This dissertation examines the outbreak of depression in the United States through an ethical lens of care and disconnection. Discussions in bioethics and collaborating fields largely speak of mental health as a series of phenomena attributable to individuals, subsequently using terms like 'disease' and 'disorder' to denote abnormality in those persons affected by distress. Alternatively, I respond to the ongoing "crisis of care" through a critique of neoliberalism and biomedicalization. I argue that widespread despair is the result of a collective way of life wherein persons are detached from fundamental physical and psychosocial needs by nature of fallacious cultural commitments and techniques. I implement constructivism to empirically ground a new application of care ethics to be considered by normative ethicists. In addition to merging several established traditions such as feminist philosophy and the capabilities approach, I also contribute a comprehensive model for understanding basic needs and the distribution of caring responsibilities/roles. Further, the project enhances the field of applied bioethics by featuring a practically-specific relational approach that is built from the experiences of those embedded in daily decision-making. The dissertation critiques the theoretical soundness of psychiatric and psychological classifications and the practical efficacy of prominent solutions such as antidepressant medications and various psychotherapies. I further assert that these depictions of mental health misrepresent the experiences of those affected by depression, and thus share their stories of derealization, isolation, frustration, resentment, and hopelessness through a lens of disconnection. These feelings apply to caregivers as well: the commodification of care alongside of the constraints attached to "professionalism" are used to inhibit their autonomy, exploit their labor, and detach them from relationships with charges and other carers. This leads to issues such as moral distress, burnout, and vicarious traumatization, all of which foster despair. Finally, I respond to these collective concerns with a new framework consisting of an expanded account of fundamental needs and an analysis of "care-abilities": the capabilities one has to meet their needs and to fulfill the needs of others who depend on them. I then supplement this account with a detailed distribution of skills and responsibilities attached to the particular caring roles that one might occupy. This ethical framework is intended to be advisory and malleable to contextual practice rather than prescriptive. / Doctor of Philosophy / This dissertation outlines the techniques and conditions which, through persuasion or coercion, direct us towards a particular way of living marked by isolation, alienation, and precarity. This life, I argue, has facilitated an epidemic of depression and related conditions of distress in the United States. We largely consider mental health to be a series of phenomena attributable to individuals, and subsequently use terms like 'disease' and 'disorder' to denote abnormality in those persons affected by distress. Alternatively, I follow a question proposed by Johann Hari, who asks "What if depression is, in fact, a form of grief – for our own lives not being as they should? What if it is a form of grief for the connections we have lost, yet still need?" The dissertation critiques the paradigms of neoliberalism, which refers to the ideology of elevating market theories to state-sponsored and enforced norms, and biomedicalization, an affiliated logic which individualizes and medicalizes all human problems. In response, I develop an ethics of care framework that prioritizes relationships, acknowledges our shared dependencies, and fosters skills for quality care and advocacy. By viewing depression as an affective reaction to social dysfunction, my analysis also challenges conventional interpretations regarding mental health and illness. This project critiques the theoretical and empirical efficacy of modern mental health solutions, details the various challenges and harms experienced by both depressed persons and particular caregivers, and outlines an alternative ethical approach to be used for evaluation and subsequent care.

America's obesity ̒epidemic̕, coupled with increasing use of biomedical technologies in healthcare, has helped usher in new technoscientific methods to medically manage the bodies of overweight and obese individuals. Potential patients now have several surgical options to choose from in efforts to lose weight and (potentially) improve health outcomes, including gastric bypass, sleeve gastrectomy, and gastric banding; this research focuses on the gastric band, an implantable and adjustable silicone device designed to restrict the amount of food consumed. This study involves: in-depth interviews with predominantly female gastric banding patients, medical practitioners, bariatric surgeons, and representatives from the two U.S.-based biomedical firms that manufacture the gastric band; a multi-site ethnography examining the patient experience and the clinical encounter; and content analysis of scientific and non-scientific texts. Through this mixed methodological approach, this study charts the band's evolution and the complex forces guiding its design, development and adoption, and draws attention to the ways in which gendered assumptions enter into the pre- and post-surgical space with repercussions for patient care. Findings suggest that patients̕ decision-making process is shaped by - and shapes - multiple social, political, economic, and regulatory contexts. As a contested and unstable technology, the band's efficacy and ̒foreignness̕ is continually both challenged and reaffirmed by a diverse arena of social actors with a vested interest in the bariatric surgical space. These actors construct the band's role in the obesity epidemic in oppositional ways, affecting its use and perceived misuse: the depiction of the band as a safe, less invasive and - most significantly - removable technology helps drive its use, directing some patients away from other options - specifically, the anatomically changing gastric bypass procedure - portrayed as unnatural and extreme, though simultaneously more effective. While the band's reversibility represents freedom over technology and control over their bodies, it also reflects patients̕ struggle for both autonomy and desire for technological assistance in managing their weight. However, despite patients̕ attempt to assert themselves as active agents, the gastric band emerges as a disciplinary weight loss technology which serves to reinforce the perceived need for clinical intervention in the care and treatment of obesity. This study contributes to our understanding of the possibilities and limitations offered by biomedical technologies, and the ways in which humans resist, comply or are ambivalent toward their adoption and use.

Esta dissertação explora o tema da medicalização. A pesquisa toma como objeto a promoção do fármaco Cloridrato de Metilfenidato, conhecido pelo nome comercial: Ritalina®. Trata-se de uma droga psicoestimulante atualmente estabelecida como tratamento de primeira linha para o TDA/H (Transtorno de Déficit de Atenção/Hiperatividade). A literatura especializada afirma que o TDA/H é uma doença de alta prevalência em crianças em idade escolar, sendo o “distúrbio neurocomportamental” mais comum na infância. Dados epidemiológicos sobre a expansão da prevalência do TDA/H e sobre aumento do consumo da Ritalina® somados às complexas relações entre diversos atores (indústria farmacêutica, pesquisadores e publicitários) sugerem que, além da apropriação dos modos de vida das pessoas pela medicina, está sendo estabelecido um vasto mercado corporativo. Este trabalho acompanha a trajetória da Ritalina® a partir da análise de material promocional destinado a profissionais da área médica. As propagandas examinadas foram encontradas através do buscador google e do Portal de Periódicos da Capes (periodicos.capes.gov.br) e compreendem o período de 1956 - quando Ritalina® foi lançada nos EUA – até 1979. Selecionei 32 informes publicitários para serem analisados, baseando-me em critérios como qualidade das imagens, confiabilidade e origem das fontes. Os anúncios mostram que este psicofármaco foi inicialmente indicado para problemas distintos como depressão, fadiga, letargia e narcolepsia. Ao fim da década de 1960 a Ritalina® passa a ser reconhecida como tratamento eficaz para “crianças hiperativas”. Argumento que ao considerarmos propagandas produzidas por laboratórios farmacêuticos como documentos legítimos é possível contribuir para resgatar aspectos históricos de determinada droga que de outro modo poderiam passar desapercebidos, uma vez que este tipo de material caracteriza-se como um elemento imprescindível no arsenal persuasivo dessas empresas. / This dissertation examines the promotion and advertisement for Ritalin (a trade name for methylphenidate). Ritalin® is a psychostimulant medication used for the treatment of attention deficit hyperactivity disorder (ADHD). ADHD is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include hyperactivity, difficulty staying focused, paying attention and difficulty controlling behavior. The worldwide prevalence estimates of attention deficit hyperactivity disorder (ADHD) are highly variable. The current study aims to examine how Ritalin®, originally promoted by Ciba as a mild antidepressant, became the drug of first choice to treat ADHD (known at the time as hyperactivity or minimal brain dysfunction). This dissertation examines the development of methylphenidate treatment and the expansion of the diagnostic category of ADHD through the analysis of pharmaceutical advertisements for Ritalin® in US and Canadian medical journals published between 1956 and 1970’s. Most of the journals were retrieved from Portal de Periódicos da Capes and MEDLINE searches. I selected a sample of 32 advertisements to analyze, based mainly on image quality. These pharmaceutical advertisements show that this psychotropic initially market for mild depression and mood disorders, fatigue, lethargy and narcolepsy. By the end of the 60’s, Ritalin is being shown – and renowned – as an effective treatment for “hyperactive children”. I suggest that when we consider pharmaceutical advertisement material as a legitimate documental source, it is possible contributing to retrieve historical aspects of a specific drug, which might otherwise go unnoticed, since this type of material is characterized as an essential component in the persuasive arsenal of those companies.

Esta dissertação explora o tema da medicalização. A pesquisa toma como objeto a promoção do fármaco Cloridrato de Metilfenidato, conhecido pelo nome comercial: Ritalina®. Trata-se de uma droga psicoestimulante atualmente estabelecida como tratamento de primeira linha para o TDA/H (Transtorno de Déficit de Atenção/Hiperatividade). A literatura especializada afirma que o TDA/H é uma doença de alta prevalência em crianças em idade escolar, sendo o “distúrbio neurocomportamental” mais comum na infância. Dados epidemiológicos sobre a expansão da prevalência do TDA/H e sobre aumento do consumo da Ritalina® somados às complexas relações entre diversos atores (indústria farmacêutica, pesquisadores e publicitários) sugerem que, além da apropriação dos modos de vida das pessoas pela medicina, está sendo estabelecido um vasto mercado corporativo. Este trabalho acompanha a trajetória da Ritalina® a partir da análise de material promocional destinado a profissionais da área médica. As propagandas examinadas foram encontradas através do buscador google e do Portal de Periódicos da Capes (periodicos.capes.gov.br) e compreendem o período de 1956 - quando Ritalina® foi lançada nos EUA – até 1979. Selecionei 32 informes publicitários para serem analisados, baseando-me em critérios como qualidade das imagens, confiabilidade e origem das fontes. Os anúncios mostram que este psicofármaco foi inicialmente indicado para problemas distintos como depressão, fadiga, letargia e narcolepsia. Ao fim da década de 1960 a Ritalina® passa a ser reconhecida como tratamento eficaz para “crianças hiperativas”. Argumento que ao considerarmos propagandas produzidas por laboratórios farmacêuticos como documentos legítimos é possível contribuir para resgatar aspectos históricos de determinada droga que de outro modo poderiam passar desapercebidos, uma vez que este tipo de material caracteriza-se como um elemento imprescindível no arsenal persuasivo dessas empresas. / This dissertation examines the promotion and advertisement for Ritalin (a trade name for methylphenidate). Ritalin® is a psychostimulant medication used for the treatment of attention deficit hyperactivity disorder (ADHD). ADHD is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include hyperactivity, difficulty staying focused, paying attention and difficulty controlling behavior. The worldwide prevalence estimates of attention deficit hyperactivity disorder (ADHD) are highly variable. The current study aims to examine how Ritalin®, originally promoted by Ciba as a mild antidepressant, became the drug of first choice to treat ADHD (known at the time as hyperactivity or minimal brain dysfunction). This dissertation examines the development of methylphenidate treatment and the expansion of the diagnostic category of ADHD through the analysis of pharmaceutical advertisements for Ritalin® in US and Canadian medical journals published between 1956 and 1970’s. Most of the journals were retrieved from Portal de Periódicos da Capes and MEDLINE searches. I selected a sample of 32 advertisements to analyze, based mainly on image quality. These pharmaceutical advertisements show that this psychotropic initially market for mild depression and mood disorders, fatigue, lethargy and narcolepsy. By the end of the 60’s, Ritalin is being shown – and renowned – as an effective treatment for “hyperactive children”. I suggest that when we consider pharmaceutical advertisement material as a legitimate documental source, it is possible contributing to retrieve historical aspects of a specific drug, which might otherwise go unnoticed, since this type of material is characterized as an essential component in the persuasive arsenal of those companies.

Esta dissertação explora o tema da medicalização. A pesquisa toma como objeto a promoção do fármaco Cloridrato de Metilfenidato, conhecido pelo nome comercial: Ritalina®. Trata-se de uma droga psicoestimulante atualmente estabelecida como tratamento de primeira linha para o TDA/H (Transtorno de Déficit de Atenção/Hiperatividade). A literatura especializada afirma que o TDA/H é uma doença de alta prevalência em crianças em idade escolar, sendo o “distúrbio neurocomportamental” mais comum na infância. Dados epidemiológicos sobre a expansão da prevalência do TDA/H e sobre aumento do consumo da Ritalina® somados às complexas relações entre diversos atores (indústria farmacêutica, pesquisadores e publicitários) sugerem que, além da apropriação dos modos de vida das pessoas pela medicina, está sendo estabelecido um vasto mercado corporativo. Este trabalho acompanha a trajetória da Ritalina® a partir da análise de material promocional destinado a profissionais da área médica. As propagandas examinadas foram encontradas através do buscador google e do Portal de Periódicos da Capes (periodicos.capes.gov.br) e compreendem o período de 1956 - quando Ritalina® foi lançada nos EUA – até 1979. Selecionei 32 informes publicitários para serem analisados, baseando-me em critérios como qualidade das imagens, confiabilidade e origem das fontes. Os anúncios mostram que este psicofármaco foi inicialmente indicado para problemas distintos como depressão, fadiga, letargia e narcolepsia. Ao fim da década de 1960 a Ritalina® passa a ser reconhecida como tratamento eficaz para “crianças hiperativas”. Argumento que ao considerarmos propagandas produzidas por laboratórios farmacêuticos como documentos legítimos é possível contribuir para resgatar aspectos históricos de determinada droga que de outro modo poderiam passar desapercebidos, uma vez que este tipo de material caracteriza-se como um elemento imprescindível no arsenal persuasivo dessas empresas. / This dissertation examines the promotion and advertisement for Ritalin (a trade name for methylphenidate). Ritalin® is a psychostimulant medication used for the treatment of attention deficit hyperactivity disorder (ADHD). ADHD is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include hyperactivity, difficulty staying focused, paying attention and difficulty controlling behavior. The worldwide prevalence estimates of attention deficit hyperactivity disorder (ADHD) are highly variable. The current study aims to examine how Ritalin®, originally promoted by Ciba as a mild antidepressant, became the drug of first choice to treat ADHD (known at the time as hyperactivity or minimal brain dysfunction). This dissertation examines the development of methylphenidate treatment and the expansion of the diagnostic category of ADHD through the analysis of pharmaceutical advertisements for Ritalin® in US and Canadian medical journals published between 1956 and 1970’s. Most of the journals were retrieved from Portal de Periódicos da Capes and MEDLINE searches. I selected a sample of 32 advertisements to analyze, based mainly on image quality. These pharmaceutical advertisements show that this psychotropic initially market for mild depression and mood disorders, fatigue, lethargy and narcolepsy. By the end of the 60’s, Ritalin is being shown – and renowned – as an effective treatment for “hyperactive children”. I suggest that when we consider pharmaceutical advertisement material as a legitimate documental source, it is possible contributing to retrieve historical aspects of a specific drug, which might otherwise go unnoticed, since this type of material is characterized as an essential component in the persuasive arsenal of those companies.

A presente pesquisa tem como objetivo “seguir” a da substância testosterona e as maneiras pelas quais ela é performada como/em diversas realidades. A partir da perspectiva da Teoria Ator-Rede de Bruno Latour, toma-se o hormônio testosterona como um ator não-humano, o qual integra uma rede que articula diferentes campos como médico/jurídico/mercadológico. Para tanto, foram realizadas entrevistas etnográficas com um médico endocrinologista, dois personal trainer e participantes de academia, dois homens trans que fazem acompanhamento com um profissional da medicina, bem como foram analisados sites, fóruns, vídeos, bulas de medicamentos e artigos científicos. No decorrer da investigação, identificamos duas principais redes nas quais a testosterona é materializada, que estão em constante disputa/coordenação, as quais nomeei de “ciclos”, em referência aos ciclos de testosterona demonstrados por alguns interlocutores deste trabalho. Tais redes são: 1) Ciclo Fármaco-Biomédico, no qual destaca-se o acesso à substância mediado pelo discurso médico e; 2) Ciclo Fármaco-Bombado, no qual a testosterona circula através de outras formas de acesso, que burlam a mediação médico-paciente e/ou prescrição médica, como aquelas que ocorrem em academias de ginástica e nas vendas/trocas de hormônios realizadas por grupos de atletas e/ou grupos de homens trans. O principal objetivo do trabalho foi demonstrar as diversas maneiras pelas quais a testosterona é performada nessas múltiplas realidades, à luz da teoria praxiográfica neo-materialista de Anemarrie Mol, a partir das descrições da rede, e seus respectivos atores e articulações. Dessa forma, demonstra-se a dissolução do binarismo natureza-cultura pensando na utilização da testosterona para a materialização de corpos de sujeitos inscritos nas masculinidades. E mais que isso, expõe que a testosterona, ao multiplicar-se em práticas que envolvem tanto homens cis quanto trans, a partir do acesso dificultado por todos esses sujeitos à substância, dissolve as fronteiras imaginadas entre tais corpos, na medida em que todo o controle acerca da testosterona pelo domínio biomédico, impulsionado pela necessidade de imitar a fisiologia, demonstra um caráter moral que está diretamente ligado à utilização dessa substância. / The present research aims to "follow" the testosterone substance and the ways in which it is performed as / in various realities. From the perspective of Bruno Latour's Theory-Actor Network, the testosterone hormone is taken as a non-human actor, which integrates a network that articulates different fields such as medical / legal / marketing. To that end, ethnographic interviews were conducted with an endocrinologist, two personal trainer and participants of the academy, two trans men who follow up with a medical professional, as well as the analysis of websites, forums, videos, medication packages and scientific articles. During the investigation, we identified two main networks in which testosterone is materialized, which are in constant dispute / coordination, which I named "cycles", in reference to the testosterone cycles demonstrated by some interlocutors of this work. These networks are: 1) Drug-Biomedical Cycle, in which the access to the substance mediated by the medical discourse is highlighted; 2) Drug-Bombed Cycle, in which testosterone circulates through other forms of access, which circumvent medical-patient mediation and / or medical prescription, such as those occurring in gyms and hormone sales / exchanges performed by groups of athletes and / or groups of trans men. The main objective of the work was to demonstrate the different ways in which testosterone is performed in these multiple realities, in the light of Anemarrie Mol's neo-materialistic praxiographic theory, from the descriptions of the network and their respective actors and articulations. Thus, it is demonstrated the dissolution of the nature-culture binarism thinking about the use of testosterone for the materialization of bodies of subjects enrolled in masculinities. And more than that, it exposes that testosterone, by multiplying itself in practices involving both cis and trans men, from the access made difficult by all these subjects to the substance, dissolves the imagined boundaries between such bodies, to the extent that all control over testosterone by the biomedical domain, driven by the need to imitate physiology, demonstrates a moral character that is directly linked to the use of this substance.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Essa dissertação tem por objetivo apresentar, de forma panorâmica, uma revisão histórica sobre o conceito de medicalização, analisando como o entendimento sobre este processo se transformou nas últimas décadas, passando de críticas mais ortodoxas, que julgavam ser este processo fruto de um imperialismo médico sobre a sociedade, às críticas contemporâneas, orientadas por uma compreensão mais nuançada a respeito do tema. Dentre as principais mudanças na leitura da medicalização, está o entendimento desta enquanto um processo interativo e coletivo, composto por inúmeros participantes-chave com interesses e papéis distintos na atualidade. Enquanto os primeiros teóricos da década 70 realçam a crítica ao controle social e malefícios da medicina, numa abordagem mais recente os indivíduos deixam de ser vistos como vítimas para protagonizarem o cenário de negociação pública acerca das fronteiras que legislam sobre os processos de saúde e doença. A noção de medicalização caminhou no sentido de uma complexidade maior, trazendo desafios que não são tão facilmente resolvíveis na conjuntura contemporânea. Ao final, destacamos como um dos desdobramentos centrais desta dissertação a pertinência atual de uma revisão mais apurada sobre o assunto, principalmente no que concerne ao tema do estreitamento da normalidade, onde o conceito de medicalização pode funcionar como uma ferramenta conceitual útil de análise. Aludimos ao exemplo da psiquiatria como um analisador nessa discussão, considerando o papel social historicamente desempenhado por esta na delimitação de fronteiras que, no fundo, ainda versam sobre antigos dilemas sobre normalidade e anormalidade. Para tanto, este estudo traz uma revisão histórica sobre o conceito de medicalização através das contribuições mais relevantes da literatura internacional. / This study aims to present a historical review of the medicalization concept, analyzing how the understanding about of this process has changed in the past decades, moving from a orthodox point of view that considered this to be the result of a medical imperialism process on the society, until a modern-day critics, guided by a more nuanced understanding of the theme. Among the major changes in the reading of the medicalization, is the perception of it as an interactive and collective process, composed of numerous key players, each one with different interests and roles nowadays. While early authors of the 70 emphasized the social control and the damage caused by medicine, in a more recent approach individuals are no longer seen as victims, but as important advocates for medicalization. The individuals have begun to play a more significant role in this process, becoming key actors of a public debate about the ever-shifting boundary that legislate on the processes of health and disease. The notion of medicalization advanced towards a complex approach, bringing challenges that are quite different nowadays. Finally, we highlight a central development of this research presenting a more thorough review on the subject, especially regarding the issue of narrowing the normal, where the concept of medicalization can function as a useful conceptual tool of analysis. The example of psychiatry is mentioned as an analyzer question in this discussion, considering the social role historically played by this in the delimitation of boundaries that still deal with old problems about normality and abnormality. Therefore, this study provides a historical review of the concept of medicalization through the most relevant contributions of the international literature.

This thesis explores the increasing medicalization of society, the process whereby social phenomenon are transformed into medical problems. Alike the general tendency of neuropsychiatric diagnoses, the number of people with ADHD (Attention Deficit Hyperactivity Disorder) has increased and expanded from a boys’ diagnosis to include both adult men and women. Studies on the latter category is however scarce. The objective of the thesis is to contribute with a micro sociological and critical perspective on the effects of the biomedicalization process, by focusing women's experience of getting and living with ADHD. The empirical material consists of narrative interviews with sixteen women, diagnosed with ADHD in adulthood. The participants, age 20 to 50, were enrolled via Swedish NGOs in 2010 and 2013. The thesis resides on four analytical themes: biomedicalization, pharmaceuticalizaton, functionality and gender. It shows how diagnostics evokes processes that involve learning and using a biomedical terminology to describe and understand oneself. ADHD is, in general, depicted as diffuse, expansionary, masculine and deviant sociability and cognitivity. Unlike depression and anxiety, described as temporary and unwanted illnesses, the ADHD-diagnosis embraces the whole personality. Hence, the women find it difficult to identifying and separating ADHD from the self. Furthermore, categorizations of oneself as a ‘woman with ADHD’ imply constructions of individual and collective identity that has ideological implications, i.e. the individual narratives are related to grand narratives. These contradictory grand narratives bring about ideological dilemmas that are handled rhetorically in the women's everyday life. The masculine connotation of ADHD, for example, render the women experiencing themselves as transgressing not only femininity but also ADHD-personhood. Additionally, as social actions are attributed to the ‘ADHD brain’, the brain is portrayed as a pathological deviant and dysfunctional object for pharmaceutical intervention. Nevertheless, this discourse is also contested by the women by pointing to 1) positive aspects of the ‘ADHD-brain’ in everyday life, or 2) gender inequalities and demands of the late-modern society. Concluding, the women in this study are not only victims of their bodies or societal norms, but also agents negotiating – adapting and opposing to – expectations of how to be an ideal citizen or woman.

A presente pesquisa tem como objetivo “seguir” a da substância testosterona e as maneiras pelas quais ela é performada como/em diversas realidades. A partir da perspectiva da Teoria Ator-Rede de Bruno Latour, toma-se o hormônio testosterona como um ator não-humano, o qual integra uma rede que articula diferentes campos como médico/jurídico/mercadológico. Para tanto, foram realizadas entrevistas etnográficas com um médico endocrinologista, dois personal trainer e participantes de academia, dois homens trans que fazem acompanhamento com um profissional da medicina, bem como foram analisados sites, fóruns, vídeos, bulas de medicamentos e artigos científicos. No decorrer da investigação, identificamos duas principais redes nas quais a testosterona é materializada, que estão em constante disputa/coordenação, as quais nomeei de “ciclos”, em referência aos ciclos de testosterona demonstrados por alguns interlocutores deste trabalho. Tais redes são: 1) Ciclo Fármaco-Biomédico, no qual destaca-se o acesso à substância mediado pelo discurso médico e; 2) Ciclo Fármaco-Bombado, no qual a testosterona circula através de outras formas de acesso, que burlam a mediação médico-paciente e/ou prescrição médica, como aquelas que ocorrem em academias de ginástica e nas vendas/trocas de hormônios realizadas por grupos de atletas e/ou grupos de homens trans. O principal objetivo do trabalho foi demonstrar as diversas maneiras pelas quais a testosterona é performada nessas múltiplas realidades, à luz da teoria praxiográfica neo-materialista de Anemarrie Mol, a partir das descrições da rede, e seus respectivos atores e articulações. Dessa forma, demonstra-se a dissolução do binarismo natureza-cultura pensando na utilização da testosterona para a materialização de corpos de sujeitos inscritos nas masculinidades. E mais que isso, expõe que a testosterona, ao multiplicar-se em práticas que envolvem tanto homens cis quanto trans, a partir do acesso dificultado por todos esses sujeitos à substância, dissolve as fronteiras imaginadas entre tais corpos, na medida em que todo o controle acerca da testosterona pelo domínio biomédico, impulsionado pela necessidade de imitar a fisiologia, demonstra um caráter moral que está diretamente ligado à utilização dessa substância. / The present research aims to "follow" the testosterone substance and the ways in which it is performed as / in various realities. From the perspective of Bruno Latour's Theory-Actor Network, the testosterone hormone is taken as a non-human actor, which integrates a network that articulates different fields such as medical / legal / marketing. To that end, ethnographic interviews were conducted with an endocrinologist, two personal trainer and participants of the academy, two trans men who follow up with a medical professional, as well as the analysis of websites, forums, videos, medication packages and scientific articles. During the investigation, we identified two main networks in which testosterone is materialized, which are in constant dispute / coordination, which I named "cycles", in reference to the testosterone cycles demonstrated by some interlocutors of this work. These networks are: 1) Drug-Biomedical Cycle, in which the access to the substance mediated by the medical discourse is highlighted; 2) Drug-Bombed Cycle, in which testosterone circulates through other forms of access, which circumvent medical-patient mediation and / or medical prescription, such as those occurring in gyms and hormone sales / exchanges performed by groups of athletes and / or groups of trans men. The main objective of the work was to demonstrate the different ways in which testosterone is performed in these multiple realities, in the light of Anemarrie Mol's neo-materialistic praxiographic theory, from the descriptions of the network and their respective actors and articulations. Thus, it is demonstrated the dissolution of the nature-culture binarism thinking about the use of testosterone for the materialization of bodies of subjects enrolled in masculinities. And more than that, it exposes that testosterone, by multiplying itself in practices involving both cis and trans men, from the access made difficult by all these subjects to the substance, dissolves the imagined boundaries between such bodies, to the extent that all control over testosterone by the biomedical domain, driven by the need to imitate physiology, demonstrates a moral character that is directly linked to the use of this substance.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Essa dissertação tem por objetivo apresentar, de forma panorâmica, uma revisão histórica sobre o conceito de medicalização, analisando como o entendimento sobre este processo se transformou nas últimas décadas, passando de críticas mais ortodoxas, que julgavam ser este processo fruto de um imperialismo médico sobre a sociedade, às críticas contemporâneas, orientadas por uma compreensão mais nuançada a respeito do tema. Dentre as principais mudanças na leitura da medicalização, está o entendimento desta enquanto um processo interativo e coletivo, composto por inúmeros participantes-chave com interesses e papéis distintos na atualidade. Enquanto os primeiros teóricos da década 70 realçam a crítica ao controle social e malefícios da medicina, numa abordagem mais recente os indivíduos deixam de ser vistos como vítimas para protagonizarem o cenário de negociação pública acerca das fronteiras que legislam sobre os processos de saúde e doença. A noção de medicalização caminhou no sentido de uma complexidade maior, trazendo desafios que não são tão facilmente resolvíveis na conjuntura contemporânea. Ao final, destacamos como um dos desdobramentos centrais desta dissertação a pertinência atual de uma revisão mais apurada sobre o assunto, principalmente no que concerne ao tema do estreitamento da normalidade, onde o conceito de medicalização pode funcionar como uma ferramenta conceitual útil de análise. Aludimos ao exemplo da psiquiatria como um analisador nessa discussão, considerando o papel social historicamente desempenhado por esta na delimitação de fronteiras que, no fundo, ainda versam sobre antigos dilemas sobre normalidade e anormalidade. Para tanto, este estudo traz uma revisão histórica sobre o conceito de medicalização através das contribuições mais relevantes da literatura internacional. / This study aims to present a historical review of the medicalization concept, analyzing how the understanding about of this process has changed in the past decades, moving from a orthodox point of view that considered this to be the result of a medical imperialism process on the society, until a modern-day critics, guided by a more nuanced understanding of the theme. Among the major changes in the reading of the medicalization, is the perception of it as an interactive and collective process, composed of numerous key players, each one with different interests and roles nowadays. While early authors of the 70 emphasized the social control and the damage caused by medicine, in a more recent approach individuals are no longer seen as victims, but as important advocates for medicalization. The individuals have begun to play a more significant role in this process, becoming key actors of a public debate about the ever-shifting boundary that legislate on the processes of health and disease. The notion of medicalization advanced towards a complex approach, bringing challenges that are quite different nowadays. Finally, we highlight a central development of this research presenting a more thorough review on the subject, especially regarding the issue of narrowing the normal, where the concept of medicalization can function as a useful conceptual tool of analysis. The example of psychiatry is mentioned as an analyzer question in this discussion, considering the social role historically played by this in the delimitation of boundaries that still deal with old problems about normality and abnormality. Therefore, this study provides a historical review of the concept of medicalization through the most relevant contributions of the international literature.