By MAIA HERIBALD & DASSAYEVE LIMA*

Consistent militancy has the obligation to ensure that the horrors promoted by the asylum logic never happen again

Theodor Adorno insisted that a good education had an obligation to prevent Auschwitz from happening again. There is a moral demand, an ethical and political imperative of emancipatory forces, to ensure that nothing like the Holocaust is repeated. Although Adorno did not include the colonial issue in this reflection, as barbaric as the Holocaust, this injunction can serve as a moral support and ethical horizon for the praxis of a left that is not afraid to say its name also with regard to the asylum issue.

The anti-asylum debate has been a historical agenda of the left all over the world since, at least, the end of the XNUMXth century. Already in that period, anarchist militants such as Piotr Kropotkin and Louise Michel denounced asylum institutions such as prisons, asylums, sanatoriums and nursing homes. The movement intensifies in the second half of the XNUMXth century, with illustrious names such as Nise da Silveira, Dona Ivone Lara, Frantz Fanon, Franco Basaglia, Félix Guattari, Michel Foucault and others. And yet, today it is probably one of the most neglected agendas among all struggles against oppression, often made invisible even among those who propose to fight for the defense of human rights.

Currently, very little is discussed about the conditions of care and assistance in mental health, if it were not an urgent and fundamental topic. If today we have concepts such as intersectionality and analyzes that think about the working class in a concrete way, without hierarchizing the guidelines of oppression, it seems to us that there was a notorious “forgetfulness” of the “psychiatric issue” and a consequent depoliticization of mental health, with reverberations in subjects who suffer psychically. This forgetfulness represents a setback, after all, researchers and activists, socialists or critics, have developed powerful theoretical analyzes and contributed to combative social movements capable of bringing the debate to public discussion.

In a 2012 interview, Mark Fisher already pointed to this forgetfulness, and to the need to overcome it, when noting that the neoliberal culture, which individualizes depression and anxiety, becomes dominant at the same time as the “antipsychiatric” movement loses strength. For Fisher, the decline of antipsychiatry would be related to the rise of “capitalist realism”. The normalization of misery is part of the privatization of stress project. The exit? Returning to the questions raised by the antipsychiatric left of the 1968 cycle of struggles: “What we need is a denaturalization (and consequent politicization) of mental illness. We need something like a revival of the antipsychiatry movement of the 1960s and 1970s. Well, not so much a revival as a reoccupation of the ground on which that movement fought.”

Mental health as a battleground

Currently, depression stands out as the most disabling health problem in the world, according to the World Health Organization (WHO). Brazil is one of the countries most affected by this scenario, as well as one of the record holders among people who suffer from anxiety and physical and mental exhaustion caused by work (burnout). Reflecting this situation, Brazil is one of the largest consumers of Rivotril in the world.

Despite this real explosion of mental suffering in Brazil and in the world, the hegemonic ideological atmosphere works in the sense of taking such questions as merely individual problems. Contrary to the naturalizing and atomistic ideology, the best research, including the World Health Organization's own reports and documents, has pointed out that this phenomenon says more about our social organization than about purely biological or individual issues.

There seems to be negligence, even on the part of the left, in realizing that the working class experiences a daily massacre and that this constitutes a central social determinant in the production of psychic suffering. If, on the one hand, suffering is part of the human condition and experience, on the other hand, this does not mean that there are no social conditions that produce and intensify suffering, conditions that, being themselves historical and contingent, can be overcome. And if they can, we must overcome them, but this is a political task, which can only be carried out collectively.

There is no psychic well-being possible with the return of hunger, high unemployment rates, systematic police violence, systematic race and gender oppression. The working class, especially the black population, when faced with their suffering, depends almost exclusively on public mental health services. The quality of this assistance is therefore of fundamental interest to male and female workers. And yet, these services are increasingly precarious, scrapped and reduced, mainly as a result of the imposition of an austerity agenda and neoliberal adjustments. The spending ceiling, constitutionally incorporated by the “PEC da Morte”, strangles the public budget in the social area and produces a population belt of lack of health care or precarious assistance.

The relevance of the anti-asylum agenda

It is precisely the working class that is the daily victim of human rights violations in mental health services that still keep the asylum logic in their operation. The vacuum of public discussion about the anti-asylum struggle and the absence of a critical and political look at mental health have produced all kinds of absurdities. These are the disastrous consequences of abandoning the anti-asylum guidelines on the horizon of the left.

In the last weeks of 2021, we are faced with two emblematic episodes that show how far we still need to go towards a minimally qualified public debate on mental health – and we are keen to emphasize: the greater responsibility must be left to the left.

The first episode concerns the surprising, significant support of parliamentarians from leftist parties to measures that directly benefit therapeutic communities. It is worth remembering that therapeutic communities are equipment that, without running the risk of committing any exaggeration, are configured as “new asylums” controlled by evangelical groups, generally neo-Pentecostal, linked to the most reactionary and conservative sector of these denominations.

These institutions present themselves as “rehabilitation and recovery clinics” aimed at people who face problems arising from the use of alcohol and other drugs. However, the vast majority of these facilities do not have any structure to function as a health service, not even a specialized team, and mostly operate from a fundamentalist perspective that aims at “cure” through religious conversion.

In addition, the Inspection Reports in Therapeutic Communities (CFP/MNPCT/PFDC/MPF) frequently point out that these equipment operate with various irregularities and commit systematic violations of human rights: deprivation of food and hygiene items, social exclusion and denial the right to come and go, deprivation of communication with family members or loved ones, physical and psychological torture, religious intolerance, gender conversion and even work analogous to slavery.

Even so, parties such as the PT, PCdoB, PDT and PSB, which should have constituted the so-called “progressive camp”, voted not only in favor of tax immunity for this equipment, but also favored the allocation of more than R$78 million in funds public access to these veritable centers of violence. Meanwhile, the Psychosocial Care Network (RAPS) of the Unified Health System (SUS), a historic achievement of popular struggles and anti-asylum movements, operates today with an alarming deficit of investments and personnel.

According to the Brazilian Mental Health Association (ABRASME), “therapeutic communities” receive more investment from the State than the entire CAPSad network, Psychosocial Care Centers aimed at people with problems resulting from the use of alcohol and other drugs. Data from the National Council on Drug Policies indicate that “therapeutic communities” receive more public investment than all public mental health actions and services in the country in their most diverse levels of complexity, from primary care to high-tech equipment. .

Right at the beginning of the covid-19 pandemic, the WHO advised its signatory countries to expand and intensify public investments in mental health. Going in the opposite direction, the federal government not only threatened to revoke more than 100 ordinances that govern the functioning of the RAPS, but also reduced investments in mental health and increased investments aimed at therapeutic communities.

It can only be a cause of indignation and horror that, in the midst of a catastrophic scenario for mental health in Brazil, parties that claim to be on the left are contributing to the dismantling of institutional structures and public policies resulting from the efforts of the left itself. But by supporting public funding of asylum equipment, that's exactly what they do.

The second episode that draws attention concerns the inauguration of an “amusement park” whose theme is an abandoned asylum, called “ABADOM SP”. According to the organizers, it is an “innovative horror experience”, where participants can experience a macabre reality based on asylum violence. It doesn't take much effort to understand how much this entertainment proposal trivializes the historic asylum violence suffered by people who were kidnapped by asylum logic.

Aiming to promote a frightening environment, based on an institution that historically served as a human warehouse, managed from violence, mistreatment and human rights violations, the organizers make unfounded and prejudiced associations, reinforcing the idea of ​​the madman as a violent and dangerous subject. They unashamedly associate madness with “cannibalism”, naturalize exclusion as a social response to psychic suffering, trivialize the institutional violence practiced in these spaces and even mock the practice of electroshock torture: “A shock doesn’t hurt [sic]… just to liven up the interns.”

The question that arises in the face of these events is: why are these episodes not being discussed? Why is there no public note or effective action to reject these evident setbacks in the field of mental health and the social relationship with madness? Why does violence aimed at people in mental distress remain so invisible? Why is it so difficult even in the left field to understand the anti-asylum struggle as a fundamental flag in the fight against oppression? What were the reasons that led a good part of the left to retreat so far from historical agendas of the struggle for human emancipation?

The answer to that is perhaps simple, although inadmissible: there is currently no public debate on the subject and today a complete erasure of a debate that was once strong within our own political field prevails. Attempts to politicize the debate on mental health, although existing, are incipient and do not cope with the complex demands of our time.

It is necessary to understand that human emancipation is intended for all human beings, and not for a part of them. If any group, however minority, is left out of our emancipation project, that emancipation will not be universal. For this very reason, it is necessary to reformulate Theodor Adorno's phrase for our time: consistent militancy has the obligation to ensure that the horrors promoted by the asylum logic never happen again.

* Heribaldo Maia is a master's student in philosophy at the Federal University of Pernambuco (UFPE).

*Dassayeve Lima is a psychologist, master in psychology and public policy, administrator of the Critical Mental Health profile.

Originally published on Boitempo's blog.