Pesquisas em saúde mental: o desafio de pesquisar mudanças e inovações em um campo demarcado por questões ético-políticas

Abstract

Research in mental health: the challenge of researching changes and innovations in a field demarcated by ethical and political issuesIn the field of Brazilian Public Health, the area of mental health has been noteworthy for the ethical ruptures that it has provoked in the scenario of policy formulation and for the striking changes and innovations in health care practices. New configurations of service networks, new forms of organization of clinical care and psychosocial rehabilitation have also elicited new methodological questions and challenges of an ethical and political nature in the field of research.The plethora of legitimated studies emerging from the area of policy, planning and management, such as those involving evaluative and participatory research, acquires new nuances and challenges to be conducted in partnership with mental health users. How can one fail to uphold the relevance of the participation of the parties concerned (stakeholders) in a field that fostered stigma and exclusion before its Reform? How can one fail to acknowledge that it is the very act of summoning them to participate in research alongside the researchers that introduces a healthy tension and destabilization in the field of procedural and methodological research? The scale of intervention that any research entails is also revealed in these designs, highlighting the obstacles and challenges that Psychiatric Reform has yet to face: bureaucratization, medicalization, maintenance of stigma, etc.The tradition of ethnographic studies, such as first-person interviews and studies into the experience of falling ill, have also seen great modifications when conducted with mental health users. It has provided access to forms of suffering that are difficult to express in words. The use of words rekindles the pain in the lives of these people. The interfaces are then multiplied by the need to sustain an ethical and political commitment to those who suffer. The research can no longer be isolated from clinical intervention and care should be respectful and delicate to ensure the smooth progress of the investigation. Partnerships between researchers and the service provided are paramount at this juncture, requiring increased care in the management of the research per se. In this movement, the acculturation strategies should also be repeatedly and carefully modified, thereby creating tools to make what is familiar appear strange (in the case of researchers coming from the services themselves). An attempt should also be made to seek ways to reveal what has not yet been identified in terms of fears and defenses. It is important to find openings to the unprecedented and make judicious use of the field diary, for example, so as not to lose a rich seam of empirical data that would not otherwise be collected. The role of the ethnographer is thereby modified, ratcheted up, though always dedicated to attempting to ascertain what appears strange to us.The training of new researchers in this context takes on the attributes of co-management and participati...