Salud y Enfermedad Mental: Del Corpus Hippocraticum a una aproximación termodinámica / Health and Mental Illness: From Corpus Hippocraticum to a thermodynamic approach

Se establece una relación entre conceptos básicos acerca de salud y enfermedad mental en los Tratados Hipocráticos y los elementos actuales de la termodinámica y de la cibernética, enlace que se formula a través de los aportes de autores como Maturana y Valera (autopoiesis y teleonomía) o Bergson (regularidades vs indeterminsmos). Se definen y caracterizan los fenómenos anancásticos y los estocásticos, destacándose su relación complementaria. Con un enfoque termodinámico se define a la enfermedad mental como una estructura que se impone hegemónicamente sobre el resto de las actividades mentales y consume la energía que regula el metabolismo restante de la persona afectada. Se aportan evidencias clínicas de las bondades de esta óptica, presentándose, por ejemplo, la ansiedad como una crisis entrópica y la depresión como interferencia de la teleonomía , al tiempo que los trastornos obsesivo-compulsivos son descritos desde una perspectiva cibernética. A lo largo del texto se le confiere mayor relevancia a la noción de la enfermedad mental como pathos hegemónico que absorbe recursos energéticos y disminuye las posibilidades de adaptación del afectado a su medio externo y de éxito en el afrontamiento de sus propias tensiones.

A link is traced between the basic concepts on health and mental illness in the Hippocratic Treaties and the current elements of thermodynamics and cybernetics, through the contributions of authors such as Maturana and Valera (autopoiesis and teleonomy) or Bergson (regularities vs. indeterminism). Anankastic and stochastic phenomena are defined and characterized, highlighting their complementary connection. Following a thermodynamic approach, a mental illness is defined as a structure that imposes itself on the rest of the mental activities and consumes the energy that regulates the remnants of the affected person s metabolism. Clinical evidences of the benefits of this perspective are given, presenting, for instance, anxiety as entropic crisis and depression as an interference of teleonomy , while obsessive-compulsive disorders are described from the cybernetic perspective. Throughout the text, the greatest relevance is conferred to the notion of mental illness as a hegemonic pathos that absorbs energy resources and diminishes the affected individuals possibilities of adaptation to their external environment, and of successfully coping with their own tensions.

Formulations in Psychotherapy: Admission Interviews and the Conversational Construction of Diagnosis.

In this article, we contribute to understanding the interactional aspects of making clinical diagnosis in mental health care. We observe that therapists, during the "problem presentation" sequence in clinical encounters, often use a specific form of diagnostic formulations to elicit more diagnostically relevant information. By doing so, they often substitute one type of verb with another, following a diagnostic hypothesis. Specifically, in interviews that arrive at a diagnosis of neurosis, therapists formulate with behavioral verbal processes; in interviews that arrive at a diagnosis of psychosis, they do so with material ones. Such formulations often prove useful to define clinical diagnoses. They can, however, also be dangerous in that they may favor the therapist's agenda over the patient's. Our analysis helps therapists not only better understand the diagnostic process but also reflect upon their own use of diagnostic formulations and become aware of the clinical effects of their interactional performance.

Stigma: The Perspective of Workers on Community Mental Health Services-Brazil.

In this study, we have surveyed how professionals from multidisciplinary teams at psychosocial care centers (CAPS), in the city of São Paulo, understand the concept of mental illness stigma. The aim of the survey was to characterize the actions developed by the team to overcome stigma and, thus, contribute to develop strategies that incorporate overcoming stigma in the territory. Our objective is to get acquainted to the concepts about stigma shared by the participants. This survey was based on the theory of stigma by Erving Goffman; data were collected through semi-structured interviews with mental health professionals belonging to the CAPS teams. Results indicate that social exclusion is understood as a synonym to stigma, and that proximity of CAPS to society in the territory facilitates social inclusion and the overcoming of the mental illness stigma.

Perceptions of Depression and Access to Mental Health Care Among Latino Immigrants: Looking Beyond One Size Fits All.

Compared with non-Latino Whites, Latino immigrants have a lower prevalence of depression. However, they are also less likely to seek professional mental health services. Our objective was to compare and contrast perceptions of depression and access to mental health care among four of the largest Latino immigrant subgroups in Florida (Puerto Rican, Cuban, Mexican, and Colombian). We conducted a total of 120 interviews (30 men and women from each subgroup). Thematic analysis of qualitative data revealed that participants across the four groups were aware of the signs and symptoms of depression and had similar perceptions of depression. However, notable differences by subgroup emerged with regard to perceptions of access to mental health care. We suggest that the variation stems from differences in life experiences and the immigration context. Understanding the variances and nuances of Latino immigrants' cultural construction of depression and immigration experience will enable practitioners to better serve this community.