Foundations of the Nise da Silveira method: clinic, society and creativity

Maddi Damião Junior

Psychologist. Doctor in Psychology from Federal University of Rio de Janeiro (Universidade Federal do Rio de Janeiro - UFRJ). Postdoc in Medical Psychology and Psychiatry from State University of Campinas (Universidade Estadual de Campinas - Unicamp). Postdoc in Science of Religions by Federal University of Juiz de Fora (Universidade Federal de Juiz de Fora - UFJF). Associate Professor at Fluminense Federal University (Universidade Federal Fluminense - UFF/CURO). Analyst Member at Brazilian Society of Analytical Psychology (Sociedade Brasileira de Psicologia Analítica - SBPA-RJ). E-mail: maddidamiao@gmail.com

ABSTRACT

The present work aims to present the bases of the method of the Brazilian psychiatrist Nise da Silveira, based on her orientation for the reading of images. In an inter and transdisciplinary perspective, Nise da Silveira reformulated the molds of psychiatry and therapeutic practices in Brazil, being a precursor to psychiatric reform. In addition, it was an important disseminator of Jungian theory and the production of a politically engaged clinic. The presentation is based on three dimensions that we consider fundamental to support the epistemological foundations and the praxis of her work, catalytic affection, self-healing forces of the unconscious and emotion of dealing. Through these three guiding principles of her work, it is possible to see how the theoretical production and her clinic takes place through the construction of a knowledge that crosses all knowledge, which corresponds to the complexity of the studied phenomenon and the psychic reality.

Keywords: Keywords Nise da Silveira, Psychiatry, Therapeutic methods.

1. Introduction

This paper aims to be a testimony of the work of Nise da Silveira as a precursor in Brazil of the "Psychiatric Reform", problematizing its methodological and epistemological foundations. This new model allowed the psychiatrist to be, effectively, the pioneer in Brazil in breaking the asylum paradigm.

The meeting of Nise da Silveira and Jung came about when Nise had the courage to write to Jung, sending photos and showing works by her patients that, although they made spontaneous paintings with "disjunction" and "fragmentation", they showed along with an ordering tendency. Drawings with dismemberment of human and animal bodies, bodies without heads, arms or legs, or of trees cut into pieces, signifying the dismemberment of personality, the imponderable phenomena of psychic dissociation, phenomena that are translated through the language of matter, into plastic expression (SILVEIRA, 1981).

Nise identifies that the psychic reality and its contents are phenomena of intense complexity and intensity, requiring a wide range of resources and forms of approach for their materialization and understanding. Far from being symptoms, they are understood by her as "innumerable states of being", creative forces of organization of a reality that demand other resources, for their communication and expression, that go beyond the propositional language.

As we know, it was through Carl Gustav Jung's theory that the psychiatrist would base her perspective on thinking about the processes of madness and health. Thus, from the inclusion of this totally other - the crazy, to give voice to him, consequently, to build a practice and knowledge based on difference, tolerance and inclusion. It can be said that, with his work and the Jungian theory, which will serve as a foundation for the construction of his knowledge, he gives birth to a "new Psychiatry", based on freedom, on the creative forces of the unconscious, and on the opening to the path of health. Thus, it understands symptoms as an attempt to reorganize the psychism, which will require adequate means to accomplish it.

The principles that guided her work can be summarized as the "catalyzing affection" and "the self-healing forces of the unconscious", besides the "emotion of coping". Thus, if the so-called "madman" were given freedom and shelter, he would be able to recover, not as society might expect, reproductively, but uniquely. This means that it would be a recovery based on their most specific experiences, moving away from the psychic disorder and building narratives, through images that would make them authors of their stories (narrators). In this sense, Nise da Silveira called this scenario "innumerable states of being", seeking in Artaud (2006), the understanding of different - and legitimate - ways of being in the world.

Thus, her work had a clinical nature, as it aimed at therapy, and a new scientific outlook, as a new production of knowledge, whose foundations the present work aims to bring. These are the books published by her during her lifetime, among interviews and films she made:

• Jung, life and work. José Álvaro Editor, 1968: Precise and clear synthesis of Jung's Analytical Psychology, excellent for those who want to start learning about his theories;

• Occupational Therapy - theory and practice. Edition Casa das Palmeiras,

• 1979: The initial name that was adopted by the hospital;

• The thrill of coping. Coordination and preface to an experiment in psychiatry at the House of Palms. Ed. Alhambra, 1987. The term he began to adopt in his work;

• Images of the Unconscious. Alhambra Publishers, 1987. This was reprinted by Vozes in 2015;

• A farra do boi. Ed. Numen, 1989;

• Artaud, the nostalgia of the more. Ed. Numen, 1989;

• Letters to Spinoza. Ed. Numen, 1990. Ed. Francisco Alves, 2nd edition, 1995;

• The world of images. Ed. Attica, 1992;

• Cats, the thrill of dealing. Léo Christiano Editorial, 1998.

She also wrote a small manual to guide the study of images, the "Benedict", which should be published soon. This book is Dr. Nise's orientation on what to read, seeking the understanding of the clinical cases and images produced by the frequenters of the Museum of Images of the Unconscious and House of Palms, a true treatise of transdisciplinarity.

2. Life and work

Nise was arrested during Getúlio Vargas' government, as she was "marginal" her whole life. She created the STOR (Occupational Therapy Sector), in the Pedro II Psychiatric Hospital, in 1946, and, in 1956, the Casa das Palmeiras, aiming to avoid the cycle of continuous readmission process to which patients were subjected in psychiatric hospitals, proud of the fact that in the Casa das Palmeiras the doors were never closed, that is, the "clients", as she called them, enjoyed full freedom to come and go (CASTRO; LIMA, 2007).

In the same way that it prized this freedom among patients, it also forbade technicians, psychologists, interns, and doctors to wear lab coats or any sign that distinguished them from "clients". This, to minimize as much as possible any restriction to creative freedom, or to create any bond that, instead of being based on affection, was determined by power, keeping the institutionalizing character away.

This political dimension of their work was thus supported by the clinical dimension and by the perception that health is a process that, far from being restricted to the psyche or the individual, is the result of a network of social relations and meanings (FRAYZE-PEREIRA, 2003).

This perspective of health, not detached from an ethical and social dimension, is present in all of Nise da Silveira's work. To develop such a perspective, she based her knowledge and practice on the Jungian perspective, that is, on the theory of the Swiss psychiatrist Carl Gustav Jung.

Nise can be considered the great disseminator of C. G. Jung's thought in Brazil. In 1956, she founded the C. G. Jung study group, which was held in her office, upstairs in her house. This group, in the best democratic spirit, was open and attended by all who wanted to attend: psychologists, students, doctors, lay people, artists, and especially psychiatric patients. This group, free and frequented by his cats and humans, was a group in which all those who participated were affected in some way.

By being a voluntary choice and being subject to these meetings, by the coexistence of diversity and difference in a space, theoretically, focused on study, it became therapeutic, by not imposing restrictions or censures to those present. Thus, she affirmed herself as a rebel psychiatrist, not only for breaking paradigms by proposing the construction of an interdisciplinary and transdisciplinary knowledge, but also for breaking with market or social conditions by creating a group in which everyone could participate without paying anything at all.

Carl Gustav Jung may be considered as the first psychiatrist to "give voice to the insane". Based on studies carried out in the psychiatric hospital of Burghoelzli, Switzerland, he defended, until then, the unusual principle that in the deliriums and hallucinations of psychiatric patients there should be some meaning. To achieve this, it was necessary to understand only their language, that is, to enter into these realities with an attentive gaze, instead of attributing certainties and truths constructed only by reason. Thus, he stopped and tried to follow those paths that were shown to him by the "crazy" or "insane", being led to realize that the difficulty was of the reason that could not follow those individuals in their "innumerable states of being", that is, beyond the limits of reason itself (CARVALHO; AMPARO, 2006).

To follow these paths, he realized the need for the construction of interdisciplinary and transdisciplinary knowledge, that is, through the study of multiple languages and knowledge, religion, mythology, natural science, history, sociology, to seek ways to integrate the meaning that was produced by his patients. In this way, he includes not only those beings considered sick, but cultures and knowledge considered "primitive" and "inferior" before Western and European rationality. He promotes a theory that will root man historically beyond his culture in the history of humanity itself, thus showing how to understand the individual, as well as society, one cannot look from only one perspective, that is, society and the individual are seen as a complex and historical system (MOTTA, 2005).

With these principles and the concept of "Self-Healing Forces of the Unconscious", Nise da Silveira will sustain a clinical, institutional and political practice, in which each of these terms are inextricably linked. That is, she will show, through her life and work, how health, ethics and politics are terms of the same experience. It is worth pointing out that politics is understood as the social dimension of the individual and the psychism, unconstrained by subjectivity, but rather, becoming a plural and collective psyche. Already in 1946, Nise laid the basis of a "psychiatric revolution", founded on the principles of freedom, affection, inclusion, and transdisciplinarity.

In 1952, Nise da Silveira founded the Museum of Images of the Unconscious, with a precious collection of paintings, drawings, and sculptures by STOR's frequenters and, in 1956, she created, together with some collaborators, the House of Palms. The latter was created with the purpose of giving support to patients leaving the hospital. At the time, there was a high percentage of readmissions (around 70%). Nise knew that the relapses were caused by the barriers to reintegrate the former patients to life in the community. It is worth noting that after psychotic outbursts, those who suffer them are very fragile, needing support to restructure the self.

Nise transited through several disciplines and areas of knowledge, ranging from what was more conventional in psychiatry to the history of religions and art. Throughout her intellectual production, it is possible to see how these studies are directed to the understanding of images, a product elaborated by interns and frequenters of the Museum of Images of the Unconscious and the Casa das Palmeiras. This specificity demands an inter and transdisciplinary knowledge, as, for example, relates to schizophrenia and the care relationship that the psychiatrist sought to establish with the individuals who arrived - demanded not only a therapeutic methodology, but also a political and pedagogical action, materialized in the positioning favoring of autonomy and individual freedom, as well as in the creation of a space governed by the welcoming and care of those assisted.

Transdisciplinarity is an approach that passes between, beyond and through the disciplines, seeking the understanding of complexity, which goes beyond each of the disciplines, but is formed in the crossing between them, in the dialectics, in the approximations, convergences and intersections (SOMMERMAN, 2006). The three pillars of transdisciplinarity, the levels of reality, the logic of the third included and the complexity, determine the methodology of transdisciplinary research. (NICOLESCU, 1999).

Thus, transdisciplinarity aims to articulate a new understanding of reality between and beyond specializations. This transdisciplinary perspective finds its fundamentals in the need to understand the symbols and the creative process, that is, to understand the immediate experience of the unconscious images, or symbols, which form the structure of the psyche, it is necessary to have knowledge that goes beyond the particular disciplines.

The foundations of Nise da Silveira's clinic can be situated, as already mentioned, from a transdisciplinary perspective, and thus, are perceived in the descriptions of the bases of her practice and knowledge, from the catalyzing affect, the self-healing and creative forces of the unconscious, and the emotion of coping.

These three foundations, of the clinic established by Nise, describe and indicate attitude and understanding of the caring action and of the clinic, which go beyond any concept or categorical definition. That is, affection, creativity and emotion overcome the limits of rationality, pointing to the immediate experience and to what is established in the dimension of the "non-self" - which is a dimension of reality that allows the awakening of any category or restricted knowledge, overcoming possibility. It can be said that the clinic, in this way, is closer to the art and philosophy of the original thinkers, than to academic and contemporary psychiatry and psychology. The above is stated by her in phrases such as "...if you want to learn about the human soul, read Machado de Assis..." (private communication by Nise da Silveira). Or even, "Art teaches more than psychiatric treatises" (ibid).

The psychism is seen as a self-regulating system. For Jung, this means that a system that is self-regulating is capable of dealing with deviations and adaptations in the face of life, which is often not favorable. The inner world also has its potentialities, which have not had the energy to emerge, therefore, have not yet been developed, difficulties and tendencies towards certain polarization and particular imbalances (MELO, 2009).

As mentioned before, within the Jungian and Nise's perspective, the psyche is seen as a self-regulating system, which relates to the conscious and the unconscious in a compensatory way. For Jung, the transformation of psychic energy can be described as a conflict between opposites because it is always the result of the continuous uniting and separating of antagonistic elements.

This manifests as synthesis and antithesis, that is, of conscious and unconscious material. The psyche, involving these two aspects, is part of a multiple totality. Jung leaves implicit in his theoretical framework the idea of movement and intentionality of the system itself as something alive and at the same time partially closed, a complex system in constant transformation.

Permanent readjustments are characteristic of living systems; open and interconnected with the world, with oneself. The acceptance of the complexity paradigm enables a definitive break with the Cartesian division and forces us to think from a transdisciplinary perspective. To unite matter and energy, to reintegrate the human being into the organic, is the first step to bring up thinkers who have dealt with nature and the bodies, such as Jung, Reich, and Groddeck. Because of this, the examples of the body and of psychosomatic are worth the choice for discussing the psychological system proposed by Jung.

It must be taken into consideration that, if the individual reacts in a sickly way, with difficulties in taking care of himself, it can be mistakenly understood that there is no such search for balance. Jung, in his vast work, shows the subject's attempts at self-organization and the production of expressions, such as the mandala, that show this movement. Dr. Nise da Silveira (1981), in her book Imagens do Inconsciente, also develops this aspect. Sometimes the moment being lived and the situation around, as well as, as Nise denounces, the treatment in hospitals, aggravate the situation more than they are favorable places.

A fundamental aspect is to remember that the human psychic system works and lives in an "economic" way, as good as possible, and thus all symptoms and anguish are attempts at psychic restructuring, to survive in an internal and external environment in crisis. The emphasis is on respecting the moment experienced by the client, and accepting the difficulties in each one, as well as the movement towards change, which needs to be respected in terms of time. One of the ways to enable and accelerate an improvement is to follow along, to mobilize in each person the catalyzing affection, always asking: Am I enough of a therapist? How much patience do I have with my limitations? How much acceptance of the Other's way of being and being in me, of the others in us and in those we know, am I able to bear? How is my therapy? How are my studies going? Can I do supervision and elaborate this experience in myself?

Nise da Silveira (1981, p. 80) emphasized that affection was a fundamental factor. It was, in fact, a "constant factor in our occupational therapy section, not only in painting, but also in bookbinding, carpentry, gardening, sewing, upholstery, etc." However, he points out that, "in this apology of affection, there is not the excessive naivety of considering it easy to satisfy the great affective needs of beings who have been so hurt, and socially rejected" (SILVEIRA, 1981, p. 80).

In any therapeutic workshop, this point of reference is the monitor. In the studio or workshop, the monitor functions as a catalyzing affective device, as does the material with which the client deals, and the space in which he or she finds him or herself. The reintegration of the self and the establishment of bonds with the external world depends on these affective devices, through which, the client or workshop attendee will gradually rebuild the bonds with an increasingly extensive world and reorganize himself, being able to deal with this world.

Nise da Silveira was also a pioneer in the perception and studies about the relationship between man and animal, in the therapeutic sense. She also reminds us that it is nothing new that a deep connection can be established between a madman and a dog. Machado de Assis, for example, narrates in Quincas Borba, the story of a dog who loved two madmen. Quincas Borba, the man, named his dog after himself because he loved him so much. The last book written by Nise deals with the theme: Cats, emotion to deal with.

As for the emotion of dealing with experience, this emotion is the experience, the action, the event charged with meaning and sensible ordering force, the aesthetics itself. It performs a synthesizing bridge between the conscious and unconscious personality, integrating opposites and symbolizing this dichotomous union.

The exercise of active imagination and creativity are activities similar to the processes experienced in a psychiatric hospital. However, as Nise points out, an artist can set out to "research new imaginary dimensions, thanks to his intact ego, always carries with him the passage back to the common space, where he carries out like everyone else the routines of daily life" (SILVEIRA, 1981, p. 42). But even for an artist, the "adventures are not without their dangers and awaken fears" (ibid.). Finally, she brings the quote from Lèger, who says "to be free and yet not lose touch with reality. Here is the drama of this epic figure, whether he is called inventor, artist, or poet" (ibid.).

3. Conclusion

The Nise da Silveira method has a genuine innovation that presents itself as revolutionary, not only in psychiatry, but also in the way we look at knowledge, reason, and the other. This is based on affection, on the expression of emotions, and assuming that individuals who are different from the average and the standard of normality will find it easier to understand the complex and unique experiences of the psyche, as well as those considered "abnormal".

Otherness, to be seen by itself and in itself, demands, according to the method established by Nise, a transdisciplinarity, which encompasses countless correlated knowledge, creates an interaction among them, and transcends what each one of them proposes.

The Jungian perspective is fundamental and conditioning for the dialectical practice of Nise da Silveira's work. It is also a structuring element for the creation, foundation and development of the method established by the psychiatrist, once the reading of the unconscious from the free expression of the "clients" became a tool that permeates not only the whole work, but also the form and legacy of life. ■

References

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