Beyond Critique: Reparative Approaches in Brazilian Mental Health

This article proposes a reparative approach to examine controversies in mental healthcare in Brazil. These controversies make it difficult to construct robust, multidisciplinary models of mental health and to translate them into effective treatments in local contexts. Polarizations are unproductive because they hamper collaboration between professionals with different theoretical backgrounds and may divert public resources. Drawing on Eva Sedgwick's distinction between paranoid and reparative readings, the article discusses mental health practices beyond the framework of medicalization. Nonparanoid perspectives in public and global health help to uncover the reparative potential of local practices and negotiations beyond reductionisms and polarization. Reparative approaches in mental health depart from a primarily critical stance and instead reframe social inquiry as a form of care and world changing activity, engaged in the practical provision of care. Focusing on controversies surrounding autism and ADHD in Brazil, the article shows how the medicalization critique conceals as much as it reveals, obscuring the possibility of alternative frameworks and the complexity of conditions on the ground. Opposing views around autism and ADHD are transcended through reparative ethnographies centered on local uses and pragmatic negotiation of categories, polices, treatments and services. This approach is committed to producing useful and effective outcomes for the provision of healthcare to people with mental distress within their communities.