Dissociação, experiência e narrativa – um estudo de caso

Dias, Marcelo Kimati; Santos, José Luiz dos

doi:10.1590/1415-47142006004002

Resumos

Dissociação da consciência é um fenômeno que ocorre tanto em situações culturalmente sancionadas, como rituais religiosos, quanto dentro de contextos médicos. As classificações diagnósticas procuram diferenciar estes episódios em dois fenômenos distintos. Ainda que haja esta tentativa, indivíduos que apresentam quadros dissociativos freqüentemente procuram diferentes possibilidades interpretativas desse fenômeno. O presente estudo procura, por meio de uma etnografia centrada na pessoa, descrever o itinerário de diferentes saberes percorrido por uma paciente com episódios dissociativos. Identificamos ainda que a construção da narrativa da experiência dissociativa apresenta especificidades relacionadas ao fenômeno psicopatológico da dissociação.

Dissociação; etnografia centrada na pessoa; narrativa; psiquiatria cultural

Disociación de la conciencia es un fenómeno que ocurre en contextos culturales, como rituales religiosos, así como en situaciones médicas. Las clasificaciones diagnósticas buscan distinguir esas dos clases de fenómenos. Aunque la diferenciación sea hecha, las personas que presentan experiencias disociativas buscan diferentes posibilidades interpretativas para esos fenómenos. El presente artículo procura a través de una etnografía centrada en la persona describir esos diferentes significados encontrados por una paciente con experiencias disociativas. Además identificamos en la narrativa de esas experiencias la especificidad del fenómeno psicopatológico de la disociación.

La dissociation de la conscience est un phénomène qui se présente dans des situations culturellement sanctionnées, comme des rituels religieux, aussi bien que dans des contextes médicaux. Les classifications du diagnostique cherchent à différencier ces épisodes en deux phénomènes distincts. Néanmoins, les individus présentant un état dissociatif cherchent, en général, différentes interprétations pour ce phénomène. Cette étude a pour but de décrire les itinéraires de différents savoirs parcourus par ces patients tout en s’appuyant sur une ethnographie centrée sur la personne. On reconnaîtra encore dans la narrative de l’expérience dissociative quelques spécificités liées au phénomène psychopathologique de la dissociation.

Dissociation; ethnographie centrée sur la personne; narrative; psychiatrie culturelle

The dissociation of consciousness is a phenomenon that can be seen in both culturally sanctioned situations (such as in religious cults) and in medical settings. Diagnosis classification manuals, such as the DSM-IV and the ICD-10, seek to separate these situations into cultural phenomena and mental disorders, respectively. Despite this difference in diagnoses, patients who have had dissociative experiences often seek different meanings for the phenomena. Through an ethnography centered on the person, this article presents a description of different experiences of a female patient who has had dissociative experiences. The psychopathologic specificities of the construction of the narrative based on these experiences are also discussed.

Dissociation; etnography centered on the person; narrative; cultural psychiatry

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Referências

ALEXANDER, P. J.; JOSEPH, S.; DAS, A. Limited utility of ICD-10 and DSM-IV classification of dissociative and conversion disorders in India. Acta Psychiatrica Scandinavian, v. 95, n. 3, p. 177-82, mar./1997.
AKYUX, G.; DOGAN, O.; SAR, V.; YARGIC, L. I.; TUCHUN, H. Frequency of dissociative identity disorder in the general population in Turkey. Comprehensive Psychiatry, v. 40, n. 2, p. 151-9, mar.-apr./1999.
BENG-YEONG, Ng. Phenomenology of trance states seen at a psychiatric hospital in Singapure: a cross-cultural perspective. Transcultural Psychiatry, v. 37, n. 4, p. 561-580. Dec./2000.
BENJAMIN, W. Obras Escolhidas. O narrador – v. 1. 3. ed. São Paulo: Brasiliense, 1987.
BOURGUIGNON, E. Multiple personality, possession trance and the psychic unit of mankind. Ethos, v. 17, n. 3, p. 371-84, 1989.
BOURGUIGNON, E. The DSM-IV and cultural diversity. Transcultural Psychiatry Research Review, v. 29, n. 4, p. 330-2, 1992.
CSORDAS, T. Health and the holy in African and Afro-American spirit possession. Social Science and Medicine, v. 24, n. 1, p. 1-11, 1987.
DAS, P. S.; SAXENA, S. Classification of dissociative states in DSM-III-R and ICD-10 (1989 draft). A study of Indian out-patients. British Journal of Psychiatry, n. 159, p. 425-7, sep./1991.
DORAHY, M. J.; SCHUMAKER, J. F.; KRISNAMURTHY, R.; KUMAR, P. Religious ritual and dissociation in India and Australia. Journal of Psychology, v. 131, n. 5, p. 471-6, sep./1997.
DOUGLAS, M. Thought Style Exemplified. The Idea of the Self, in Risk and Blame – Essays in Cultural Theory London: Routledge, 1992. p. 211-34.
ESCOBAR, J. L. Transcultural aspects of dissociative and somatoform disorders. Psychiatric Clinical North America, v. 18, n. 3, p. 555-69, sep./1995.
FRIEDL, M. C; DRAIJER, N.; de JORGE, P. Prevalence of dissociative disorders in psychiatric in-patients: the impact of study characteristics. Acta Psychiatrica Scandinavian, v. 102, n. 6, p. 423-8, dec./2000.
GAST, U.; RODEWALD, F.; NICKEL, V.; ENRICH, H. M. Prevalence of dissociative disorders among psychiatric inpatients in a German university clinic. Journal of Nervous and Mental Disease, v. 189. n. 4, p. 249-57, apr./2001.
GLEAVES, MAY e CARDEÑA. An examination of the diagnostic validity of dissociative identity disorder. Clinical Psychology Review, v. 21, n. 4, p. 577-608, Jun./2001
HALPERIN, D. Trance and Possession: are they the Same. Transcultural Psychiatric Research Review, v. 33, n. 1, p. 33-42, 1996.
HAUGEN, M.C.; CASTILLO, R. J. Unrecognized dissociation in psychotic outpatients and implications of ethnicity. Journal of Nervous Mental Disease, v. 187, n. 12, p. 751-4, dec./1999.
HESS, D. Ghosts and domestic politics in Brazil: some parallels between spirit possession and spirit infestation. Ethos, v. 18, n. 4, p. 407-38.
HOCKMAN, J.; POPE, H. G. Jr. Debating dissociative diagnoses. American Journal of Psychiatry, v. 154, n. 6, p. 887-8, jun./1997.
HOLLAN, DOuglas. The relevance of person-centered ethnography to cross-cultural psychiatry. Transcultural Psychiatry, v. 34, p. 219-234, Jun./1997.
KIRMAYER, L. J. Taking possession of trance. Transcultural Psychiatric Research Review, n. 39, p. 283-6, 1992.
KIRMAYER, L. J. Pacing the Void: Social and Cultural Dimensions of Dissociation. In: SPIEGEL, D. (ed.). Dissociation: Culture, Mind and Body (91-122). Washington, DC: American Psychiatry Press, 1994.
KIRMAYER, L.J. & SANTHANAN, R. The anthropology of hysteria conversion disorder. In: HALLIGAN, P.W., Bass, C. & MARSHALL, J. C. (eds.). Contemporary Approaches to the Study of Hysteria: Clinical and Theoretical Perspectives. Oxford: Oxford University Press, 2001. p. 251-70.
KLEINMAN, A. Patients and Healers in the Context of Culture University of California Press, 1980.
KLEINMAN, A. Rethinking Psychiatry: From Cultural Category to Personal Experience. New York: The Free Press, 1988.
KLUFT, R. P.; FOOTE, B. Dissociative identity disorder: recent developments. American Journal of Psychotherapy, v. 53, n. 3, p. 283-8, summer-1999.
LEWIS, I. M. Êxtase religioso. São Paulo: Perspectiva, 1977.
NELIAH, J.C. A psychodynamic view of psychosomatic medicine. Psychosomatic Medicine, v. 62. n. 3, p. 299-303, May-Jun./2000.
NORTH, C. S. The toll of refugee status and the state of trauma research. Archives of General Psychiatry, v. 58, n. 5, p. 483-4, may/2001.
POPE JR., H.G., OLIVA, O.S., HUDSON, J.I., BODKIN. J.A., GRUBER. A.J. Attitudes toward DSM-IV dissociative disorders diagnoses among board – Certified American psychiatrists. American Journal Psychiatry, v. 156. n. 2, p. 321-3, Feb./1999.
RABNOW, PAUL Antropologia da razão: ensaios de Paul Rabinow. Organização e tradução de João Guilherme Biehl. Rio de Janeiro: Relume-Dumará, 1999.
REDKO, C.P. Fighting against the “evil” Religious and cultural construction of the first psychotic experience of young people living in São Paulo, Brazil (2000).A thesis submitted to the Faculty of Graduate Studies and Research in partial fullfilment of the requirements of the degree of Ph.D in Anthropology McGill University.
RICOEUR, PAUL. (1994). A história e a narrativa. In: Tempo e narrativa. Campinas: Papirus, 1994. t. 1.
SAR, V.; TUTKUN, H.; ALYANAK, B.; BAKIM, B.; BARAL, I. Frequency of dissociative disorders among psychiatric outpatients in Turkey. Compreensive Psychiatry, v. 41, n. 3, p. 216-22, may/2000.
SCOTT, J. W. (1999). Experiência em falas de gênero. In: da S. LEITE, Alcione; LAGO, Mara Coelho de Souza e RAMOS, Tânia Regina Oliveira (orgs.). Teorias, análises, leituras Florianópolis: Mulheres.
SOMER, Eli and SAADON, Meir Stambali. Dissociative possession and trance in a Tunisian healing dance. Transcultural Psychiatry, n. 37, p. 580-600, Dec./2000.
THOMPSON, E. P. Formação da classe trabalhadora inglesa S.I/E/ed., 1990.
TUTKUM, H.; SAR, V.; YARGIC, L. I.; OZPULAT, T.; YANIK, M.; KIZILTAN, E. Frequency of dissociative disorders among psychiatric inpatients in a Turkish University Clinic. Am J. Psychiatry, v. 155, n. 6, p. 800-5, jun./1998.
ZATZICK, D. F.; MARMAR, C. R.; WEISS, D. S; METZLER, T. Does trauma-linked dissociation vary across ethnic groups? Journal of Nervous and Mental Disease, v. 182, n. 10, p. 576-82, oct./1994.

Datas de Publicação

Publicação nesta coleção
Dez 2006

Histórico

Recebido
Abr 2006
Aceito
Jul 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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[2] AKYUX, G.; DOGAN, O.; SAR, V.; YARGIC, L. I.; TUCHUN, H. Frequency of dissociative identity disorder in the general population in Turkey. Comprehensive Psychiatry, v. 40, n. 2, p. 151-9, mar.-apr./1999.

[3] BENG-YEONG, Ng. Phenomenology of trance states seen at a psychiatric hospital in Singapure: a cross-cultural perspective. Transcultural Psychiatry, v. 37, n. 4, p. 561-580. Dec./2000.

[4] BENJAMIN, W. Obras Escolhidas. O narrador – v. 1. 3. ed. São Paulo: Brasiliense, 1987.

[5] BOURGUIGNON, E. Multiple personality, possession trance and the psychic unit of mankind. Ethos, v. 17, n. 3, p. 371-84, 1989.

[6] BOURGUIGNON, E. The DSM-IV and cultural diversity. Transcultural Psychiatry Research Review, v. 29, n. 4, p. 330-2, 1992.

[7] CSORDAS, T. Health and the holy in African and Afro-American spirit possession. Social Science and Medicine, v. 24, n. 1, p. 1-11, 1987.

[8] DAS, P. S.; SAXENA, S. Classification of dissociative states in DSM-III-R and ICD-10 (1989 draft). A study of Indian out-patients. British Journal of Psychiatry, n. 159, p. 425-7, sep./1991.

[9] DORAHY, M. J.; SCHUMAKER, J. F.; KRISNAMURTHY, R.; KUMAR, P. Religious ritual and dissociation in India and Australia. Journal of Psychology, v. 131, n. 5, p. 471-6, sep./1997.

[10] DOUGLAS, M. Thought Style Exemplified. The Idea of the Self, in Risk and Blame – Essays in Cultural Theory London: Routledge, 1992. p. 211-34.

[11] ESCOBAR, J. L. Transcultural aspects of dissociative and somatoform disorders. Psychiatric Clinical North America, v. 18, n. 3, p. 555-69, sep./1995.

[12] FRIEDL, M. C; DRAIJER, N.; de JORGE, P. Prevalence of dissociative disorders in psychiatric in-patients: the impact of study characteristics. Acta Psychiatrica Scandinavian, v. 102, n. 6, p. 423-8, dec./2000.

[13] GAST, U.; RODEWALD, F.; NICKEL, V.; ENRICH, H. M. Prevalence of dissociative disorders among psychiatric inpatients in a German university clinic. Journal of Nervous and Mental Disease, v. 189. n. 4, p. 249-57, apr./2001.

[14] GLEAVES, MAY e CARDEÑA. An examination of the diagnostic validity of dissociative identity disorder. Clinical Psychology Review, v. 21, n. 4, p. 577-608, Jun./2001

[15] HALPERIN, D. Trance and Possession: are they the Same. Transcultural Psychiatric Research Review, v. 33, n. 1, p. 33-42, 1996.

[16] HAUGEN, M.C.; CASTILLO, R. J. Unrecognized dissociation in psychotic outpatients and implications of ethnicity. Journal of Nervous Mental Disease, v. 187, n. 12, p. 751-4, dec./1999.

[17] HESS, D. Ghosts and domestic politics in Brazil: some parallels between spirit possession and spirit infestation. Ethos, v. 18, n. 4, p. 407-38.

[18] HOCKMAN, J.; POPE, H. G. Jr. Debating dissociative diagnoses. American Journal of Psychiatry, v. 154, n. 6, p. 887-8, jun./1997.

[19] HOLLAN, DOuglas. The relevance of person-centered ethnography to cross-cultural psychiatry. Transcultural Psychiatry, v. 34, p. 219-234, Jun./1997.

[20] KIRMAYER, L. J. Taking possession of trance. Transcultural Psychiatric Research Review, n. 39, p. 283-6, 1992.

[21] KIRMAYER, L. J. Pacing the Void: Social and Cultural Dimensions of Dissociation. In: SPIEGEL, D. (ed.). Dissociation: Culture, Mind and Body (91-122). Washington, DC: American Psychiatry Press, 1994.

[22] KIRMAYER, L.J. & SANTHANAN, R. The anthropology of hysteria conversion disorder. In: HALLIGAN, P.W., Bass, C. & MARSHALL, J. C. (eds.). Contemporary Approaches to the Study of Hysteria: Clinical and Theoretical Perspectives. Oxford: Oxford University Press, 2001. p. 251-70.

[23] KLEINMAN, A. Patients and Healers in the Context of Culture University of California Press, 1980.

[24] KLEINMAN, A. Rethinking Psychiatry: From Cultural Category to Personal Experience. New York: The Free Press, 1988.

[25] KLUFT, R. P.; FOOTE, B. Dissociative identity disorder: recent developments. American Journal of Psychotherapy, v. 53, n. 3, p. 283-8, summer-1999.

[26] LEWIS, I. M. Êxtase religioso. São Paulo: Perspectiva, 1977.

[27] NELIAH, J.C. A psychodynamic view of psychosomatic medicine. Psychosomatic Medicine, v. 62. n. 3, p. 299-303, May-Jun./2000.

[28] NORTH, C. S. The toll of refugee status and the state of trauma research. Archives of General Psychiatry, v. 58, n. 5, p. 483-4, may/2001.

[29] POPE JR., H.G., OLIVA, O.S., HUDSON, J.I., BODKIN. J.A., GRUBER. A.J. Attitudes toward DSM-IV dissociative disorders diagnoses among board – Certified American psychiatrists. American Journal Psychiatry, v. 156. n. 2, p. 321-3, Feb./1999.

[30] RABNOW, PAUL Antropologia da razão: ensaios de Paul Rabinow. Organização e tradução de João Guilherme Biehl. Rio de Janeiro: Relume-Dumará, 1999.

[31] REDKO, C.P. Fighting against the “evil” Religious and cultural construction of the first psychotic experience of young people living in São Paulo, Brazil (2000).A thesis submitted to the Faculty of Graduate Studies and Research in partial fullfilment of the requirements of the degree of Ph.D in Anthropology McGill University.

[32] RICOEUR, PAUL. (1994). A história e a narrativa. In: Tempo e narrativa. Campinas: Papirus, 1994. t. 1.

[33] SAR, V.; TUTKUN, H.; ALYANAK, B.; BAKIM, B.; BARAL, I. Frequency of dissociative disorders among psychiatric outpatients in Turkey. Compreensive Psychiatry, v. 41, n. 3, p. 216-22, may/2000.

[34] SCOTT, J. W. (1999). Experiência em falas de gênero. In: da S. LEITE, Alcione; LAGO, Mara Coelho de Souza e RAMOS, Tânia Regina Oliveira (orgs.). Teorias, análises, leituras Florianópolis: Mulheres.

[35] SOMER, Eli and SAADON, Meir Stambali. Dissociative possession and trance in a Tunisian healing dance. Transcultural Psychiatry, n. 37, p. 580-600, Dec./2000.

[36] THOMPSON, E. P. Formação da classe trabalhadora inglesa S.I/E/ed., 1990.

[37] TUTKUM, H.; SAR, V.; YARGIC, L. I.; OZPULAT, T.; YANIK, M.; KIZILTAN, E. Frequency of dissociative disorders among psychiatric inpatients in a Turkish University Clinic. Am J. Psychiatry, v. 155, n. 6, p. 800-5, jun./1998.

[38] ZATZICK, D. F.; MARMAR, C. R.; WEISS, D. S; METZLER, T. Does trauma-linked dissociation vary across ethnic groups? Journal of Nervous and Mental Disease, v. 182, n. 10, p. 576-82, oct./1994.