L’idée qui traverse l’ensemble de la thèse est la possibilité de la rencontre de deux mouvements : Psichiatria democratica et la psychothérapie institutionnelle, de deux psychiatres Basaglia et Tosquelles, rencontre entre médecin et patient ; rencontre entre patient psychotique et le monde, monde étant compris comme la société mais aussi le groupe de soin.La réflexion est basée sur des points « d’accrochage » entre différents discours : psychanalytique, historique, sociologique, philosophique ou phénoménologique à travers un axe central : celui de la relation possible entre médecin et patient au-delà d’une logique institutionnelle close. La pratique de la rencontre, à travers leurs protagonistes : opérateurs, usagers, patients etc… Ne peut, de fait, être comprise qu’à travers les concepts qui la fondent : l’inconscient, le transfert, la pulsion, etc. Elle est, comme on l’entendra ici, un rencontre transférentielle lieu de relations interpersonnelles qui doivent savoir s’adapter à la singularité de chacun. / The main theory of the thesis is the possibility of two psychiatrical movements meeting at a crossroad: Italian "psichiatria democratica" and French "psychothérapie institutionnelle". In the study their two founders, the psychiatrists Basaglia and Tosquelles are compared as well as the relation between psychiatrist and patient and patient and world (as society but also as group of care). The observation is focused on common grounds among different disciplines, psychoanalytic, historical, sociological, philosophical and phenomenological, over a central axis: the relationship between physician and patient outside the logic of closed institutional clinics. The setting of this intellectual encounter of operators, users and patients can only be understood through the concepts that underlie it: the unconscious, the transfer, the impulse. Lastly our “encounter” is, as we'll understand it here, a transferential encounter. It is a network of interpersonal relations that must adapt to each other actor’s singularity and individuality.

Made available in DSpace on 2016-04-29T13:31:29Z (GMT). No. of bitstreams: 1 Fuad Kyrillos Neto.pdf: 1025543 bytes, checksum: c5a50c40e19f68d3a263c9ec785ad132 (MD5) Previous issue date: 2007-03-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study discuss the circulation of the knowledge related to the notion of social inclusion in the mental health open services set on the policy established by the federal government. In order to do it, the text presents the foucault s theory about madness used by the Italian Democratic Psychiatry, as well as Franco Basaglia s theory. The basaglia s model brought some contributions to the mental health s field because it pointed the relevance of the psychiatric patients s social insertion. However, there are some critiques to the citizen s conception used in the implementation of this model and to the kind of the social bow requested by him. Those critiques are made from these theories: the Lacan s subject concept, the psychoses s psychoanalytical concept and the Lacan s theory of the four speeches. With the psychoanalysis as a conducting axle, we dialogue with thinkers of other fields of knowledge, specially those who are interest in the ideology and in the symbolic power. Based on small parts of the open services s quotidian, as well as the clinical cases s parts, this study review the social alliance produced in the mental health s substitutive services. It also points out that the workers play the role of the masters in the relation with the users while they have as a significant master the imperative of the social inclusion. Finally, this study considers some proposals of psychoanalysis field s authors, confirming this basic requirements for a consistent treatment and for a real inclusion of the psychotic one: to include the notion of structure in the diagnosis elaboration, to include the concept of foreclosure in the semiology and in the psychiatric reform institutional service s net and to include the the unconscious s subject psychoanalitical concept and the premise of the subject s participation in the treatment / O presente estudo discute a circulação do saber relacionado à noção e inclusão social nos serviços abertos de saúde mental a partir das diretrizes estabelecidas pelo governo federal. Para tanto, apresenta os pressupostos foucaultianos acerca da loucura utilizados pela Psiquiatria Democrática Italiana, bem como os pressupostos teóricos da obra de Franco Basaglia. Admite-se que existem contribuições positivas trazidas pelo modelo basagliano para o campo da saúde mental, já que apontam a relevância da inserção social dos pacientes psiquiátricos. Porém, formulam-se críticas à concepção de sujeito utilizada na implementação desse modelo e também ao tipo de laço social por ele implicado. Isso é feito a partir de considerações teóricas fundamentadas na noção lacaniana de sujeito, na concepção psicanalítica das psicoses e na teoria lacaniana dos quatro discursos. Ao ter a psicanálise como eixo condutor, dialogamos com pensadores de outros campos do saber, principalmente aqueles que se interessam pela ideologia e pelo poder simbólico. Partindo de fragmentos do cotidiano nos serviços abertos, bem como de fragmentos de casos clínicos, o estudo procede a crítica do laço social produzido nos serviços substitutivos de saúde mental e aponta o fato de que os trabalhadores ocupam o lugar de mestria na relação com os usuários ao ter como significante mestre o imperativo da inclusão social. Finalmente, no estudo, são discutidas proposições de autores do campo da psicanálise, que endossam os seguintes requisitos fundamentais para um tratamento consistente e para uma inclusão efetiva do psicótico: incluir a noção de estrutura na elaboração do diagnóstico, incluir o conceito de foraclusão na semiologia e na própria estrutura da rede de serviços institucionais da reforma psiquiátrica, incluir o conceito psicanalítico de sujeito do inconsciente e a premissa de implicação do sujeito no tratamento