Racionalidades, territorialidades e intersubjetividades: paralaxe para uma crítica às práticas de linguagem no cuidado em saúde

Abstract

Based on the contemporary problems in which this research is located, the research refers to the forms of language that organize care in what I call “Health Care based on the Territory”, present in the current public health policies. For the development of this thesis, I discussed the processes of rationalization and the pathologies of Habermas's modern rationality, as well as his linguistic turn. In addition, I established a dialogue with the meanings of language from Bakhtin and the space shift brought through Lefebvre, with notes present in Milton Santos. Thus, the critical paradigm was expressed in a multi-theoretical way from the interface with several areas of knowledge, such as Psychology, Sociology, Philosophy and Geography. Facing the thematic amplitude, I proposed as a general objective to understand how the forms of language organization instrumentalize health care practices in territorial based assistance. I opted for the specific methodology called “praxis-reconstructive”. By using qualitative research, I sought a comprehensive critical reconstruction through the processes of understanding that are produced through language and, at the same time, the implication of the researcher with the field committed to the change of reality. The process of constructing the empirical information/field material was done through a methodological vector triangulation, which included: Narrative Vector (with narratives interviews about care), Interactive Vector (with narrative circles), Contextual Vector (with systematic observations), and Implicative Vector (with the Territory and Health Workshop). The research area was Primary Health Care (in Portuguese, “Atenção Primária à Saude – APS”) and the Psychosocial Care Network (in Portuguese, “Rede de Atenção Psicossocial – RAPS”); Fortaleza city was the empirical field where the research took place, and a multi-professional team and the community assisted by each of these services were taken as participants of the empirical research. The discussions were divided into two axes that systematized the four major analytical categories of the qualitative material constructed: “Systemic (Biomedical) Rationality and Mundane Rationality (Caregiver)”, “Language and Signs of Care”, “Territorial Production” and “Paralaxis in Health”. From the contents discussed in the last part of the thesis (Reconstructive Territories), the debates about the metaphors of coverage and need that permeate the dialog scene in health care in APS and RAPS took place, respectively; the debates about the distance between health actions and the social needs that generate demands on health services and professionals were also relevant, and they have as an effect a certain way of organizing the work and carrying out care techniques; finally, Zizekian (Slavoj Žižek) parallax helped to understand the intricate meaning mechanism of anatomic-physiological bodies as social bodies, expurgating certain dimensions and conceptions of the “political” action in health. The proposed concepts of “care genre” and “glocal health sphere”, responding to the absorption of the intersubjective and spatio-temporal dimensions, constitute a model of the reconstruction of care towards the aesthetic-political-dialogic poiesis of life.