Abstract

This article discusses the articulation between the participants and data analysis according to the methodology in participatory research-intervention linked to the Gaining Autonomy & Medication Management (GAM) approach. For this intervention study, all participants are researchers, which alters the prevailing understanding about how to analyze in a study. We understand that there is a circular relationship between participation and analysis: effective participation depends on the collective achievement of the analysis by all researchers; the analysis allows the identification and transformation of different qualities of participation, being a tool to promote autonomy and co-management. In this article, we seek to identify two main qualities of participation present in the field experience with a group of GAM family members: automatic participation and autonomous participation. This distinction has as one of its main references Francisco Varela's enactive approach, his characterization of cognitive automatism and his concept of breakdown. In this context, participation and analysis are mutually implicated, since the analysis allows the identification of automatisms and the promotion of breakdowns, fomenting the autonomy in the participation; on the other hand, this has the effect of collectivizing the analysis and the distribution of the task of knowledge production among all participants.

Keywords:
Community-Based Participatory Research; Data analysis; Gaining Autonomy & Medication Management; Intervention Research; Enactive Approach

Introduction

The theme of participation has a prominent place in the health field in Brazil (Cavalcanti; Cabral; Antunes, 2012CAVALCANTI, M. L. T.; CABRAL, M. H. P.; ANTUNES, L. R. Participação em saúde: uma sistematização de artigos publicados em periódicos brasileiros: 1988/2005. Ciência & Saúde Coletiva, Rio de Janeiro, v. 17, n. 7, p. 1813-1823, 2012.). As an organizational principle of the Brazilian National Health System (SUS), popular participation has gained relevance not only as an object of scientific studies, but also as part of research methodologies. Hence the importance, in the Brazilian and Latin American context, of intervention studies and participatory health research, composing a transformation landscape in which scientific investigations seek to organize themselves in a more socially distributed way (Pellegrini Filho, 2004PELLEGRINI FILHO, A. Pesquisa em saúde, política de saúde e eqüidade na América Latina. Ciência & Saúde Coletiva, Rio de Janeiro, v. 9, n. 2, p. 339-550, 2004.).

On the other hand, the theme of data analysis has received less attention. Widely explored by non-participatory research methodologies, it is little addressed by participatory research-intervention. Thus, we seek to discuss the articulation between participation and analysis from the perspective of the methodology of a participatory research-intervention on mental health. This discussion is based on field experience with the Gaining Autonomy & Medication Management (GAM) approach.

GAM originated in Canada aiming at expanding the autonomy of users of mental health service through a critical debate on the use of psychiatric drugs.¹1Cf. <https://bit.ly/2Bg0afX>. In Brazil, this discussion gained space thanks to the performance of the Universidade de Campinas (Unicamp), the Universidade Federal do Rio Grande do Sul (UFRGS), the Universidade Federal do Rio de Janeiro (UFRJ) and the Universidade Federal Fluminense (UFF) (Campos et al., 2012CAMPOS, R. T. O. et al. Adaptação multicêntrica de um guia para a gestão autônoma da medicação. Interface: Comunicação, Saúde, Educação, Botucatu, v. 16, n. 43, p. 967-980, 2012.). These universities promoted a participatory research-intervention for translation, adaptation and validation of the instrument used in this approach: the GAM Guide (GGAM) (Onocko Campos et al., 2012ONOCKO CAMPOS, R. T. et al. Guia da gestão autônoma da medicação (GAM). Campinas: Unicamp, 2012. Disponível em: <Disponível em: https://bit.ly/2n1358H >. Acesso em: 2 out. 2019.
https://bit.ly/2n1358H... ). In different fields, Intervention Groups (GI) were held with users and workers from Psychosocial Care Centers (CAPS - Centros de Atenção Psicossocial) where GGAM was discussed collectively. In the municipality of São Pedro da Aldeia (RJ), we validated the GAM device and GGAM with users, family members and workers from CAPS. Developed for users, the GGAM consists of questions covering daily experience of treatment, drug use and mental health issues, as well as informative texts on psychotropics, users’ rights, and health and social care network. ²2GGAM is available at <https://bit.ly/2n1358H>, and its English version can be found at <https://bit.ly/34AX9TR>.

The experience with GI with users, workers and university students (GIU) showed that users’ family members ³3Throughout the text, a linguistic problem emerged in Portuguese: what gender should be used when designating research participants? Especially when dealing with family members, generalizing to the male grammatical distinction generates discomfort: women, especially mothers, are the protagonists in the care of users. In Brazil, many families are run by women and, in many places, care is still seen as a primarily female task. This reality was reflected in the composition of the GIF, made up mostly of women (although — or even because of — the occasional presence of two fathers and one brother was significant and important). In GIF, unlike the GIU performed in the same CAPS, university researchers and female workers were also women, which brought the gender issue to the heart of the concrete description of the research experience, in contrast to the abstract male grammatical distinction. We avoided seeking a quick solution to this issue and chose to keep the text with gender fluctuations (male generalizations, ambiguous designations, and female forms) as a way of “staying with the problem” (Haraway, 2016). played a decisive role in managing psychiatric drugs use. In often precarious contexts of treatment and care, the medication was one of the only resources available to deal with possible crisis, causing family members to fear that users would stop taking their medication. Therefore, family members helped to control when psychiatric drugs should be taken, to obtain prescriptions and to provide the drugs to their relatives being treated (sometimes without consent). We thus understood that, to critically discuss the use of medication, it was necessary to create a device to include family members, the Family Intervention Group (GIF - Grupo de Intervenção com Familiares). At these meetings, we discussed the GGAM, trying to reformulate it when necessary.

This study will address the articulation between analysis and participation in the GIF. It will initially present a brief overview of intervention research and the place of participation in scientific research. Then, the different forms of participation found will be discussed - we were interested in asking which would be the ways of participating in the different devices. Finally, the study discusses how these modes of participation were articulated with the analysis and effects of this analysis on knowledge production and transformation of realities.

Intervention research, participation and data analysis

The expression “intervention research” represents a milestone for epistemological politics in human sciences, seeking to affirm the social insertion of knowledge production practices. Thus, although there are diversity of modes and areas, this expression always points to the idea of participation.

We could trace the path of forms of participation in research since Lewin’s action research in the United States in the 1930s (Barros, 1994BARROS, R. D. B. Grupo: a afirmação de um simulacro. 1994. Tese (Doutorado em Psicologia) - Pontifícia Universidade Católica de São Paulo, São Paulo, 1994.), passing through the emergence of a Latin American tradition in the 1950s and 1960s of participatory research linked to different social movements of emancipatory vocation (Brandão, 2006BRANDÃO, C. R. A pesquisa participante e a participação da pesquisa: um olhar entre tempos e espaços a partir da América Latina. In: BRANDÃO, C. R.; STRECK, D. R. Pesquisa participante: a partilha do saber. Aparecida: Ideias & Letras, 2006. p. 21-54.) and finally arriving to the current knowledge production methodologies linked to complexity theory, such as sociopraxis (Cordeiro; Villasante; Araújo Júnior, 2010CORDEIRO, J. C.; VILLASANTE, T. R. P.; ARAÚJO JÚNIOR, J. L. A. C. A participação e a criatividade como ferramentas de análise das políticas públicas. Ciência & Saúde Coletiva, Rio de Janeiro, v. 15, n. 4, p. 2123-2132, 2010.), which evokes the matrices of participatory democracy to challenge research problems and the direction of public policy. There is also the affirmation of the social relevance of knowledge production and its link with social movements, related to Southern epistemology and post-abyssal methodologies (Santos, 2018SANTOS, B. S. O fim do império cognitivo: a afirmação das epistemologias do sul. Coimbra: Almedina, 2018.).

A common idea to these perspectives is that research is not at the service of a description of reality: it modifies it. The researcher plays a role in transforming the contexts surveyed, albeit with varying degrees of engagement and diverse political positions. For this reason, “data analysis” does not occupy a central place in intervention research methodologies: the very notion of “data” is problematic here (Barros; Barros, 2014BARROS, L. M. R.; BARROS, M. E. B. O problema da análise em pesquisa cartográfica. In: PASSOS, E.; KASTRUP, V.; TEDESCO, S. (Org.). Pistas do método da cartografia: a experiência da pesquisa e o plano comum. Porto Alegre: Sulina, 2014. p. 175-202.). Interested in the transformations promoted by its own performance, the primordial matter of intervention is not a datum, a pre-existing something waiting for representation or interpretation. Thus, the term “analysis” in an intervention research is linked to the production of transformations (Lourau, 1975LOURAU, R. A análise institucional. Petrópolis: Vozes, 1975.).

The researcher is not the only one to participate in intervention research. One of the most striking interventions of this approach is the assertion of the participation of others, assessing its effects. This is the case of the “participatory research”, which claims as one of its main interventions the social, political and/or epistemological transformations of the active participation of others in their research devices (Passos; Barros, 2000PASSOS, E.; BARROS, R. B. A construção do plano da clínica e o conceito de transdisciplinaridade. Psicologia: Teoria e Pesquisa, Brasília, DF, v. 16, n. 1, p. 71-79, 2000.) ⁴4We emphasize here that intervention research always points to participation, but one may well emphasize the reverse idea. As pointed out by Rocha and Aguiar (2003, p. 66), “Intervention research is a tendency of participatory research that seeks to investigate the life of collectivities in their qualitative diversity, assuming an intervention of socioanalytic character.”This method also presents various degrees and nuances, as one can participate as a collaborator to achieve certain pre-established goals or as a co-author in the knowledge production process. Ultimately, as a co-author of knowledge, the research participant is assumed to be a researcher as well. If university researchers are holders of technical knowledge concerning research methodologies and field of study, participating researchers are holders of embodied knowledge of the experience to be investigated. Thus, the quality of participation is not the same in all research situations, nor during all moments of the same research. Arnstein’s scale (1969ARNSTEIN, S. R. A ladder of citizen participation. Journal of the American Planning Association, Abingdon, v. 35, n. 4, p. 216-224, 1969.), adopted in the field of sociology, for example, describes eight degrees of participation in research projects or social intervention.

The so-called participatory or participant field of methodologies is thus composed of different theoretical approaches and definitions of what participation would be. However, a common characteristic between them is their purpose of breaking with dogmas present in research methodologies of today’s majority tradition, such as the assumption of neutrality of the researcher and the condition of informant of the research subjects (Rocha; Aguiar, 2003ROCHA, M. L.; AGUIAR, K. F. Pesquisa-intervenção e a produção de novas análises. Psicologia: Ciência e Profissão, Brasília, DF, v. 23, n. 4, p. 64-72, 2003.. Schmidt, 2006SCHMIDT, M. L. S. Pesquisa participante: alteridade e comunidades interpretativas. Psicologia USP, São Paulo, v. 17, n. 2, p. 11-41, 2006.; Villasante, 2010VILLASANTE, T. R. Historias y enfoques de una articulación metodológica participativa. Cuadernos CIMAS, Madri, p. 1-18, 2010.). Thus, participatory methodologies seek to break with “extractive methodologies”, in which there is total unilaterality in the subject/object cognitive interaction, and those who see their knowledge being treated as raw materials never have control over the extractive process (Santos, 2018SANTOS, B. S. O fim do império cognitivo: a afirmação das epistemologias do sul. Coimbra: Almedina, 2018.). If participation is understood in its strong sense, it is not possible to sustain that the notion of “data analysis” of a research is a representation (or at best an interpretation) of reality carried out in a neutral and isolated manner by the researcher or scientist.

The analysis here necessarily articulates with the ethical-political engagement of the research and the different degrees of participation of all involved. Thus, because the participatory research does not fit the traditional scientific criteria and privileges its impact on a given social reality, the analysis gains a multiplicity of meanings, and it is not possible to definitively decide if it means a procedure linked to the production of knowledge or if it is an instrument operator of transformations. It is precisely the tension between these two dimensions - the production of knowledge and the transformation of reality - that, in our view, constitutes the intervention research. The analysis simultaneously involves both senses and allows us to see more vividly the interdependence between knowledge production and reality transformation.

It is undeniable that singular ways of sustaining the tension between these two dimensions throughout the research intervention process will trigger different aspects within each study. The notion of analysis will gain different meanings according to each methodological approach put into practice. In some cases, the analysis appears linked to the interpretation of reality data, even though they have been collected collaboratively; in others, the terms traditionally used in research assume new meanings, as happens in the works inspired by institutional analysis (Lourau, 1975LOURAU, R. A análise institucional. Petrópolis: Vozes, 1975.), in which the analysis appears as the operator of sociopolitical changes. In other cases, there is a break with the methodologies of the majority tradition, eliminating all their terminological vestiges and avoiding talking about “data analysis”.

Therefore, the analysis could hardly be defined in a general way, equally valid for such diverse practices. Our interest is less to propose a systematization of what analysis is (or should be) in this field, and rather to share some of the challenges we face in understanding what it was to analyze in the case of GAM research. We will discuss how our work was constituted in dealing with the tension between knowledge production and reality transformation, as well as the reasons that led us to add the term “participatory” to describe what we did.

How did we participate in intervention research?

To deepen the discussion on analysis and participation, we will present concrete experiences enabled by the GIF. It is noteworthy the heterogeneous composition of the GIF - made up of workers, family and academics -, which was due to a bet on the importance of lateralization of different points of view as a strategy to transform established power relations and expand the possibilities of participation of those involved.

Throughout the discussion process, the group experienced different moments and forms of participation and analysis. When we started working with family members of CAPS users, there was already a group made up, who met weekly and was coordinated by two workers. Validating GGAM in the existing family group was not part of the initial proposal of our project and raised questions and unforeseen problems. Due to the difficulties of setting up a new group, we chose to adapt the methodology, inserting the project in this device already in progress (Ramos, 2012RAMOS, J. F. C. A autonomia como um problema: uma pesquisa a partir da realização do dispositivo GAM em um CAPS fluminense. 2012. Dissertação (Mestrado em Psicologia) - Universidade Federal Fluminense, Niterói, 2012.; Renault, 2015RENAULT, L. A análise em uma pesquisa-intervenção participativa: o caso da gestão autônoma da medicação. 2015. Tese (Doutorado em Psicologia) - Universidade Federal Fluminense, Niterói, 2015.).

Initially, the mode of operation already established in the group was based on a form of participation that caught our attention, which we provisionally entitled “participation by testimonials and reports”. Given any question asked by the worker to the group, the family members answered with statements related to the question asked, without interfering in the speech of the “deponent”. Then, another relative would speak, referring to the initial question, as if during the previous speech people were just waiting for the opportunity to give their statement. There were very few exchanges between group participants. After the statement by all who wished to speak, the professional gave her opinion, made some encouraging comments or indicated that she would take action on the matters exposed. Then, another theme was brought to the agenda by the worker, raising new testimonials from family members.

The mode of participation of workers in the group was analogous to that perceived among family members. The workers were involved in a series of activities related to mental health in the municipality and intended to have family members as partners. To this end, during group meetings, they transmitted to family members news about the progress of the proceedings - which did not always concern situations that directly involved them. They repeatedly asked, “What’s up? What do you think? Do you think this is good?”, to which they answered yes. Following this, the report agenda continued. Thus, although the meeting had the purpose of sharing with family members, in practice, this way of doing so did not trigger a process of exchange between the participants of the group itself. Participation was mitigated.

Interestingly, this functioning could not be attributed to specific participants, but it was diluted in the way the group interacted. Initially, we, the university researchers, had a similar participation: we followed the reports and testimonials as if they did not concern us much and were not linked to our purpose of validating the GGAM. We were then waiting for our time to talk about the Guide and, in a way, to give our testimony of intervention research.

After perceiving this way of working, the handling of the group was dedicated to deconstruct it and transform our own way of participating, inviting participants to give their opinions on what others said. “So, what does the group think of what X said?”, “Did anyone think anything other than what was said?”, “Y is saying such a thing, but how is to others?”, we asked. As we changed our way of being in the group, the participations of others also changed. The speeches progressively began to intersect more and to question each other, becoming inextricably involved.

The handling of the group, then, deliberately aimed at this type of functioning: initially located in the researchers, the handling sought its own distribution, decentralizing itself (Melo et al., 2015MELO, J. et al. Acesso e compartilhamento da experiência na gestão autônoma da medicação: o manejo cogestivo. In: BRASIL. Ministério da Saúde. Cadernos HumanizaSUS: saúde mental. Brasília, DF, 2015. v. 5. p. 233-247.). Each participant became co-responsible for handling, making questions, reflections and becoming sensitive to the participation of others. This mode of operation was considered an important effect of the GAM device on the GIF and configured a way of participating quite different from the initial one. We understand that the direction of handling was, starting from “participation by testimonials and reports”, to foster what we call “autonomous participation”.

To broaden our understanding of these two forms of participation, we will use the distinction between autonomy and automatism⁵5Such a distinction had already inspired us, in a research on memory, to elaborate the categories of ‘automatism’, ‘egoic control’ and ‘autonomy’ to refer to degrees of openness to experience (Passos et al., 2018). (Passos et al., 2018PASSOS, E. et al. A entrevista cartográfica na investigação da experiência mnêmica. Psicologia: Ciência e Profissão, Brasília, DF, v. 38, n. 2, p. 275-290, 2018.; Varela; Thompson; Rosch, 2003VARELA, F., THOMPSON, E.; ROSCH, E. A mente incorporada: ciências cognitivas e experiência humana. Porto Alegre: Artmed, 2003.). The forms of relationship established between subject and world are constantly interrupted by breakdowns that affect the stability of such relationships (Varela, 1995VARELA, F. Sobre a competência ética. Lisboa: Edições 70, 1995.). Faced with these destabilizations of the forms adopted, initially in our natural attitude, microworlds and microidentities already constituted are evoked to deal with the process. Due to the promptness with which it is offered to action, recurring to existing forms is called automatism, which consists of the incorporation of previously established modes of relationship with the world.

The participation observed in the GIF indicated that the dynamics established among the participants favored the recurrence of existing meanings. We understand that “participation by testimonials and reports” can be considered an “automatic participation”, as it puts in place pre-existing identities and understandings with little potential for transformation.

Another way to deal with breakdowns is to create existential arrangements that involve the emergence of new subjects and worlds. In this case, breakdown is presented as a disturbance in the relationship supposedly given between identity and world. There is a breakdown of generally triggered microidentities, as they no longer offer the required readiness-for-action in the face of an unprecedented situation. There is a rupture in the sense of continuity that makes us more sensitive to the emergence of new identities and new worlds that are coextensive with them.

This disturbance of given relations makes breakdown a privileged occasion for the manifestation of autonomy. As the own etymology of the word indicates, autonomy presupposes the creation of rules that have a “self” as a reference (from the Greek auto: self; nomos: rules). An unexpected situation that breaks with automatism calls for the creation of new rules that allow for appropriate action (both in the sense of being suitable for the situation and in the sense of taking for one’s own use, referring to a “self”). The constitution of these rules amounts to the creation of a “self” and new worlds for it.

This autonomous creation is not a choice to be made by subjects; it is the emergence of subjects and worlds in experience. Thus, it is therefore understandable that the autonomy is not of an individual, but a dynamic that allows the emergence of individuals and worlds. In these occasions of emergence of new ways of being in the world, there is an increase in autonomy, as existential possibilities are expanded.

As a result of the handling carried out by/in the group, a collectivization effect allowed the construction of other forms of participation. It is a more autonomous form, as it is more permeable to the reinvention of oneself and the world. When the speeches intersected more and the participants interfered in the stories of others, a space was opened for the collective construction of new meanings. The other’s experience resonated, echoed with personal experiences, and generated new narratives and experiences, transformed by the experience in/of the group. This form of participation was closer to “autonomous participation”, that is, less determined by automatisms. These two ways of participating in the group - automatic and autonomous - showed us that participation in GAM could not be understood in terms of all or nothing. In the beginning, at a first glance, we actively participated, with testimonies, reports, comments and measures. However, the effects of this form of participation were the reinforcement of the isolation between experiences, the reification of identities and the attribution of individualized responsibilities. Although, in a way, everyone participated in the group, there was no “group contraction” (Sade et al., 2013SADE, C. et al. O uso da entrevista na pesquisa-intervenção participativa em saúde mental: o dispositivo GAM como entrevista coletiva. Ciência & Saúde Coletiva, Rio de Janeiro, v. 18, n. 10, p. 2813-2824, 2013.).

To perceive these effects required reflection - or, we might say, analysis. This reflection was not performed in isolation, that is, it was automatically a first step in/of the group toward breakdown experiences that favored autonomy. There was room for the emergence of somewhat unheard microidentities in the group. The experiences narrated were no longer the testimony of lived experiences already given (Passos et al., 2018PASSOS, E. et al. A entrevista cartográfica na investigação da experiência mnêmica. Psicologia: Ciência e Profissão, Brasília, DF, v. 38, n. 2, p. 275-290, 2018.), but the expression of co-constructed meanings in the group, open to transformation. Cultivating these modes of group participation, including ours, became a direction of work.

Therefore, participation (in research, in intervention) is transformative, being both a matter and a source of reflection - we reflect on it and thanks to it. A participation that “moves no one” (does not move the speaker nor listener) does not generate reflection nor analysis (Ferrand, 2008FERRAND, C. (Coord.). Le croisement des pouvoirs: croiser les savoirs en formation, recherche, action. Paris: L’Atelier, 2008.), does not produce knowledge nor transform realities. Understanding the difference between modes of participation was our clue to understanding the role of analysis in GAM intervention research. To analyze was to reflect, or rather, to co-reflect on participation - we collectively reflected on our ways of being in the group, and in a circular manner such reflections transformed our participation by redistributing boundaries and setting us in motion.

“Automatic participation” and “autonomous participation”

The two forms of participation pointed out are not intended to exhaust the discussion of participation in groups and GAM groups. However, we were interested in this approach in order to address the problem of analysis in participatory research-intervention.

Firstly, it is important to note that, if the formula “intervention research” always points to participation, it does not necessarily indicate which quality of participation is at stake. When we characterize it as “participatory”, we refer to “autonomous participation”, seeking to highlight this quality of participation that sets us in motion, which generates, at the same time, knowledge and transformation.

Secondly, we learned from GIF that autonomous participation does not always present itself as we expect. Attending a meeting regularly and speaking out are not necessarily synonymous with participating autonomously. The notion of recalcitrance (Despret, 2008DESPRET, V. The becomings of subjectivity in animal worlds. Subjectivity, Nova York, v. 23, n. 1, p. 123-139, 2008.; Latour, 2007LATOUR, B. Como falar do corpo? A dimensão normativa dos estudos sobre a ciência. In: NUNES, J.; ROQUE, R. Objectos impuros: experiências em estudos sociais da ciência. Porto: Afrontamento, 2007. p. 40-61.) indicates that complacency with researchers is not as interesting as the objections offered by participants. Resisting the questions posed by researchers transforms the relationship between subject and object in research and produces knowledge. The quality of participation can be appreciated under the criterion of analysis, which, on the prowl of recalcitrant occasions, puts participation to the test of the group’s reflection, generating new reflections. Autonomous participation allows the transformation of participants into research subjects, and this strategy for GAM is fundamental, as it is in line with its own objectives of promoting autonomy and protagonism of users. In other words, the intervention research method achieves the objectives of the GAM strategy.

When participation takes place more autonomously, the modes of operation instituted in the group are analyzed, widening the openness to the emergence of new articulations and senses, new microidentities and microworlds. On the other hand, when more automated, the analysis tends to ratify the already established domains. Thus, analysis is linked to the production of knowledge and the transformation of reality. When there is only ratification of identities and worlds, no knowledge is actually being produced, nor is there transformation in the psychotherapeutic or socioanalytical sense of subjective repositioning.

There is, then, an intimate link between participation and analysis: the more participation is autonomous, the more it generates analysis; and simultaneously, the greater the availability of analysis, the stronger the tendency for autonomous participation.

In GIF, autonomous participation was not always “engaged,” as typically represented, and we could not even claim that it was a direct participation in the research device: sometimes it was the indirect participation by users (whose experiences were present in the report of family members), the timid and silent presence of someone who mobilized us, or even the absence of someone who was a source of analysis (as happened, for example, when GIF spent long periods without a worker).

A refusal to participate in certain associative spaces can be an occasion for analysis, allowing to put into question the assumptions of the research itself (Despret, 2004DESPRET, V. Hans, le cheval qui savaient compter. Paris: Les Empêcheurs de Penser en Rond, 2004., 2013). The analysis has the dual function of allowing both the production of knowledge about the specific and concrete research situation and the transformation of devices, expanding possibilities for participation.

Discussing this type of refusal, Callon and Rabeharisoa (1999CALLON, M.; RABEHARISOA, V. La leçon d’humanité de Gino. Réseaux, Paris, v. 17, n. 95, p. 197-233, 1999.) conducted an investigation with a carrier of a genetic disease who refused to participate in all instituted forms of association for disease carriers. Analyzing and questioning the automatic understanding that this refusal would correspond to the lack of mobilization and political awareness, the authors understand it as recalcitrance instead. This refusal becomes a way of questioning the conditions of public debate as it is often conceived, in which the opposition between the public and the private sphere defines autonomy as individual voluntarism in the face of prefabricated choices. In this sense, autonomy would be the property of an individual able to rationally choose from options already given - supposedly the only way to avoid irrationality and dependence. When we started the GIF, we found a similar situation among family members: family members showed no interest in forming an association of users and family, despite the insistence of workers and the enthusiasm of the university researchers with the proposal (Ramos, 2012RAMOS, J. F. C. A autonomia como um problema: uma pesquisa a partir da realização do dispositivo GAM em um CAPS fluminense. 2012. Dissertação (Mestrado em Psicologia) - Universidade Federal Fluminense, Niterói, 2012.; Renault, 2015RENAULT, L. A análise em uma pesquisa-intervenção participativa: o caso da gestão autônoma da medicação. 2015. Tese (Doutorado em Psicologia) - Universidade Federal Fluminense, Niterói, 2015.). The options seemed pre-defined: “participating” would necessarily amount to striving to create the association; the alternative would be to ratify the identities of family members as demobilized and dependent.

However, what seemed to be a lack of mobilization and poor participation in discussions about mental health could be analyzed and understood in its recalcitrant dimension. Progressively, disinterest was understood as an active refusal to distribute individual responsibilities in the mental health service. The “demobilized” identities were shaken and new possibilities (of comprehension and subjective transformation) opened up. By breaking the automatism of participations, we understood the fear of family members about a possible isolation and loss of help from workers in a context of great precariousness.

This shows that very atypical forms of participation from the point of view of instituted associations are not necessarily forms of absolute “non-participation” or demobilization. In GIF, collectively analyzing the resistance to the constitution of the association led us to understand the demand of family members for closer follow-up of workers. Due to the fragmentation of the psychosocial care network in the city and its low level of articulation with other services of the network, the family members shared the feeling of overload: there were numerous reports of accumulation of responsibilities and lack of support in the care of their relatives. Family members feared that if they assumed a more active role they would lose the support of workers and perform duties that they considered as a responsibility of the service, risking, in their view, to be even more alone to deal with difficulties.

Questioning the automatisms of participation also required questioning ways of establishing the boundaries between public and private. Failure to participate in certain instituted forms of association amounted to a refusal (political and public) of a certain way of separating the intimate and collective spheres, as well as the alternatives that were shown as given (Callon; Rabeharisoa, 1999CALLON, M.; RABEHARISOA, V. La leçon d’humanité de Gino. Réseaux, Paris, v. 17, n. 95, p. 197-233, 1999.).

In a seemingly paradoxical way, producing knowledge about the refusal to participate in an association was the occasion for a shift of point of view and repositioning on the issue: new ways of being in the GIF were produced and later allowed the collective construction of an association between users and family members (Renault, 2015RENAULT, L. A análise em uma pesquisa-intervenção participativa: o caso da gestão autônoma da medicação. 2015. Tese (Doutorado em Psicologia) - Universidade Federal Fluminense, Niterói, 2015.). Knowledge production and reality transformation were articulated around the changes that the analysis-participation pair went through.

Participatory analysis and collective autonomy

Autonomous participation cannot be characterized in advance by certain predefined characteristics. It does not necessarily correspond to political activism, engagement in an association, or even attendance at group meetings. What, then, are the indicators of autonomous participation?

To develop this issue, we can follow some of the transformations that happened during the GIF. The first steps of GGAM propose that each user reflects on themselves, their preferences and work prospects, as well as how they care and relate to other people, among other everyday issues. Since the Guide addressed to users was discussed by family members, our expectation was that they could answer such questions by trying to imagine how their relatives would respond to these questions.

However, this was such a surprise that family members began to respond on their own behalf. For example, to the question “How do you introduce yourself to someone who wants to know a little about you?”, the family members answered “I am So-and-So, I live in such a place…”. Given these answers, we reiterated the proposal to discuss how family members thought their relatives (users) would position themselves on the issues. Our insistence on the initial proposal elicited vague answers, such as “I don’t know…” or “I don’t think he would be able to introduce himself to anyone”, showing that there was no interest on the part of the family in this form of discussion.

This mode of participation forced us to review our position in relation to the experiences brought by the group: it was not possible to discuss the GGAM with family members disregarding their experiences in relation to the debates triggered by the guide. The experiences of users and family members were not separate: to produce knowledge about each other’s experience was also to analyze one’s own experiences. To discuss a mother’s experience in following her child’s daily life and care, it was necessary to embrace her own experiences of caring for herself. The initial refusal of family members to discuss the users’ perspective represented a breakdown from the initially proposed objectives. It was necessary to analyze the automatism of the research, which, thanks to the refusal of the family to participate in the expected way, had to review its handling and objectives.

Gradually, the family members shared their own experiences, whose legitimacy the university students aimed to understand from a certain point of view (pointing to the possibility of the existence of others). During the meetings, a mode of sharing was produced and not always allowed identifying to whom the experience that was being shared belonged, whether the family member or the user.

For family members, the possibility of analyzing their own experiences in a collective device allowed greater individual openness to understand different perspectives. As a result, the group’s permeability to different points of view gradually expanded, favoring the perception of other ways of experiencing the issues, including the users’ experience. The users’ point of view emerged thanks to the expansion of GIF’s autonomy, not due to the research automatism.

In this example, we identified two indicators of increased autonomous participation. First, the increased concern over different points of view. The university researchers were forced to broaden the research frameworks, including the experience of family members. These departed from their individual experiences, then included those of the other family members present, until reaching the users.

The second indicator is related to an increase in permeability for the emergence of new existential arrangements. Forming the group led to the emergence of situations that represented breakdowns for university and family automatisms. We observed that, instead of reproducing the already established ways of dealing with situations, we constructed another way of experiencing them, expanding the group’s creative potential.

Considering the links of dependency between different points of view allows us to embrace the creative potential of ourselves and the world. In the GIF, the experience of family members did not exclude the experience of users, on the contrary: by welcoming the experience of some, we found the experience of others, in a collective composition. That is why we refer to the “autonomy” that qualifies participation as a “collective autonomy”: it is not an attribute of an individual, nor is it confused with the independence of a subject. It assumes the inclusion of experience in its co-emergent dimension and the acceptance of otherness. Thanks to the analysis in the GIF, we could question university automations and transform the handling of the group when needed. Instead of asking ourselves why there was no autonomous participation, we sought to analyze our own automatic participations and our preconceptions about participation. When family members were absent from the group, we tried to collectively analyze in the supervisions what was going on. On these occasions, we perceived that our experiences as moderators were closely linked to those of family members, and accessing their point of view in supervision allowed us to reposition and transform the research intervention work. Thus, non-participation was analytical, as it made us find new forms of participation. As Clinique de Concertation indicates:⁶6CLINIQUE de Concertation. [S. l.], c2017. Available at: <http://concertation.net>. Accessed on: Oct. 3, 2019. We thank Lemaire and the work of Clinique de Concertation for their comments on the presence of absentees.

Paradoxically, autonomous participation is not limited to the participation of those attending a particular meeting or gathering. It also concerns openness to the other and the presence of the “absent” (Halleux; Lemaire, 2006HALLEUX, L.; LEMAIRE, J. M. Combien d’oreilles pour une écoute constructive? La Clinique de Concertation. L’Observatoire, Liège, n. 50, p. 85-88, 2006. Disponível em: <Disponível em: https://bit.ly/2oCWVf9 >. Acesso em: 02 out. 2019.
https://bit.ly/2oCWVf9... ), pointing to a public dimension. Accessing the experience of family members in the GIF led us to the experience of users, who in turn summoned that of service workers, health professionals, citizens of the municipality… Each experience included the experiences of others, building a public horizon from which it was not possible to determine in advance who would be part of it.

Some GGAM issues seemed at first glance to refer only to users’ private lives (such as about personal care or love relationships), but they were not separate from the sphere of citizenship. The opposition between public and private was not due to the nature of the issues themselves, but to the degree of openness to the inclusive and expansive potential we adopted towards them. The autonomous participation tends to an horizon of inclusion whose limits are not predefined, referring to a work always open, under permanent construction.

Final considerations

Analysis in intervention research is inseparable from participation because, as an instrument of knowledge production, it allows us to discern between different types of quality of participation and to intertwine different points of view. As an intervention tool, the analysis transforms participation, breaking automatisms and fostering autonomy.

At the same time, the shift from “automatic participation” to “autonomous participation” allows analysis to become an effectively collective task. Analyzing is no longer the exclusive activity of university researchers, reserved for experts, but public by right, inviting the participation of all. In a circular movement, participation and analysis continually refer to each other, ensuring openness to the intervention research.

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