viernes, 31 de octubre de 2014

La salud mental es más importante que la psiquiatría








Trabajo en un lugar llamado Instituto Nacional de Salud Mental. Desde luego, no existe definición completamente satisfactoria de lo que es "salud mental", y no la hay siquiera de lo que es simplemente "salud". Pero intuitivamente uno puede asumir que salud mental tiene que ver con la forma en que vivimos, nuestro estilo de vida y la escala de valores respecto a lo que consideramos prioritario o de segundo orden en nuestra conducta y nuestro diario quehacer.

Cada vez son más frecuentes las consultas cuyo motivo no es una enfermedad psiquiátrica en el sentido clásico del término (esto es, por melancolía, esquizofrenia, psicosis maniaco-depresiva o trastorno obsesivo-compulsivo) sino por vicisitudes de la vida humana cotidiana o por los golpes del destino ("los heraldos negros que nos manda la muerte", al decir vallejiano) y que no pueden capearse.

Pero hablar de salud mental y estilo de vida no necesariamente es asunto que los médicos saben y dominan por el solo hecho de ser médicos. Muy por el contrario, muchas veces los médicos tienen un estilo de vida insano y penoso: consumista, crematístico, acumulatorio, trabajólico. Y si, en el caso de los psiquiatras, han cedido a la psiquiatrización y psicofarmacologización galopante de la existencia humana, muy probablemente quien acude a la consulta podría salir con una receta de psicofármacos endilgada, y de más de un psicofármaco probablemente, aunque ninguno realmente necesario, y menos dos o tres.

Se establece así un círculo vicioso y penoso (gente que acude por un sinsabor de su existencia y sale diagnosticada como "Bipolar II", personas que tienen dificultades en su adaptación por diversas contingencias vitales y resultan siendo supuestos casos de "TDAH del adulto"). Y aunque la consulta psiquiátrica sigue siendo resistida y estigmatizada (en estos casos con justa razón), cada vez más son los psicólogos que recomiendan a sus usuarios que visiten al psiquiatra "para que los mediquen y resulte mejor la terapia". No hay escapatoria en muchos casos así.

Carentes del soporte social que otrora brindaban los parientes provectos y experimentados, los ancianos de la tribu, los pastores de la grey, ahora los psiquiatras bisoños, muchas veces premunidos apenas de su ingenua buena intención y de su arsenal de psicofármacos, se yerguen como árbitros de la normalidad y la anormalidad (y el médico usualmente conoce solo y a lo más de anormalidades) con los resultados lamentables y consiguientes que vemos cotidianamente por doquier.

Textos como el de Ortiz-Lobo (autor del imprescindible Hacia una psiquiatría crítica) que ahora traemos a colación: El malestar que producen los problemas de la vida, propende justamente a que seamos capaces de desdiagnosticar y desmedicalizar eventos y sinsabores de la existencia que llegan a nuestra consulta y reconozcamos y restablezcamos los sistemas homeostáticos de individuo, familia y colectivo grupal, sin la muleta espuria del DSM y los ISRS's, a los que somos tan acríticamente adictos.

Pienso en que un granito de arena ponemos nosotros al viento cuando despachamos a los rotantes de nuestra emergencia psiquiátrica al promediar la temprana tarde rumbo a sus enamoradas(os), sus pasatiempos favoritos, sus horas de solaz y esparcimiento feliz con el recordatorio de que cuiden su salud mental pues, más que la psiquiatría, esta es la primera que debemos conocer, respetar, mimar y nunca descuidar.





_______________________________


ENLACE:

- Ortiz-Lobo A, Sobrado AM. El malestar que producen los problemas de la vida. AMF. 2013;9(7):366-372



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113 comentarios:

José Manuel Brea dijo...

Los médicos somos los peores pacientes, y predicamos poco con el ejemplo. Supongo que como los curas en lo suyo. Y creo también que, como dices, pecamos de excesos diagnósticos y terapéuticos, cayendo en las redes de la medicalización que desearíamos evitar. Así que pecadores todos, religiosos y seglares, médicos y pacientes. Lo que no obsta para que intentemos preservar, con modestia, nuestra salud mental, aunque su enmarque sea difuso.
¡Salud!, amigo Lizardo.

Lizardo Cruzado dijo...

¡Salud, amigo José Manuel! Rubrico plenamente tus palabras como corolario impecable de mi entrada escueta y reflexiva. Un abrazo.

Oscar Marquez dijo...

Muy acertada tu entrada, quisiera republicarla en mi blog: http://unbipolarmas.blogspot.com/, si aeptas lo hare. sino simplemente la citare en una de mis proximas entradas.

Lizardo Cruzado dijo...

Adelante, Óscar, bienvenido y gracias por tu gentileza. Saludos.

Agustina dijo...

Hola nuevamente Lizardo. Esta vez te escribo para invitarte, si tenés ganas, a participar de una revista que estoy dirigiendo. Sé que has escrito poesías y muy buenas. La revista es de Buenos Aires. Hay unas pocas bases y condiciones para poder participar que se detallan aquí:

http://www.percepcionesdigital.blogspot.com.ar/p/como-participar.html

Asimismo si conocés a alguien que esté buscando publicar sus obras, podes pasarle el link.

Un saludo!

Lizardo Cruzado dijo...

Muchas gracias por el enlace, Agustina, y felicitaciones por esta iniciativa literaria. Valoro tu amable invitación.
Un abrazo.

MOodTim dijo...

Muy buena publicación, escueta, informativa y fácil de entender; precisamente pensaba en esto en estos días. No soy psiquiatra, ni si quiera médico pues me graduaré recién en 2 meses. Sin embargo, nunca faltan las consultas improvisadas de amigos que creen que un médico o un estudiante de medicina está en la capacidad de solucionar. Y han sido varios amigos quienes me han consultado por problemas que según lo aprendido en el curso de psiquiatría no encajarían necesariamente en uno de los diagnósticos del DSM o el CIE10. Y efectivamente, he podido notar que sus quejas básicamente son acerca de vicisitudes de la vida, malas decisiones y malas juntas o amistades dañinas. Algo que podría agregarse a su publicación desde mi punto de vista, es que la ayuda a estos pacientes bien puede brindarse desde el primer nivel de atención. Un buen filtro en el primer nivel de atención provocaría que los psiquiatras reciban en su consulta a los pacientes que realmente los necesitan. Pero para ello hace falta inculcar más la importancia de la salud mental que como usted dice, en médicos e incluso en estudiantes de medicina, no se practica. Saludos desde lima-Perú.

Lizardo Cruzado dijo...

Gracias MOod Tim por tu enriquecedor comentario. Totalmente de acuerdo en lo que apuntas acerca de la prioritaria atención primaria para este tipo de problemas que se tratan peor en entornos especializados. Qué bueno que ya estés a punto de acabar tu carrera y te interesen los problemas de salud mental. Alguien dijo que la mejor definición de enfermo es "alguien que necesita un médico" pero se necesitan médicos con más criterio y frónesis, más cercanos a lo humano y su compleja índole, más conocedores de la vida y no solo de la farmacología.
Un saludo cordial.

Oscar H dijo...

Hola compañero! soy psiquiatra y trabajo en España. No puedo estar más de acuerdo con tu post. Vivimos en una sociedad compleja, donde la tolerancia al sufrimiento cada vez es menor, la gente acude a visitarnos por vicisitudes de la vida. Muchas veces derivados por colegas, y lo malo, es que no hablamos de ellos, los medicamos, les damos el elixir de la felicidad, no damos lugar a la frustración y reforzamos los narcisimos insanos. Soy un defensor de la terapia, del vínculo, eso no quita que a veces la medicación ayuda y mucho. Solo eso. Por cierto a mí también me marcó la lectura de "Monte Miseria" cuando comenzaba la especialidad. Abrazos fuertes

Lizardo Cruzado dijo...

Gracias, Óscar, por tu opinión: aquí andamos ni más ni menos como tú lo graficas bien. Un abrazo a la distancia.

Unknown dijo...

A propósito de la sociopolítica de la salud mental, comunico la publicación de mi último libro (Rodríguez Garzo, M. Esquizofrenias y otros hechos de lenguaje. De la clínica analítica del Macba (2002-2013), Brumaria, Madrid, 2015).

Esquizofrenias y otros hechos de lenguaje resulta de una aplicación psicoanalítica en un contexto ajeno al ámbito de la salud mental, el Museu d’Art Contemporani de Barcelona (Macba), trabajando con personas diagnosticadas de trastornos mentales graves e investigando con ellos la mecánica de la producción de los hechos de lenguaje. Se diseñó un dispositivo analítico para operar en los márgenes de la salud mental, adaptable a una circunstancia interinstitucional: un museo, el Macba, y los Centros de Día vinculados a la Xarxa de Salut Mental de Barcelona. El proyecto se desarrolló durante once años (2002 y 2013), y el objeto de la aplicación era investigar los procesos de creación de lenguaje en la relación sujeto-trabajo analítico en virtud del último progreso incontestable de la psiquiatría contemporánea: la identidad psicosis - personalidad, propuesta y razonada en 1934 por Jacques Lacan, y de su incidencia en la clínica de las psicosis leída por Francesc Tosquelles y Jean Oury.

Nuestra hipótesis se construyó a posteriori, cuando el dispositivo ya tenía un amplio recorrido y lo que iba resultando dejaba ver el paralelismo entre la mecánica del lenguaje en las construcciones sinthomáticas, las suplencias, y la mecánica de los lenguajes artísticos con fundamento visual. Para argumentar este supuesto elegimos la obra de Ignasi Aballí, paradigma de la exploración impecable de la reducción del sentido obrando con la pintura y con el hacer cinematográfico.

Un cordial saludo.
Montserrat Rodríguez
Psicoanalista (Barcelona)
 

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sin pepas dijo...

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Miguel, de psiquiatria pitiusa dijo...

Hola,
Estoy realizando un master. Otro más... no para un curriculum al que ya resulta inútil engordar, sino por una mezcla de amor al estudio y reconocimiento de mi incapacidad para organizarme: me es más sencillo dejarme guiar y ser examinado que elegir yo mis lecturas desordenadas.
Tenía que responder una cuestión sobre proceso desarrollo y reacción. He recordado que K. Jaspers escribió su psicopatología muy joven. Y he recordado que el dato lo obtuve gracias a ti. He buscado la edad exacta (28 años) y me doy cuenta que echo de menos la lectura de este blog.
¿sigues escribiendo? ¿ya no hay largas guardias?
Un fraternal abrazo.
Miguel

Mirell dijo...

gracias por este lindo artículo!

Clipping Path dijo...

Lovely blog. Thanks for sharing with us.

Psicologia foro dijo...

Gracias por este buen articulo de psicologia en madrid centro y toda la ayuda que brindas

Psicologos madrid dijo...

Buen articulo. Muchas gracias por el aporte, los psicologos siempre buscamos la salud ante la medicacion, solo sirve para llegar a ponerse bien sin sufrir

Carlos Encina Psiquiatra dijo...

Muchas gracias por la reflexión. Es importante ahondar en el término de salud mental. Te invito a leerme.
Saludos!

con psiquiatras dijo...

Gracias por la info
Saludos
Pamela

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Psicólogos Barcelona dijo...

Es muy importante que la gente se cuide y acuda a especialistas para poder tener una mente más sana

Centro de psicología en Madrid dijo...

Es muy importante la salud mental, por el tema del COVID-19 cada vez hay más gente con problemas y en vez de pedir ayuda piensan que lo pueden resolver solos (spoiler: en la mayoría de los casos no sale bien).
Por eso todos los expertos debemos aportar nuestro granito de arena

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