O trabalho reflete acerca dos critérios referentes à avaliação psiquiátrica nas internações e tratamento involuntários. A restrição da liberdade é infração aos direitos do homem e, se ela é justificada em nome da patologia mental, qualificá-la é um imperativo legal e ético. Historicamente, a internação crônica em hospitais psiquiátricos levou à exclusão social e rompimento dos laços significativos da vida pessoal. Nos serviços de emergência ela é muitas vezes determinada em nome de um risco. Assim, é proposta uma análise crítica (à semelhança da desconstrução de Derrida e da genealogia de Foucault) do saber médico-psiquiátrico, que é ferramenta essencial do trabalho clínico. Um panorama dos arranjos dos dispositivos públicos de regulação das internações psiquiátricas involuntárias no ocidente mostra a inter-relação de um modelo médico com um modelo legalista (focado nos direitos dos pacientes), cada qual com seus ganhos e dificuldades. A medicalização da vida humana é um fenômeno do mundo moderno, e é vista como um processo dinâmico, onde a apropriação das categorias médicas por parte dos usuários e familiares também gera empoderamento e mudanças. Vemos como, historicamente, o viés moral da práxis realizada no hospital psiquiátrico é indissociável da construção do saber, e a psicopatologia oficial é de uma nosologia descritiva; mas o trabalho clínico permite outras psicopatologias, mais participativas, centradas na relação do sujeito com o mundo, que possam servir a ele como instrumentos de compreensão e ajuda na experiência vivida. Assim, a categoria da vontade em psicopatologia clássica adota a perspectiva aristotélica de uma deliberação racional, mas a leitura filosófica de Arendt destaca a centralidade da liberdade e da espontaneidade inerentes ao conceito. Esta dicotomia entre vontade livre e determinação traz repercussões para a clínica e para a justiça, como nos casos da avaliação da responsabilidade dos pacientes sobre seus atos. Neste campo, assim como na avaliação do juízo crítico, a ciência não garante a objetividade totalizante, deixando sempre a decisão sobre a internação psiquiátrica involuntária na dependência do político, da moral e da ética que constituem a clínica. / This work is a reflection on the criteria used in psychiatric practice to justify involuntary detention and treatment. The restriction of freedom is an infringement of human rights, and if it is to be justified on the grounds of mental pathology, it must be legally and ethically qualified. Historically, long term internment of people in psychiatric institutions led to social exclusion and the rupture of importante social and personhood ties. Emergency hospitalization is often justified on the grounds of risk. Hence, a critical analysis is offered (along the lines of Derridas deconstruction and Foucaults genealogy), of our current medical-psychiatric understanding, which is the foundation of all clinical work. An overview of the many arrangements for psychiatric involuntary detention on a variety of Western countries demonstrates an interplay between medical and legal (rights based) models. These arrangements all come with benefits and challenges. The medicalization of human life is a modern, world-wide phenomenon, and is viewed as a dynamics process where the appropriation of medical categories by users and their families also produces empowerment and change. We see how, historically, moral bias of practice performed at psychiatric hospitals is inseparable to knowledge construction, and oficial psychopathology is a descriptive nosology, but clinical practice allows other psychopathologies, more participative ones, centered on the relations between the subject and the world, which may help him to understand and survive life experiences. Thus classical pathology adopts a rational aristotelian approach to understanding the concept of Will, while the philosophical view of Arendt emphasizes the centrality of freedom and spontaneity. The inherent dichotomy between free Will and determinism leads to clinical and legal repercussions, in the case of assessing a patients level of responsibility for his actions. In this field, as in the evaluation of a patients level of insight, science does not warrant total objectivity. Hence the decisions about psychiatric involuntary detention will always depend on the basis of the complex interplay between politics, morality and ethics, basis of all clinical work.

Bakgrund: I Sverige definieras begreppet upprepade missfall som att en kvinna har fått tre eller flera missfall i följd och det uppskattas drabba ca en procent av världens alla par i fertil ålder. Då detta är en liten grupp kvinnor kan det vara svårt för den drabbade kvinnan att veta var hon kan vända sig med sina funderingar och vad hon har rätt till för vidare hjälp. Vid flera upprepade missfall växer behovet av att få svar på vad som sker och varför samtidigt som behovet av stöd och förståelse från sina närstående blir större. Tillgången till utredning och behandling ser olika ut men med hjälp från barnmorskans och vårdens sida kan lämplig planering utifrån kvinnan situation utvecklas. Syfte: Syftet med denna studie är att undersöka kvinnans upplevelse av upprepade missfall och belysa hennes behov under och tiden efter missfallet. Metod: Metoden för denna uppsats var en kvalitativ metasyntes med metaetnografisk analysmetod. Totalt kvalitetsgranskades 29 artiklar varav 16 gick igenom kvalitetsgranskningen och sammanställdes till ett resultat. Resultat: Sju kategorier med nyckelbegrepp bildades. Kategorierna som identifierades var missfallsprocessen, utrymme för sorg, undvikande beteende, partnerrollen, socialt stöd, förväntningar på vården och att bli gravid igen. Slutsats: Då alla kvinnor är olika varierar upplevelsen och behoven vid en missfallsprocess. Genom att ha kunskap om vad kvinnan går igenom både fysiskt- och psykiskt vid upprepade missfall bidrar det till en ökad förståelse för vad kvinnan behöver, både från sin omgivning men även från vårdens sida. Klinisk tillämpbarhet: Studien skulle kunna bidra till att utforska möjligheten att ändra på kriterierna för utredning vid upprepade missfall. Studien skulle även kunna leda till en förbättring av kunskapsläget både för individen, samhället och vården gällande hur bemötandet av denna grupp av kvinnor ser ut. Barnmorskor kan som yrkesgrupp stödja och hjälpa denna grupp kvinnor genom uppföljning i samband med att de kommer i kontakt med barnmorskemottagningen för att meddela att graviditeten har slutat i ännu ett missfall. Vidare kan etableringen av stödgrupper inom vården vara ett bra stöd för kvinnor som är med om upprepade missfall och dessa grupper skulle potentiellt ledas och samordnas av en barnmorska som innehar kompetens inom området upprepade missfall. / Background: In Sweden, the concept of recurrent miscarriage is defined as a woman having three or more miscarriages in succession and it is estimated to affect about one percent of all couples of childbearing age worldwide. Since this is a small group of women, it can be difficult for the effected woman to know where she can turn with her thoughts and what she is entitled to regarding further help. After enduring multiple recurrent miscarriages, the need to get some answers and at the same time the need to receive support and understanding from their close surroundings increases. The access to further investigation and treatment is different depending on where you are but with some help from a midwife and other healthcare providers, an appropriate plan based on the woman's situation can be developed. Purpose: The aim of this essay was to investigate the experiences of women who have endured recurrent miscarriages and their further needs that occurred during and the time after the miscarriage. Methods: The method used in this essay was a qualitative metasynthesis with metaethnographic analysis method. In total, 29 articles were collected of which 16 of them went through the quality review and were compiled to a result. Results: seven categories containing of key concepts were formed. The categories identified were the process of miscarrying, room for griefing, avoiding behavior, the partners role, social support, expectations of the healthcare and becoming pregnant again. Conclusion: Due to the fact that all women are different, the experiences and needs during a miscarrying process varies. By having the knowledge of what the woman goes through both physically and mentally during recurrent miscarriages, it contributes to a greater understanding of what the woman needs, both from her surroundings but also from the healthcare. Clinical applicability: This essay could help to explore the possibilities of modifying the criteria for an investigation of recurrent miscarriages. The essay could also lead to improvement of the knowledge situation for the individual, the society and the care providers regarding how this group of women wants to be treated. Midwives as a profession could help to support this group of women by initiating contact with the women when or after she has contacted the midwife clinic to announce another pregnancy loss. Furthermore, the establishment of support groups for women with recurrent miscarriages could be helpful and supportive for these women. The support groups could potentially be coordinated by a midwife with specific knowledge about recurrent miscarriage.

Problemformulering: Studier har visat att frivilliga inhyrda tenderar vara mer nöjda med aspekter som arbetstillfredsställelse och stöd från arbetsgivare, medan ofrivilliga är mer otrygga i sin rörliga arbetssituation och är mer benägna att sluta. Detta är en fråga om arbetstillfredsställelse, som är avgörande för vår hälsa. Ett problem när vi vill undersöka frivillighet i valet av en anställning som inhyrd är att många studier om detta är gamla eller internationella och gjorda i länder med annan reglering för bemanning än vi har i Sverige. Det innebär att många enkäter och frågeställningar är utformade på ett sätt som inte säkert fungerar optimalt i en svensk kontext, vilket kan innebära en avsaknad av skalor som kan mäta frivillighet anpassat till bemanning i Sverige. Syftet är att utveckla, reliabilitetstesta och preliminärt validera en skala passande i en svensk kontext, som kan mäta graden av frivillighet i en anställning som inhyrd via bemanningsföretag. Som metod användes en mixad metod, med fem kvalitativa kognitiva intervjuer som hjälp för att utforma skalan, som sedan skickas ut som webbenkät till 77 bemanningsanställda, vilket genererade i 26 kvantitativa svar. Dessa låg sedan till grund för tester av skalans reliabilitet och validitet. Resultat: Skalan i sin helhet hade otillräcklig reliabilitet och delades upp i två subskalor. En med items relaterade till frivillighet och en till ofrivillighet, vilket gav acceptabel reliabilitet till skalorna. Korrelationerna mellan de båda skalorna och indexet för arbetstillfredsställelse, visade sig dock vara mycket svaga, något som kan vara en konsekvens av ett mycket litet sampel. Slutsats: Trots acceptabel reliabilitet hos skalorna, visar sig validiteten vara övergripande svag. Skalan för frivillighet visar ett svagt positivt samband mellan arbetstillfredsställelse och frivillighet som ligger i linje med i flera tidigare studier. Skalan för ofrivillighet visar däremot närmast obefintligt samband med arbetstillfredsställelse. / Studies has shown differences between voluntary and involuntary agency workers perceived employment security and satisfaction in their flexible work situation. This is a matter of job satisfaction, that is crucial to our health. A problem when wanting to investigate voluntariness of agency workers is that many previous studies are old or international, and as the staffing regulation may differ in different countries, this has led to a lack of surveys that measure voluntariness in adaptation to a Swedish context. The aim of this study was to develop, test reliability and preliminary validate a scale that measure voluntariness of agency workers in staffing companies, suitable in Sweden. A mixed method was used; five qualitative cognitive interviews helped design the scale, that later was sent out as a web survey. The responses underwent reliability and validity tests, which revealed that the scale had poor reliability. The scale was therefore divided into two subscales, one related to voluntariness and the other to involuntariness, which gave acceptable reliability to the scales. However, despite the approved reliability, the validity proved to be overall weak. The voluntary scale however, showed a small positive relationship between job satisfaction and voluntariness, which is in line with previous studies.

This thesis explores the experience of living with cancer-related cachexia (CRC) from the patient perspective. Critique of the literature indicates few examples where patients have had the opportunity to speak. Following a challenging recruitment process, six people living with the syndrome were interviewed to elicit their narrative. Their stories were examined and themes identified relating to their personal feelings and how these affected social interactions. Thematic analysis was applied to produce what is a rich qualitative description of the experience from this small sample. Living with CRC requires development of strategies to survive. Emergent themes included the loss of sense of self and a changing relationship to the social world, social isolation and dissatisfaction with truth-telling by health professionals. Recommendations are made to mitigate the suffering of patients by empowering them through better information and acknowledgement of their condition. The balance between nutrition and wellbeing is re-examined, calling for a reorientation of perspective from a focus on intake towards a focus on quality of life. This clearly falls within the nurse-as patient-advocate paradigm and the relevance and meaning of this research to the nursing profession is explored. Potential areas for further research in regards to both patient experience and nursing practice are extrapolated.

In Australia, as in other industrialised countries, rates of childlessness amongst women are rising. This has been attributed, in part, to a rise in the number of women choosing never to give birth; however, women’s perception of what constitutes choice in remaining childless is under-investigated. The aim of this study was to investigate Australian women’s experience of childlessness at mid age and explore the role of choice in this reproductive outcome. It investigated the determinants of childlessness, considered the consequences of never giving birth, and explored how choice affects childless women’s evaluation of non-motherhood. / A cross-sectional study of the experience of never giving birth was conducted, which comprised two components. The minor component was a secondary analysis of survey data (collected in 1996) from the Women’s Health Australia (WHA) project. WHA is a longitudinal study which recruited a nationally representative sample of 14,099 women born between 1945 and 1952. These women are amongst the first to have lived all their reproductive lives since the introduction of the oral contraceptive. This study compared demographic characteristics, self-rated health, and life satisfaction between 1,069 mid-aged childless women (exclusive of known adoptive and step-mothers) and 12,643 of their peers who are mothers. It was found that at mid-age, childless women have higher levels of education and are more extensively engaged in the paid workforce than mothers, however, there were no differences in health status between mothers and childless women. Life satisfaction differences between the two groups are complex and mediated by marital status. / The major component of the investigation was a study-specific survey (October 2002) completed by 426 nulliparous women who were all participants in the mid-aged cohort of Women’s Health Australia. This component investigated the determinants of childlessness, the role of choice, and the experience of non-motherhood. / In contrast to existing studies into childlessness, this large quantitative investigation has a sample which comprises a broad selection of nulliparous women irrespective of their marital status, medical history, or level of choice in never giving birth. Using an original classification system, women were categorised into three childless groups which describe three levels of choice in never giving birth: 37.1% of respondents chose childlessness actively (Active Choice), 15.4% chose childlessness given their personal circumstances (Constrained Choice), and 47.5% felt denied the opportunity to give birth (Denied Choice). The predominant reason for childlessness amongst the Active Choice women was not experiencing a strong ‘maternal instinct’, the Denied Choice group mainly cited infertility or the lack of a husband/partner, whilst the Constrained Choice group gave a mixture of voluntary and involuntary explanations. / This study developed a balance sheet approach to assessing both the positive and negative aspects of non-motherhood – the Consequence of Childlessness Balance Sheet (CCBS). It also introduced a technique for measuring ambivalence that was developed within social psychology. In contrast to the public discourse that depicts childlessness as a negative life outcome, participants in this study gave a favourable evaluation of their lives. Even so, more than half (55.6%) of the participants experienced moderate levels of ambivalence. Comparisons between the three childless groups revealed that as choice increased participants were more likely to give a higher rating to the positive aspects of their lives, a lower rating to the negative ones, and experience lower levels of ambivalence. However, Denied Choice women generally did not find childlessness a devastating experience. / Therefore, amongst the mid-aged participants in this study the experience of childlessness was complex and diverse, varying with the level of choice women had in never giving birth. Childlessness was not, however, a burdensome or detrimental life outcome for these women.

Extensive changes are taking place in working life and creating new and important areas for research. New knowledge is needed in order for individuals and organizations to be able to maintain long-term development. The aim of this thesis is to increase our understanding of how change and (im)mobility in the labor market are related to employees’ health, wellbeing, and work-related attitudes. The thesis comprises three studies, based on questionnaire data from different samples. Study I examined the potential consequences of downsizing in two organizations that had implemented change in two different ways (proactively and reactively). A proactive approach seems to lessen change-related demands and provide an opportunity for increased participation, which helps lessen the negative effects on employee work attitudes and wellbeing. The descriptive data from a representative sample in Study II revealed that 28 percent of the permanent and 50 percent of the temporary employees did not work in their preferred occupations. The results indicate that those individuals who were involuntarily embedded (locked-in position), especially among the permanent employees, had more health problems and less development at work. Study III utilizes a newly developed construct (work-related health attributions) that focuses on the individual’s perception of the relation between work and health. The results indicate that it seems to be a promising construct for predicting job satisfaction, organizational commitment, and turnover intention. For employees to have the opportunity to participate in organizational change, as well as the opportunity to exercise mobility and alter their circumstances when the organization, occupation, or job is not contributing to their better health appear to be factors that help improve health and sustainability for both employees and organizations.

The purpose of this study was to investigate the adequacy of the Stages of Change model in a group therapy treatment program for male batterers. The sample consisted of three groups with a total sample size of 22 participants. Data for this study were obtained by administering the Safe at Home Instrument and the Group Climate Questionnaire – Short Form. Results indicated the Safe at Home Instrument had limited clinical utility with involuntary male batterers. Independent of scoring method used, the majority of participants reached the action stage early in group treatment. Because the action stage is the highest stage attainable in this study, further growth was not measurable. The lack of variability in participants’ scores on the Safe at Home Instrument limits its clinical usefulness. Results from the Group Climate Questionnaire – Short Form indicate the groups did not progress according to a popular group development theory (MacKenzie & Livesley, 1983). The groups appear to enter the differentiation stage but do not successfully master the developmental issues needed to progress through the subsequent stages. The results from both instruments indicate that treatment groups with involuntary, male batterers did not progress as expected. Recommendations for future research and clinical practice are discussed.

Submitted by Ana Carla Almeida (ana.almeida@ucsal.br) on 2016-12-22T12:02:44Z No. of bitstreams: 1 DE JESUS, MCL-2016.pdf: 2562871 bytes, checksum: 8e18e2627abcb549d2d36192470e5d99 (MD5) / Approved for entry into archive by Rosemary Magalhães (rosemary.magalhaes@ucsal.br) on 2017-01-16T13:11:25Z (GMT) No. of bitstreams: 1 DE JESUS, MCL-2016.pdf: 2562871 bytes, checksum: 8e18e2627abcb549d2d36192470e5d99 (MD5) / Made available in DSpace on 2017-01-16T13:11:25Z (GMT). No. of bitstreams: 1 DE JESUS, MCL-2016.pdf: 2562871 bytes, checksum: 8e18e2627abcb549d2d36192470e5d99 (MD5) Previous issue date: 2016-10-26 / O presente estudo se propõe verificar a qualidade de vida, em médio prazo, dos familiares de dependentes de cocaína/crack após os internamentos voluntário e involuntário, realizado em serviço especializado e privado para o tratamento da dependência química, no município de Camaçari/Bahia. A dependência química é vista como um problema de saúde pública frequente e atual. Para melhor fundamentar a pesquisa, abordou-se, a priori, conceitos básicos sobre dependência química, transtornos da personalidade associados, as famílias contemporâneas, qualidade de vida e as percepções dos familiares de dependentes químicos sobre o tema, bem como as formas de intervenção no tratamento. A metodologia utilizada foi a descritiva, comparativa e reflexiva através da abordagem de pesquisa empírica. Empregou-se o método da triangulação, associando a pesquisa quantitativa e qualitativa em um único plano, através de entrevistas semiestruturadas e questionários aplicados pela pesquisadora. Os resultados evidenciaram uma tendência dos familiares declararem ter uma boa qualidade de vida e de saúde de forma geral e, também, nos domínios físico, psicológico, social e ambiental. Percebe-se múltiplas respostas sobre o conceito de qualidade de vida entre os entrevistados e um progresso das relações interpessoais a partir das vivências dos tratamentos dos seus entes. Variáveis sóciodemográficas podem estar associadas a melhor qualidade de vida entre os familiares, como ser do sexo masculino, ter renda superior a cinco salários mínimos e estar casado/união estável. Na pesquisa qualitativa, as famílias tendem a aumentar sua exposição à religiosidade/espiritualidade com o processo de drogadicção do parente e seu internamento por perceberem aumento do apoio social/emocional adquirido, além de ser positiva e protetora na recuperação da dependência química. Porém, na pesquisa quantitativa, observa-se que a religião não é destacada pelos entrevistados como um fator que contribua para a melhor qualidade de vida deles, percebendo resultados complementares sobre o impacto dessa variável no bem-estar dos mesmos. Quando se compara as modalidades de internamentos voluntários e involuntários, a qualidade de vida dos familiares, após o internamento à médio prazo, mostram-se semelhantes nesta pesquisa. / A basic goal of this study was to investigate perceptions on their quality of life by family members of cocaine/crack addict persons after their voluntary and involuntary admissions, in a specialized private service for drug treatment in the city of Camaçari/Bahia/Brazil. Chemical dependency is seen as a problem of public health, and more concern with family should be addressed. The research first discuss themes such as chemical dependency, disorders associated with personality, contemporary families, quality of life and perceptions of drug addicts family members on the subject, as well as forms of intervention in treatment. An empirical research follows such conceptual debate using descriptive, comparative and reflective methodological approaches. The model is the triangulation methodology, combining quantitative and qualitative research in a single plane, through semi-structured interviews and questionnaires. The results showed that family members tend to declare that they have a good quality of life and health in general, as well as when physical, psychological, social and environmental fields are specifically focused. It was found multiple concepts of quality of life among respondents. It was also a common finding the perception that the treatment of their familiar member collaborated with a progressive improvement of their relations. It was found that sociodemographic variables are associated with better quality of life perception. In this way, it was highlighted: to be male, to have income above five minimum wages and to be married/stable. Through the qualitative research, it was found that households tend to increase their exposure to religiosity/spirituality with their relatives drug addiction process. This also held true with their internment. Indeed religiosity/spirituality collaborated to social/emotional support, besides being positive and protective to the recovery from chemical dependency. However, in the quantitative research, it is observed that respondents do not highlight religion as a factor that contributes to improve their quality of life. When compared, the modalities of voluntary and involuntary admissions, no meaningful differences were found in relation to the quality of life of the focused family member.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The present dissertation has a mixed methods research design combined with a documental feature. From the legal proceedings for involuntary commitment of crack cocaine users, this piece of work aims at reflecting on the interactions of certain institutions (such as family, Unified Health System (SUS), welfare, Judiciary, etc.) in the process of health care provision to drug users. From this general objective, we produced two specific aims, which are the focus of the present dissertation: (a) to analyze academic and legal documents related to the topic of involuntary commitment, and, (b) to build a social and epidemiological listing of the legal proceedings (involuntary commitment requests) involving users of crack cocaine, received in 2013. We produced a social and epidemiological listing of the legal proceedings (involuntary commitment requests) involving drug users received by the 4th Regional Health Division (RHD) in 2013. The analysis of the documents gathered in the 4th RHD was based on descriptive statistical analysis, performed using software IBM SPSS, version 21. Furthermore, this research used Critical Social Psychology and Theories of Social Representation as theoretical and methodological foundations. The present research also used the body of knowledge from authors who focus on the issues related to mental health, drug users (more specifically crack cocaine users) and involuntary commitment. After presenting our methodological choices, the dissertation is organized in four chapters: the first one is entitled: Social representation and drugs ; the second chapter, Brazilian Policies on drugs: what kind of care do I need? ; the third chapter is entitled Involuntary commitment for crack cocaine users ; and the fourth and last chapter s title is Social and Epidemiological listing of legal proceeding of the 4th CRS: results and discussion . We concluded that the discourses contained in the legal proceedings are from people other than the crack cocaine users. Therefore we emphasize the necessity of listening to drug users. It is from their experiences and knowledge that health care will be planned and put into execution. The singular therapeutic project will be effectuated from a warm welcome and a listening without prejudices. / A presente dissertação, com design quali-quantitativo e de caráter documental, busca descrever a partir dos processos judicias para internação compulsória de pessoas que fazem uso de crack, como certas instituições família, Sistema Único de Saúde (SUS), Assistência Social, Judiciário, etc. interatuam na produção de cuidado em saúde. Desse objetivo, geramos dois objetivos específicos: (a) analisar documentos acadêmicos e jurídicos relativos ao tema da internação compulsória e (b) realizar um levantamento sócio epidemiológico dos processos judiciais (pedidos para internação compulsória) recebidos em 2013, de pessoas que fazem uso de crack. Foi realizado um levantamento sócio epidemiológico dos processos judiciais (pedidos para internação compulsória), recebidos pela 4ª Coordenadoria Regional de saúde em 2013, de pessoas que fazem uso de drogas. Os documentos levantados na 4ª CRS foram analisados com base na análise estatística descritiva, realizada com o auxílio do software IBM SPSS Statistcs, versão 21. Além disso, esta pesquisa tem como base teórica e metodológica os pressupostos da Psicologia Social Crítica e da Teoria das Representações Sociais, bem como, foi utilizado o corpo teórico de autores que enfocam as temáticas referentes à saúde mental, pessoas que fazem uso de drogas, mais especificamente, a droga crack e internação compulsória. Após apresentar as incursões metodológicas, organizamos a dissertação em quatro capítulos: o primeiro capítulo é intitulado Representações Sociais e drogas ; o segundo capítulo, Políticas sobre drogas no Brasil: qual o cuidado que eu preciso? ; terceiro capítulo, intitulado Internação compulsória de pessoas que fazem uso de crack e o quarto e último capítulo, possui como título Levantamento sócio epidemiológico dos processos judiciais na 4ª Coordenadoria Regional de Saúde: resultados e discussão . Concluiu-se que os processos possuem discursos sobre esses sujeitos, a partir de outras vozes que não a sua. Dessa forma, enfatizamos que as vozes dessas pessoas devem ser escutadas. É a partir das suas experiências e de saberes que o cuidado em saúde vai ser desenhado. A partir do acolhimento e de uma escuta sem preconceitos que o Projeto Terapêutico Singular se efetivará.

O trabalho reflete acerca dos critérios referentes à avaliação psiquiátrica nas internações e tratamento involuntários. A restrição da liberdade é infração aos direitos do homem e, se ela é justificada em nome da patologia mental, qualificá-la é um imperativo legal e ético. Historicamente, a internação crônica em hospitais psiquiátricos levou à exclusão social e rompimento dos laços significativos da vida pessoal. Nos serviços de emergência ela é muitas vezes determinada em nome de um risco. Assim, é proposta uma análise crítica (à semelhança da desconstrução de Derrida e da genealogia de Foucault) do saber médico-psiquiátrico, que é ferramenta essencial do trabalho clínico. Um panorama dos arranjos dos dispositivos públicos de regulação das internações psiquiátricas involuntárias no ocidente mostra a inter-relação de um modelo médico com um modelo legalista (focado nos direitos dos pacientes), cada qual com seus ganhos e dificuldades. A medicalização da vida humana é um fenômeno do mundo moderno, e é vista como um processo dinâmico, onde a apropriação das categorias médicas por parte dos usuários e familiares também gera empoderamento e mudanças. Vemos como, historicamente, o viés moral da práxis realizada no hospital psiquiátrico é indissociável da construção do saber, e a psicopatologia oficial é de uma nosologia descritiva; mas o trabalho clínico permite outras psicopatologias, mais participativas, centradas na relação do sujeito com o mundo, que possam servir a ele como instrumentos de compreensão e ajuda na experiência vivida. Assim, a categoria da vontade em psicopatologia clássica adota a perspectiva aristotélica de uma deliberação racional, mas a leitura filosófica de Arendt destaca a centralidade da liberdade e da espontaneidade inerentes ao conceito. Esta dicotomia entre vontade livre e determinação traz repercussões para a clínica e para a justiça, como nos casos da avaliação da responsabilidade dos pacientes sobre seus atos. Neste campo, assim como na avaliação do juízo crítico, a ciência não garante a objetividade totalizante, deixando sempre a decisão sobre a internação psiquiátrica involuntária na dependência do político, da moral e da ética que constituem a clínica. / This work is a reflection on the criteria used in psychiatric practice to justify involuntary detention and treatment. The restriction of freedom is an infringement of human rights, and if it is to be justified on the grounds of mental pathology, it must be legally and ethically qualified. Historically, long term internment of people in psychiatric institutions led to social exclusion and the rupture of importante social and personhood ties. Emergency hospitalization is often justified on the grounds of risk. Hence, a critical analysis is offered (along the lines of Derridas deconstruction and Foucaults genealogy), of our current medical-psychiatric understanding, which is the foundation of all clinical work. An overview of the many arrangements for psychiatric involuntary detention on a variety of Western countries demonstrates an interplay between medical and legal (rights based) models. These arrangements all come with benefits and challenges. The medicalization of human life is a modern, world-wide phenomenon, and is viewed as a dynamics process where the appropriation of medical categories by users and their families also produces empowerment and change. We see how, historically, moral bias of practice performed at psychiatric hospitals is inseparable to knowledge construction, and oficial psychopathology is a descriptive nosology, but clinical practice allows other psychopathologies, more participative ones, centered on the relations between the subject and the world, which may help him to understand and survive life experiences. Thus classical pathology adopts a rational aristotelian approach to understanding the concept of Will, while the philosophical view of Arendt emphasizes the centrality of freedom and spontaneity. The inherent dichotomy between free Will and determinism leads to clinical and legal repercussions, in the case of assessing a patients level of responsibility for his actions. In this field, as in the evaluation of a patients level of insight, science does not warrant total objectivity. Hence the decisions about psychiatric involuntary detention will always depend on the basis of the complex interplay between politics, morality and ethics, basis of all clinical work.