Mental health

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By ALFREDO BALEEIRO*

Considerations about campaigns and suicide prevention in Brazil

“Health is our ability to fight against everything that oppresses us!”

It is possible that we are in a good mental health condition in Brazil at a time when half of the country's population is living in a situation of food insecurity, without perspectives or security in relation to how their survival condition will be in the next month, week or even tomorrow? How do we have about 15 million unemployed and another majority of workers in a condition of profound informality, precariousness and overexploitation?

The working class has been suffering a violent withdrawal of basic rights in all dimensions of social life, such as access to public health, which is being increasingly denied due to the scrapping and destruction of the SUS to the benefit of market health sectors; as the right to education regressing to the level of a right for the few; as the intensification of patriarchal violence in all its forms and dimensions, affecting the existence of women (the majority of the population), especially black women, in every aspect of their daily lives; such as racism delegating black men and women (also the majority of the population) to marginalization, overexploitation, incarceration or death.

All of this in a historic moment in which we are experiencing a profound ultra-conservative advance and a fascistization of sectors of society, which has pushed social conscience towards an intense exercise of racism, patriarchal violence, LGBTphobia, xenophobia, religious intolerance and the naturalization of all kinds of violence, combined with an accelerated destruction of nature and of the ways of life and dignity of countless peoples and communities. And, let's not forget, in the midst of a pandemic that had and continues to have drastic consequences on the way of social life and that so far has led to almost 600 deaths, the majority of which occurred due to omission and denialism. These aspects that we are experiencing are also complemented by the fact that we are going through a profound crisis of capitalism at this historical moment, a moment in which the bourgeois State has reorganized itself so that, more than ever, it elects the majority of the Brazilian people (the popular classes) as its enemy and deepens the abyss of social inequality in Brazil.

This is our country in 2021, where in September, at least since 2014, suicide prevention campaigns, Yellow September, are built. However, the contradictory and important aspect to be mentioned is that generally all this social context mentioned, which means what most affects and directs our lives, is practically absent in the Yellow September campaigns.

Does this mean that suicide prevention campaigns and the mental health debate they spark are unimportant? No way! They are deeply necessary, even as permanent campaigns, however, it is necessary to first point out that there is no individual health without collective health, and collective health basically means in which world, in which society and which material conditions are placed for our life as a people; and in capitalist society, this means what material conditions are in place for a fundamental and majority class of society, the working class, the popular classes, to which we belong.

Therefore, it is necessary to break with the individualizing logic of health that, especially through neoliberal ideology, tries to make us understand, as well as in other dimensions of life, that we are isolated individuals and that everything that affects and interests us happens on an individual, fragmented basis, disconnected from social, cultural, economic and community aspects, aspects that permeate and are the basis of our lives. And understanding this determining basis is not in contradiction with understanding ourselves also as unique subjects, that is, with stories, perception, personality, unique subjectivities, but always crossed by the other, by social life.

Another reflection that is important is about the need to understand the logic by which health is historically exercised by the dominant classes in Brazil, which is the logic of health as a commodity and that precisely because of this, it is a factor that produces suffering, which puts the commitment to invert it in a popular health perspective, which meets the interests of the majority of the people, starting to be understood as our capacity to fight and live with dignity. In this perspective, we make the exercise of understanding the human being as an integral organism, not divided in the non-existent paradigm between body and mind, or fragmented between organs and dissociated systems, as the dominant science does. For this, it is necessary to rescue, for example, the traditional knowledge and experiences of popular knowledge, formed in the history of care for our peoples, through seeds, plants, spirituality.

That said, we state that Yellow September in Brazil is a very relevant campaign, initially articulated by the Center for Valorization of Life (CVV) and seeks to encourage prevention of the phenomenon of suicide, which is one of the greatest causes of death in the world and a increasingly growing phenomenon in Brazil, which denounces the deep psychosocial suffering in which we find ourselves. The Pan American Health Organization points out that about 800 people commit suicide annually in the world, and an even greater number attempt suicide, which leads us to imagine the number of people in suffering processes and with suicidal ideation. It is the second leading cause of death among people between the ages of 15 and 29, as well as a worldwide phenomenon. However, it was identified that, in 2016, 79% of suicides occurred in countries where the majority of the population has low and medium income.

According to information available in the Epidemiological Bulletin (2017) of the Ministry of Health, between 2011 and 2015, 55.649 deaths by suicide were recorded in Brazil, representing 5,5 suicides per 100 inhabitants. In the same study, it is pointed out that the risk of suicide is four times greater for men than for women, based on the consideration that men are more successful in execution, although an important factor is that there is a more attempts by women. Another little-mentioned factor is how suicide has strongly affected the various indigenous peoples based on the constant violence and subjugation to which they are subjected in Brazil. Therefore, we understand that this is a serious public health problem, which affects the popular classes as a whole.

One of the biggest factors associated with suicide is depression. This, as a scientific consensus, is usually manifested by a lowering of affect, little pleasure in carrying out activities previously considered pleasant, constant tiredness or loss of energy, reduced ability to concentrate, make decisions or even think, and also symptoms of changes in sleep, appetite, behavior, social isolation, crying spells, suicidal ideation, among others. The causes of depression can be understood as biopsychosocial, therefore, it is evident that they are strongly linked to the context discussed above, with emphasis on elements that have already been mentioned, such as situations of violence against women and in the family, which, in addition to these, affect children, adolescents and the elderly, as well as factors related to situations of alcoholism, abusive use of other drugs, parental alienation, economic precariousness, LGBTphobia and transphobia, among other factors related to the cycle of the main forms of violence constituted in our society. In view of this, it is worth reflecting on an important and commonly mentioned factor: unlike hiding, not talking, treating fear and stigma as taboo, it is necessary to express the reality of suicide in Brazil, to present forms of prevention, policies and devices, and widely debate the phenomenon as a public health problem to be faced.

Dealing with the public health problem also obviously involves strengthening public policies for prevention and health promotion within the scope of the Unified Health System (SUS) - which has devices such as the Primary Care policy, the NASF's, the entire of Psychosocial Care (RAPS), such as the CAPS, the policy of deinstitutionalization, harm reduction, etc. and within the scope of the Unified Social Assistance System (SUAS), the CRAS, the CREAS, the Coexistence and Linkage Strengthening Centers, among others. We know that these policies were and still are insufficient, despite being very important. However, we also know that all these policies have been intentionally precarious from the massive withdrawal of resources, the result of neoliberal policies carried out mainly by the Temer and Bolsonaro governments, representatives of the interests of sectors of the bourgeoisie in offensive against the popular classes, expressed by for example, in EC 95 (spending cap) and in other neoliberal reforms that have come in recent periods, dismantling the entire social protection network and deepening poverty.

Another aspect of the problem of suicide and mental health in Brazil that is difficult to deal with is the historical stigmas that this field faces. In Brazil, the history of asylum violence is deep, in this process, we had important advances and achievements in the institutional field, from the Psychiatric Reform and the construction of mental health policies, but contradictions and very strong aspects of the asylum ideology still remain, the which may be content for another text. The fact is that even today this violence feeds repressive stigmas against “madness”, such as the logic of supposed rationality, which denies and diminishes mental suffering and associates them with weakness, freshness, drama, or even religions, which attribute suffering to "lack of God," etc.

Allied to these stigmas, the history of action in the field of mental health by sciences such as Psychiatry and Psychology, which even today, despite important internal disputes, have not been able to break with its hegemonic character, which in its practice still represents an enormous distance popular classes and little insertion in the field of public health and social and community rights, being restricted to the few who can pay to have access to the field of medical and psychological clinic. Therefore, it means to say that we do not have a structured and rooted mental health network in Brazil. On the contrary, the built experience of the Psychosocial Care Network - RAPS, although fundamental and with great potential, was not implemented in Brazil due to the refusal imposed by the sectors that control health, representing the interests of the dominant classes by establishing precariousness and even the absence of any mental health policy as the dominant logic in most territories, deepened in this historical moment.

In view of what has already been exposed, we understand that the challenges of suicide prevention and health promotion in the world and in Brazil involve gigantic and structural challenges. They are related since the struggle for the restructuring, creation and strengthening of public policies within the State through SUS, SUAS and its action devices, campaigns and network articulation of services. It is also of fundamental importance to strengthen the so-called Integrative and Complementary Health Practices (PICS) as unique care tools, which address health in its entirety, as a right, with the aim of promoting life and dignity, and not serving to the profit of private business sectors of the pharmaceutical and hospital industry, and which incorporate (or should and may incorporate) a popular and community character, exercising a counter-hegemonic role in the face of the dominant sciences and medicine, which is limited, which violates and fragments people and the right to full life. And for this reason, with a popular health character, they need to be expanded and democratized within the scope of public health in Brazil.

Therefore, understanding the debated context and what is at issue more broadly, we emphasize that facing the problem of suicide and psychosocial suffering also crosses the struggle for the construction of a set of broad rights of the people. This implies, more immediately, interrupting the Bolsonarist and neoliberal project in progress – which represents the deepening of violence against the working class and strong ties with the sectors of the bourgeoisie responsible for the destruction of social rights and nature – combining this confrontation with the construction and advancement of a popular program and project that involves the democratization of education in the countryside and in the city; the rooting, expansion and strengthening of the SUS and SUAS based on its principles; popular agrarian reform; sovereignty and food security for all people; guaranteeing the right to land and life to traditional peoples and communities; stopping the destruction and looting of our natural resources; broad access to basic rights to decent housing, employment and income; cultural diversity; the different rights and the end of the violence faced by youth, women, black men and women, LGBTIA's+, sectors that make up the majority of the Brazilian people; and a broad set of transformations that constitute the Popular Project for Brazil, which implies popular organization as a basis and which we understand to be viable only from the autonomous and sovereign exercise of power by the popular classes, leading us to the destruction of the project of death of the bourgeois capitalist state and the transition to socialist society.

PS – The CVV – Centro de Valorização da Vida provides emotional support and suicide prevention, providing voluntary and free assistance to all people who want and need to talk, under total secrecy by telephone, email and chat 24 hours a day, in a free of charge, through the telephone number 188.

*Alfred Whaler, psychologist, is a member of Consulta Popular Núcleo Caetité-BA.

 

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