ayres de jazz

El nombre, de claras resonancias piazzollianas, tiene su sentido. El jazz es, ante todo, libertad, mestizaje cultural y elogio de la diversidad. Ayres de Jazz es un pequeño velero que se desplaza en el oceano ciberespacial guiado por la curiosidad con el anhelo de comprender lo que esta sucediendo. Eso es todo.

Saturday, April 14, 2012

La dignidad del riesgo como antidoto al estigma

Por Eduardo Basz

Miembro del Observatorio Dignidad( de seguimiento de la Convencion de los Derechos de las Personas con Discapacidad y de la Ley de Salud Mental).



Si aspiramos a que el diagnostico no fortalezca el estigma debemos vivir la dignidad del riesgo.Debe hacernos pensar que estos dos conceptos ( el del estigma y el de la dignidad del riesgo) vinieron de afuera del campo de la salud mental.Es decir, de personajes que eran algo asi como extranjeros o viajeros que visitaron un continente antiguo y lo observaron con ojos nuevos.Estoy hablando de un sociologo y de un pastor metodista. Ambos americanos.Aunque el libro clasico de Goffman fue escrito en el ´63, con casi un decenio de anticipacion a la formulacion de la nocion de dignidad del riesgo, ya plantea algunas propuestas para enfrentar al estigma. Despues de un largo y sinuoso camino, estos conceptos se fusionaron con el paradigma de nuestra epoca: politicas de salud mental compatibles con los derechos humanos.Hoy dia, sabemos que puede ser humillante la proteccion y puede haber dignidad en el riesgo.quiero decir, que cuando hablamos de extension de derechos y garantias no estamos hablando de otra cosa sino de la autonomia de las personas.

Aun asi, puede haber estigma sin diagnostico. De echo es lo que suele suceder.Basta que un sujeto empiece a manifestar problemas de salud mental para que todo el dispositivo social del estigma caiga sobre el y que la maquinaria kafkiana (estatal o privada) ponga en funcionamiento el modelo tutelar.La “locura” moviliza mitos primitivos sobre la posesion diabolica, vigentes hoy dia en la figura del “loco peligroso”. Eso no impide que ante la irrupcion de un psicopata tenga en forma inmediata un sequito de devotos.Por definicion el estigma es una marca visible, una diferencia abominable que el canon social establece como intolerable. Afecta a un individuo que podia intervenir enel juego social pero queda fuera de juego al poseer (o estar poseido) por ese rasgo que coloca en la penumbra sus cualidades y talentos.La persona estigmatizada esta desacreditada, es una no-persona y en situaciones extremas un subhumano, untermench. Suele recordarse que el proyecto genocida del III Reich comenzo en los manicomios. No esta mal. Pero tambien seria bueno tener presente que el unico fiscal de toda la Republica de Weimar que se atrevio a llevar a Hitler a un proceso penal fue una persona con trastorno bipolar.

Porque si puede haber estigma sin diagnostico, el desafio etico es que este recurso del pensamiento cientifico actue en favor de los derechos. Si queremos actuar en favor de la autonomia de las personas con problemas de salud mental, podiamos buscar nuevas practicas que permitan la intervencion de los usuarios en la elaboracion de su diagnostico. Esto tiene un valor adicional si comprobamos la dificultad para la elaboracion de un diagnostico preciso. Al establecer una relacion cuasi-igualitaria con el usuario, la figura del profesional queda desacralizada y definida en terminos laicos y terrenales. Su ejercicio profesional es valorado en terminos de pericia tecnico-cientifica. Lamentablemente, no es lo que suele suceder. Poco despues de un diagnostico psiquiatrico (preciso o erroneo) pero mas aun despues de una internacion, una persona queda expuesta a la marca abominable del estigma. De todos modos, cuando Goffman escribio su libro en el 63 mencionaba entre las poblaciones estigmatizadas a los judios, los negros, los homosexuales, las personas con discapacidad fisica, lo que nosotros llamamos “pibes chorros” y por supuesto los asi llamados

“enfermos mentales”. Desde entonces, muchas de estas poblaciones hanavanzado en la lucha contra la discriminacion y lograron cambios significativos en la percepcion social. De echo, hace poco estuve en El Bolson y ahi las personas con algun problema de salud mental exprensan que tienen el apoyo de la comunidad.Las practicas discriminatorias son ejercidas por una minoria. En contraste, en el Chaco sufren un maltrato constante aunque en esa provincia no hay manicominios.Nunca los hubo. De todos modos, la maquinaria kafkiana se las ingenia para funcionar a la perfeccion sobre todo si el sujeto afectado es pobre, negro y loco.

En la nueva agenda de los derechos humanos, la autonomia de las personas aparece como una cuestion central. Entonces, ¿en que punto el diagnostico opera en favor del estigma?: cuando frente a determinados problemas de salud mental deriva en una anulacion de derechos. En estas situaciones, los profesionales de la salud pasan a formar parte de la maquinaria kafkiana. Lo contrario sucede cuando el diagnostico puede convertirse en un punto de apoyo solido para que el usuario enfrente a sus demonios y salga del infierno. Dicho en terminos de la Red Mundial de Usuarios y Sobrevivientes de la Psiquiatria, se trata de “crear solidos modelos alternativos para una respuesta social a las personas que vivencias locura, problemas de salud mental y trauma. Estos modelos hacen hincapie en la experiencia en primera persona, honrando pensamientos y sentimientos cumpliendo con necesidades practicas, tomando el tiempo suficiente para la solucion o la curacion y ponen enfasis en la capacidad de cada persona de transformar su vida”. Esto no es otra cosa que una critica de la mitologia del desvalimiento y proponer una etica de la confianza en si mismo. La mitologia del desvalimiento da lugar a un conjunto de reglas de ayuda y proteccion que solo sirven para la invalidacion e infantilizacion de las personas con algun problema de salud mental. Es como si hubiera habido una conspiracion, por decirlo de alguna manera, entre diferentes fuerzas sociales para instruir al asi llamado “enfermo mental” a comportarse de una manera preestablecida: un inutil para el juego social, el idiota de la familia, un individuo debil de carácter y asustadizo. Desgraciadamente, muchos lo aceptaron y le reclaman a la familia, al estado, a la religion que los proteja y les resuelva sus problemas.

Cuando Robert Perske (pastor metodista, capellan de un instituto psiquiatrico, veterano de la guerra del Pacifico) creo la expresion dignidad del riesgo a comienzos de los ´70 le dio su significado muy distinto. “La sobreproteccion puede parecer amable en la superficie pero puede ser muy mala. Puede asfixiar emocionalmente a la gente. Exprimir sus esperanzas y despojarlas de su dignidad.La sobreproteccion puede impedir que la gente se convierta en lo que deberia ser. Por otro lado, el riesgo es real porque no se sabe de antemano si una persona va a tener éxito. El mundo real no siempre es seguro y predecible. No siempre dice “perdon”, “por favor”, “lo siento”. En el pasado, encontramos formas ingeniosas de evitar el riesgo de las personas con discapacidad. Ahora, tenemos que trabajar igual de duro para que estas personas ejerzan su derecho de apropiarse del riesgo. Puede haber un desarrollo saludable en la toma de riesgo y puede ser paralizante la seguridad de la indignidad”.

Constituido en sujeto social, el usuario interviene en el debate de las politicas de salud mental con una voz nueva, diferente y desafiante. En este sentido, la lucha contra el estigma y la practica de la dignidad del riesgo aparecen en el nudo de los problemas contemporaneos, donde se encuentran y chocan el pensamiento cientifico con los derechos humanos.

Sabemos que el encierro degrada a las personas. Posiblemente, la dignidad del riesgo no tenga todas las respuesta ni todas las soluciones. Pero es una propuesta efectiva para poner en crisis el dispositivo kafkiano del maltrato, de la cruelda y para decirlo con todas las letras de la tortura. Pero sobre todo para abrir nuevos caminos.

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