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Social Psychiatry and Psychiatric Epidemiology
Published in:

Open Access 18-12-2023 | Research

The politicizing clinic: insights on ‘the social’ for mental health policy and practice

Authors: Dominique P. Béhague, Helen Gonçalves, Suélen Henriques da Cruz, Larissa de Cruz, Bernardo L. Horta, Natália P. Lima

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 3/2024

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Abstract

Purpose

In this paper, we explore how Brazilian socially sensitive therapy can respond to care-users’ desire to change the social and political forces shaping their lives. We use this case to demonstrate the limits of the “social determinants of health” agenda which, when operationalized, tends to leave questions of lasting structural change aside.

Methods

We report on mixed methods ethnographic and epidemiological results from the 1982 Pelotas (Brazil) birth cohort study, a prospective study of 5914 children. Ethnographic analysis explored the cyclical relationship between schooling, mental health care, conceptualizations of mental distress, social and political engagement, and experiences with diverse forms of discrimination. Epidemiological bivariate and multivariate analyses examined differences in socio-political participation and the reporting of discrimination at different time-points for participants who used therapy with those who did not. Effect modification analysis tested the hypothesis that the socially empowering effects of therapy were greater for marginalized and minoritized youth.

Results

Most young people living in situations of precarity experienced therapy, particularly when based in schools, to be a blame-inducing process. A more fulfilling and impactful therapeutic experience took shape when young people were able to shift the focus away from symptom reduction and behavioral management toward narrative life analyses, social debate, and political agency. Use of socially sensitive therapy was statistically associated with increased political participation and reporting of discrimination after controlling for confounders. The empowering effects of therapy were greater for those with less formal education and family income, but not for young people who identified as black, brown, or non-white.

Conclusion

The findings underscore the importance of considering agency, sociality, and politics when theorizing “the social” in clinical practice, and health and social policy.
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Metadata
Title
The politicizing clinic: insights on ‘the social’ for mental health policy and practice
Authors
Dominique P. Béhague
Helen Gonçalves
Suélen Henriques da Cruz
Larissa de Cruz
Bernardo L. Horta
Natália P. Lima
Publication date
18-12-2023
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 3/2024
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-023-02573-2

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