Within the diversity of academic fields, topics, subjects and theoretical-methodological reference points presented by the texts that make up the sections of issue 34 of Interface - Comunicação, Saúde, Educação, the following contributions stand out: representations among healthcare and education professionals regarding distress, becoming ill and care; healthcare education and professional training as a strategy for producing care and promoting health; medicalization of the social sphere; and the complexity involved in the field of producing care for mental health.
The "Dossier on medical discourse: diagnose and medicalization" is structured with two articles that make up different viewpoints on medical discourse. They bring new views on the wide-ranging and long process of medicalization and modification of the borders between normal and pathological.
The debate on increasing use of medications, especially through expansion of the use of psychiatric drugs for therapeutic purposes and their spread beyond this domain, is richly updated through the approach used for attention deficit disorder, with or without hyperactivity. The social implications of expansion of this diagnosis and the spread of drug use (especially ritalin) as a therapeutic method are discussed by María Cecília Tamburrino and coworkers in the article "Medical discourse and marketing strategies in the pharmaceutical industry, within the processes of medicalization of childhood in Argentina". From an analysis of the discourse within the medical field (pediatrics, child and adolescent psychiatry and child neurology) in the regions of Buenos Aires, Corrientes, Salta and Tierra del Fuego, concerning the diagnosis of attention deficit disorder and medical treatment with drug use for the child population, the authors indicate that, although most of the interviewees recognized the difficulty in making precise diagnoses, drugs become imposed as the therapeutic choice in most cases. The treatment circuit within which the decision to medicated emerges covers different spheres such as the school (which proposes the treatment), the family (which asks the physician for it) and the physician (who, even with difficulty in defining the diagnosis, prescribes the drug). The influence of the pharmaceutical industry within the spheres of this circuit can also be highlighted. Through marketing strategies, these companies disseminate information that goes beyond the medical community and penetrates schools and families, which are the main areas of children's lives.
The second study, "Ritalin in Brazil: production, discourse and practice", by Francisco Ortega and coworkers, discusses the social perception of drugs in this country, where the use of drugs to treat attention disorders has increased considerably over the last decade, while at the same time, their use by healthy individuals seeking to improve their cognitive functions has been observed. The results from two fields of investigation are analyzed: firstly, in relation to Brazilian publications on ritalin (both within scientific journals and within the popular media); and secondly, in relation to representations by university students, their parents and healthcare professionals about the use of ritalin for improving cognitive performance. From this second field, a rich discussion emerges regarding the frontiers between natural and artificial and between nature and culture, including repercussions within the area of what should be morally acceptable. In the authors' opinion, while biological nature was previously considered to be immutable, it has become a relative matter, in that tolerance to neurological changes stemming from a social ideal that places value on individuals' performance is emphasized.
In the Articles section, studies dealing with the new production of mental healthcare that has come through the Brazilian psychiatric reform movement have prominence. They highlight the complexity of practices, knowledge and social and cultural values within day-to-day activities in mental health institutions and associations. In a study on the meanings of work and organizational imaginary at a psychosocial attendance center in Rio de Janeiro, Vinícius Vasconcellos and Creuza Azevedo discuss the professionals' experiences of pleasure and distress. With arguments based on the tenuous balance between, on the one hand, therapeutic success in the work performed and the recognized importance of the reform proposals and, on the other hand, the adversities stemming from the scarcity of materials and resources, along with the low social value placed on the work, the limits and possibilities for transforming mental healthcare are discussed. With equal concern regarding the production of care within this field, a study by researchers in Rio Grande do Norte (Kamila S. Almeida, Magda Dimenstein and Ana Kalliny Severo) analyzes day-to-day activities at a local association that brings together mental healthcare users, members of their families and professionals, and seeks to gain an understanding of these associative devices, as strategies for empowering users and their families, in terms of boosting these subjects' strength and autonomy. This study shows that there are limits to the empowerment of users and their families, which emerge from multiple factors, including institutional, political and financial factors. The pertinence of the subjects' empowerment and participation in policies, as a potential means of therapy, is highlighted in the sense of achieving rights and exercising active citizenship.
Among other equally interesting questions debated in the remaining studies that make up this issue, the experience reported in the Open Space section regarding the implementation of a healthcare service linked to a Camdomblé religious temple in a satellite municipality of Rio de Janeiro deserves to be highlighted. In this way, questions relating to prejudice, religious intolerance and cordial racism, among others, are explored within the context of healthcare actions aimed towards the black population that has links to Afro-Brazilian religions. This study serves to provide reflections regarding equity and comprehensiveness within healthcare.
On Interview section, Mary Jane Spink promotes an interesting dialog with Lupicinio Iñiguez- Rueda, Social Phycology full professor of Barcelona Autonm University, discussing emergent issues focusing on health life syles and "health promotion" thath were investigated during the research project "Control and use of tobacco in sociability public spaces", developed with the CNPq support.
Our readers are thus invited to appreciate the richness of these topics, the complexity of the subjects and the depth of the debates.
Márcia Thereza Couto
Department of Preventive Medicine