From the emergence of psychiatry to neoliberal logic: the commodification of contemporary suffering

Abstract

This study discusses the concepts of normality and pathologization in contemporaneity from a historical context of the emergence and growth of psychiatry associated with the development of neoliberalism. The psychiatric knowledge begins to grown allied to an economic management of the government, transforming the suffering in commodity. Therefore, the psychiatric reform face challenges against the asylum logic, still present in society, which seeks to catalog diseases and diagnose natural issues of everyday life. Thus, we seek to understand how neoliberal logic is associated with psychiatric knowledge and consequently influences the increase in diagnoses of mental disorders in contemporary times. To achieve this goal, we analyzed journalistic articles and scientific research that address the increase in diagnoses of Autism Spectrum Disorder (ASD) and Attention Deficit with Hyperactivity Disorder (ADHD). It was concluded that it is still necessary to question the influences of psychiatric knowledge and the pharmaceutical industry on what is transmitted to society regarding this subject.

Key words:
Mental Health; Psychiatric Reform; Medicalization; Mental Disorders

Resumo

Neste estudo discute-se os conceitos de normalidade e patologização na contemporaneidade a partir de um contexto histórico do surgimento e do crescimento da psiquiatria como ordem política e o desenvolvimento da lógica neoliberal. O saber psiquiátrico se desenvolve aliado a uma gestão econômica do governo, transformando o sofrimento em mercadoria. Diante disso, a reforma psiquiátrica enfrenta desafios na luta contra a lógica manicomial, ainda presente na sociedade, que busca catalogar as doenças e diagnosticar questões naturais do cotidiano. Portanto, busca-se compreender como a lógica neoliberal se associa ao saber psiquiátrico e, consequentemente, influencia no aumento de diagnósticos de transtornos mentais na contemporaneidade. Para alcançar tal objetivo, foram analisadas matérias jornalísticas e pesquisas científicas que abordam o aumento de diagnósticos de Transtorno do Espectro Autista (TEA) e Transtorno do Déficit de Atenção com Hiperatividade (TDAH). Concluiu-se que ainda é preciso questionar as influências do saber psiquiátrico e da indústria farmacêutica sobre o que é transmitido para a sociedade a respeito dessa temática.

Palavras-chave:
Saúde Mental; Reforma Psiquiátrica; Medicalização da vida; Transtornos Mentais

Resumen

En este estudio se discuten los conceptos de normalidad y patologización en la contemporaneidad a partir de un contexto histórico del surgimiento y crecimiento de la psiquiatría y el desarrollo de la lógica neoliberal. El saber psiquiátrico se desarrolla aliado a una gestión económica del gobierno, transformando el sufrimiento en mercancía. Ante esto, la reforma psiquiátrica enfrentan desafíos contra la lógica manicomial, todavía presente en la sociedad, que busca catalogar las enfermedades y diagnosticar cuestiones naturales de la vida cotidiana. Por lo tanto, se busca comprender cómo la lógica neoliberal se asocia al saber psiquiátrico y, consecuentemente, influye en el aumento de diagnósticos de trastornos mentales en la contemporaneidad. Para alcanzar este objetivo, se analizaron reportajes periodísticos e investigaciones científicas que abordan el aumento de diagnósticos de Trastorno del Espectro Autista (TEA) y Trastorno por Déficit de Atención con Hiperactividad (TDAH). Se concluyó que aún es necesario cuestionar las influencias del saber psiquiátrico y de la industria farmacéutica sobre lo que se transmite a la sociedad con respecto a esta temática.

Palabras chave:
Salud Mental; Reforma Psiquiátrica; Medicalización; Transtornos Mentales

Introduction

According to Pan American Health Organization (PAHO)/World Health Organization (WHO)¹, mental disorders are characterized by “[...] a combination of abnormal thoughts, perceptions, emotions, and behaviors, which may also affect relationships with other people”. The disorders most commonly cited are depression, bipolar affective disorder, schizophrenia and other psychoses, dementia, intellectual disability, and developmental disorders, including autism. First, we should understand why the term “mental disorders” is used so frequently. The International Classification of Diseases, Tenth Revision², uses the term “disorder” and justifies it as a way to avoid problems inherent in the use of terms such as “disease” or “illness”. In this regard, “disorder” is defined as “a clinically recognizable set of symptoms or behavior associated in most cases with distress and with interference with personal functions” (p.5). Both definitions refer to a set or combination of symptoms, indicating that a diagnosis should not be made on the basis of a single symptom. On the other hand, the term “mental disorder” is understood to have originated initially from the terms “mental problem” and “mental alienation”, concepts created and adopted by psychiatry. These concepts are grounded in the assumption of normality.

The concepts of normality and abnormality have already been widely discussed in the literature, but a brief consideration is warranted here. In “The Normal and the Pathological”, Canguilhem³ discusses these concepts, arguing that what is normal may become pathological in another situation if it remains unchanged. Thus, there is no universal standard that can define what is normal. Disease, in this case, would be a new dimension of life rather than a variation of health. This underscores the normalizing power of Medicine, which was fundamental to the constitution of disciplinary society, a concept developed by Foucault in “Discipline and Punish”⁴. With the advent of discipline, institutions, beyond those that constituted medical knowledge, came to disseminate the principle of normalization and, consequently, to produce normalized subjects.

Given this, one may ask: What is being understood as abnormal behavior? The “normal” and the “pathological” are criteria that may be subject to change, as Canguilhem³ asserted. In ICD-10, only the possibility of change is emphasized: “A classification can never be perfect, and there will always be room for further improvement and simplification in the future as our knowledge and experience with the classification increase”² (p.ix). However, this statement paves the way for the constant increase in psychiatric diagnoses to extend indefinitely, since these classifications may change at any time.

Freitas⁵ conducted a search in international and national newspapers in 2017 to understand what information reaches the population regarding the use of psychiatric medications. According to the author, in Brazil during that period, news about the increase in psychiatric medicalization was hard to find in the media, whereas such coverage was more common in the United States and Europe. The author’s question invites reflection on what changes might be found in the media after years of the pandemic and amid growing discussions of the population’s mental health. Although Freitas⁵ focused on news about the use of psychotropics, to begin the discussion proposed in this text, which focuses on mental disorders today, a search was conducted in the Brazilian media regarding the increase in diagnoses of Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD).

In 2022, an IBGE census entitled “2022 Demographic Census: People with Disabilities and People Diagnosed with Autism Spectrum Disorder - Preliminary Results from the Sample”⁶ identified 2.4 million people diagnosed with ASD, corresponding to 1.2% of the Brazilian population. Prevalence was higher among men and children. Regarding ethnicity/skin color, the highest percentage of people with autism was observed among those who self-identified as White. Rio de Janeiro is the third Brazilian state with the largest number of people diagnosed with autism⁷. IBGE technicians indicated that the higher number of diagnoses among children may be related to more recent awareness of the disorder, which facilitates access to diagnosis⁸.

However, psychiatrists’ opinions are presented in the media in a controversial way. Questions are raised about treating mental disorders only as individual and biological problems, dissociated from collective, social, and economic problems, while at the same time, early diagnosis is defended, especially in children, by highlighting the main signs of autism⁹. In addition, there are adult accounts of late autism diagnosis, such as the one described by Holden Thorp¹⁰, who argues that the increase in autism cases is not a problem because it reflects greater public awareness. He also does not question the frequent changes in diagnostic criteria, but merely points to them as one of the reasons for the increase in cases.

Regarding ADHD, fewer reports are found in the media. Reports were found about self-diagnosis, which has grown alongside the increase in accounts of the disorder on social networks (on TikTok, videos of less than one minute showing supposed symptoms of the disorder have more than 3.5 million views). This poses risks because it may conceal the correct diagnosis and lead to inappropriate self-medication. However, Cognitive Behavioral Therapy and medicalization are still defended as the appropriate treatment to improve symptoms and quality of life. The possibility of cure remains outside the scope of consideration^11,12.

When examining journalistic reports published in Brazilian media on the increase in psychiatric diagnoses of ASD and ADHD, one may ask whether scientific studies on the subject exist. Here, the results of a search for national and international scientific articles on the growth of these diagnoses will be presented. Regarding autism, as early as 2004, Mark F. Blaxill¹³ pointed to the increase in autism cases in the United States and the United Kingdom and indicated that the issue should be treated as a public problem. In more recent research, Almeida and Neves¹⁴ highlight the growth in diagnosis in recent years in Brazil; however, they question the possibility of an epidemic and point instead to a “popularization” of the disorder, which is difficult to explain through psychiatry alone. Russell et al. ¹⁵ and Underwood et al. ¹⁶, in studies with the population diagnosed with autism in the United Kingdom, indicate that these cases have increased among adults. The first article mentions an increase, especially among women, and states that this may be related to greater recognition of the disorder by the population and increased use of the diagnosis by doctors. The second highlights the difficulty individuals experience in having the diagnosis recognized in health services. Regarding the diagnosis of ADHD, studies have reported that at least 5% of children in the global population have been diagnosed^17,18. However, the prevalence of the condition differs across countries because of diagnostic criteria, indicating that, at the time the studies were conducted, the disorder was still underrecognized and underdiagnosed in many countries.

What can be observed from reading journalistic reports published in Brazilian media and scientific studies conducted in recent years on diagnoses of ASD and ADHD is the constant reference to the increase in the prevalence and incidence of diagnoses. However, questioning of this increase is rarely present; on the contrary, the need to diagnose in order to treat is emphasized. This raises several questions: Why have diagnoses of these mental disorders increased in recent years? What impact does this have on society? Since it would not be feasible to provide a quick, few-word answer to these questions, this article seeks to reflect on possible responses. Therefore, in an attempt to understand and debate the progressive increase in psychiatric diagnoses of Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD), we shall discuss the social, cultural, and political context that encompasses contemporary distress.

The emergence and growth of psychiatry as a political order

Before the eighteenth century, against a backdrop of demands related to social policy and public morality, the hospital complex became a mixture of a house of correction, a charity institution, and a hostel. In “The Psychiatric Order”¹⁹, Castel describes the general hospital as originally not a medical institution but a social order of exclusion, assistance, and philanthropy. It was, therefore, not characterized by the presence of the medical norm²⁰. By the eighteenth century, as emphasized in Foucault’s “The Birth of the Clinic”²¹, the apparatus of normality can be seen as essential to the civilizing process in modernity. In this process, Medicine is a civilizing strategy. Health policy in this period begins with the idea that medical practice is integrated into an economic management that aims to rationalize society. Thus, medicine gives political form to biological processes and begins to address issues beyond life and death, becoming concerned with all conditions that affect the evolution of the population. Therefore, under the systematic and dominant action of discipline, the hospital becomes a medicalized institution. The context in which medicine developed is presented here in order to introduce the idea that this way of thinking would grow over time and currently influence the constitution of psychiatric diagnosis and the commodification of mental health, as will be discussed below. However, before continuing the theoretical discussion presented here, we should stress that this article does not intend to build a critique of medicalization or Medicine in general. Whenever the term is used, it refers to the psychiatric context and aims to describe the pathologization of life experiences and contemporary distress.

The history of Psychiatry involves important theoretical and practical milestones, notably described by Desviat²². First, we should highlight the concept of “mental alienation,” created by Philippe Pinel. This concept separates madness from exclusion and transforms it into a clinical entity in need of cure. The emergence of alienists triggered the recognition of Psychiatry as a medical specialty, although the term “alienist” was not replaced by “psychiatrist” until the twentieth century. Second, it is known that, by the mid-nineteenth century, mental alienism was replaced by the paradigm of mental diseases, in which the presumed lesion predominated in their etiology. According to Castel¹⁹, a science is founded on Pinel’s technology when the population considered mad is classified into broad behavioral syndromes, transforming the “insane” into the “sick” and chaining them as objects of psychiatric knowledge. In summary, French alienist Psychiatry was structured around the following heterogeneous dimensions: classification of institutional space, the nosography of mental diseases, and moral treatment.

Subsequently, in the 1930s, the mental disease model would be replaced by the notion of pathological structures. At this point, discovering the psychological mechanisms that cause diseases became more important than describing symptoms. The process Castel¹⁹ called “aggiornamento” characterizes this updating of a device of control and social discipline into the modern promotion of mental health. Thus, social control mechanisms were updated, shifting from repression to the social normalization of health, giving rise to contemporary biologicist hegemony.

According to Basaglia²³, Medicine transforms the separation between the unproductive and the productive into the sick and the healthy. The author affirms that “the birth of the clinic seems to indicate the achieved coincidence between the unproductive and the sick and, therefore, the integration between Medicine and the organization of production”²³ (p.301). Thus, Psychiatry, since its creation, has been constituted between Medicine and public order. Psychiatry states that disease lies in everything that the social organization defines as dangerous to its equilibrium. In this way, people with mental illness lived in asylums under the order of the irreversibility of this exclusion and were therefore “isolated on the margins of the productive organization”²³ (p.308).

The first experiences of the so-called psychiatric reforms emerged in Europe after the Second World War. In Brazil, questioning of the asylum logic emerged more forcefully in the 1970s, in a context marked by the growing power of large corporations and the privatization of the public sector, as well as difficulty accessing health services. In this context, Nise da Silveira’s contributions through her experience at the Engenho de Dentro Psychiatric Hospital stand out for questioning the asylum logic. Beyond the European and Brazilian contexts, we should mention Frantz Fanon’s experience at Blida-Joinville Psychiatric Hospital (which can be explored further in the essays in the book “Alienation and Freedom”²⁴). Both were important milestones in the history of the Anti-Asylum Movement and Psychiatric Reform.

The process of Brazilian Psychiatric Reform, associated with deinstitutionalization, can be understood as a project for deconstructing a dominant paradigm. By proposing transformations in public policies and mental health services, it seeks to deconstruct the hegemonic asylum logic that had been established until then. This initiative signals the inability of psychiatry, as a field of knowledge, to discuss the question of madness in isolation²⁵. Thus, with the predominance of an epistemological critique of the knowledge constitutive of Psychiatry, the psychiatric reform movement in Brazil became associated with Collective Health as part of a counter-hegemonic science.

However, in the text “Letter from New York - The Artificial Patient”, Basaglia²⁶ describes the shift from an asylum model to new psychiatric institutions, showing that the denial of the reality of asylums was only apparent. Although new services were built and implemented, the asylum continued to exist as an institution of violence and exclusion, a space where society’s “disturbing elements” are excluded. The author states that “if the asylum continues to serve as a dumping ground for disturbed patients, the rest is mystification”²⁶ (p.154). Thus, the asylum institution itself would be creating these apparently more open and nondiscriminatory psychiatric units. In the current Brazilian context, we are experiencing the closure of asylums that existed for years and the emergence of new mental health services. However, this does not prevent the growth of the asylum logic still found in society or the emergence of new asylum institutions (as is the case with current religious institutions that call themselves “therapeutic communities”).

Also, according to Basaglia²⁶, the creation of other psychiatric units separated from asylums did not diminish the importance attributed to psychiatric knowledge; on the contrary, it functioned as a possible source of power for Psychiatry. Even as new mental health services supported by Social Psychiatry were being built, Psychiatric Hospitals functioned as places where ill subjects defined as “chronic” or “disturbed” were sent. The proximity to the term “disorder” is no mere coincidence: no one wanted to be identified as a mentally ill subject with a psychiatric diagnosis, because those who were so identified were supposed to be institutionalized. Today, this situation has changed, insofar as a mental disorder diagnosis is essential to ensure care in mental health services and other public policy benefits.

However, Freitas⁵ says that just as society once accepted asylums, lobotomy, and eugenics as science-based procedures and as the dominant paradigm, today it accepts excessive diagnoses and psychoactive drugs. Thus, we live under a “disease paradigm” that legitimizes institutionalized violence. The main question, then, is: Have we really put an end to asylums, or are we living a mystification? Could the excess of mental disorder diagnoses and new psychiatric treatments be a way of masking a society that is, in fact, exclusionary and discriminatory?

Neoliberalism and psychiatric knowledge: patient or consumer?

We live in a society in which neoliberalism has managed to achieve what it had so long sought: to associate freedom with entrepreneurship, free enterprise, and competitiveness. As Safatle²⁷ stated: “[...] one does not suffer in the same way inside and outside neoliberalism” (p.33). There is a new “social grammar of distress” that is constituted when the rise of neoliberalism is observed. This concept is associated with the emergence of DSM-III, which changed the categorization of psychic distress in 1970. Later, in 1992, journalist Lynn Payer coined the term “disease mongering,” that is, the commodification of diseases, whereby healthy people are converted into patients. This shows that the location of psychic distress as part of neoliberal logic did not end in the 1970s²⁸.

That said, how does psychiatric knowledge become associated with the context of neoliberal logic? According to Neves et al. ²⁹, Psychiatry moved from a therapeutic function of normalizing and rationalizing the subject, located within medical practice, to a function of enhancement belonging to neoliberal logic. Updates to manuals such as the DSM and ICD allowed Psychiatry to move closer to the pharmaceutical industry and marketing, naturalizing and trivializing diagnoses and disorders through massive media and social dissemination. Thus, an intimate relationship is evident between psychiatric knowledge and neoliberal logic, which seeks to mask human fragilities, inconsistencies, and precarities according to the criterion of maximum productivity.

Although these authors address important issues for the discussion initiated in this article, one formulation they defend needs to be problematized. When mentioning the “paradoxical echoes of psychiatric reform,” the authors position the anti-asylum movement as a force vector for neoliberal imperatives in expanding mental disorder to society as a whole. However, the discussion of the real principles and purposes of psychiatric reform was not developed in sufficient depth. It is not merely a matter of closing asylums, but of destroying the asylum logic entrenched in society, a logic that, beyond the proposal of isolation, also aims to catalog diseases and diagnose natural aspects of everyday life.

To illustrate this point, one may cite Guattari’s³⁰ experience at the La Borde Clinic in 1955, described in his text “Analytical Practices and Social Practices”. The author proposes a permanent internal recreation of psychiatric institutions, since closing asylums does not prevent the same logic from continuing to exist in new care arrangements. The poor conditions under which psychiatric hospitals were closed did not allow real reform solutions to be implemented. Guattari³⁰ argues: “In any case, the Italian reformers of Psychiatry had touched on an essential dimension of the problem: only the sensitization and mobilization of the social context could create favorable conditions for real transformations”³⁰ (p.194). The author adds that there must be a “renewal of Psychiatry so that it does not close in on itself”³⁰ (p.198).

Therefore, the aim is to deconstruct the hegemonic paradigm of Psychiatry, which is associated with the increase in diagnosis and the consumption of psychotropics, and moves in the opposite direction from the anti-asylum movement, one of whose purposes is to de-medicalize life. The growing pharmaceutical industry and the advent of psychotropics from the 1950s onward disseminated an advance in therapeutic potential related to the treatment of mental disorders. With the marked presence of this new trend, especially in the late 1980s, medicalization became linked to the abusive and inappropriate use of medications, since the medical-industrial complex prioritizes abundant profits and sales instead of directing its resources to the treatment of diseases and improvement of quality of life²⁸.

Thus, the idea of pathologization, which seeks to normalize the subject, began to appropriate issues of everyday life, and, consequently, distress came to be explained exclusively as a problem of a medical nature (which would justify the excessive number of mental disorders in diagnostic classification manuals). Desviat²⁸ discusses how feelings of anguish and sadness have become fully associated with diagnoses of anxiety and depression, when they could often be natural sensations within a life experience.

The pathologization of life has been widely discussed in the field of mental health, and two fundamental authors who contributed to this debate should be highlighted. The first, Ivan Illich, showed in his book “Medical Nemesis: The Expropriation of Health”³¹ how subjects’ autonomy decreases as medicalization increases. The second, Thomas Szasz³², wrote in his seminal work “The Manufacture of Madness” about how psychiatry transformed social behaviors into pathologies. In “Anatomy of an Epidemic”, Whitaker³³ demonstrates that scientific evidence is lacking to support the fundamental principle of the biomedical model in psychiatry, according to which mental disorders are produced by chemical imbalances and regulated through the use of psychotropic drugs. The author states that Psychiatry and the pharmaceutical industry constructed myths that were disseminated throughout society and caused an increase in diagnostic categories, prioritized pharmacological treatment, and consequently increased the prescription of psychiatric drugs. The list continues: Whitaker³³ denounces the increase in patients chemically dependent on psychiatric drugs, the enormous social and economic costs of these patients, and the influence of the pharmaceutical industry on scientific research, the training of mental health professionals, and public assistance policy guidelines³⁴.

Freitas⁵ points out that, even with millions being treated by Psychiatry, there remains a lack of care for subjects’ distress. There is, then, a paradox: the excessive number of psychiatric diagnoses associated with medication use coexists with distress that is fed by diagnosis and by prescribed drugs. The author believes that most individuals undergoing psychiatric treatment are dissatisfied because they do not find health professionals who are truly concerned about and attentive to their distress. On the other hand, the emergence of “disease activists” is noted, that is, groups of patients created by the pharmaceutical industry in order to defend their rights and obtain benefits, such as free psychiatric medications or discounts. The problem is that these subjects end up becoming a defense mechanism for the industry insofar as they exist to legitimize the disease, the treatment, and the beneficial action of psychotropics.

Final considerations

To change the situation in which little is said about deconstructing the foundations of Psychiatry’s disease model, space must be created for new alternative experiences of care involving the reduction of psychiatric medication use. These include the Open Dialogue experience, which emerged in Finland and demonstrated treatment results for psychotic crises without the use, or with minimal use, of antipsychotics³⁵, and the Soteria therapeutic recovery model³⁶. They also include care experiences provided by organizations of former users, such as voice-hearing groups, which gather people who consider hearing voices to be a human and meaningful (albeit uncommon) variation, thereby supporting family members, activists, health professionals, and mental health users⁵. Reducing the diagnostic issue to a biological dimension removes the complexity of the experience, creating a one-dimensional and reductionist view. This biological reductionism diminishes the importance of experience and of the social and family relationships constructed by the subject, as well as of the subject’s own life narrative. In this regard, there are other ways of thinking about, seeing, and explaining contemporary distress that consider the importance of a multidimensional view derived from philosophical, psychological, phenomenological, and cultural knowledge.

In addition, some points are also raised that may help us think about changes that need to be made in the training of health professionals and researchers. First, the relationship between the pharmaceutical industry and medical training and continuing education must be regulated (both in the financing of courses and in participation in scientific journals, conferences, and research). Next, some argue that the pharmaceutical industry should be required to contribute to the National Fund for Science and Technology, distributing resources through public calls for proposals. Finally, professional associations that hold conferences and other events with funding from the pharmaceutical industry need to be regulated so that they become the result of public policies and social control.

In the text “The 10 Most Important Myths for Critics of Psychiatry”³⁷, the author debunks some popular beliefs about critical views of Psychiatry. For example, she emphasizes that challenging the medical model is not the same as denying the experiences of distress of subjects diagnosed with mental disorders. Moreover, people should not be told how to describe themselves and their experiences (although medical vocabulary is routinely imposed on them). Furthermore, the author argues that, at a minimum, people need to be informed that there are nonmedical ways of understanding their expectations. In this sense, the social and financial benefits related to diagnosis should be linked to the person’s needs rather than to the existence or absence of a mental disorder.

Finally, it is clear that it is no coincidence that neoliberalism, the new social grammar of distress, the pathologization of life, and the increase in psychiatric diagnoses have advanced together. As we follow an “entrepreneurial ideal of the self”, it seems that the only way to achieve it is through the excessive categorization of diseases, in search of a quick answer and an effective solution that will end distress so that the subject can return as soon as possible to their routine of production. Exiting this neoliberal cycle is an arduous task that demands time, effort, and struggle. For this reason, demystifying the epistemological critiques directed at psychiatric power and the pharmaceutical industry is an important part of creating dialogue with society about the excessive number of diagnoses. Although this is an old struggle among those who believe in the proposals of the anti-asylum movement and the de-medicalization of life, it is still necessary to occupy more spaces in society and continue building new dialogues.

References

• ¹ Organização Pan-Americana de Saúde (OPAS). Transtornos mentais [Internet]. 2025 [acessado 2025 ago 4]. Disponível em: https://www.paho.org/pt/topicos/transtornos-mentais
  » https://www.paho.org/pt/topicos/transtornos-mentais
• ² Organização Mundial de Saúde (OMS). Classificação estatística internacional de doenças e problemas relacionados à saúde: 10a revisão (CID-10). 10ª ed. Genebra: OMS; 1993.
• ³ Canguilhem G. Doença, cura, saúde. In: Canguilhem G. E+O normal e o patológico. 7ª ed. Rio de Janeiro: Forense-Universitária; 2012. p. 125-143.
• ⁴ Foucault M. Vigiar e Punir. 16ª ed. Petrópolis: Editora Vozes; 1997.
• ⁵ Freitas F. Direitos Humanos e opressão psiquiátrica: a violência da medicalização. In: Amarante P, Whitaker R, organizadores. Desmedicar: a luta global contra a medicalização da vida. São Paulo: Zagodoni; 2024. p. 50-68.
• ⁶ Siqueira B. Agência IBGE Notícias. Censo 2022 identifica 2,4 milhões de pessoas diagnosticadas com autismo no Brasil [Internet]. 2025 [acessado 2025 ago 4]. Disponível em: https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/43464-censo-2022-identifica-2-4-milhoes-de-pessoas-diagnosticadas-com-autismo-no-brasil
  » https://agenciadenoticias.ibge.gov.br/agencia-noticias/2012-agencia-de-noticias/noticias/43464-censo-2022-identifica-2-4-milhoes-de-pessoas-diagnosticadas-com-autismo-no-brasil
• ⁷ Rezende A, Caparelli K, Portes A. Rio é o terceiro estado com mais pessoas com diagnóstico de autismo no país, diz IBGE [Internet]. 2025 [acessado 2025 ago 4]. Disponível em: https://g1.globo.com/rj/rio-de-janeiro/noticia/2025/05/23/pessoas-com-diagnostico-de-autismo-no-pais-censo-ibge.ghtml
  » https://g1.globo.com/rj/rio-de-janeiro/noticia/2025/05/23/pessoas-com-diagnostico-de-autismo-no-pais-censo-ibge.ghtml
• ⁸ Lacerda L. Brasil tem 2,4 milhões de pessoas com diagnóstico de autismo; maior proporção é entre crianças [Internet]. 2025 [acessado 2025 ago 5]. Disponível em: https://www1.folha.uol.com.br/cotidiano/2025/05/brasil-tem-24-milhoes-de-pessoas-com-diagnostico-de-autismo-maior-proporcao-e-entre-criancas.shtml
  » https://www1.folha.uol.com.br/cotidiano/2025/05/brasil-tem-24-milhoes-de-pessoas-com-diagnostico-de-autismo-maior-proporcao-e-entre-criancas.shtml
• ⁹ Queiroz M. Cresce procura para avaliação de autismo na rede pública do Rio, mas maioria dos pais recebe outro diagnóstico [Internet]. 2025 [acessado 2025 ago 4]. Disponível em: https://g1.globo.com/rj/rio-de-janeiro/noticia/2025/07/23/cresce-procura-para-avaliacao-de-autismo-na-rede-publica-do-rio-mas-maioria-dos-pais-recebe-outro-diagnostico.ghtml
  » https://g1.globo.com/rj/rio-de-janeiro/noticia/2025/07/23/cresce-procura-para-avaliacao-de-autismo-na-rede-publica-do-rio-mas-maioria-dos-pais-recebe-outro-diagnostico.ghtml
• ¹⁰ Thorp H. Recebi o diagnóstico de autismo aos 53 anos; eu sei por que as taxas estão aumentando [Internet]. 2025 [acessado 2025 ago 4]. Disponível em: https://www1.folha.uol.com.br/equilibrioesaude/2025/03/recebi-o-diagnostico-de-autismo-aos-53-anos-eu-sei-por-que-as-taxas-estao-aumentando.shtml
  » https://www1.folha.uol.com.br/equilibrioesaude/2025/03/recebi-o-diagnostico-de-autismo-aos-53-anos-eu-sei-por-que-as-taxas-estao-aumentando.shtml
• ¹¹ Reis S. Desatenção, hiperatividade e impulsividade: entenda por que o TDAH vai além dos grandes sintomas e é desafio para médicos e pacientes [Internet]. 2024 [acessado 2025 ago 4]. Disponível em: https://g1.globo.com/saude/noticia/2024/12/12/desatencao hiperatividade e impulsividade entenda por que o tdah vai alem dos grandes sintomas e e desafio para medicos e pacientes.ghtml
  » https://g1.globo.com/saude/noticia/2024/12/12/desatencao hiperatividade e impulsividade entenda por que o tdah vai alem dos grandes sintomas e e desafio para medicos e pacientes.ghtml
• ¹² Vasconcelos J, Miranda M. TDAH: entenda os riscos de se autodiagnosticar pelas redes sociais e saiba como buscar ajuda adequada [Internet]. 2025 [acessado 2025 ago 4]. Disponível em: https://g1.globo.com/sp/campinas-regiao/noticia/2025/04/04/tdah-entenda-os-riscos-de-se-autodiagnosticar-pelas-redes-sociais-e-saiba-como-buscar-ajuda-adequada.ghtml
  » https://g1.globo.com/sp/campinas-regiao/noticia/2025/04/04/tdah-entenda-os-riscos-de-se-autodiagnosticar-pelas-redes-sociais-e-saiba-como-buscar-ajuda-adequada.ghtml
• ¹³ Blaxill MF. What's Going on? The Question of Time Trends in Autism. Public Health Rep 2004; 119(6):536-551.
• ¹⁴ Almeida ML, Neves AS. A Popularização Diagnóstica do Autismo: uma Falsa Epidemia? Psicol Cien Prof 2020; 40:1-12.
• ¹⁵ Russel G, Stapley S, Newlove-Delgado T, Salmon A, White R, Warren F, Pearson A, Ford T. Time trends in autism diagnosis over 20 years: a UK population-based cohort study. J Child Psychol Psychiatry 2022; 63(6):674-682.
• ¹⁶ Underwood JFG, Delpozo-Banos M, Frizzati A, John A, Hall J. Evidence of increasing recorded diagnosis of autism spectrum disorders in Wales, UK: an e-cohort study. Autism Int J Res Pract 2022; 26(6):1499-1508.
• ¹⁷ Sayal K, Prasad V, Daley D, Ford T, Coghill D. ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry 2018; 5(2):175-186.
• ¹⁸ Taylor E. Attention deficit hyperactivity disorder: overdiagnosed or diagnoses missed? Arch Dis Child 2017; 102(4):376-379.
• ¹⁹ Castel R. A ordem psiquiátrica: A idade de ouro do alienismo. Rio de Janeiro: Edições Graal; 1978.
• ²⁰ Amarante P. Loucos pela vida: a trajetória da reforma psiquiátrica no Brasil. 2ª ed. Rio de Janeiro: Editora Fiocruz; 1995.
• ²¹ Foucault M. O nascimento da clínica. Rio de Janeiro: Forense Universitária; 1988.
• ²² Desviat M. O conhecimento: A Necessidade de uma Psicopatologia. In: Desviat M. Coabitar a diferença: da Reforma Psiquiátrica à Saúde Mental Coletiva. São Paulo: Zagodoni; 2018. p. 90-106.
• ²³ Basaglia F. Lei e psiquiatria: Para uma análise das normas no campo psiquiátrico. In: Basaglia F. Escritos selecionados em saúde mental e reforma psiquiátrica. Rio de Janeiro: Garamond Universitária; 2010. p. 299-323.
• ²⁴ Fanon F. Alienação e liberdade. São Paulo: Ubu Editora; 2020.
• ²⁵ Alves D. Integralidade nas Políticas de Saúde Mental. In: Pinheiros R, Mattos R, organizadores. Os sentidos da integralidade na atenção e no cuidado à saúde. 8ª ed. Rio de Janeiro: UERJ, IMS, Abrasco; 2009. p. 171-180.
• ²⁶ Basaglia F. Carta de Nova York - O doente artificial. In: Basaglia F. Escritos selecionados em saúde mental e reforma psiquiátrica. Rio de Janeiro: Garamond Universitária; 2010. p. 151-160.
• ²⁷ Safatle V. A economia é a continuação da psicologia por outros meios: sofrimento psíquico e o neoliberalismo como economia moral. In: Safatle V, Silva Junior N, Dunker C, organizadores. Neoliberalismo como gestão do sofrimento psíquico. Belo Horizonte: Autêntica; 2023. p. 17-46.
• ²⁸ Desviat M. A construção social da doença: Medicalização e iatrogenia. In: Desviat M. Coabitar a diferença: da Reforma Psiquiátrica à Saúde Mental Coletiva. São Paulo: Zagodoni; 2018. p. 143-157.
• ²⁹ Neves A, Ismerim A, Brito B, Costa FD, Santos LRP, Senhorini M, Silva Junior N, Beer PAC, Bazzo R, Gonsalves RLC, Coelho SP, Carnizelo VCR. A psiquiatria sob o neoliberalismo: da clínica dos transtornos ao aprimoramento de si. In: Safatle V, Silva Junior N, Dunker C, organizadores. Neoliberalismo como gestão do sofrimento psíquico. Belo Horizonte: Autêntica; 2023. p. 125-175.
• ³⁰ Guattari F. Práticas Analíticas e Práticas Sociais. In: Guattari F. Caosmose: um novo paradigma estético. São Paulo: Editora 34; 1992. p. 183-203.
• ³¹ Illich I. Nêmesis médica: a expropriação da saúde. Rio de Janeiro: Nova Fronteira; 1976.
• ³² Szasz T. A fabricação da loucura. Rio de Janeiro: Guanabara; 1971.
• ³³ Whitaker R. Anatomia de uma epidemia: pílulas mágicas, drogas psiquiátricas e o aumento assombroso da doença mental. Rio de Janeiro: Editora Fiocruz; 2017.
• ³⁴ Amarante P, Freitas F, Gomes C, Marques J. Consolidando um Novo Dispositivo na Luta pela Desmedicalização da Vida: Oito Anos de Mad In Brasil. In: Amarante P, Whitaker R, organizadores. Desmedicar: a luta global contra a medicalização da vida. São Paulo: Zagodoni; 2024. p. 39-49.
• ³⁵ Seikkula J, Aaltonen J, Alakare B, Haarakangas K, Keränen J, Lehtinen K. Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies. Psychother Res 2006, 16(2):214-228.
• ³⁶ Mosher LS. Soteria and other alternatives to acute psychiatric hospitals. A personal and professional Review. J Nerv Ment Dis 1999; 187:142-149.
• ³⁷ Taylor-Page C. Os 10 mitos mais importantes para os críticos da psiquiatria. In: Amarante P, Whitaker R, organizadores. Desmedicar: a luta global contra a medicalização da vida. São Paulo: Zagodoni; 2024. p. 154-164.

Funding

Instituto Aggeu Magalhães - Fiocruz (IAM-FIO CRUZ).

Data availability statement

The data sources adopted in the research are indicated in the article’s body.

Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva, Vania de Matos Fonseca

Publication Dates

• Publication in this collection
  05 Oct 2026
• Date of issue
  2026

History

• Received
  16 Dec 2025
• Accepted
  13 May 2026
• Published
  15 May 2026