentale. Une étude anthropopsyquiatrique Montréal: Université de Montréal, Thèse PhD, Manuscript, 1988.

Datas de Publicação

Publicação nesta coleção
Oct-Dec 2002

Histórico

Recebido
Set 2001
Aceito
Ago 2002

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[1] CORIN, E. At the Margins of Culture in Psychosis. Paper presented in the session “The Edge of Experience: Culture, Schizophrenia and Subjectivity”. American Anthropological Association Conference, Washington: 1997.

[2] CORIN, E. The Tickness of Being: Intentional Worlds, Strategies of Identity, and Experience Among Schizophrenics. Psychiatry v. 61, p. 133-46, 1998.

[3] DIOP, M. La dépression chez le noir Africain, Psychopathologie Africaine v. 3, p. 183-94, 1967.

[4] GERMAN, G.A. Mental health in Africa I: the extend of mental health in Africa today. British Journal of Psychiatry v. 151, p. 435-9, 1987.

[5] GERMAN, G.A. Mental health in Africa II: the extend of mental disorder in Africa today, some clinical observations. British Journal of Psychiatry v. 151, 1987, p. 440-6.

[6] GOOD, B., DELVECCHIO, M.J., MORADI, R. The interpretation of Iranian depressive illness and dysphoric affect. In: KLEINMAN, A. & GOOD, B. (ed.). Culture and Depression: Studies in Anthropology and Cross-Cultural Psychiatry of Affect and Disorder. Berkeley: University of California Press, 1985, p. 369-428.

[7] KLEINMAN, A. Rethinking Psychiatry. From Cultural category to Personal Experience New York: The Free Press, 1988.

[8] KLEINMAN, A. Anthropology and Psychiatry. The Role of Culture in Cross-Cultural Research on Illness. British Journal of Psychiatry v. 151, p. 447-54, 1987.

[9] KLEINMAN, A., GOOD, B. Introduction In: KLEINMAN, A. & GOOD, B. (ed.). Culture and Depression: Studies in Anthropology and Cross-Cultural Psychiatry of Affect and Disorder Berkeley: University of California Press, 1985, p. 1-40.

[10] KLERMAN, G.L. The advantages of DSM-III. The American Journal of Psychiatry. v. 141, n. 4, p. 539-42, 1984.

[11] KUHN, T. A estrutura das revoluções científicas São Paulo: Perspectiva, 1975.

[12] LANTÉRI-LAURA, G. Sémiologie et critique de la connaissance. L’évolution psychiatrique v. 51, n. 4, p. 825-33, 1986.

[13] MARSELLA, A.J., SARTORIUS, N., JABLENSKY, A., FENTON, F.R. Cross-Cultural Studies of Depressive Disorder: An Overview, In: KLEINMAN, A. & GOOD, B. (ed.). Culture and Depression: Studies in Anthropology and Cross-Cultural Psychiatry of Affect and Disorder. Berkeley: University of California Press, 1985. p. 299-324.

[14] ODEJIDE, A.O., OYEWUNMI, L.K., OHAERI, J.U. Psychiatry in Africa: An overview. American Journal of Psychiatry, v. 46, 6, p. 708-16, 1989.

[15] ORTIGUES, M.C. & ORTIGUES, E. Oedipe Africain Paris: Plon, 1973.

[16] PRINCE, R. The changing picture of depressive syndromes in Africa: is it fact or diagnostic fashion? Canadian Journal of African Studies Montréal. v. 1, p. 17792, 1968.

[17] UCHÔA, E. Epidemiologia e Antropologia. Contribuições a uma abordagem dos aspectos transculturais da depressão. In: CANESQUI, A (org.). Ciências sociais e saúde São Paulo: Hucitec-Abrasco, 1997, p. 87-112.

[18] UCHÔA, E. Les femmes de Bamako (Mali) et la santé mentale. Une étude anthropopsyquiatrique Montréal: Université de Montréal, Thèse PhD, Manuscript, 1988.

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