Determinação social da esquizofrenia: fundamentos ontológicos para o desvendamento do desenvolvimento da esquizofrenia

Abstract

This text exposes the theoretical synthesis on the ontological foundations for unveiling the social determination of schizophrenia, constituting a materialist, historical and dialectical reading of the process of health, illness and psychological suffering. In this process, we critically analyzed the understanding of schizophrenia by Hegemonic Psychiatry, demonstrating its bases in the Kraepelinian and biomedical paradigms. The foundations of Kraepelin's study in Wundtian psychology are rescued in the first chapter of this work, as well as Khaulbaum's influence on Kraepelin's psychiatry. Therefore, we weave a Marxist critique, revealing the limits of this model for the theoretical explanation of the phenomenon. Analyzing the foundations of the biomedical model and, based on the formulations of Breilh and Laurell, we point out ways to understand the structure and dynamics of the health and disease process, through critical epidemiology, advancing in the complex called “internal nexuses of the social determination of health ”, demonstrating its mediations with the apprehension of Lukács’ Ontology of Social Being; the dialectical reading of human biology, by Levins and Lewontin; the dialectical reading of epigenetics, supported by Jablomka and Lamb; of the category “experience” as the unit of personality, in Vygotski, and by its unitary association with the category “sociability”, in Lukács. Thus, scrutinizing the mediations of the social constitution of the human being as a dialectical unit in which the social is the preponderant moment, in this direction, we point to the conformation of the internal links of the health and disease process: biological plasticity; epigenetics; experience and sociability; subsumption of the biological to the social. Next, we critically recover the formulations of historical-cultural psychology on the social constitution of consciousness, to highlight this as the dialectical unity between Psychological Systems, understanding by psychological systems “emotion, imagination and thought (predominant moment)”, activities that are more complex than the higher psychological functions (FPS), but constituted by the links between these functions. After establishing the foundations that supported us in building our thesis on the social determination of schizophrenia, we analyzed Vygotskian texts on the subject, indicating their possibilities and limits for understanding the phenomenon and, supported by descriptions of experiments by Zeigarnik and Poliakov, we deepen the interpretation of his conclusions, overcoming the Vygotskian thesis of the disintegration of “thought into concept”. Complexifying the Vygotskian hypothesis that schizophrenia is a pathology of the “Apices” of Psychology, that is, of the socially and historically developed FPS, we point out the apprehension of schizophrenia as a process of disaggregation and change in the nexus of psychological systems and an alteration of the dialectical unity of consciousness in which, prior to the development of schizophrenia, thought is the preponderant moment and which, in moments of crisis, has imagination and creation as preponderant moments, promoting an unusual development of consciousness. Thus, we seek to substantiate the means by which the experiences of the exploitation-oppression unit can provide conditions of dehumanization that affect the development of schizophrenia, as shown by studies that correlate and demonstrate the prevalence of its development in populations that are victims of these forms of violence that in a Capitalist sociability is constituted as a complex of expressions of the social question.