Béhague Dominique P
Vanderbilt University, USA; King's College London, UK; London School of Hygiene and Tropical Medicine, UK.
Soc Sci Med. 2015 Oct;143:320-8. doi: 10.1016/j.socscimed.2014.11.028. Epub 2014 Nov 13.
In the late 1990s researchers in Pelotas Southern Brazil began documenting what they considered to be unacceptably high rates of licensed psychotropic use among individuals of all ages, including youth. This came as a surprise, since the vast majority of psychiatrists in Pelotas draw on psychoanalytic theory and approach pharmaceutical use, especially for children and adolescents, in a consciously tempered way. Drawing from a longitudinal ethnographic sub-study, part of a larger 1982 birth cohort study, this paper follows the circuitous trajectories of emergent pharma-patterns among "shantytown" youth over a ten-year period, exploring the thickly layered and often moralized contingencies in which psychodynamic psychiatrists' intention to resist excessive pharmaceuticalization both succeed and crumble. I juxtapose these trajectories with the growing salience of an "anti-biologizing" explanatory framework that psychiatrists and researchers are using to pre-empt the kind of diagnostics-driven "biopsychiatrization" so prevalent in North America. My analysis suggests that psychiatrists' use of this framework ironically contributes to their failed attempts to "resist" pharmaceuticalization.
20世纪90年代末，巴西南部佩洛塔斯的研究人员开始记录他们认为在包括青少年在内的各年龄段人群中，精神药物的许可使用率高得令人无法接受。这令人惊讶，因为佩洛塔斯的绝大多数精神科医生借鉴精神分析理论，并以一种有意识克制的方式使用药物，尤其是针对儿童和青少年。本文取材于一项纵向人种志子研究，该研究是1982年一项更大规模出生队列研究的一部分，它追踪了“棚户区”青少年在十年间出现的药物使用模式的迂回轨迹，探讨了精神动力学家抵制过度药物治疗的意图既成功又失败的层层叠叠且常被道德化的意外情况。我将这些轨迹与“反生物化”解释框架日益凸显的情况并列，精神科医生和研究人员正在使用这个框架来预先防止在北美如此普遍的那种由诊断驱动的“生物精神病化”。我的分析表明，具有讽刺意味的是，精神科医生对这个框架的使用导致了他们“抵制”药物治疗的尝试失败。
