Saúde mental e restrição de liberdade: relato de experiência como médica psiquiatra em centro de detenção de refugiados

Abstract

RESUMO O relato de experiência refere-se ao trabalho da autora, por seis meses, como psiquiatra por Médicos Sem Fronteiras (MSF) em centro de detenção de refugiados localizado em Nauru, um país insular da Oceania. O estudo traz descrições do trabalho de campo e reflexões teóricas. Discute-se a temática do suicídio e a especificidade dessa questão para o grupo de refugiados e solicitantes de asilo atendidos, assim como relata-se a descoberta de um novo diagnóstico clínico chamado síndrome de resignação. Busca-se ainda refletir sobre o papel dos profissionais de saúde mental diante de situações de privação de liberdade e discutem-se impasses éticos, vividos em campo, com relação à política de imigração australiana, sua importância econômica para Nauru e o impacto na população de refugiados; impasses esses vividos até a expulsão da equipe de MSF pelo governo local em 05 de outubro de 2018.

Psychosocial Aspects of Quarantine, Social Isolation and Social Distance

“…In this study, the author discusses the suicide and the specificity of this issue for the group of refugees and asylum seekers served, as well as reporting the discovery of a new clinical diagnosis called resignation syndrome. Schmid observed that at least 78 of the patients treated by MSF had suicidal ideas and/or performed acts of self-mutilation or suicide (Schmid, 2019). He verified that hopelessness was the guiding thread for suicidal ideation and suicide attempts.…”

“…This suicide feature, as a recovery of power, strongly impacted his research. According to Schmid, detained for five years in Nauru, refugee patients expressed, in the discussion about their own death, the only possibility of protest and affirmation of some decision-making power over themselves (Schmid, 2019).…”

“…In this sense, it is possible that people who present a Narcissistic Personality Disorder, a Challenge and Opposition Disorder and other psychopathological manifestations that reflect the great difficulty of the subject to deal with the feeling of castration (Freud, 1905) that is fostered by the restriction of freedom and social isolation (due to the coronavirus), seek in the suicide attempt the empowerment that was removed from them with the need for quarantine or isolation. Schmid (2019) also observed, among refugees, the development of psychopathologies such as Posttraumatic Stress Disorder (PTSD), especially among children, PTSD with psychotic features and the "Resignation Syndrome (SR)" (Schmid, 2019). The author states that the refugees (and their patients) started resignation chart with depressive symptoms, evolving with suicidal ideation, episodes of psychomotor agitation, alternating with a stuporous chart marked by hypotonicity.…”

“…It is important to emphasize that, in this period of social distancing, quarantine or social isolation, people who present depressive syndromes should be supervised by their family members regarding adherence to treatment (medication and psychotherapeutic), as their condition may evolve to other serious psychopathological conditions that also offer risk of death, such as the resignation syndrome, which, according to Schmid, can affect individuals in circumstances of restriction and loss of freedom or isolation from social interactions (Schmid, 2019).…”

Prática médica e imigração: o caso dos refugiados sírios na cidade de São Paulo

“…Essa intervenção, além de violar os direitos humanos dos refugiados, tem graves impactos sobre a saúde mental dessas pessoas(Silove et al, 2000;Steel, Silove, 2006).293 Os Estados Unidos construíram centros de detenção para imigrantes nas fronteiras desse país com o México, violando gravemente os direitos humanos. Para maiores informações acesse: https://www.bbc.com/portuguese/internacional-44604153.294 São incontáveis as denúncias de violação dos direitos humanos perpetradas pelo governo australiano aos refugiados detidos no Centro de Detenção de Naru, criado em 2001(Schmid, 2019;Lowth, 2017). Para maiores informações sugerimos a leitura de matérias publicadas no jornal inglês, The Guardian, em 2016a.…”