Entre milagres, pedras preciosas e manchas vermelhas na parede: tessituras entre cultura e território na produção de cuidado a usuários de saúde mental do município de Seabra, Bahia.

Abstract

The present study aimed to analyze the production of care for users of the Psychosocial Care Network (RAPS) in the city of Seabra, Bahia, and its articulation with the culture in the territory. To this end, it prioritized the characterization of formal and informal care practices, the mapping of territories and spaces of care, both within and outside health services, and the identification of the repercussions of sociocultural aspects on the provision of care in the daily lives and relationships of these users. The methodology adopted a qualitative, descriptive, and exploratory approach through multisituated ethnography, using participant observation (or observant participation), interviews, and field journal as data production techniques. With inclusion and exclusion criteria, three users and some actors involved in their care production were selected. They were followed for seven months, between 2024 and 2025, based on their narratives and trajectories through formal (health services) and informal (their homes and streets) networks. Based on a hermeneutic analysis, the study presented an ethnographic description of the context of CAPS, RAPS, and the cases of the three users based on the researcher's experiences as a psychologist and citizen of Seabrense, which resulted in three categories of analysis. The first highlighted the formal and informal care practices produced in the itineraries of these three cases. Among the results, we highlight the presence of practices aligned with an ambulatorial logic, anchored in biomedical rationality and contributing to an approach focused on medicalization, pathologization, and social exclusion. The presence of other care practices was evident, such as those produced by the researcher and the users themselves, which focused on emancipatory care based on aspects of otherness, geared toward encounters and affections. In the second category, some sociocultural aspects were demonstrated from an intersectional perspective, circumscribed in the daily routine of services, relationships, and territories, such as: the local value system based on christian morality, which produced an ambiguous relationship of care with users, in addition to the so-called “culture of gossip,” which materialized as a practice of socialization through which information about these people actively circulated throughout the city, producing spaces of care and reproduction of stigmas. In the third category, it was highlighted how functional and symbolic territories produced experiences based on sociocultural, historical, and affective values. Therefore, these experiences revealed exclusion and stigma based on colonialism of being, knowledge, and power, contributing to the intersection of experiences based on race/color, gender, and class as structuring factors in the experience of daily suffering, illness, and the production of new meanings of life. In general, the relevance of understanding the complexity present in care practices produced in mental health itineraries was highlighted. When territorial and cultural aspects inherent to small towns and rural areas are highlighted, such practices become even more complex and may be paths for prioritizing mental health issues in political agendas and in the production of new practices and encounters.