Prácticas discursivas sobre salud mental de profesoras/es de psicología en dos universidades en Medellín, Colombia

Abstract

In this doctoral thesis we set out to understand the discursive practices on mental health of psychology professors from two universities in Medellín, Colombia, with a view to defending that mental health is a transversal axis to all psychology and not exclusive to one specialty. For example, from clinical psychology. This does not mean that mental health is specific to psychology, it is a broad phenomenon, to which much knowledge has already contributed, but which discursively in psychology requires some clarification. We question the association that reduces mental health to psychopathology, and we describe some of the effects that the use of this discourse provokes in concrete life, among them, the one that is exemplified by the decision of the Colombian Ministry of Education that requires undergraduate psychology a level of compulsory clinical practices under the supervision model of medicine, that is, of an individual practice in an office and focused on the disease. We see a problem here, because the status quo of the discourse of illness and the individualist is being reinforced in psychology training, thus confusing clinic with psychotherapy. We understand that clinical, in its meaning of method according to Lightner Witmer, has to do with the general understanding of the human being, not necessarily from a pathological perspective; and we conceive psychotherapy as a specialized treatment that would require a postgraduate level or continuous and supervised training. However, we recognize that psychotherapeutic practice, as it has been interpreted in its mainly intrapsychological nuance, leads to social exclusion, since we know that not everyone can access it, without this implying that it should disappear. Therefore, these "clinical" practices oriented exclusively under the supervision model, which by protocol is the same as that applied to medical practice and its various specialties, would be promoting the consolidation of a hegemony that had been minimized thanks to other conceptualizations of health, including collective mental health. On the other hand, that clinical obligation in its medical supervision format is ignoring the precarious conditions that these professionals face in the Colombian labor market, characterized by a greater offer in organizational and work psychology or that forces them to constant changes of employment and, therefore, of applied field. Based on social constructionism and the Discursive Practices and Meaning Production perspective proposed by Mary Jane Spink, we conducted a remote workshop with 12 teachers who advise practices at a public and a private university in Medellín. They were divided into four groups of three people each. We use narrative lines, trees, dialogic maps, and word association analysis as analytical strategies. The use of these strategies allowed us to delve into the discursive nuances, their dynamics, content, and form, especially reiterating two meanings built on mental health from discursive practices. The first refers to the positive and negative definitions of mental health; the positive meaning was based on repertoires such as well-being, spirituality, tranquility, harmony, and the negative on symptoms, disorders, crises, anguish. The second meaning gave prominence to the discourses of the individual and the social, which is exemplified with a discursive genre or typical statement among teachers. This statement appeared in the form of a question or recommendation that some supervisors ask their student interns to go to therapy to solve their difficulties, understanding it as an individual responsibility. We discuss these two issues from an approach that we call pragmatic/constructionist, defined by Kenneth Gergen as the clarification of the social function of the constructed meanings, that is, that the use of discursive practices has consequences in cultural life. To advance the reflection, we focus on the dialogue proposed by the Circle of Bakhtin, on which Gergen also based himself to affirm that it is necessary to broaden the dialogical spectrum of discourses, that is, to recognize that in the face of the hegemony or primacy of a definition -which in the case of our participants is the negative definition of mental health- it is important to maintain a diversity of voices, and therefore they would not be only those of clinical psychology, which has traditionally been associated as the only person in charge of mental health. The Bakhtinian dialogue in turn proposes an ethic that consists of respect for difference and a responsive attitude, read responsible, in the face of our statements in the interaction with people. We conclude that 1) some uses of our discursive practices of mental health justify excluding practices such as psychotherapy to which people with higher incomes have ready access, therefore the need for an expansion and diversification of the concept of mental health to promote other practices that facilitate the access of other social groups to psychological support; 2) this extension could be included in the model of supervision of clinical practices that is being demanded for universities in Colombia and that would avoid returning to a hegemony of the discourse of the disease that reiterates in a conception of the individual in whom all responsibility for what falls What happens. 3) With the Bakhtinian dialogue we rescue not only the importance of the multiplicity of voices on mental health or on any other topic, but also philosophically bases the rupture between disciplinary and discursive borders with a view to a more dialogical and less dichotomous communication that would have an impact in university education and in general in everyday social life. 4) If dialogic principles were to go through training in psychology, that is, less governed by hyperspecialization and more focused on common phenomena such as mental health in its various meanings, we would be training for a world of work that goes beyond the type of institution or place where they work and that has been described as an "applied field", relativizing the idea that clinical practice is located exclusively in the "office" or in the health system where mental health is only addressed there. 5) Finally, we clarify that mental health should not be the only phenomenon common to psychology, because it can also be that of democracy or that of struggles against all kinds of social exclusion; The fundamental thing, in dialogical terms, is to share common purposes accepting discursive diversity and professional practice, this being our main contribution to the debate, and which we know is not where it ends.