A necessidade da aplicação da escuta diagnóstica para a abordagem precoce em saúde mental na atenção primária e a viabilidade de sua aplicação ao ensino médico

Abstract

This theoretical essay investigates the reasons supporting the need for implementing Diagnostic Listening within the field of Mental Health. It was grounded on an active research with Clinical-Qualitative Methodology, which was held at the Programa de Pós-Graduação em Ciências da Saúde da Criança e do Adolescente da UFMG. The ensuing masters thesis was entitled: A Escuta Diagnóstica: uma proposta de ensino para a relação médico-paciente (PIRES, 2007). The results obtained in an experimental discipline, through the triangulation method, showed that in actual clinical practice there is a hole in the knowledge correlated to the difficulties reported by students in unifying their accounts in a "knowledge community". The difficulties relating to the wall of language were taken by means of Russell's Paradox applied to the theory of knowledge, revealing the structural-logical inconsistency of the symbolic order as a founding contradiction of two different, although simultaneous, dialectics. There is a dialectic of an "individual"as long as he or she is considered social and susceptible to universalization by scienceand another dialectic, which is that of the subject structurally split by language. Beyond preemptively excluding organic frameworks, the modern Diagnostic Classifications in psychiatry, because of their lack of propaedeutic to prove an etiology or an anatomopathological substrate, adhere to the symptoms as criteria, taking the disease as their object. Therefore, there are two different epistemological statuses between the Objects: the object of Psychiatry the disease and the object of Mental Health the patient. In the vast field of Mental Health, the complexity of diagnosis in Primary Care can be confused with the implementation of categories that may be useful as tools for databases. The Objectives are different: patients can be seen as the passive objects of therapies or heard as subjects. In cases of difficult and undefined differential diagnosis in Primary Mental Health Care, especially the higher-risk age group of adolescence, a hasty approach may not be sufficient or the most appropriate, posing a risk to patients/subjects. Even if a quick response is demanded from the physician, he or she should not take over that role, instead offering the patient/subject an opportunity to speak. During medical school it is necessary to warn the student that each patient/subject establishes relationships tangential to knowledge, according to their symptoms and their Structure, and that the Clinical Structures developed by Lacan provide different possible types of transfers and social ties. This preventive theoretical warning is necessary and should be mandatory in the curriculum so that the formulation of diagnostic hypotheses of earlier Structures is made possible. In cases requiring Diagnostic Listening this gives rise to an opportunity for teachers and students who are interested in this procedure to listen to a speaking subject, in his or her structurally paradoxical relationship between knowing/not knowing, and engage in an early Mental Health approach in Primary Care. By facilitating this kind of investigation a subject might also emerge within the student, questioning his or her own reasons, discussing the medical profession and the ethical implications of medicine as a whole.