Nova indústria da loucura: análises de violações de direitos humanos a partir do relatório da inspeção nacional em comunidades terapêuticas

Abstract

The issue of drugs has been part of society since the beginning of humanity; in the evolution of capitalist society, different forms of intervention emerged, such as prohibitionism and proposals related to health. In Brazil, this issue began to be treated as a public health issue from the 2000s onwards, through the formulation of a specific mental health policy to assist people with problems related to the use of alcohol and other drugs. A policy based on care in the territory, with guidelines aligned with the principles of Psychiatric Reform (PR), and it adopts Harm Reduction as a guiding principle. However, some institutions that offer treatment to this population do not align with the guidelines established in the PR and the Comprehensive Care Policy for users of alcohol and other drugs, the so-called Therapeutic Communities (TCs). TCs are private or philanthropic institutions, which offer treatment based on users' social isolation, work, discipline and spirituality (IPEA, 2017). Despite going against the grain of psychiatric reform (COSTA, 2020), these establishments were, paradoxically, included in public policies on drugs, benefiting from public funding. Thus, in this work our aim was to understand, based on the national inspection report on therapeutic communities (FCP, 2018), how TCs are legitimized and aligned with what is set out in theoretical and normative frameworks and which human rights of users are violated when they undergo treatment in these institutions. The report is the result of a national inspection carried out by the Federal Council of Psychology (FCP) in partnership with other public bodies of the health and justice system in 28 CTs, in 12 Brazilian states, in 2017. To support the study, a bibliographic review was carried out based on books, scientific articles, theses and dissertations researched on online platforms such as: CAPES journal portal, Redalyc, SCIELO; documentary research of the main regulatory frameworks that deal with drugs and mental health in Brazil and critical analysis of the report. The analysis of the report was divided into five categories, namely: 1) asylum nature versus care in the territory; 2) harm reduction versus abstinence versus prohibitionism; 3) mortification of the self and control of bodies; 4) access to rights and the psychosocial care network and 5) work. Through the analysis, it was possible to observe that TCs are asylum institutions, as they do not prioritize care in the territory, resembling mental hospitals. Treatment is based on abstinence with a prohibitionist approach and disregards harm reduction. Users are deprived of exercising their rights and accessing RAPS as well as other policies. TCs use religion and moral doctrine to adjust individuals to society, causing them a permanent process of self-mortification. Work is used as a mechanism of punishment and also of exploitation of both users and volunteers. We conclude by pointing out that TCs violate human rights, produce subjective (and also physical) death, they are not health establishments nor do they align with the assumptions of PR. And despite the accusations contained in the report, the State continues to economically promote this type of institution, supporting the maintenance of a “new” industry of madness.