ARTIGOS

 

ICT Intervention-Research in a mental health service in Brazil

 

Pesquisa-intervenção com TIC em um serviço de saúde mental no Brasil

Pesquisa-intervención com TIC en un servicio de salud mental en Brasil

   

 

Cleci Maraschin^I, Marisa Lopes da Rocha^II e Virginia Kastrup^III

^I Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.

^II Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.

^III Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil.

 

 

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ABSTRACT

This article discusses the use of intervention-research as a qualitative method that aims at exploring how knowledge production can be affected and transformed by intervention. It describes and examines four levels of reflexive feedback in an intervention experience based on information and communication technology (ICT) workshops in a mental health clinic for children and teens in Porto Alegre/Brazil. It is argued that an intervention can offer a rich reflexive experience that challenges the research group’s misconceptions, the participants’ reflexive notions, institutional common sense and the research direction. We posit that the methodology also enables the exploration of new capacities and emotions not only by the young participants, but by everyone involved in the process.

Keywords: Intervention-Research; Qualitative Research Methods; ICT Workshops; Mental Care.

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RESUMO

O presente artigo discute o uso da pesquisa-intervenção como um método qualitativo que tem por objetido explorar como a produção de conhecimento pode ser afetada e transformada pela intervenção. Em particular, descreve e analisa quatro níveis de retroalimentação reflexiva em uma experiência de intervenção utilizando oficinas de tecnologias de informação e comuni-cação (TIC) em um serviço de saúde mental para crianças e jovens de Porto Alegre/Brasil. Argumenta que a pesquisa-intervenção pode oferecer uma importante experiência reflexiva que questiona as concepções da equipe de pesquisa, as noções dos participantes e o senso-comum institucional e todos esses fatores podem deslocar as direções da pesquisa. A metodo-logia também permite a exploração de novas capacidades e emoções, não somente para crian-ças e jovens, mas para todos os envolvidos no processo.

Palavras-chave: Pesquisa-Intervenção; Metodologia Qualitativa; Oficinas com TIC; Saúde Mental.

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RESUMEN

Este artículo trata acerca del uso de la investigación-intervención como un método cualitativo que tiene como objetivo explorar cómo la producción de conocimiento puede ser afectada y transformada por la intervención. En particular, se describen y examinan cuatro niveles de retroalimentación reflexiva en una experiencia de intervención utilizando talleres de tecnolo-gías de información y comunicación (TIC) en un servicio de salud mental para niños y jóvenes de Porto Alegre/Brasil. Se argumenta que la investigación-intervención puede ofrecer una importante experiencia reflexiva que cuestiona las propias concepciones del equipo de inves-tigación, las nociones de los participantes, el sentido común institucional y (todo esto) puede hacer cambiar las direcciones de la investigación. Se puede decir que la metodología también permite la exploración de nuevas capacidades y emociones, no sólo para los niños o los jóve-nes, sino para todos los involucrados en el proceso.

Palabras-clave: Pesquisa-Intervención; Metodología Cualitativa de Investigación; Talleres con TIC; Salud Mental.

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The research context

Since the 1980s, Brazil has developed public policies in order to implement and eval-uate proposals towards the wholesale use of information and communication technology (ICT) in education. Similar initiatives have not been seen in the health field, nor, specifically, in the mental health field. The fields of mental health and education are connected because most of the children and adolescents who are referred to a mental health service are those most likely to fail in school (or those that schools fail). In this paper we present an experience of use of ICT workshops in a mental health clinic for children and young people focusing on the effects stemming from the methodological approach.

Towards the end of 2004, the São Pedro Psychiatric Hospital (HPSP) of Porto Alegre, Brazil, invited one of the authors to propose a method of using computers with children and youths in a specialized mental-health clinic. Some months later, an intervention-research pro-ject was set up in partnership with the Federal University of Rio Grande do Sul (UFRGS) and HPSP to conduct computer workshops and to launch an ICT-based program aimed at young in-patients of the Centro Integrado de Atenção Psicossocial (CIAPS)—an integrated center for psycho-social care. The workshops provided instruction in information and communication technology: computer use for web browsing, writing, photography, robotics and games. The project sought to incorporate the center’s staff into the activities of the academic research team; activities were coordinated by a service technician and followed by a student linked to the project.

One of the challenges of the project was to find a methodology that would fit our pur-poses and, at the same time, enable us to evaluate its effects on the subjects, on the staff and on the institutions involved (hospital and university). The intervention-research approach seemed to be the most suitable and potentially most rewarding methodological tool for our aims. We concur with Holland, Renold, Ross & Hilman (2010) that participatory research is not necessarily better or ethically superior to any other research but it can provide a pertinent ethical, epistemological and political framework to knowledge production.

The research group and the center’s staff together established the main research goal of the project: to examine how interaction networks are created among children and teens in ICT workshops aimed at fostering social spaces that would allow expression and reation in modalities different than those they were accustomed to. The point was to broaden the possi-bilities of interactive networks so as to facilitate other narratives that those they usually shared. At the start, the young patients’ social networking experience was fragile and unrelia-ble: most of the children and youths were more connected to drug abuse networks and less connected with their families and schools. In addition, historically, the mental health estab-lishment has treated subjective expressions by patients more as clinical symptoms and less as a sign of invention (Amarante, 2012; Costa, 2009). Thus, initially, the project needed to over-come these obstacles emerging from prior experiences in both the participants and the institu-tion itself.

This paper aims to introduce the intervention-research approach and to discuss its use within our fieldwork. In the first part we develop a characterization of the intervention-research approach and follow it up with a discussion of the most significant aspects of our research.

From action-research to intervention-research

Action-research and its use with individuals, groups and institutions have a long histo-ry. It was first proposed in 1944 by German-American psychologist Kurt Lewin based on his work conducted in the 1930s on the treatment of social problems and organizational issues. When Lewin conceived the term “action-research”, he was cognizant of the implications of intervention in a research project and observed that the work of research—interviews, group dynamics, data analysis and devolution—implicitly has an effect on the object of the re-search. Some Brazilian researchers such as Barros and Silva (2013) and Rocha and Aguiar (2010) posit that action-research as proposed by Lewin might be a novel way to research and act upon the social field but it has remained tied to a functionalist perspective. Further, Lewin’s method focuses inordinately on the identification of dysfunction within the social groups investigated even when the researcher's goals are to analyze the organizational or social function of resources to ensure that they perform adequately.

In Latin America, and particularly in Brazil, action-research has produced a more nuanced and insightful approach to fieldwork by giving theory and practice equal weight. When social issues are problematized in conjunction with social groups and grass-root organizations, when issues and actions are contextualized and the complexity of change processes is embraced, this research method can significantly contribute to the building of an active citizenship (Rocha and Aguiar, 2010). In many instances, by putting together researchers and participants, action-research has produced real change in disadvantaged communities in the provision of social programs and literacy education within excluded and stigmatized groups (Freire, 1993). As a result, action-research acquires ethical and political overtones during the creation of the researcher-participant relation. Critical action-research has also proven to be an effective tool for collective participation through the method itself by establishing a link between research and politics (Aguiar & Rocha, 2007; Passos & Barros, 2009).

In action-research, the scope of intervention in the research field ranges from the micro-political to the macro-political. Although both poles cope with tensions differently in order to improve the dynamics of change and transformation, each has its own ways of navigating conceptual opposition, dealing with levels of tension, and the various subjective faculties that each involves. The distinction between micro-political effects and macro-political impacts is a complex one but what is of importance here is the difference of scale in the forces that effects daily life—even if the micro-political is often unduly conditioned by the macro-political. The macro-political involves structures and norms that perpetuate rigid stratifications which condition the organization and the flow of power within the socio-historic context in which an event is taking place, usually including issues of class, race, ethnicity, religion and gender. The micro-political involves the resolution of tensions between the dominant heterogeneity of everyday life—with its relative stability—and the movements originating in the forces that are present in otherness (Rolnik, 2010). The focus of the observations during our research tend to emphasize the singular, the individual and the micro yet all the while maintaining a vigilant eye on macro-political forces. Specifically, the goings-on in concrete experiences, the inevitable tensions and conflicts arising periodically, the gestures and movements of the everyday and on the affects produced as the opening to the possibility of experience according to a general logic that supports the visible world.

Intervention-research has developed from the action-research and from the influence of the Institutional Analysis (IA) movement. In intervention-research there is a strong link between theoretical and social concepts: for Rocha & Aguiar (2010), intervention-research extends beyond its theoretical and methodological foundations towards a participatory modality in research. Intervention-research is not only a methodological approach that is epistemologically justified but also an intervention tool which sustains that research is always a political action: it aims to be transformative through micro-interventions in a variety of social environments. The IA movement emerged in France in the 1960’s and in Latin America in the following decades. The principal proponents in France were Lourau (1997, 2004), Lapassade (1998), Guattari (1992, 1993), and Hess and Authier (1994). In Latin America, Baremblitt (1992), Saidón (1987, 2002), Rodrigues, and Leitao and Barros (1992) among others, have developed it considerably. IA is a tool that turns intervention into a collective praxis which embraces diversity so as to conceive alternatives in everyday life. It is important to note that the method of the IA approach is not just the execution of protocolary procedure by researchers but a flexible research practice that allows the community to be involved as a ‘thinking’ stake-holder.

Conceptual tools

In IA, a group is not simply a number of individuals connected by a common factor or denominator. The group results from relations among individuals created through a process of shared actions and meaningfulness arising from joint experience. Thus, a group is a multiplicity of tensions that generate change with and within the circumstances of its creation and through the course of its own movement and attunements. In the same way, institutions are not understood as static or unchanging organizations or corporations. They are the result of socio-historical and economic policies, which incorporate values and traditions as enhancing dimensions. In everyday life, these added dimensions tend to become implicit and taken as absolute truths.

As exponents of intervention-research, we do not see everyday life as a closed system of linear relations or a fixed articulation of hegemonic and prevailing values. As the focus of the analytic work of intervention-research and as productive of a space that enables change (Rocha and Aguiar, 2010; Saidon, 2002), everyday life becomes a tentative and open process. For the analysis of everyday life to acquire relevance and pragmatic applicability, we moved away from uni-dimensional, linear, cause and effect determinations to compose collectively with the contradictions of research as a multiplicity of fragmentary and discontinuous actions. By integrating our observations in the field, our insights into the research process and the feedback from participants, we came to see the emergence of new meanings and realities from the experiences of our research practice. The notion of experience is important in the conception of everyday life because for us experience is the location where difference takes place. Difference arises from successive and repeated operations, sometimes affirming tradition and habits and sometimes erasing them in a process of continuous learning and unlearning (Kastrup, 2007).

Within the IA approach, the production of “analyzers” connects specific actions and modes of relation to established norms and practices as well as to conventional genres or models of organizational existence. Analyzers are tools which direct the attention of the researcher to the collective process. As such, analyzers break down the research experience along various axes. In an intervention-research we worked with six analyzer-process: (1) events or individuals catalyzing dispersed factors within social practices; (2) requests: who (an individual or agency) makes the request for the intervention and how they go about it; (3) demands: these tune in to stated and unstated aspirations at play within the process thus becoming an opening to the virtual and the affective; (4) transversalities: identify institutional vectors that influence the process as; 5) implications: how stake-holders—such as researchers or the broader institutional framework–participate in the research process; and (6) the self-managed project: indices of collective appropriation of the analytical process as a self-perpetuating dynamic.

In the present study, we analyze our ICT workshops not only as collective learning but as a space activating collective work. In Portuguese, the word oficina (workshop) comes from the Latin officina, an artisan’s workspace, derived from opificium (opus – work – and facere – to make) (Houassis and Villar, 2001: 2052). Thus, oficina (workshop) simultaneously means repair and creation: a space that puts together know-how and how-know. In the workshops, the actions involved in the creation of a work of self-expression (a text, an image, a photograph, a web page) may or may not reproduce the same actions and meanings intended in the everyday life of the institution. It is our contention that the ICT workshops generate new ways of relating and meaning, functioning much like a micro-political event.

In the intervention-research approach, when establishing a collective work project, it is fundamental to involve the community in the analysis of micro-political events so that alongside the researchers it can gain insight into its own problems, forms of action and social processes. The process under development in intervention-research creates the conditions where each participant is able to express themselves within the formulation of the intervention as it unfolds. The intervention is only effective at the time that local experiences may come under review of the socio-historical and political contextualization. This means that the workshops' actions are understood in their complexity, through their attempt to deconstruct dualities, internal determinism and psychological individualizations.

Intervention-research enables and facilitates the creation of alternatives towards the analysis of the everyday life of groups in their qualitative diversity. This perspective does not align itself with the representation of a preexisting reality but through a process-based inventive simultaneous becoming of itself and the world (Varela, 1995; Kastrup, 2007). In this view, subject and object are not polar opposites existing a priori to the process of knowing but emerge as reciprocally-caused and conjoined within collective cognitive action (Maraschin and Cappela, 2014; Maurente and Maraschin, 2014): subjectivity and objectivity are not foundations of cognition but effects of this process. This conception is rooted in constructivism (Piaget, 1978; Dias, 2012) and developed in enactivism by Maturana & Varela (1980, 1990), Stewart, Gapenne and Di Paolo (2010) and Froese (2011). Thus, we make the important distinction in our method of conducting “research-with” and not of conducting “research-on” a group to emphasize the ethical and epistemological character of the collective production of knowledge within our constructivist perspective. Because of its contingent nature, this method can also result in unexpected consequences and deviations. In establishing the research process, the researcher may have an initial plan of action but unexpected findings can act like wayward attractors, which deviate intentions and expectations as well as transform the consistency of the research field. Guillier (2004) emphasises the significance of divergent and disruptive elements that impart importance to something which may at first have been deemed inconsequential but which later ends up significantly redirecting the re-search.

In the qualitative approach of intervention-research, it is necessary to be cognizant of the fact that the data is generated from, within and through the intervention—like the subjects and objects of research, the findings do not exist as an a priori, as a pre-existing given or as a pre-determined fact. The data as a finding emerges from intervention in the act of its determination as a coming to being; the realization of knowledge takes place in its actualization at the moment of its finding. Thus, the researcher needs to pay attention to what’s going on, to the what’s happening but also to the gestures, expressions, and subtle intimations, to the positive affirmation of actions and the detractive negation of reaction by which meaning is conveyed and which collectively compose reality. Same words, for example, can come to indicate other performances according to the relationships involved at that moment.

The challenge for intervention-researchers is to analyze how new expressions of thought, of life, can interact with existing structures, traditions and customs of the community. In addition, it is important to come to understand the processes within the social group which render certain values second-nature and produce expectations as generative of social movement—but to carry out this type of research one must understand micro-analysis. The collective practices are crossed by forces extraneous to the research process and it is necessary to use a magnifying glass on the relations and the effects of actions which give body to a broader, larger-scale policy. The “micro” perspective takes awareness-raising into account but considers it insufficient on its own to bring about significant social change. Gestures, sensitivities, perceptions, emotions and affects need to be brought into the mix in order to understand how difference is produced. Neutralizing the status quo is one dimension of the struggle, but not the only one—research has to go beyond the implied legitimacy of the existing state of affairs in order to create novel modes of existence.

Research-intervention seeks to bring out into the open other dimensions of everyday life and introduces tensions between representation and experience with the prospect of finding new ways to furnish consistency to experience. The approach is linked, therefore, to focus on the tracings of movement within a collective, seen through the contradictions, disa-greements, deviations and actions that constitute difference against the hegemonic thought that often comes as second nature. This point of view emphasizes the fluid character, the vagueness of actions, the possibility of relaxing traditional boundaries, whose social practices, experiences, and determinations are the creation of meaning and not a reality to be found elsewhere.

ICT workshops in a mental health clinic

What follows is a discussion of some of the effects of intervention on the participants in the ICT workshops, on the field of research, on the research team and on the research directions. The effects will be discussed through four incidents which highlight specific aspects of the research within the overall process. The incidents were chosen at different points in time of the unfolding of the research. The first one took place during the computers’ setup and shows how the children's reaction led the research team to think about the analytical implications of intervention-research. The second incident demonstrates how the ICT improved the social interaction between workshop participants and demonstrates the complex and dynamic nature of intervention-research. The third explains how intervention-research works as transversal analysis by identifying and foregrounding institutional influences that are operative but not usually perceptible in everyday life. The fourth incident points out how some results can change the direction of an intervention and demonstrates how intervention-research is permanently a work in process.

Incident 1: Intervention and the research team—unpacking the computers

Intervention-research is a journey full of surprises. For example, a curious incident occurred during the setup of the computers. When the children came into the room where the computers were being set up, they became so enthralled with the pile of cardboard packaging next to the computers that they were completely oblivious to the machines. This made the research team think about their projection of symbolic value of objects onto these children and their value by the different parties.  For the researchers, the computers had an important symbolic value because they represented a significant investment of time, effort and money; the hospital usually receives outdated secondhand donations for use by the in-patients and the kids gave no value to the machines’ productive possibilities. So the children's interest in the boxes made the research team reconsider their imperatives: perhaps the latest technology was more important to the research itself. This incident also pointed out the need for acute listening and observation by the researchers to determine ‘what was really going on’. It was necessary to observe and analyze the small everyday gestures and movements that reveal the stance of the other—their difference—in terms of what was happening objectively as the very proposition of the research. But the project also needed to take into consideration the preconceptions researchers were bringing in to process through ‘tainted’ observations which were coloring or skewing their perceptions and interpretations.

By using a cartographic method (Passos, Kastrup and Escóssia, 2009) to map the ex-perience and field of research, we avoided directly subjecting the participants to the research propositions. We sought instead to analyze their reaction to the process, to gauge their re-sistance to the questioning in our intervention and to identify possible sources of bias in the process. Mapping participants’ actions and reactions is a powerful tool because it allows us to understand which movements gain force and how they shape the work over time. These ac-tions allowed the researchers to closely monitor children’s experiences which often exhibited noticeable change between one meeting and the next. In the end, we had a living record of the path traced collectively and we were able to map out what was relevant or problematic at every step.

However, not all situations were determinable or revelatory of what was at play at a particular moment. There were many situations that poked holes in the rationale, which guid-ed our attitudes and practices, that challenged our knowledge that questioned our abilities to analyse and draw out implications: we might have had full access to the specific experiences that inhabit a territory, but this does not imply directly a full understanding of the situation. The issue of the limitation of our comprehension recurred during research debriefings usually as a result of indeterminate or enigmatic experiences. The problematizing (analytical com-plexifica-tion) of a situation might generate so many questions with conflicting answers that we would find ourselves having to re-think the direction and reformulate a specific interven-tion. Yet, rather than ascribe this to a failure of the process, we came to see this indeterminacy as constitutive of the conditions for the possibility of new knowledge. It can be stated that the indeterminacy of a situation becomes indicative of a deterritorialization which challenges the limit of our knowledge yet opens up new vistas for conceptual innovation.

Incident 2: Intervention and the research participants—a blog posting

The ICT workshops conducted as part of an intervention-research methodology, demonstrate that the visibility regime, self-worth, interpersonal skills and social awareness of the participants improved within the research environment. Given the reduced circumstances of the participants, we cannot discount the positive side effects that access to the latest tech-nology and media had on the children and teens. Even if the young in-patients could not ar-ticulate the reasons verbally, they were elated by the possibility of participating directly in the cultural pervasiveness of ICT and the greater Brazilian socio-political proposal to provide widespread access to digital technology. This elation was accompanied by a curious manifes-tation of completion afforded by the hardware and on-line access—‘finally’ getting their hands on the devices was like a fulfillment of a technological destiny: many of the young in-patients demonstrated from the get-go an intuitive second-sense, an innate familiarity and facility with the equipment and a keen desire to mesh with the technology.

For the young participants, the research environment was not only liberating from a technological perspective but from a social and creative standpoint as well. We framed our work within the tradition of Social Psychology research that does not seek to directly impose normative change on subjects, but rather seeks to generate the propitious conditions which enable the possibility of subjective empowerment and change through the affirmation of difference. In this case, we sought to open spaces for creation, to develop expressive or communicational potential, and activate possibilities for change of through the production of new relations between subjects by means of technologies (Maurente 2010; Diehl 2007; Vianna, 2008). In the space created by the workshops, the participants could experiment various stances of authorship—those doing the most experimentation were those who were most familiar with the technology and could compose with it. The young users who took on different roles by shifting authorship stances were also those most likely to experiment with other modes of expression, such as poems, texts and drawings. For example, publishing their works and disseminating their ideas in an on-line space or participating in mediated chat rooms, granted the young in-patients public visibility, social legitimacy and the opportunity to socialize with their peers—a chance they might not otherwise get. As a group practice, this type of intervention allows the children and teens to construct and benefit from what we refer to as a collective plane of composition. In this type of clinical creative-expressive ecology, it becomes safe to share experiences and emotions while improving social skills—by building and fostering networks of trust within the research-intervention process, territories are created that foment individual, inter-personal or collective subjectivities. We understand this approach as a novel cognitive political praxis which we call inventive cognition, as opposed to “recognitive” cognition (Kastrup, 2007; Kastrup, Tedesco and Passos, 2008).

The exchanges that take place between the participants themselves and the occasional guiding mediation of the facilitators within intervention-research look to encourage the type of interaction which sparks subjectivity. The on-line chatroom conversation featured in Figure 1 demonstrates this potential. It starts off with a reference to Vila Santa Isabel, a neigh-borhood in a city near Porto Alegre, Brazil and the conversation which ensues develops themes of sociability and communication such as empathy, listening and questioning—the translation of the exchange tries to convey the ‘rough around the edges’ of the original.

Figure 1: Chat room posting in oficinandoemrede.blogspot.com.br, Sept. 2007.

 

 

Original posting:

Vila Santa Isabel.
On my block, there is a square where people get together to smoke.
Fat J.

Response to original posting:

Y – I used to smoke a joint there…
T – Guys, besides smoking, what else is interesting about the square? What else is cool there? Any other cool places to know? Who do you like to hang out with? T.  [Research group collaborator]
H – I KNOW THE PLACE. BUT WHY DO YOU CALL YOURSELF FAT? I BET YOU’RE FINE. DOESN’T MATTER WHETHER YOU’RE FAT OR SKINNY. WHAT MATTERS IS HOW YOU EXPRESS YOURSELF. KISSKISSKISSKISS H.
H – I'D LIKE TO GET TO KNOW YOU BETTER HERE IN THE CHAT ROOM.
J – I want to get to know you better too, why is Fat J my nickname? ‘cause that’s what people started calling me...
J – I’m J. [addressing H]

The theme of this incident is indicative of the social duress sustained by the partici-pants. The workshops were being attended by children and teens from all over the state and consequently many of them are far away from home. Postings containing references to a group member’s hometown, or where they lived prior to their admission for treatment, gave rise to commentary and interaction. References to these towns and villages prompted the youths to comment on their own hometown, or to comment on their knowledge of other chat room participants’ hometowns. In this project, the conversation often revolved around an assemblage of social belonging involving towns, nicknames and names (Baum and Maraschin, 2013) where identity markers were often in question during the exchanges. The children’s and teens’ experiences as in-patients and their stories of dislocation merged into a shared emotional ground which could be transmitted as language acts conducive to empathic dialogue and not as self-centered or identity-based monologue. The most commented posts reflected a similarity, a shared commonality, with the youth's own experiences. Although not always the case, the technology operates to express and connect these narratives while con-structing new meanings, new relations, new affinities as the immediation of the creation of subjectivity.

Incident 3: Intervention and the research field—new questions and old problems

From the start, the research field of our intervention-research has reflected the ten-sions, questions, discussions and analysis arising from the collaborative process between the CIAPS and UFRGS teams. Unlike the approach of the researcher in a ‘static’ field within a given pre-existing practice, intervention-research aims to construct the field of intervention as a processual event and problematizes the research around the practices, values and principles that emerge within, through and as a result of the process.

During the unfolding of this project, we were exposed to ongoing institutional chang-es resulting from a country-wide psychiatric reform policy and to the effects of the opposition and resistance to its adoption. Since 2001, Brazil has been undergoing a psychiatric policy changeover that advocates the turning out of mental illness into the streets of the city. The reform seeks to replace the mental asylum by decentralized, smaller-sized mental healthcare facilities, such as the CAPs (psychosocial care centers), in order to provide services at a local community level. The new perspective proposes an interdisciplinary approach to mental health which involves the patient, the family and the community in therapeutic decisions (social control) in order to de-stigmatize mental illness, focus on integration and create more effective support networks. The goal is to reduce the need for in-patient mental health facili-ties and to shift the direction of the provision of mental health services from the large single-purpose psychiatric hospitals onto predominantly out-patient facilities within general hospi-tals. Thus, the Brazilian experience reflects the Italian mental health care reform of the 1980’s and 90’s (Amarante, 2012). But this socially integrative policy has met with political opposition from the medical and psychiatric associations and media corporations. The oppo-nents of reform wish to preserve not only the psychiatric hospital system but to increase its capacity in order to address the growing problem of drug abuse in children and youth.

The intervention-research methodology aligns itself philosophically with the psychiat-ric reform movement. However, the policies advanced by the reform were neither unani-mously supported by the staff members of the CIAPS. The tensions produced by these politi-cal differences between the staff members manifested themselves as issues of control and concerns over the indeterminate repercussions of the research activities on the young in-patients and their therapeutic programs, access to and management of resources, and conti-nuity of care and its extension into the community. Even before the start of the ICT work-shops, clinic staff voiced concerns regarding how much leeway to accord the researchers and the project: How to control internet use among children and teens? Should discharged pa-tients continue to have access to the workshops, even if it is only a virtual presence through the web? Would children interact with teenagers (in this clinic, children and adolescents are interned in different sectors of the building)? Problematizing questions became impasses, which came to take on special relevance requiring immediate attention from both sides. Con-cerns focused on the dichotomies arising from the relational dynamic between the research intervention and the therapeutic intercession and how to delimit boundaries between research practice and clinical/therapeutic jurisdictions. The staff’s apprehensions brought up important questions related to the integration of seemingly divergent drives: How is academic research to be conducted within a functioning clinical setting all the while dealing with the implicit problems arising from institutional strictures of time, resources, coordination of personnel, bureaucratic imperatives and political resistance? These tensions worked as transversal vectors that crossed the ITC workshops and shaped the analyses and the meanings produced. But regardless of the institutional effects on the unfolding research, the ICT workshops brought to light internal issues and tensions which were plaguing the CIAPS and revealed the many professional challenges faced by the staff.

The need to establish a reflection on the effects of the institution on the research pro-ject soon made itself clear to the research team. Yet, given the nature of the project it could not be a one-sided affair. On a par with the questionings on the methodology of research, the organization of workshops, the analysis of the intervention, and the organization and analysis of records, the ongoing dialogue with the clinic staff provided the research team with addi-tional learning opportunities and improved understanding of the everyday issues of the clinic work as an exercise in participatory analysis and the production of analyzers. According to Nind (2011) participatory analysis is a process of reciprocal learning and exchange and not one of creating conditions where only “the analysis and the themes that fit with those of the academic researcher may make their way forward into discussion” (Nind 2011: 359). The conversations not only addressed the day to day mechanics of the workshops and the man-agement of the research, but dealt with questions that went beyond the scope of the project itself as the immediate object of interest. These went a long way to come to terms with the impact of the institution and the effects of the ideological and logistical impasses on the re-search process, particularly evidenced in the tension between the conceptual dyad of “open" and "closed."

In the research group’s discussion of institutional effects, four mechanisms within the clinic’s daily operation seemed to recur in the analysis: fragmentation, homogenization, ac-celeration and hierarchy. Fragmentation was seen as more than an isolating operation. It is a mode of abstraction which decontextualizes experience and reduces them to stand-alone enti-ties according to reductionist categories (the ‘violent youth’ or the ‘young researcher’). As an analytical device, fragmentation breaks things down into partial, devalued, independent com-ponents whose reduced self-determinative or subjective power cannot be expressed collec-tively. Homogenization is the result of labeling or identifying a population. It renders its con-stituents uniform, featureless and devoid of singularity or distinguishing difference. It is what allows the perpetuation of fragmentation. Homogenization evacuates meaning and signifi-cance from discussions because alternatives are demeaned or non-existent. Homogenization weakens deliberative power and reduces discretionary subjectivity within the exercise of choice and leads technocrats to emphasize simple iteration and the loss of meaning in work. Acceleration follows as a result of iteration and simplification and the flattening of differ-ences. Because decentralization does not apply to management but to the execution of tasks, there is now an overemphasis on the managing of tasks. The dictates of productivity metrics which push for ever-greater yields and returns expect the execution of multiple tasks simulta-neously at increased speed. Finally, hierarchy controls the flow and repartition of power, dis-cipline, surveillance, order and authority. It legitimizes the accomplishment of state power through the occupation of administrative positions by those who look to enforce the struc-tures of governance or who hold and control official knowledge. It is important to highlight that these conditioning mechanisms affect both the clinical staff and the research team.

Incident 4:  Intervention and the Research Itself—The Photography Workshop

During the research process situations can arise that modify the problem and alter the unfolding of the research as initially posited by the researcher. As an example, we wish to consider an incident from one of the photography workshops (Maurente, 2010). The images produced in the photographic workshops by CIAPS staff and young people made us recon-sider our ideas about the various forces operative within the clinic and what forces we needed to contend with. According to Smith, Gidlow and Steel (2012) there are two main reasons for encouraging participants to take their own photographs: participants have control over data production and their personal decisions are implicit in their data choices. Yet, the photog-raphy workshops often demonstrated that the photographs were revelatory of deeper truths, forces and connections than what they were initially being given credit for—the expressive power of the images again and again went beyond the naive, express intentions of the bud-ding photographers.

Figure 2: The staff’s answer to “What is CIAPS?” (Maurente, 2010)

 

 

Figure 3 and 4: The adolescents’ answer to “What is CIAPS?” (Maurente, 2010)

 

 

 

 

In one workshop, after a brief introduction to digital cameras, we proposed that participants answer the question "What is CIAPS?" through their own pictures. Figure 2 shows a photograph taken by a member of the CIAPS staff and Figures 3 and 4 show images taken by adolescent participants. In Figure 2, present us with a general view of the clinical facility. In the foreground plane, balancing the two sides of the frame, we see two mature, leafy trees (one in better shape than the other) on an expansive lawn; in the rear plane we can discern the institution; in the intermediate space which links these two planes, we see a bare vertical pole between the trees and just behind there’s a horizontal obstruction; together, the vertical line and the horizontal produce an impenetrable cross. The rigid, unbending and structured is hidden behind the organic, the pliant and the living: what appears at first sight to be a life-affirming image of a natural feature quickly yields to a guarded institutional rigidity as a second impression. On the other hand, the teens presented a different visual understanding of their CIAPS experience. Figure 3, for example, shows a dog cowering in apprehension on a rough dirt floor in a dingy space bounded by a spattered concrete wall and an uneven and rugged bare brick wall. The lighting is flat and low key; the dog appears uneasy and his slightly hunched head might indicate fear; the stark bleakness of the image is accentuated by the bright reflection of the flash in the dog’s eyes. Figure 4 shows a complex and sophisticated bucolic image taken on the grounds of the hospital. In front of a luxuriant wall of trees we see several empty benches in a sun-lit clearing. The image would seem to speak of calmness, rest and serenity—of the healing powers of nature—but the relation between the inviting restfulness of the benches and the overhanging tsunami of chaotic foliage might be telling a different story. What is that chaos threatening to overwhelm the placidity of the clearing? How long can the chaos be held at bay? Why is the solitary bench on the left looking away from the other two in the middle of the frame? And why the juxtaposition of the lone bench on the left side of frame and the dark, brooding tree on the right being engulfed by chaos? Each of these images provides us with different levels of insight into the clinical experience—insights which cannot be discounted because they are operative within the clinical environment and are therefore part of the research field even if they remain hidden and manifest themselves in offhanded ways. But we need to underscore that each image expresses a particular aspect of the quotidian reality and that each image interacts and affects every other one to create a montage constitutive of the knowledge emerging from the intervention.

These and many other images produced in the workshops informed our understanding of concerns that were not patently obvious in the everyday and that often remained unvoiced under the surface. Our aim was not to dualistically address the issues of reform or contra-reform, but to glean an understanding of the forces at work, to garner insights into the experi-ence of mental illness and the provision of care. The participatory analysis that went into the study of these images revealed a rift in the discourse of the provision of mental health care and gave visibility to the disparity between institutional attitudes and user perceptions of that very same system. Everyone learned from the exchange including the staff of the CIAPS who came to see their perspective differently as a result of participating in the workshops. The CIAPS staff members initially seemed to be more concerned with the inviolability of the in-stitutional concept whereas the young patients seemed to be suffering from both the loss or absence of attentional focus within the therapeutic process and from a lack of validation of their experience. The images which emerged from the photography workshops showed that many of the teens not only explicited these concerns but articulated ‘states of mind’ in ways that often transcended their linguistic capabilities. These expressions gave voice to their ex-pectations and legitimated their subjective concerns as recipients of therapeutic treatment and beneficiaries of the mental health system.

Conclusions

We have examined the effects of a research-intervention project in a series of ICT workshops offered to children and adolescent inpatients in a mental health facility in Porto Alegre, Brazil. The four incidents analyzed have tried to identify and elaborate on the effects that intervention-research can produce on the participants, on the field of research, on the research team and on the research directions.

The involvement of the researchers, the staff and the participants contributed to the creation of the conditions which brought hidden operative forces to light in the movement of the narratives in the ICT workshops. Some of these forces were able to build new narrative positions, new directions to the research, like we saw in the first and fourth episodes, or rein-force existing ones.

The micro-political strategies of intervention-research which were set up to operate within the clinical context, revealed tensions, dichotomies and incongruities within the thera-peutic environment that were not patently evident in the day-to-day life of the clinic (internal vs. external; children vs. teens; reform and contra-reform; research vs. clinical priorities). A series of on-going educational activities were designed and set-up in order to gain insight and work out these issues. This analytical opening led us to create workshops involving the clinical staff. As we presented in the third incident, the questions addressed to the staff could also be addressed to the research team. In intervention-research, these micro-political openings are the main source of knowledge for all participants.

But it was also necessary to relate these tensions to a macro-political level. Academic or health care institutions do not exist outside of larger-scale socio-historical movements; but these institutions can only survive if there is a corresponding micro-political will. The indi-viduals functioning within these institutions as researchers, clinicians, or patients all occupy the fold between the macro and the micro and are required to articulate that difficult relation as best they can. Thus, it becomes imperative for intervention-research to find ways within macro-scale processes to produce micro-political practices which resist fragmentation, ho-mogenization and hierarchization. Micro-political practice has no choice but to take into ac-count macro movements and forces, but its field of activity, its plane of composition, is on another level. The micro-political works in the immediate, in the intuitive, in the relational through affective realizations. The practices, the techniques, the activities only posit condi-tions for the ethical-aesthetic propositions to be experienced as a way of existence.

In this respect, no one was immune to the experiences. The work with the technology enabled the exploration of new expressive capabilities and emotions not only by the children and the youth, but by everyone involved, including the clinical staff and the researchers. The blog, the photographs and the ICT workshops were able to open interfaces between realities and identities that often have low permeability. Identities like “the crazy,” “the fat one,” “the mental health worker,” “the researcher” and “the student” did not hold much sway inside the ICT workshops in spite of their homogenizing institutional value. The workshops were, there-fore, shared learning experiences where each participant had something to tell that was rooted in personal, subjective experience and was validated as part of a vague, formless, yet palpable network of affirmation and support.

What was being learned was something other than what was being taught. The value of intervention-research comes from the lasting effects that it produces, from the affectual movement it actualizes and the subjective social dynamics it generates. We discussed the changes in power positions, in the perception of hierarchy, in learning new sensibilities. These personal effects feed into a collective effect, into a trans-individual attunement, a concretized holisitic effect as a collective agency of mobilization. That agency would appear in moments where the power of the collective needed to be evoked in opposition to fragmentary, non-integrative, stigmatizing tactics. For example, when the clinical staff and research team needed to discuss with the Research Ethics Committee about the wish of the children and teens to sign their posts on the public blog (as it is a psychiatric hospital, the Committee wasof the opinion that the participants do not want to see their names connected to the hospital). Or, when the staff decided to make a web page featuring their own work and needed to negotiate with the hospital administration on the webpage content.

During the seven years of research and interaction with the young in-patient popula-tion, much progress in subjective self-management was achieved. The analysis of collective issues resulted in improvements in the quality of care and services in the clinic and a better understanding of what is at play when academic research meshes with clinical practice. Dur-ing the intervention process, the researchers faced external challenges from a variety of seem-ingly unrelated sources but which found common expression in the unfolding research pro-cess. These external strains included shifts in government mental health policy, socio-political changes arising from federal and state governmental leadership, changes in the hospital administration, institutional tensions within the clinic itself, university politics,  changes to research policies and deontological guidelines, strictures from funding bodies,     and the limitations on the participation of the young participants and their families. The confluence of these disparate effects from outside the research produced unforeseen strains on the process and on the relations between the researchers, the clinical staff and the young participants. In addition, the internal make-up of the research group was in constant change  because some of the members moved on professionally or finished their program of studies which called for the incorporation of new research assistants.

Currently (mid-2015) the ICT workshops are still being conducted and have been in-corporated into the clinic. Further study would be needed to evaluate whether these work-shops have maintained their creative spirit or if they have been normalized as a result of  in-stitutional co-optation.

Acknowledgements

The first author wishes to acknowledge Professor Michael Apple and the Friday Sem-inar Group, from UW-Madison University for their helpful comments and suggestions on an earlier draft of this article.

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Data de submissão: 16/03/2015
Data de aceite: 20/05/2015

 

^I É professora titular do Instituto de Psicologia da UFRGS. Docente e orientadora dos Programas de Pós-Graduação de Psicologia Social e Institucional e de Informática na Educação. Pesquisadora do CNPq. E-mail: cleci.maraschin@ufrgs.br

^II É professora associada do Departamento de Psicologia Social e Institucional da Universidade do Estado do Rio de Janeiro. Pesquisadora do CNPq. E-mail: marisalrocha@uol.com.br

^III É professora titular do Instituto de Psicologia da Universidade Federal do Rio de Janeiro. É professora e e orientadora do Programa de Pós-Graduação em Psicologia e pesquisadora do CNPq. E-mail: Virginia.kastrup@gmail.com