Heresia à clínica: um ensaio sobre a crise das classificações psiquiátricas

Abstract

In 2013, the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, triggered a crisis on psychiatric classifications. At the academic field, and on social and class movements, the quantitative increase in the DSM classification categories, throughout its editions, was cited as a tendency towards pathologization, as opposed to the ethical clinic of psychoanalyses, psychology or enlightened psychiatry. However, some scholars of this field have pointed out similarities between this instrument and the procedure of the clinic in general, an element that suggested the need of a broader analysis. On this research, I proposed to extend the critic and analyze the role of contemporary clinic as a strategy that could contribute to the medicalization of life and therefore to biopolitics. Taking the essay as a form, I sought to understand the structure of the main critics towards the DSM, to revise the notion of contemporary clinic from its birth in the 18th century, and to compare the clinical function, strategies and impacts to the ones regarding the DSM. The findings revealed that the clinic could only be borne at this period on history, when materialization and ontologization of the disease were made possible by a discursive blow of applying taxonomy to the classification of pathologies. On the other hand, the guarantee of its permanence through the years resided on the its capacity to function as a political instrument that enables the creation and support of the institution: health. A role that was played through spectacularization of suffering promoted on patient presentations and praxis pedagogy, which consolidated its semblance of guardian of the diagnostic truth by the classification capable of replication and prediction. An image that enabled a reconfiguration of its field to areas beyond the hospitals. On the assumption of knowing about the truth of health and disease, and the normal and the abnormal, the clinic could function as the foundation upon which the medicalization of existence was organized in the face of epidemics and the need for creation and accumulation of workforce on capitalism. At the end of the research, I observed the confirmation of a certain adequacy on the usage of term “clinic” to adjective these psychiatric manuals. I then concluded that the post-DSM-5 crisis is rather a crisis of the clinic itself, on this same contemporary clinic that was organized as an auxiliary strategy to the medicalization of life and, consequently, to biopolitics. I also point out that part of the power related to this instrument is granted by the affinity between how the clinic and the capitalist system operates in the current context. Finally, on the one hand, I end up recognizing the medical value of an universal clinic, and on the other, I point out the importance of an ethically oriented position that allows some practitioners who are conscious of their act, if they so wish, to able to separate themselves from this practice so that they can, in fact, guide their doing inside out the current politics, that by the inside out the biopolitics.