O desejo na psicose e a construção do Projeto Terapêutico Singular: considerações psicanalíticas sobre a direção de tratamento na saúde mental pública

Abstract

The present research intends to discuss the construction of a Projeto Terapêutico Singular (Unique Therapeutic Project) in public mental health, specifically in the Centro de Atenção Psicossocial infanto-juvenil( Center for Psychosocial Childhood Care) - CAPSi, considering the dimension of the desire in the composition of such projects, and more specifically the desire in the psychotic subject. For this, we will walk through the postulates of Lacan about the direction of treatment and emphasizing the direction of treatment in psychosis. We will present a clinical vignette at the end of the study in order to analyze the clinical effects of positioning the psychotic as subject of desire for the work formulated in the CAPSi. We will articulate the proposal of the Projeto Terapêutico Singular (Unique Therapeutic Projects) -PTS established by the Política Nacional de Humanização (National Policy of Humanization)- PNH with the intention of singling out the care and psychoanalysis that has as ethical foundation the radical defense of the subject in his singular expression. In this sense, we will return to the changes in the paradigm of care in the field of Mental Health from the resonances that the Psychiatric Reform and Sanitary Reform had in reordering the practices, which started to be based on the perspective of Psychosocial Care, proposing another place to the psychic suffering subject. The premise become to be the singularized care. From the considerations of psychoanalysis about the desire, we will discuss the operations of psychic constitution in order to inscribe psychosis as one of the modalities of possible structure, highlighting it of the signs of gravity and disease presenting it as an existential possibility, signaling the particularities of the desire in psychosis. Thus we return to the radical defense of the subject in its singularity which articulates psychoanalysis to the SUS by raising the ethical-political dimension by situating the psychotic subject as desiring