Hello, I’m back to talk some more about module one, remember, where we discussed the health-disease process reflecting on the relationship between social organization and health? In our first video, we talked a little about the concept of health as it was historically constituted over centuries with the organization of society, and how we have perceived and construed the concept of health in different ways over time. It is no different with “Madness.
” Until the 17th century, madness was seen as something present in society and there was no fear of the so-called crazy people who frequented that society. They were viewed with a mixture of apprehension and fascination, but without major concerns or the need for isolation. It was only in the 18th century that we began to think differently about madness.
From the 18th century onwards, madness came to be understood as pertaining to reason, where behavior, the way of acting, thinking, wanting, having passions, making decisions, and being free became an issue. So, those who thought differently, expressed passions more intensely and acted other than expected, started being perceived as strange within society. This logic and attempt to regulate a given behavior is a moral issue that arises and begins to be extremely important and interfere with the way madness comes to be understood in our society.
Around that time, big hospitals, which had received leppers, remember that? People with leprosy, who were always isolated from society? At a certain point, there was no longer the need to use those spaces for this health condition, so they began to take in the so-called crazy people.
Those who presented a different behavior, who were taken by passion, or lack of reason. There was a growing fear that this kind of behavior could cause the disorganization of family and State, and we witnessed the rise in the logic of asylums and isolation for people presenting these types of behavior. Being taken to a psychiatric hospital or to an asylum away from the city was aimed at distancing the subject from society and their relations in an attempt to modify or understand how that person acted in isolation from society and adjust this behavior to a model based on reason.
This logic of being taken to a hospital and being isolated was meant to protect society from those who appeared to be dangerous and from whom society needed to be protected. This model, this logic, led countless people to psychiatric hospitals, which at that time did not yet have the theoretical robustness or knowledge in treating those conditions. We know of extreme violence being committed in those places, such as lobotomies, and electroshock therapy being conducted without the knowledge we have today.
So, there was a lot of violence, abandonment, and mistreatment in psychiatric hospitals, and this happened all over the world. Once again, the great social event that was World War II ended up promoting a very important reflection on madness as well. When the war ended, people began to compare psychiatric hospitals to concentration camps.
Imagine that! Imagine what concentration camps and psychiatric hospitals were. There were similarities that began to be questioned, and a movement arose in the world that questioned this logic of care, or not, I don’t think we can refer to this as care, and that questioned this logic of isolation, exclusion, and asylums.
After World War II, starting in 1948, various movements denounced these forms of treatment and signaled that we had to think differently, that we had to eliminate Psychiatric Hospitals or at least present new forms of care where people could interact with their society, community, and territory. In Brazil, it was only in 2001 that a law, known as “The Mental Health Law” was passed and guaranteed a shift in the logic of treating people with mental disorders. This law reinforces the rights of these patients and states that mental health care should be territorially based and that we needed to progressively shut down these asylums for all that they represented.
In place of these hospitals, a large psychosocial care network was thought of, with various mechanisms that needed to be created to receive, treat, and care for these people. Think that we are shifting the logic of the Psychiatric Hospital, of isolation and exclusion, towards a network of psychosocial care services that needs to offer a series of mechanisms and actions to guarantee the insertion and reception of all people, because that is a right of all. This historical context helps us to reflect on why we have so much difficulty talking about mental suffering and mental illness.
Historically, every time we think about mental illness, we relate it to madness and the prejudice and fear it carries, and we ignore, or at least do not emphasize, and do not recognize that mental suffering is part of this great field of health that we are all part of. Attention, the idea here is that we recognize that mental suffering, that health as a whole includes physical and mental health, and due to our historical process, we have been disregarding mental health and mental illness out of fear, prejudice, and stigma. I'm concluding this video so we can articulate what was said in the first and second moments of these two videos about the idea that health needs to be thought of in an expanded context of health as physical and mental health and that in the expanded concept of health, we need to think about these various health determinants.
To think of these various determinants and that health is a right and duty of the State, is to think about actions that need to be developed so that we can in fact seek this well-being. And then, we will talk about health promotion as those actions that will enable us to move towards health, and these are many… We will think about disease prevention as those important actions that are aimed at diseases, such as the issue of covid-19 vaccination in today’s world. It is important to talk about the covid pandemic because I think it brings another context to Mental Health.
Sometime before the pandemic, the World Health Organization had already claimed that depression was going to be the second biggest cause of absence from work, and today, in the post-pandemic context, it is undeniable and impossible to recognize how this event, as in the case of World War II, affects our mental health. Perhaps this unfortunate event, the covid pandemic, alerts us that it is possible, necessary, and urgent for us to be attentive to our mental health and be able to recognize and identify that all processes in life, for example in the workplace, can lead to illness, not only physically but mentally as well. These are all important factors.
I will end here with the idea, and a certain insistence, that we need to take care of our health. We need to take care of our mental health, and this is a challenge for all of us. I dare say it is a challenge of this century.
