The politics of clinic and critique in Southern Brazil

Talk by Associate Professor Dominique P. Béhague, Department of Medicine, Health, and Society, Vanderbilt University, Nashville (USA) & Department of Global Health and Social Medicine, King’s College London, London (UK).

Abstract

To what extent can experiments in “psychiatric reform” open a space for the dismantling of enduring structures of inequity and oppression? What assumptions about “the social” do those participating in psychiatric reform often make? How do these assumptions limit possibilities for “social change”?

I explore these questions by drawing on a historical ethnography of how Brazil’s psychiatric reforms shaped young people’s lives beginning in the 1990s, following the end of the country’s 20 year-long military dictatorships. Reformists were inspired by psychoanalysis, Marxist-inspired social medicine, radical anti-psychiatry writers, and Foucauldian theories of governmentality. The ideals of psychiatric reform were not merely aspirational. Though a minority, some young users of therapy co-created – together, and sometimes in tension with clinicians, teachers, and parents – the politicising clinic: a space that challenged the imperative for a “cure,” stretched definitions of “care,” and encouraged engagement with social injustice and political oppression. Fast forward to 2022 and all traces of the politicizing clinic have seemingly vanished. Dominating the Brazilian landscape today one finds a proliferation of diagnoses – attention-deficit hyperactivity disorder, conduct disorder, anxiety, and depression – that indicate bio-neuro developmental dysfunction and the need for targeted, often pharmacological, treatments.

I theorise this history by exploring, ethnographically, how different kinds of “critique” and “reflexivity” were enacted, arranged, and normalised in the clinic and the everyday, by clinicians and young people. Building on Eve Sedgwick’s analysis of the hermeneutics of suspicion, my argument is that narrow applications of “critique” nurtured weak forms of resistance to bio-reductionism. To unsettle this hermeneutic, I put my young interlocutors’ theories of power into conversation with Georges Canguilhem’s concept of the milieu and with feminist writings on prefigurative politics and decolonial pedagogies. Attention to the ways young people interacted with systems of oppression from the vantage point of an imagined not-yet, creating what I conceptualise as unthreading affective politics, shows how the politicizing clinic is in existence today and might yet still flourish.