Mad in Brasil: Part of a Global Effort to Create a New Paradigm of Care

It is with great satisfaction and great hope that we are launching our Mad in Brasil website. We want to thank the Mad in America Foundation for their invaluable support that has made this possible.

With madinbrasil.org, we are joining the growing Mad in America global community. Madinamerica-Hispanohablante will serve Spanish speakers around the world, and now Mad in Brasil will be a home for Portuguese speakers around the world. The creation of these sites will make it possible for this global community to exchange scientific knowledge, experiences, and information about new projects.

We understand that other “Mad” sites are in the process of being created, such as a Mad in Japan. This launch of new sites tells of a shared goal, across many cultures, for creating a new paradigm of care in psychiatry, one that will replace the medical-biological paradigm that is dominant today. All share the goal of creating the social, political, and cultural conditions that will better promote the mental health of our citizens.

The headquarters of Mad in Brasil is located in a department within Brasil’s National School of Public Health (ESNP), which in turn is part of the Oswaldo Cruz Foundation (FIOCRUZ). FIOCRUZ is the most important federal education and research institution in Brasil dedicated to improving public health. Our department is called the Department of Human Rights, Health and Diversity, and our social mission is to articulate and protect the human rights of all people, promote the health of all people, and confront the challenges of doing so in a diverse society.

In the United States, Mad in America may be seen as confronting the current paradigm of care from the outside. Mad in Brasil may be seen as an effort to confront and change the current paradigm of care from within.

In Brasil, we have a history of psychiatric reform. We have accomplished a number of things in the past decades. One of our most significant achievements was to pass Law 10 2016/2001, which mandated the progressive closure of psychiatric hospitals, and the creation of replacement services. The new services include Psychosocial Care Centers (CAPs), therapeutic residences, harm reduction programs, and income-generation workshops.

There are now more than 2000 CAPs in Brasil. These centers provide daily support and clinical care for people with mental disorders, and promote their social reintegration through work, recreation, the exercise of civil rights, and the strengthening of family and community ties. CAPS also serve people in their time of crisis. The multidisciplinary staff includes psychologists, social workers, psychiatrists, and others, and their support reaches into the community, as they seek to help the individual in everyday life.

In Brasil, we have a strong social movement organized to protect the rights of users of psychiatric care services. The Anti-Asylum Movement and the National Anti-Asylum Network are known for their democratic character. The active members include users of mental health services, their families, professionals, students, and anyone who is dedicated to defending the rights of people struggling with mental disorders. The organizations promote respect for all people struggling with mental disorders, and seek to transform the cultural relationship between society and those with such difficulties. Both are organizations that bring people together from all of the states of Brasil, and without any hierarchy of control.

Every two years, the organizations host national meetings that lead to plans for political action. One such past effort was the Return Home Program. It was established by President Lula, when he signed Federal Law 10708 on July 31, 2003. The law provides for psychosocial help to those who have been long-term patients in psychiatric hospitals, and are now returning to society. The goal is to help them reintegrate into society, obtain ongoing care, and rebuild a social life, and encourage them to exercise their full rights as citizens. The program is now helping more than 2,600 people, who also receive a small monthly financial benefit.

We now have had several decades of experience employing psychosocial approaches to help people in psychiatric distress, which range from traditional psychotherapeutic practices, such as psychoanalysis and cognitive behavioral therapy, to non-traditional practices such as yoga, acupuncture, and massage. We also are developing artistic and cultural efforts, as can be seen in the video posted on the front page of our website.

The “Crazy Program for Music” brought together—on the same stage in some of our best theaters for musical shows in the country—professional artists of Brasilian popular music and musical groups composed of “users” of mental health services and mental health professionals. These initiatives and experiences have led to important advances in Brasilian society in terms of the socio-cultural integration of people with psychiatric diagnoses, and the social construction of new subjective alternatives to describing people as “mentally ill.”

Despite the many and significant achievements we have made in terms of moving beyond the asylum model that characterized psychiatric care in Brasil since the mid-nineteenth century, we recognize the enormous challenges that still remain. Our reading of books by Robert Whitaker—Mad in America, Anatomy of an Epidemic, and Psychiatry Under the Influence—and then his lectures given in Brasil as part of events organized by our Brasilian Association of Mental Health (ABRASME), together with our systematic monitoring of posts on Madinamerica.com, led us to realize that we still face many challenges today in our everyday care, and to realize too that we lacked a good understanding of the complex reasons that this is so.

A significant portion of the difficulties in psychiatry we face in Brasil are of a similar kind faced by most societies today, and that is our growing dependence on a medical-biological model. While we have been critical of that model, our psychiatric reform efforts were not able to break free of the “disease” status inherent in the DSM model of diagnosis. Although many of our innovative initiatives are rooted in a psychosocial approach, our reform efforts did not release users of psychiatric services from their addictions to psychopharmacological treatment.

Thanks to the Mad in America community, it is possible for a wide audience—made up of health professionals and researchers to be sure, but also users, families, and the general public—to have access to scientific findings, philosophical writings, and personal narratives that provide a solid basis for a new paradigm of care, one that will replace the medical model with a psychosocial model. The Mad in America community makes the adoption of a new paradigm of care scientifically acceptable and socially desirable to society.

Although we have a strong movement related to the struggles of users (“usarios” in Portuguese) and their families, we do not have a strong movement of “psychiatric survivors.” That voice is absent in our society, and of course that is a strong voice for creating a new paradigm of care. In fact, our societal beliefs are still shaped by the myths created by psychiatry as an institution about the biological determinism of mental disorders. As a society, we still believe in the “chemical imbalance” story and how antipsychotics, antidepressants, anxiolytics, and other psychiatric medications “fix” those disorders.

While it is true that Brasil has succeeded in reintegrating people with mental disorders into society, it is also true that we have been forming a huge population of “chronic” patients who are dependent on psychiatric drugs. And while it is true that we believe we have much to teach the world about how it is possible to “re-socialize” those who spent years or even decades inside the walls of an asylum, it is also true we have much to learn from experiences of others on how to help those who today are dependent on those drugs withdraw successfully from the medications, and become free from that “psychiatric life.”

Madinbrasil.org consists of several sections. Specifically:

• The News section will feature findings from national and international scientific journals, and thus help more and more people in our society become aware of what the scientific evidence really shows about the nature of psychiatric disorders and the effects of psychiatric drugs.
• The Blogs section will feature posts by national and international writers, from professionals in the field, family members, and—most important—those with personal experiences. These blogs will open up a larger debate that will take place in the “comments” section.
• Around the Web will feature reports from the media and writings about psychiatry on other websites. We will focus on both national and international reports.
• The Drug Information section will help readers be better informed and kept up to date about scientific findings related to psychiatric drugs.
• The Videos section will feature documentaries and important films that can be accessed online.
• In the Events section, we will keep readers informed about Congresses, Meetings, and Seminars in Brasil, and also international events as well.
• Readers can also sign up for a weekly Newsletter, which will feature a review of the most important postings for the week.
• Finally, we will create a “Contributions” section, so that we can sustain this website with the support for our readers.

Ours will be a collaborative effort. We look forward to being part of a global effort that will succeed in creating a new paradigm of care, one that will promote true robust recovery from psychiatric crises.