Mental health care in Brazil has undergone reforms that view mental health as a complex social process, yet cultural dimensions of suffering are often overlooked. This paper follows a patient in Rio de Janeiro who chose therapy based on her Afro-Brazilian religious beliefs—using ayahuasca in Umbanda—instead of standard mental health treatment. Using concepts of autoatención (self, domestic, and group care in lay contexts) and medical landscapes, the authors examine how therapeutic negotiations reflect embodied cultural traits and social and political determinants. They argue that recognizing sociocultural differences and therapeutic negotiations is key to more inclusive health practices, relevant both in Brazil and globally where local and global knowledge intersect.
A mindfulness-based health promotion program adapted for Brazil's public health system was tested in nine groups in Rio de Janeiro primary care units. Of 62 mostly low-income women participants, 80% had chronic conditions, including anxiety (42%) and depression (35%). After eight weeks, anxiety and depression improved significantly, and quality of life improved in psychological, physical, and social domains. Participants reported using mindfulness practices for insomnia and emotional distress, and involving family members helped create space for meditation at home. Mindfulness was seen as a complement to medication and therapy. The intervention proved feasible and effective for psychosocial support in low-resource primary care settings.