Editor’s note: This is an English translation of a memorial tribute to Fernando Freitas by psychiatrist Paulo Amarante that was published in one of Brazil’s most important health journals, OUTRASAÚDE.
Last week we lost a great activist in the fight against the pathologization and medicalization of life. Fernando Freitas was a psychologist, PhD in Social Psychology, former professor at UERJ and, at the end of his professional career, a researcher at Fiocruz. He couldn’t defeat the cancer that had been making him suffer for five months.
Although he is gone, Fernando left a work that will not only continue, but that will grow much more, because of the relevance of the issue to which he dedicated the last years of his life and because of his impactful work.
Traditionally focused on the study of social and human sciences in the field of psychology and mental health, especially in their relationship with the arts and culture, Fernando was markedly motivated by a book by Marcia Angell: The Truth About Pharmaceutical Companies: How They Deceive Us and What We Can Do About It. It is a convincing work, very well supported by documents, about the lies, tricks, falsehoods, and unethical attitudes carried out by Big Pharma, the pharmaceutical industry. Angell, a former Harvard professor and editor of one of the most influential scientific journals in medicine and health around the world, the New England Journal of Medicine, revealed as never before what goes on behind the scenes in the pharmaceutical industry and, more than that, the fraud and manipulation in scientific production and dissemination.
And from Marcia Angell, particularly from an article published in Brazil in Revista Piauí about depression and antidepressants, Fernando Freitas discovered the work of Robert Whitaker, award-winning scientific journalist, author of Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness and, more recently, co-author of Psychiatry under the Influence: Institutional corruption, Social Injury, and Prescriptions for Reform.
After that, nothing else would be as important to Fernando. The theme of medicalization became central to his academic activity. In this sense, it is necessary to emphasize that the term “medicalization” should not be reduced to the irrational or abusive use of medicines. Medicalization is used to refer to the process of capturing the dimensions of life by medical rationality, that is, the transformation of the nature of things, which are reduced, exclusively or predominantly, to medical phenomena. More recently, to avoid this reductionism, the term pathologization has been used, with the purpose of clarifying the meaning of this process, which, roughly speaking, means turning diverse and multiple experience in life into a symptom or abnormality.
An emblematic example can be found in the transformation of the meaning of the experience of sadness into depression, an expression that now contains a sense of illness! Depression is no longer talked about without associating it with “illness, disorder,” etc. As if it were no longer possible to suffer, to be depressed.
Especially after DSM-5, the manual of mental disorders of the American Psychiatric Association, the bible of scientific colonization in this field, everything in life is turned into a disease. There are 500 different diagnoses. Practically all forms of expression of life can be categorized as diagnoses, despite the absolute lack of scientific foundation. No genetic or anatomical evidence, no markers (such as tumor markers), no biochemical changes (such as blood glucose, liver function tests.) The widely used hypothesis of a biochemical alteration in serotonin reuptake mechanisms, the apple of the eye of medicalization defenders, was completely buried at the end of last year based on robust research by a team coordinated by UK professor Joanna Moncrieff.
One of the myths created by psychiatry and financed by the pharmaceutical industry is that the increase in the list of diagnoses is due to the scientific improvement of psychiatric knowledge, which would be able to identify more and more diseases. On the contrary, and this is one of the myths demolished by Whitaker, it is exactly the opposite: the less scientific knowledge, the less objectivity, the more the possibility of expanding and medicalizing, of absorbing human diversity into subjective diagnoses.
In the novella The Alienist, by the great Brazilian author Machado de Assis, the character Simão Bacamarte opens the first asylum in his provincial town of Itaguaí, and soon, eager to find the causes of and discover the treatments for mental illness, declares to Mr. Soares that he has found the boundary between the sane and the insane:
“Think of humanity as a great oyster shell. Our first task, Soares, is to extract the pearl—that is, reason. In other words, we must determine the nature and boundaries of reason. Madness is simply all that lies beyond those limits. But what is reason if not the equilibrium of the mental faculties? An individual, therefore, who lacks this equilibrium in any particular is, to that extent, insane.”
And with this demarcation, Bacamarte soon declares more and more of his neighbors “mad” and confines them in his asylum.*
It was based on these concerns that the Associação Brasileira de Saúde Mental (Abrasme), with Fernando Freitas, made the issue a priority and included it in their proposals for public mental health policies. This effort was made possible by the presence, for the first time in 2014, of the journalist Robert Whitaker. From then on, Whitaker would regularly take part in the events promoted by the association.
In 2017, we decided to translate and publish Anatomia de uma Epidemia, which we signed and co-authored and the preface. But, given the greater depth of Whitaker’s work, especially the website Mad in America, Fernando decided, and convinced us, to create Mad in Brasil, to participate in the “Mad community.” Partners began to appear in France, Italy, Spain, Mexico, Canada, Sweden, Finland, The Netherlands, England, and Asia. At the moment, Mad in Portugal is being created, in cooperation between researchers from LAPS (Ensp/Fiocruz) and the Center for Social Studies at the University of Coimbra, of which Fernando is one of the founders. We are honored to inform you that Mad in Brasil has the second largest number of readers in the entire MAD community, second only to Mad in America. And, of course, this is due to the dedication of Fernando’s permanent, almost obstinate, commitment to keeping it alive and updated.
The title of Whitaker’s book would also serve as inspiration for the organization of the International Seminars’ “The Epidemic of Psychiatric Drugs,” which, last year, held its sixth conference. In addition to Whitaker, this event was responsible for introducing to the Brazilian public researchers such as Jaakko Seikkula of the very original and revolutionary Finnish experience of “Open Dialogue”, in which psychotic crises are addressed without the aid (or with very timid use) of antipsychotic drugs; Irving Kirsch, a leading expert on depression research; Dainius Pūras, responsible at the time for the area of UN human rights and health; Joanna Moncrieff, whom I mentioned earlier; Laura Delano and Peter Lehmann, psychiatric survivors, who gave rise to invaluable work to help users withdraw from psychiatric drugs; and even Allen Frances, leader of the task group that developed the DSM-IV, and who became one of the most eloquent critics of the DSM system itself! Finally, the seminars brought together some of the most important names in critical research on psychiatry and its strategies for pathologizing life.
Due to the very special dedication of Fernando Freitas, we began to participate, together with some of the most important researchers from around the world, in the creation of the International Institute for Psychiatric Drug Withdrawal, based on the observation, by researchers in several academic centers, of the serious chemical dependence produced by psychiatric drugs, as well as the difficulty that people have in getting off them. Until recently, official psychiatry did not admit that psychiatric drugs caused dependencies, let alone withdrawal syndromes.
Fernando has left us. But he left us with some tasks: not abandoning the fight against the pathologization and medicalization of life, and continuing to organize international seminars and keeping Mad in Portugal alive and influential. In a beautiful and touching article about Fernando, Robert Whitaker highlighted a huge number of expressions of condolence received from the international community of critical psychiatry and called him a “warrior of radical change”.
The fight points, on the one hand, to the denunciation and the necessary resistance against the abusive increase in psychiatric diagnoses: it is important to emphasize that these increases in diagnoses are leading to the pathologization of life. On the other hand, the fight is to block this absurd process of prescription of psychiatric drugs, a great objective of the pharmaceutical industry, which finances this marketing process of pathologization!
* As English-speaking readers may not be familiar with this novel, we have added the context for understanding this quote. In Brasil, it would be understood that the character, in making this distinction between reason and insanity, is soon to see many of the people in town as “mad.”
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