RESUMO Transformações na lógica do cuidado em saúde mental, no Brasil, deram início a um importante debate sobre o lugar da família no tratamento. No contexto desse debate, o presente artigo tem por objetivo compreender como familiares de pacientes de um Hospital-Dia constroem sentidos sobre sua participação no tratamento. Foram conduzidas 10 entrevistas. A análise temática realizada apontou para cinco formas de participação dos entrevistados no tratamento. São elas: cuidado à família, aprendizado sobre a doença mental, transformação das relações familiares, cuidado com o familiar em semi-internação e cuidado mútuo entre as famílias. Discutimos como a construção do apoio às famílias ocorre no cotidiano do serviço por meio do investimento na qualidade das relações entre profissionais, pacientes e familiares.

The genetically determined muscular dystrophies are caused by mutations in genes coding for muscle proteins. Differences in the phenotypes are mainly the age of onset and velocity of progression. Muscle weakness is the consequence of myofiber degeneration due to an imbalance between successive cycles of degeneration/regeneration. While muscle fibers are lost, a replacement of the degraded muscle fibers by adipose and connective tissues occurs. Major investigation points are to elicit the involved pathophysiological mechanisms to elucidate how each mutation can lead to a specific degenerative process and how the regeneration is stimulated in each case. To answer these questions, we used four mouse models with different mutations causing muscular dystrophies, Dmd (mdx), SJL/J, Large (myd) and Lama2 (dy2J) /J, and compared the histological changes of regeneration and fibrosis to the expression of genes involved in those processes. For regeneration, the MyoD, Myf5 and myogenin genes related to the proliferation and differentiation of satellite cells were studied, while for degeneration, the TGF-β1 and Pro-collagen 1α2 genes, involved in the fibrotic cascade, were analyzed. The result suggests that TGF-β1 gene is activated in the dystrophic process in all the stages of degeneration, while the activation of the expression of the pro-collagen gene possibly occurs in mildest stages of this process. We also observed that each pathophysiological mechanism acted differently in the activation of regeneration, with distinctions in the induction of proliferation of satellite cells, but with no alterations in stimulation to differentiation. Dysfunction of satellite cells can, therefore, be an important additional mechanism of pathogenesis in the dystrophic muscle.

Since the Brazilian Psychiatric Reform, we have witnessed an increased value of family participation in treatment. Alternatives of attention to family members in the context of services have been sought. When the challenges of bringing clinical practices into the Unified Health System are added to the debate, the concept of the expanded clinic arises, and this concept associates the notions of subjectivity and citizenship. Emphasis is placed on the importance of dealing with each concrete situation as part of contexts and social relations. A Program of Family Care in a Psychiatric Day Hospital exists in line with these concerns. This program offers several activities for families. Family Reunions are amongst these activities, and they are the specific context of this research. The contributions of a social constructionist orientation for family therapy guide family reunions with a focus on processes of meaning making. This research aimed to analyze the approximation of a practice with families (family reunions) to the notion of the expanded clinic in mental health care. The research specifically aims to: a) understand the process of meaning making in this practice, while analyzing the construction of conversational resources in the interaction, as well as their effects to the transformations of the meanings of problem and self throughout the process; and b) describe how these resources contribute to the expansion of clinical practices with families. Thirtythree family reunions (three family cases) were followed in the institution. These sessions were audio recorded, and fully transcribed, in order to constitute the research corpus. A social constructionist understanding about research practices is the methodological guide for this investigation. All sessions were submitted to a thematic-sequential analysis of the process of meaning making. We have described the negotiation and transformation of meanings about a problem that was considered, by the patient and by their family, as central to their lives. For each case, the main conversational resource constructed during the process was analyzed and described. These conversational resources are: a) inviting the social into the individual; b) weaving family dialogue; and c) knowing yourself in other voices. The analysis of each case considered: how something was constructed as a problem to be worked out; how the use of the resources was carried through; and the effects the use of this resource created throughout the case. We offer, as our thesis, a social constructionist reading of the expanded clinic, where we call attention to how the expansion of clinical practice is crafted from the effects that particular ways of interacting create in the context of practices. It is in the interactive moment that professionals and patients jointly generate understandings about who they are, what their problems are, and what they can do in relation to them, while they talk about their health issues. We discuss how the use of these resources is constructed in interactions, and how ...

Na trajetória deste Mestrado, com diferentes contribuições, inúmeras pessoas me ajudaram a chegar até o fim. A todos, o meu agradecimento sincero e profundo pelos os momentos vividos. À Profa. Dra. Carla Guanaes Lorenzi, companheira principal desta jornada, agradeço por me receber de braços abertos e por confiar sempre em mim. Agradeço a liberdade, sempre acompanhada pela competente assistência: reconheço o quão sortudo sou por isso! Há neste pesquisador e nesta pessoa marcas de você que sempre me acompanharão. Muito obrigado. Aos professores Sheila McNamee e John 'Jack' Lannamann, agradeço o empenho e carinho com que me receberam em seu país e em sua universidade. Minha experiência nos Estados Unidos foi um ponto importante em minha história e vocês tornaram isto possível de uma forma muito especial. Ao Prof. Dr. Emerson Rasera, a minha imensa gratidão por ter me apresentado à prática de pesquisa e ao mundo acadêmico de maneira tão encantadora e responsável, e por ter me apresentado ao construcionismo social. Obrigado pela amizade presente e transformadora.

Beginning with an understanding of family as a social construction, this article suggests that people actively make meanings about family during social interchanges. The idea is that family can be conceived as a discursive achievement: Family is defined in terms of what people who are drawing on various available socially produced discourses describe together as family. We propose that different realities regarding family are created via social processes of negotiating meaning in the interactive moment. Therefore, there are many different versions of family, and each of them has diverse implications for the social world. Examples of these implications for psychological theories, research, and family therapy are also presented, in considering how they might be useful in the field of psychology.

The comprehension of the health-disease process from a multifactorial perspective has allowed important transformations in the healthcare practices. In this article, we discuss the use of the support group as a resource for mental health care, analyzing how conversations about social issues are managed in this context. Based on contributions from the social constructionist movement, we analyzed the transcripts of the conversations developed in meetings of a support group offered to patients of a mental health outpatient clinic. The analysis of the process of meaning making indicates that the discourse of the social influence on mental health is not legitimized, due to a predominant individualistic discourse, which psychologizes care and is centered on the emotional analysis of the problems of the quotidian. We argue that this mode of management brings limits to the construction of the group as a device for promoting autonomy and encouraging the social transformation processes.Keywords: social constructionism; mental health; support groups; social determinants of health. RESUMOA compreensão do processo saúde-doença a partir de uma perspectiva multifatorial tem permitido importantes transformações nas práticas de saúde. Neste artigo, discutimos o uso do grupo de apoio como um recurso para os cuidados de saúde mental, analisando como as conversas sobre as questões sociais são manejadas neste contexto. Com base nas contribuições do movimento construcionista social, analisou as transcrições das conversas desenvolvidas nas reuniões de um grupo de apoio oferecido aos pacientes de um ambulatório de saúde mental. A análise do processo de construção de significado indica que o discurso da influência social sobre a saúde mental não é legitimado, devido a um discurso individualista predominante, que psicologiza cuidado e é centrado na análise emocional dos problemas do cotidiano. Argumenta-se que este modo de manejo traz limites para a construção do grupo como um dispositivo para promover a autonomia e incentivar os processos de transformação social.Palavras-chave: construcionismo social; saúde mental; grupos de apoio; determinantes sociais da saúde.

Buscando contribuir com a reflexão sobre a constituição heterogênea da clínica construcionista social, marcada por diferentes vocabulários e posturas terapêuticos, este artigo analisa as relações entre o discurso construcionista social e os conceitos e práticas da Terapia Focada na Solução, descrita por alguns autores como partilhando ênfases promovidas pelo construcionismo. Por meio de seleção da literatura e da análise conceitual e comparativa, identificam-se pontos de convergência - especialmente a ênfase nas potencialidades e na ação e o abandono da procura por descrições essencialistas sobre a realidade do cliente -, e também de divergência -, a postura terapêutica diretiva e de especialidade, o foco em mudanças comportamentais e a concepção individualista de self presentes na Terapia Focada na Solução. Conclui-se que a Terapia Focada na Solução pode ser uma opção discursiva útil e convida-se a uma reflexão sobre suas implicações para cada contexto terapêutico situado.

Social constructionism offers an account of therapeutic process that focuses on conversation and relationships as the space where people jointly create understandings about themselves, their lives, and their problems. Conversational resources are guides that focus practitioners’ attention on the ways they interact, relate, and talk to patients and amongst themselves. Focus is also placed on the effects that these conversations create in interaction. This article describes three conversational resources: ‘inviting the social into the individual,’ ‘weaving family dialogue,’ and ‘knowing oneself in other voices’, which help bring about change in the context of a clinical practice with families in mental health. It analyses the transcripts of 33 family therapy sessions (with three families) in a psychiatric day‐hospital. This focuses on how resources are worked out in conversation and describes practical therapeutic resources for professionals who are interested in working within a critical and transformative frame with families in mental health care.