We present our viewpoint, confusing though it may be, of the reality in psychiatric hospitals in Brazil The approach is based on a discourse that is sometimes influenced by the ideal of de-hospitalization. In the search for a new reality, many forget that clinical work is often difficult and may even verge on the impossible The analysis and discussion presented here were based on two sets of data, namely, notes from a field diary written by the authors when working as public employees in the coordination of mental health programs and on two cases of clinical supervision in a public municipal psychiatric hospital in Rio de Janeiro, Brazil, both of which occurred in 2004. The analysis of the notes led us to the conclusion that something can be done to effect changes in the current situation described in the notes, and that the past need not be repeated. It is important that health teams avoid becoming agents of the banalized terror that reduces hope. Between the public, the private and the ineffable of madness, the subject's response must be heard and accepted. This is the tiny element that reminds us of the uncanniness and irreducibility of someone who, in the case of madness, is separated from the collectivity.
Psychiatry; psychiatric hospital; mental health care