Histeria e diagnóstico psiquiátrico na contemporaneidade: tensões com a psicanálise

Abstract

Este trabalho apresenta uma breve apresentação crítica da história do DSM. A partir de fragmentos de um caso clínico atendido em um Centro de Atenção Psicossocial (CAPS) e com base nas controvérsias criadas em torno da classificação DSM, faz-se uma comparação entre um diagnóstico concebido pelo DSM e um diagnóstico realizado pelo viés da Psicanálise com o objetivo de demonstrar que diferentes razões diagnósticas acarretam distintas conduções do tratamento. Demonstram-se ainda as consequências clínicas do modus operandi da Psicanálise com o sujeito histérico, cujo cerne é fazer emergir o sujeito a partir de sua fala. Apontam-se algumas consequências da razão diagnóstica predominante na Psiquiatria contemporânea com sua lógica diagnóstica que desconhece a singularidade do sujeito em seu jogo com o sintoma. Conclui-se que o sintoma histérico pode funcionar como um convite para que o médico ocupe uma posição subjetiva em relação ao sujeito, afastando-se do discurso científico e objetivo, característico da instituição médica.

Full text

Psicol. Argum. 2014 abr./jun., 32(77), 75-83
doi: 10.7213/psicol.argum.32.077.AO01
Psicol. Argum., Curitiba, v. 32, n. 77, 
PSICOLOGIA ARGUMENTO ARTIGO
[R]
Abstract
This paper presents is a brief critical presentation of the history of DSM. From fragments of a
clinical case treated at a Psychosocial Care Center (CAPS) and based on the controversy created
  
perspective of DSM and Psychoanalysis in order to demonstrate that different diagnostic rea-
sons entail distinct clinical interventions. We also demonstrate the clinical consequences of the

from his/her speech. We point out some consequences of the prevailing diagnostic reason in con-



 [#]
[K]
Keywords: Psychoanalysis. DSM. Diagnosis. Hysteria. [#]
[R]
Resumo

mentos de um caso clínico atendido em um Centro de Atenção Psicossocial () e com base
   
   

modus operandi




         
característico da instituição médica.[#]
[P]
Palavras-chave:[#]
[T]
Histeria e diagnóstico psiquiátrico
na contemporaneidade: tensões com a psicanálise
[I]
Hysteria and psychiatric diagnosis in contemporary times: tensions with Psychoanalysis
[A]
Fuad Kyrillos Neto[a], Carlos Lemes e Silva[b],
Aquinoã Abigail Pederzoli[c], Maria Luísa Azôr Hernandes[d]
[a] Doutor em Psicologia

Departamento de Psicologia da




[b] 
da Universidade Federal do



[c] 
Psicologia da Universidade



[d] 
da Universidade Federal do




Received: 03/23/2012
Aprovado: 16/10/2012
Approved: 10/16/2012
75

Psicol. Argum. 2014 abr./jun., 32(77), 75-83
Kyrillos, F. Neto., Silva, C. L., Pederzoli, A. A., & Hernandes, M. L. A.
76
Breve apresentação crítica do DSM
     

na investigação intitulada A psicopatologia e o DSM
IV: um diálogo com a Psicanálise
  
   

de um Centro de Atenção Psicossocial () e suas


       




um  municipal e modular, uma linha de debate

       
político, ideológico e até mercadológico.
        
      
siste em “importunar” a sociedade implicada na

   

 
   
ças e transtornos mentais e da necessidade de cria
ção de uma linguagem de comum entendimento

possibilidades de diagnóstico entre todos os estu

 
a necessidade de catalogação e coleta de dados es
tatísticos acerca dos transtornos mentais por cau
      
    
    
    
      
   
co na clínica. O primeiro desenvolvimento de uma

        
      

 

    
Association [APA], 2002).
Com a necessidade de uma terminologia mais
   
    


     



      
      
     


      

     

ciado principalmente pelos ideais da perspectiva


tores psicológicos, sociais e biológicos.
A partir de então, os colaboradores das reedi




     

    
       







   




   
      
 


Psicol. Argum. 2014 abr./jun., 32(77), 75-83
Histeria e diagnóstico psiquiátrico na contemporaneidade 77
 
      




       
 


tamento deve começar com uma avaliação médica
precisa.   
para dados empíricos em detrimento do humanis
        





        
manual.
       
criados com uma ideologia estritamente ateórica e
com uma abordagem predominantemente descriti


 
ve nenhuma menção de uma possibilidade de outro
ponto de vista. Eles simplesmente ignoraram o corpo
do conhecimento com base em uma hipótese alterna

     

individuais. (p. 2)
Uma perspectiva semelhante é adotada por
      
       
      
   

e mensuração. Para ele, “a abordagem descritiva do
        
      

       
elementos da teoria comportamental, embora eles
     
       
manual.
  







interpretação do clínico.


    
 
   
abordagens tentam contornar o problema dessa
    
   
composto por uma síndrome ou padrão de compor
    


     
       
       


       

      
       



    
na sociedade:  
        

p. 3)


     
  
       
        


      
       

Psicol. Argum. 2014 abr./jun., 32(77), 75-83
Kyrillos, F. Neto., Silva, C. L., Pederzoli, A. A., & Hernandes, M. L. A.
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     





     


gia a descrição dos sintomas ao invés da patologia.

e Fendrik (2011), intitulada O livro negro da psico-
patologia contemporânea. A obra denuncia a pato



        
     
 


sentado como avanço na capacidade de curar tenha
levado a ampliar em uma progressão geométrica a
     
Fendrik, 2011, p.6)
Advertido das controvérsias criadas em torno da


mentos de um caso clínico a ser apresentado e um


     


modus operandi


Fragmentos clínicos do caso
Através da discussão de vinhetas clínicas de um
caso atendido em um, a intenção é apresentar





      

1       
 por apresentar comportamentos de risco
    

     
novo. Por morar perto da casa deles, o irmão mais




nascer.




   



       

       
     






         

muito sobre doenças.



        
      
   
    



        
   
¹          
identidade da paciente.

Psicol. Argum. 2014 abr./jun., 32(77), 75-83
Histeria e diagnóstico psiquiátrico na contemporaneidade 79




  
  

para ela, ri.
        


 

Mônica na perspectiva do DSM
       


  

     





        
     





de: delirium    
paciente apresenta algumas ideias delirantes com
 

 



transtorno da personalidade paranoide (301.0) e


   

como um critério importante para se estabelecer

Com a propriedade apresentada no manual de se
 

    esquizofrenia do tipo
indiferenciado (295.90) com delirium por into-
xicação com álcool (291.0), transtorno da perso-
nalidade histriônica (301.5) com problemas no
grupo primário de apoio.
O viés psicanalítico
    


ceio da sua rivalidade com o progenitor do mesmo

Édipo. Os resultados da resolução da crise edipia

edipiano e, de outro, a subtração do perigo da cas



       

     



As psiconeuroses partilham dos mesmos pro
   

    
       


 

 

uma saída no corpo.

      
  

      
        
         
        


Psicol. Argum. 2014 abr./jun., 32(77), 75-83
Kyrillos, F. Neto., Silva, C. L., Pederzoli, A. A., & Hernandes, M. L. A.
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




       

    
        



   
 





  





     

medo, pois os homens a olhavam com cobiça. Ainda
segundo Freud, a aversão aos homens possivelmen


proteção contra o renascimento de uma percepção
recalcada. Essa percepção corresponderia ao re



      

 Introdução
ao narcisismo, 

       

nuíno de mulher. Com a puberdade, a maturação dos
      




     
    
mulheres amam apenas a si mesmas com intensidade
    



A citação evidencia a lógica histérica, não de
       
       









 

      
 
terapeuta em um lugar privilegiado, elegido como





        


sedutor, o histérico é um ser de medo” (p. 113), pois







      






      

Psicol. Argum. 2014 abr./jun., 32(77), 75-83
Histeria e diagnóstico psiquiátrico na contemporaneidade 81

para ele represente a possibilidade de desintegra

  
sua autoimagem negativa em busca de cuidado em

e academia são caros e sempre pensa em se relacio
nar com homens casados para nunca ter um relacio



         
     
  







     


        
     
      
  





       

    



       
 




  
   
 estão “dando em cima” dela, pois ela


pergunta se ela não estaria se colocando nesse lugar

respeito disso.

  
  



  
     
  




Considerações finais: a histeria e a razão diagnóstica
predominante na Psiquiatria contemporânea

pilar da modernidade, é possível posicionar o saber
do “mestre antigo” (a opinião e a realidade social
mente construída) como permanentemente em





   


do inconsciente.

em uma supervisão institucional como um caso con





estatísticas, é tratado predominantemente com me
     

 


      
    


Psicol. Argum. 2014 abr./jun., 32(77), 75-83
Kyrillos, F. Neto., Silva, C. L., Pederzoli, A. A., & Hernandes, M. L. A.
82
     

     
     

a ser desconsiderado.
       
         
  

    


      



     






 
  
      
    

      


       
   
   
 


do como um semblante contra o real. As estruturas

coram no real.

    




lisando histérico”.
O analista não abre mão de ocupar um lugar e de

       


 
      



      

     


  




ideia de conservar seu estado.
Essa possibilidade aponta para o risco da
       
       
       
  
     2 Os psica
 
assim como a demanda dirigida ao analista, não é
puramente uma demanda de cura. E, no momen
         
tratamento:
    
 

não corresponde pura e simplesmente a uma possibi

² O discurso é um modo de relacionamento social repre

discursos como modos de uso da linguagem como vínculo

      




como

    
“eucracia”.

Psicol. Argum. 2014 abr./jun., 32(77), 75-83
Histeria e diagnóstico psiquiátrico na contemporaneidade 83
         
 

   Introdução ao narcisismo  
Companhia das Letras. (Originalmente publicado em

O livro negro da psi-
copatologia contemporânea
     

A querela dos diagnósticos

 O avesso da Psicanálise

        
      

       
     
Philosophical perspectives on psychiatric
   

A histeria: teoria e clínica psicanalítica.

           
ou psicopatologia para quê?    
maio de 2011, de http://www.estadosgerais.org/

Os nomes da loucura

Histeria e Psicanálise depois de Freud.
Campinas: Unicamp.



Um novo lance de dados. Psicanálise e
Medicina na contemporaneidade   

   
.
 





       
co e do paciente o alicerce dessa relação. A partir

 
  


 

do mestre.
Referências
     Histeria 
Casa do Psicólogo.
DSM-
IV-TR Manual Diagnóstico e Estatístico de Transtornos
Mentais
       
 Chaves da Psicanálise  

A ordem médica: poder e impotência
do discurso médico
   Estruturas e clínica psicanalítica  

      
 
  Revista
Latino-americana de Psicopatologia Fundamental,
4
Figueiredo, A. C., & Tenório, F. (2002). O diagnóstico em
   Revista Latino-americana
