Tempo, idade e cultura: uma contribuição à psicopatologia da depressão no idoso. Parte III: A depressão, o tempo e a cultura

Bastos, Cláudio Lyra

doi:10.1590/1415-47142006002009

Resumos

Procuramos aqui relacionar dois aspectos fundamentais das intuições culturais sobre a passagem do tempo - a temporalidade cíclica e a contínua - com a terapêutica médica e especialmente com a psicopatologia, numa visão crítica do constructo moderno da depressão no idoso. Inspirado em perspectivas de natureza antropológica, o texto se apoia na experiência clínica cotidiana e na atitude fenomenológica que orienta essa prática. Nas concepções culturais que tendem a perceber a passagem do tempo de forma predominantemente cíclica, o envelhecer é parte de um movimento eterno e a família se perpetua em seus descendentes, nas suas tradições, no vínculo com a terra ou no exercício do ofício familiar. As transformações culturais que têm proporcionado a passagem para enfoques mais direcionais do tempo vão destacando cada vez mais o papel individual na história social. Quanto mais difícil for a passagem de Weltanschauungen tradicionais, de tendência circular, fatalista, repetitiva e eterna para outras de tendência individualizante, burocratizante, planejadora e sucessiva, maiores as dificuldades para uma senectude satisfatória e maior a tendência à medicalização desse fracasso. Esta é a terceira parte de uma série de três artigos.

Psicopatologia e cultura; temporalidade e medicina; depressão no idoso; psicogeriatria

Procuramos aquí relacionar dos aspectos fundamentales de las intuiciones culturales sobre el pasaje del tiempo - la temporalidad cíclica e a continua - con la terapéutica médica y más especialmente con la psicopatologia, en una visión critica del constructo moderno de la depresión en la vejez. Inspirado en perspectivas antropológicas, el texto busca apoyo en la experiencia clínica diaria y en la actitud fenomenológica que la orienta. Para las concepciones culturales del tiempo que tienden a percibir su pasaje deforma predominantemente cíclica, envejecer es parte de un movimiento eterno, la familia se perpetúa en sus descendientes, en sus tradiciones, en el vínculo con la tierra o en el ejercicio del trabajo familiar. Las transformaciones culturales que han proporcionado el pasaje para enfoques más direccionales del tiempo van destacando cada vez más el rol individual en la historia social. Cuanto más dificultoso sea el pasaje de Weltanschauungen tradicionales, de tendencia circular, fatalista, repetitiva y eterna, para otras, de tendencia individualizante, burocratizante, planeadora y sucesiva, más grandes las dificultades para una senectud satisfactoria y mayor la tendencia a la medicalización de este fracaso. Esta es la tercera parte de una serie de tres artículos.

Psicopatologia y cultura; temporalidad y medicina; depresión en el anciano; psicogeriatría

Nous cherchons ici à relationer deux aspects fondamentales des conceptions intuitives culturelles sur la passage du temps - la temporalité cyclique e la continue - avec la thérapeutique médicale et plus spécialement avec la psychopathologie, dans une vision critique de la conception moderne de la dépression chez la vieillesse. Inspirée des perspectives anthropologiques, le texte se soutien dans l' expérience clinique de chaque jour et dans l´attitude phénoménologique guidant cette pratique. Dans las conceptions culturelles du temps de tendance cyclique, le vieillissement est part d'un mouvement éternel et la famille se perpétue par ses descendants, sas traditions, ses liens avec la terre ou l'exercice du métier familier. Les transformations culturelles que proportionnent la passage pour un approche plus directionnel du temps détachent de plus em plus le rôle individuel das l'histoire social. La plus difficile est la passage des perspectives traditionnelles, tendants à la circularité, à la répétition, au fatalisme et à l'éternité, pour autres de tendance à l'individualisation, à la bureaucratie, à la planification et à la succession, les plus grandes les entraves à une vieillesse satisfaisante et la tendance à la médicalisation de ce problème. Cet article est la troisième part d'une série de trois.

Psychopatologie et culture; temporalité et medicine; depression et l'âgée; psychogeriatrie

Two fundamental aspects of intuitive cultural conceptions of the passage of time - cyclical and continuous - are related here to medical therapy and psychopathology, from a critical perspective of the condition of depression in old age as a modern construct. Although inspired by anthropological perspectives, this article is based on daily clinical experience and takes a phenomenological attitude. In predominantly cyclical cultural perceptions of time the ageing process is part of an eternal movement, and families perpetuate themselves in their descendants, their traditions, ties with the land, or in the practice of family crafts and skills. Cultural transformations that give rise to more directional approaches to the passage of time tend toward growing emphasis on individual roles in social history. The more difficult the change from fatalist, repetitive, traditional and eternally cycling Weltanschauungen, on the one hand, to others, based on individualizing, bureaucratizing, planning-based and successive concepts, the greater are the chances of unsuccessful old age and the médicalisation of this failure. This paper is the new of a three-part series.

Psychopathology and culture; temporality and medicine; depression and ageing; psychogeriatrics

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Referências

ALEXOPOULOS, G. S. Depression and other mood disorders. In: Geriatrics Review Syllabus, 4th ed. New York: American Geriatrics Society, 1999. p. 167-75.
BASTOS, C. L. O tempo, as representações sociais de doença e a psicoterapia. Informação Psiquiátrica, v. 15, n. 4, p. 139-44, 1996.
BASTOS, C. L. Tempo, idade e cultura: uma contribuição à psicopatologia da depressão no idoso. Primera parte: Temporalidade e cultura. Revista Latinoamericana de Psicopatologia Fundamental, ano VIII, n. 4, p. 738-753, dez. 2005.
BASTOS, C. L. Tempo, idade e cultura: uma contribuição à psicopatologia da depressão no idoso. Segunda parte: Uma investigação sobre a temporalidade e a medicina. Revista Latinoamericana de Psicopatologia Fundamental, ano IX, n. 1, p. 89-113, mar. 2006.
BLAZER, D. G. Epidemiology of psychiatric disorders in late life. In: Busse, E. W. & Blazer, D. G. (org.). Textbook of Geriatric Psychiatry. 2nd ed. Washington: American Psychiatric Press, 1995.
BURGESS, E. O.; SCHMEECKLE, M. & BENGTSON, V. L. Aging individuals and social contexts. In: Nordhus, I. H.; Vandenbos, G R.; Berg, S. & Fromholt, P. (org.). Clinical Geropsy cholo gy. Washington: American Psychological Association, 1998.
CANDAU, J. Mémoire et identité. Paris: PUF, 1998.
COLE, T. R. Aging, meaning and well-being: musings of a cultural historian. International Journal of Aging and Human Development, n. 19, p. 329-36, 1984.
COLE, T. R. The Journey of Life: A Cultural History of Aging in America. New York: Cambridge University Press, 1991.
DUMONT, L. Essais sur Vindividualisme. Paris: Éditions du Seuil, 1991.
EBERSOLE, P. Toward Healthy Aging: Human needs and nursing response. 3rd.ed. St. Louis: Mosby, 1990.
ELIAS, Ν. A sociedade dos indivíduos (Die Gesellschaft der Individúen). Rio de Janeiro: Zahar, 1994.
GALL, J. S. & SWABO, P. A. Psychosocial aspects of aging. Geriatrics Reviews Syllabus, 1999-2001.
GARDNER, Ε. Α.; BALM, A. K.; MACK, M. Suicide and psychiatric care in the aging. Arch. Gen. Psychiatry, n. 10, p. 547-53, 1964.
GEORGE, L. K. Social and economic factors related to psychiatric disorders in late life. In: Busse, Ε. W. & Blazer, D. G (org.). Textbook of Geriatric Psychiatry. 2nd. ed. Washington: American Psychiatric Press, 1995.
HASSED, C. S. Depression: dispirited or spiritually deprived? Medical Journal of Australia, n. 173, p. 545-7, 2000.
HAZAN, H. Old Age, Constructions and Deconstructions. Cambridge: Cambridge University Press, 1994.
HEALY, D. The Anti-Depressant Era. Cambridge: Harvard University Press, 1997.
HENDRICKS, C. D. & HENDRICKS, J. Concepts of time and the aged. In: Gubrium, J. F. (org.). Time, Roles and Self in Old Age. New York: Human Sciences Press, 1976.
INGEBRETSEN, R. & SOLEM, P. E. Death dying and bereavement. In: Nordhus, I. H.; Vandenbos, G R.; Berg, S. & Fromholt, P. (org.). Clinical Geropsychology. Washington: American Psychological Association, 1998.
JASPERS, K. Psicopatologia geral (Allgemeine Psychopathologie). Rio de Janeiro: Atheneu, 1973. 2 vv.
KASL-GODLEY, J. E.; GATZ, M. & FISKE, A. Depression and depressive symptoms in old age. In: Nordhus, I. H.; Vandenbos, G. R.; Berg, S. & Fromholt, P. (org.). Clinical Geropsychology. Washington: American Psychological Association, 1998.
KLEINMAN, A. & GOOD, B. (org.). Culture and Depression. Berkeley: University of California Press, 1985.
KRAUSE, Ν.; JAY, G; LIAN, G. Financial strain and psychological well-being among the American and Japanese elderly. Psychology and Aging, v. 6, n. 2, p. 170-81, 1991.
LAPLANTINE, F. Antropologia da doença (Anthropologie de la Maladie). São Paulo: Martins Fontes, 1991.
LYNESS, J. M.; KING, D. Α.; COX, C; YOEDIONO, Z.; CAINE, E. D. The importance of subsyndromal depression in older primary care patients: prevalence and associated functional disability. Journal of the American Geriatric Society, v. 47, n. 6, p. 647-52,1999.
METGE, C. J. & CAHN, B. Health Policy. In: Ruskin, P. E. & Rogers, E. L. MEGA -Multidisciplinary Education in Geriatry & Aging. Baltimore: University of Maryland, 2000.
MINKOWSKI, E. Traité de psychopathologie. Collection Les Empêcheurs de Penser en Rond. Synthélabo. Le Plessis-Robinson, 1999.
MYERS, J. Κ.; WEISSMAN, M. M.; TISCHLER, G. L. et al. Six-month prevalence of psychiatric disorders in three communities: 1980-1982. Archives of General Psychiatry, n. 41, p. 959-67,1984.
NIKELLY, A.G. Does DSM-III-R diagnose depression in non-Western patients? International Journal of Social Psychiatry Winter, v. 34, n. 4, p. 316-20, 1988.
OLSHANSKY, S. J. & CARNES, Β. A. The Quest for Immortality: Science at the Frontiers of Aging. New York: W. W. Norton, 2001.
REGIER, D. Α.; MYERS, J. K.; KRAMER, M. et al. The NIMH Epidemiologic Catchment Area program: historical context, major objectives, and study population characteristics. Archives of General Psychiatry, n. 41, p. 934-41, 1984.
ROBINSON, G. Cross-cultural perspectives on menopause. Journal of Nervous and Mental Disease Aug, v. 184, n. 8, p. 453-8, 1996.
RUSSO, J. & HENNING, M. F. O sujeito da "psiquiatria biológica" e a concepção moderna de pessoa. Antropolítica, η. 6, p. 39-55, 1999.
SCHMITZ-SCHERZER, R. Reflections on cultural influences on aging and old-age suicide in Germany. International Psycho geriatric s Summer, v. 7, n. 2, p. 231-8, 1995.
SHETTERLY, S. M.; BAXTER, J.; MASON, L. D.; HAMMAN, R. F. Self-rated health among Hispanic vs non-Hispanic white adults: the San Luis Valley health and aging study. American Journal of Public Health, v. 86, n. 12, p. 1798-801, 1996.
SWENSON, C. J.; BAXTER, J.; SHETTERLY, S. M.; SCARBRO, S. L.; HAMMAN, R. F. Depressive symptoms in Hispanic and non-Hispanic white rural elderly: the San Luis Valley health and aging study. American Journal of Epidemiology, v. 152, n. 11, p. 1048-55, 2000.
THURSBY, G. R. Aging in Eastern traditions. In: Cole, T. R.; Kastenbaum, R. & Ray, R. (org.). Handbook of Aging and the Humanities. New York: Springer, 1999.
U.S. Department of Health and Human Services. Depression in Primary Care: Volume 1. Detection and Diagnosis. AHCPR Publication n. 93-0550, Clinical Practice Guideline n. 5, 1993.
van MARWIJK, H.; HOEKSEMA, H. L.; HERMANS, J.; KAPTEIN, Α. Α.; MULDER, J. D. Prevalence of depressive symptoms and depressive disorder in primary care patients over 65 years of age. Family Practice, v. 11, n. 1, p. 80-4, mar. 1994.
van PRAAG, Η. M. The diagnosis of depression in disorder. Australian and New Zealand Journal of Psychiatry, v. 32, n. 6, p. 767-72 e discussion p. 773-7, 1998.
WEISSMAN, M. M.; MYERS, J. K. Affective disorders in a US urban community: the use of research diagnostic criteria in an epidemiological survey. Archives of General Psychiatry, n. 35, p. 1304-11, 1978.
West, C. G; Reed, D. M.; Gildengorin, G. L. Can money buy happiness? Depressive symptoms in an affluent older population. Journal of the American Geriatric Society, v. 46, n. l,p. 49-57, 1998.
ZUNG, W. W.; BROADHEAD, W. E.; ROTH, M. E. Prevalence of depressive symptoms in primary care. Journal of Family Practice, v. 37, n. 4, p. 337-44, 1993.

Datas de Publicação

Publicação nesta coleção
Apr-Jun 2006

Histórico

Recebido
Dez 2005
Aceito
Abr 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ALEXOPOULOS, G. S. Depression and other mood disorders. In: Geriatrics Review Syllabus, 4th ed. New York: American Geriatrics Society, 1999. p. 167-75.

[2] BASTOS, C. L. O tempo, as representações sociais de doença e a psicoterapia. Informação Psiquiátrica, v. 15, n. 4, p. 139-44, 1996.

[3] BASTOS, C. L. Tempo, idade e cultura: uma contribuição à psicopatologia da depressão no idoso. Primera parte: Temporalidade e cultura. Revista Latinoamericana de Psicopatologia Fundamental, ano VIII, n. 4, p. 738-753, dez. 2005.

[4] BASTOS, C. L. Tempo, idade e cultura: uma contribuição à psicopatologia da depressão no idoso. Segunda parte: Uma investigação sobre a temporalidade e a medicina. Revista Latinoamericana de Psicopatologia Fundamental, ano IX, n. 1, p. 89-113, mar. 2006.

[5] BLAZER, D. G. Epidemiology of psychiatric disorders in late life. In: Busse, E. W. & Blazer, D. G. (org.). Textbook of Geriatric Psychiatry. 2nd ed. Washington: American Psychiatric Press, 1995.

[6] BURGESS, E. O.; SCHMEECKLE, M. & BENGTSON, V. L. Aging individuals and social contexts. In: Nordhus, I. H.; Vandenbos, G R.; Berg, S. & Fromholt, P. (org.). Clinical Geropsy cholo gy. Washington: American Psychological Association, 1998.

[7] CANDAU, J. Mémoire et identité. Paris: PUF, 1998.

[8] COLE, T. R. Aging, meaning and well-being: musings of a cultural historian. International Journal of Aging and Human Development, n. 19, p. 329-36, 1984.

[9] COLE, T. R. The Journey of Life: A Cultural History of Aging in America. New York: Cambridge University Press, 1991.

[10] DUMONT, L. Essais sur Vindividualisme. Paris: Éditions du Seuil, 1991.

[11] EBERSOLE, P. Toward Healthy Aging: Human needs and nursing response. 3rd.ed. St. Louis: Mosby, 1990.

[12] ELIAS, Ν. A sociedade dos indivíduos (Die Gesellschaft der Individúen). Rio de Janeiro: Zahar, 1994.

[13] GALL, J. S. & SWABO, P. A. Psychosocial aspects of aging. Geriatrics Reviews Syllabus, 1999-2001.

[14] GARDNER, Ε. Α.; BALM, A. K.; MACK, M. Suicide and psychiatric care in the aging. Arch. Gen. Psychiatry, n. 10, p. 547-53, 1964.

[15] GEORGE, L. K. Social and economic factors related to psychiatric disorders in late life. In: Busse, Ε. W. & Blazer, D. G (org.). Textbook of Geriatric Psychiatry. 2nd. ed. Washington: American Psychiatric Press, 1995.

[16] HASSED, C. S. Depression: dispirited or spiritually deprived? Medical Journal of Australia, n. 173, p. 545-7, 2000.

[17] HAZAN, H. Old Age, Constructions and Deconstructions. Cambridge: Cambridge University Press, 1994.

[18] HEALY, D. The Anti-Depressant Era. Cambridge: Harvard University Press, 1997.

[19] HENDRICKS, C. D. & HENDRICKS, J. Concepts of time and the aged. In: Gubrium, J. F. (org.). Time, Roles and Self in Old Age. New York: Human Sciences Press, 1976.

[20] INGEBRETSEN, R. & SOLEM, P. E. Death dying and bereavement. In: Nordhus, I. H.; Vandenbos, G R.; Berg, S. & Fromholt, P. (org.). Clinical Geropsychology. Washington: American Psychological Association, 1998.

[21] JASPERS, K. Psicopatologia geral (Allgemeine Psychopathologie). Rio de Janeiro: Atheneu, 1973. 2 vv.

[22] KASL-GODLEY, J. E.; GATZ, M. & FISKE, A. Depression and depressive symptoms in old age. In: Nordhus, I. H.; Vandenbos, G. R.; Berg, S. & Fromholt, P. (org.). Clinical Geropsychology. Washington: American Psychological Association, 1998.

[23] KLEINMAN, A. & GOOD, B. (org.). Culture and Depression. Berkeley: University of California Press, 1985.

[24] KRAUSE, Ν.; JAY, G; LIAN, G. Financial strain and psychological well-being among the American and Japanese elderly. Psychology and Aging, v. 6, n. 2, p. 170-81, 1991.

[25] LAPLANTINE, F. Antropologia da doença (Anthropologie de la Maladie). São Paulo: Martins Fontes, 1991.

[26] LYNESS, J. M.; KING, D. Α.; COX, C; YOEDIONO, Z.; CAINE, E. D. The importance of subsyndromal depression in older primary care patients: prevalence and associated functional disability. Journal of the American Geriatric Society, v. 47, n. 6, p. 647-52,1999.

[27] METGE, C. J. & CAHN, B. Health Policy. In: Ruskin, P. E. & Rogers, E. L. MEGA -Multidisciplinary Education in Geriatry & Aging. Baltimore: University of Maryland, 2000.

[28] MINKOWSKI, E. Traité de psychopathologie. Collection Les Empêcheurs de Penser en Rond. Synthélabo. Le Plessis-Robinson, 1999.

[29] MYERS, J. Κ.; WEISSMAN, M. M.; TISCHLER, G. L. et al. Six-month prevalence of psychiatric disorders in three communities: 1980-1982. Archives of General Psychiatry, n. 41, p. 959-67,1984.

[30] NIKELLY, A.G. Does DSM-III-R diagnose depression in non-Western patients? International Journal of Social Psychiatry Winter, v. 34, n. 4, p. 316-20, 1988.

[31] OLSHANSKY, S. J. & CARNES, Β. A. The Quest for Immortality: Science at the Frontiers of Aging. New York: W. W. Norton, 2001.

[32] REGIER, D. Α.; MYERS, J. K.; KRAMER, M. et al. The NIMH Epidemiologic Catchment Area program: historical context, major objectives, and study population characteristics. Archives of General Psychiatry, n. 41, p. 934-41, 1984.

[33] ROBINSON, G. Cross-cultural perspectives on menopause. Journal of Nervous and Mental Disease Aug, v. 184, n. 8, p. 453-8, 1996.

[34] RUSSO, J. & HENNING, M. F. O sujeito da "psiquiatria biológica" e a concepção moderna de pessoa. Antropolítica, η. 6, p. 39-55, 1999.

[35] SCHMITZ-SCHERZER, R. Reflections on cultural influences on aging and old-age suicide in Germany. International Psycho geriatric s Summer, v. 7, n. 2, p. 231-8, 1995.

[36] SHETTERLY, S. M.; BAXTER, J.; MASON, L. D.; HAMMAN, R. F. Self-rated health among Hispanic vs non-Hispanic white adults: the San Luis Valley health and aging study. American Journal of Public Health, v. 86, n. 12, p. 1798-801, 1996.

[37] SWENSON, C. J.; BAXTER, J.; SHETTERLY, S. M.; SCARBRO, S. L.; HAMMAN, R. F. Depressive symptoms in Hispanic and non-Hispanic white rural elderly: the San Luis Valley health and aging study. American Journal of Epidemiology, v. 152, n. 11, p. 1048-55, 2000.

[38] THURSBY, G. R. Aging in Eastern traditions. In: Cole, T. R.; Kastenbaum, R. & Ray, R. (org.). Handbook of Aging and the Humanities. New York: Springer, 1999.

[39] U.S. Department of Health and Human Services. Depression in Primary Care: Volume 1. Detection and Diagnosis. AHCPR Publication n. 93-0550, Clinical Practice Guideline n. 5, 1993.

[40] van MARWIJK, H.; HOEKSEMA, H. L.; HERMANS, J.; KAPTEIN, Α. Α.; MULDER, J. D. Prevalence of depressive symptoms and depressive disorder in primary care patients over 65 years of age. Family Practice, v. 11, n. 1, p. 80-4, mar. 1994.

[41] van PRAAG, Η. M. The diagnosis of depression in disorder. Australian and New Zealand Journal of Psychiatry, v. 32, n. 6, p. 767-72 e discussion p. 773-7, 1998.

[42] WEISSMAN, M. M.; MYERS, J. K. Affective disorders in a US urban community: the use of research diagnostic criteria in an epidemiological survey. Archives of General Psychiatry, n. 35, p. 1304-11, 1978.

[43] West, C. G; Reed, D. M.; Gildengorin, G. L. Can money buy happiness? Depressive symptoms in an affluent older population. Journal of the American Geriatric Society, v. 46, n. l,p. 49-57, 1998.

[44] ZUNG, W. W.; BROADHEAD, W. E.; ROTH, M. E. Prevalence of depressive symptoms in primary care. Journal of Family Practice, v. 37, n. 4, p. 337-44, 1993.

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