The woman who chose the terreiro. Lay care and medical landscapes in mental health care in Rio de Janeiro.

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.

Study at a glance

Abstract

Brazilian mental health care reform understands mental health as a complex social process. There is a large literature production within the country focused on deinstitutionalization policy, social determinants of mental health and human rights, however, with little recognition beyond Latin American borders. In addition, cultural dimensions of mental suffering have been neglected in Brazilian debates which limits an expanded understanding of health care and users' inclusion. This paper aims to discuss the role of cultural determinants in mental health care in Brazil. We followed a patient in the city of Rio de Janeiro who opted for therapy based on her religious beliefs-using ayahuasca in the context of the Afro Brazilian religion of Umbanda-over the treatment-as-usual in mental health. We draw on the notions of autoatención (self, domestic, and group-care in lay contexts) and medical landscapes to examine how therapeutic negotiations reflect embodied cultural traits and both social and political determinants shaping therapeutic spaces. We argue that recognizing sociocultural differences and therapeutic negotiations are key elements in making a more inclusive health practice. Moreover, this recognition enables identifying and reasoning the broader social processes framing health practices. This debate is relevant to the Brazilian mental health context and to other scenarios, especially those where local and global knowledge and practices in mental health are entangled.