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Pesquisas e Práticas Psicossociais

On-line version ISSN 1809-8908

Pesqui. prát. psicossociais vol.12 no.4 São João del-Rei Oct./Dec. 2017

 

ARTIGOS

 

The theory of subjectivity in the study of chemical dependency: reflecting about existing theories and practices

 

A teoria da subjetividade no estudo da dependência química: refletindo sobre as teorias e práticas profissionais existentes

 

La teoría de la subjetividad en el estudio de la dependencia química: reflejando

 

 

Thamiris Melo CaixetaI; Valéria Deusdará MoriII; Marília Santos BezerraIII

IPsicóloga graduada pelo Centro Universitário de Patos de Minas (Unipam, 2007-2011). Pós-graduada em Filosofia pelo Instituto Universitário Sophia (Florença, Itália, 2011-2015). Pós-graduada em Dependência Química pelo Instituto AMW (2015-2016). Mestranda pelo Uniceub em Psicologia e Saúde (2016-atual)
IIDoutora em Psicologia pela Universidad San Carlos de Guatemala. Mestre em Psicologia pela Universidade de Brasília. Graduada em Psicologia pelo Centro Universitário de Brasília
IIIGraduada em Psicologia pelo Centro Universitário de Brasília (2012). Mestra em educação pela Faculdade de Educação, UnB. Doutoranda pela Faculdade de Educação, UnB

 

 


ABSTRACT

The topic related to chemical dependence has been increasingly approached in studies of professionals from different areas. From its theoretical models to professional practice models, the use of chemical substances has generated questions that reflect the need to create new modes of intelligibility of the theme. The present work, using the constructive-interpretative method that is based on Qualitative Epistemology (González Rey, 1997, 2005b), presents a reflection about the theme, emphasizing the production of social subjectivity, individual subjectivity and processes related to health in the context of the clinical dependency. For this, a case study was carried out, where the production of knowledge values the singular and the dialogical, during the process of information construction.

Keywords: Chemical Dependency. Subjectivity. Health.


RESUMO

O tema relacionado à dependência química, por sua atualidade, tem sido cada vez mais abordado em estudos de profissionais de diversas áreas. De seus modelos teóricos aos modelos de prática profissional, o uso de substâncias químicas tem gerado questionamentos que refletem a necessidade da criação de novos modos de inteligibilidade do tema. O presente trabalho, fazendo uso do método construtivo-interpretativo que se pauta na Epistemologia Qualitativa (González Rey, 1997, 2005b), apresenta uma reflexão acerca do tema, colocando em relevo a produção da subjetividade social, da subjetividade individual e dos processos relativos à saúde no contexto da clínica da dependência química. Para isso, foi realizado um estudo de caso, onde a produção de conhecimento valoriza o singular e o dialógico, no decorrer do processo de construção da informação.

Palavras-chave: Dependência química. Subjetividade. Saúde.


RESUMEN

El tema relacionado con la dependencia química, por su actualidad, ha sido cada vez más abordado en estudios de profesionales de diversas áreas. De sus modelos teóricos a los modelos de práctica profesional, el uso de sustancias químicas ha generado cuestionamientos que reflejan la necesidad de la creación de nuevos modos de inteligibilidad del tema. El presente trabajo, haciendo uso del método constructivo-interpretativo que se regula en la Epistemología Cualitativa (González Rey, 1997, 2005b), presenta una reflexión acerca del tema, poniendo de relieve la producción de la subjetividad social, de la subjetividad individual y de los procesos relativos en el contexto de la clínica de la dependencia química. Para ello, se realizó un estudio de caso, donde la producción de conocimiento valora lo singular y lo dialógico, en el transcurso del proceso de construcción de la información.

Palabras clave: Dependencia química. Subjetividad. Salud.


 

 

Introduction

Currently characterized as the "drug issue", the voluntary practice of psychoactive substance intoxication, is understood from a polyphony of discourses and techniques that come from multiple fields of knowledge, action and policies. It is intended here, not only to explain the main models of study for understanding chemical dependency as a phenomenon, but also to elaborate a path that leads us to a new form of intelligibility about the theme.

Despite the existence of a great variety of studies on the issue of compulsive consumption of addictive substances and the number of models that offer a theoretical foundation to try to explain the complexity of the nature of chemical dependency, over time four theoretical models have been developed and are considered Academic leaders and professionals in the field. They are: the disease model, the model of learned behavior, the psychoanalytic model and the familiar model (Figlie, Zanelatto, Bordin, Grandi & Laranjeira, 2015).

The disease model understands dependence as a primary disorder and independent of other conditions, in other words, this is a biological susceptibility inherited from the effects of alcohol or drugs. The model of learned behavior refers to the abusive use of substances that comes from learned or conditioned behaviors, meaning that, feelings, thoughts and physiological changes that occurred in the process can be modified through the application of new learning processes. The classic psychoanalytic model, on the other hand, understands the use of alcohol and drugs as a possibility to retake the pleasurable states of childhood and lastly, the family model contributes to understand the chemical dependence regarding the rules that conducts the family relationships and how they contribute to the recurrent use of the substances (Figlie et al., 2015).

It is then possible to perceive the existing difficulty in approaching the complexity of chemical dependence. The currently addressed models are not capable of considering the human being as a whole: it is either framed only in a pathological aspect, or only in a process of learning and behavior, or in a matter of the construction of the psychic apparatus or in a range of family relationships, where these relationships are capable of sovereignly dictating the existence of relapses or successes in the course of the abstinence process.

With this in mind, a fifth model has recently been developed, which conceives chemical dependence as a biopsychosocial factor, which Zanelatto and Laranjeira (2013) claim to be a multifactorial in its genesis. There is, therefore, the need to associate several theories to determine the cause of the problem, its development and prognosis.

Although the biopsychosocial model presents a more elaborate understanding of the origin of chemical dependence, it is important to emphasize that "no theory, so far, can alone account for fully explaining the genesis and maintenance of the process of dependence" (Figlie et al., 2015, p. 4). Thus, in the means of action and practice today, one must find the points of interaction and dialogue between the aforementioned models, considering this a means of broadly addressing the phenomenon of chemical dependence.

Although, in theoretical questions, the biopsychosocial perspective emerged as an alternative to the traditional biomedical model, it is known that there is an inherent need for a continuous dialogue between knowledge and practice so that the individual and social aspects that involve the context of the individual are contemplated. Thus, it can be seen that when divisions between psychic variables and social factors are attributed, a fragmentation over the person in the process of illness is created, not only excluding part of the necessary possibilities of dialogue between these factors, but also bringing forward the recurrent existence of the biomedical vision, even within the biopsychosocial model (De Marco, 2006).

In this regard, González Rey (2004) affirms that the quality of life of a person must be understood considering the socio-cultural and subjective configuration in which this person is inserted. In a context where human understanding is sought from a biopsychosocial model, the dualistic and causal view derived from the biomedical model highlights the fragmentation over the existing relationship between health and illness. In this context, the pathological factors of the biopsychosocial system are highlighted, excluding the possibility of acquiring quality of life. It is known, therefore, that the subjects of culture and subjectivity were not considered to explain the genesis and development of the psychological processes that emerge in cultural development (González Rey, 2011).

It should be emphasized that in biopsychosocial studies of drug addiction, the drug addict is considered either intrapsychically or within a causal relationship between external and internal factors. The individual is not considered in his subjective productions and in construction with the social, within a relational and not purely causal context. By disregarding the singular in a phenomenon seen as epidemic, theories and practices are developed for the great masses, not taking into consideration the local culture and the historical moment in which the one who uses/abuses of psychoactive substances lives.

Thereby, history is seen as a singular subjective configuration of the drug addict's experiences in concrete social spaces. Within these spaces, individual and society develop concomitantly. Thus, the idea of social subjectivity is associated with a system definition, where the various processes that occur at macro and micro social level are considered in relation to interdependence. According to González Rey (2012, p. 148)

The subjective organization of a society, its social subjectivity, is not a reflection of any of its constituent systems, but a production that nourishes itself of all the systems, processes and facts that are part of that society. These are constituted at the subjective level as meanings, modifying their original quality in relation to the system of reference which they are part of and becoming, in a subjective sense, a part of the social subjectivity and individual subjectivity of the subjects that act in these social subjectivity spaces.

It is, above all, a question of deinstitutionalizing the drug addict's existence in its concreteness of life, thus removing it from the social oscillation that it experiences between the institutions of the drug addiction industry and the mass policies of the State. Deinstitutionalization, in this regard, will be related to the various factors of the person's existence and their subjective production, in a way that the drug user, once the object of political knowledge and health, becomes the owner of a voice and own action (Amarante, 2009).

Thus, new possibilities of life are born that match the singularity of the individual, bringing to the surface a new meaning to the one that previously only had the drug addiction as a subjective resource to deal with the processes of life. Now there is room for the recognition of the person in his human condition and all of its inherent complexity. Dealing with the complex brings an openness to think theoretical and practical models that are based on the production of the person in relation to culture, history, politics and ethics; at the same time without reducing themselves to these dimensions (Morin, 2005). It leads us, above all, to realize that drug addiction is not the cause, but the effect of a world that has fallen ill (Hart, 2014) and reified in its own power games, public policies, industrialization of health, education and economy.

It is important to emphasize here that being a subject is not an acquired quality, but "a condition that is achieved permanently in the process of action and relations that accompany a process of subjectivation" (González Rey, 2007, p. 184). Thus, to recognize the possibility that the person may emerge as a subject, brings out his ability to take his own life at hand, through his reflective commitment within the communicative space, in a relational and social context.

In different contexts, the emergence of a subject capable of reflecting critically brings to light the importance of thinking beyond such discourses and hegemonic phenomena, thus formulating questions concerning life and social action. Emerging subject becomes the action of becoming responsible for oneself, for one's own life (González Rey, 2012).

Therefore, keeping the focus on the production of social subjectivity and individual subjectivity, the present work aims to highlight the processes related to health arising from the advent of individual and social subjects, which are capable of generating new conditions of subjectivation and new alternatives of life in the context of chemical dependency. In order to do this, we carried out a case study, using the constructive - interpretive method that is based on Qualitative Epistemology (González Rey, 1997, 2005b) and that conceives the production of knowledge valuing the singular and the dialogical, during the process of construction of information.

 

Methodology

The Qualitative Epistemology (González Rey, 1997, 2005b), on which the constructive-interpretative method is based, was elaborated from the challenges of scientific research on the subject of subjectivity, giving new theoretical visibility to the individual and social subjective dynamics, elaborating new ways of investigating them.

To understand the method, it is necessary to walk a path that leads to its historical and social understanding in a context where the qualitative research has become the generator of new spaces of study and human conception in the face of the instrumentalist conjuncture presented by positivist science.

Thereafter, González Rey (2013) affirms that positivism derives from an ordered representation of the world, in which the relations between different processes and phenomena can be defined and known by their regularity. It is emphasized in this model of science the deterministic character and the standardization of information.

This model of scientific research, propagated from the nineteenth century, promoted the constant need for objectifying knowledge, thus presenting the studied phenomena as unquestionable facts, letting the knowledge be permeated by the necessary lucidity that must permeate research, especially with regard to the limitations that occur in the course of knowledge production (Gatti, 2012).

Faced with the characteristics that marked the making of science over time, it becomes complex to define what qualitative research means today, since this concept develops in several fields of knowledge in distinct ways. For this reason, González Rey (1997) situates qualitative analysis in an epistemological perspective by defining the epistemological bases of a qualitative approach in the field of Psychology.

Here, epistemology is characterized as a way of constructing knowledge, being this directly linked to the reflective capacity of the researcher who uses it, basing and interrogating the methodological principles so that there is a possibility of transiting within the limits and contradictions existing in research, thus developing a theoretical awareness and an epistemological discussion (González Rey, 2005a).

Within this context, the interpretative constructive method allows comprehension of knowledge as a means of production that values reality as it presents itself: nonlinear, complex and full of interrelated fields. As we approach this complex system through the practice of scientific research, it becomes possible to form a new field of reality that recursively generates new susceptible aspects that are likely to be meaningful in research, as well as enables the development of a new theoretical dimension. (González Rey, 2005a)

Therefore, the notion of method to which we refer is closely related to the theoretical definitions that support it, in a way that the methodological elaboration itself aims to support the expansion and development of the theory in the field of investigation.

The researcher's role is, therefore, to behave as a reflexive and discursive subject that allows his research to be permeated also by his symbolic and emotional productions. This construction of knowledge is based on human production that relies on a relational and dialogical character.

It is then necessary to keep our eyes focused on what is beyond what can be seen, considering the participant of the research as a unique person and maintaining a dialogical relationship with them. Thus, there is no imposition of knowledge of the researcher on the participant subject, but rather a relation of co-participation, where the real possibility of giving autonomy to the subject is presented, allowing him to express himself freely in his speech and in his behavior, thus leading the researcher to the subjective senses and possible subjective configurations.

In this sense, within the qualitative research, a concretization of a new way was made possible where the overcoming of the limitations resulting from the different models of hegemonic discourse was based on a new epistemological basis, which also guided the new theoretical resources presented in a cultural-historical perspective of the Theory of Subjectivity (González Rey, 2002a).

The Qualitative Epistemology presents three epistemological assumptions in its base: the constructive interpretative character of knowledge, the singular as a production of knowledge and the dialogue as the core of the research. These pillars enable a better articulation of the researcher in his immersion in the field, since they emphasize research as a production of knowledge derived, above all, from the appreciation of the singular and the dialogue developed in the relation.

By confirming the process of constructing knowledge as constructive-interpretative González Rey (1999), recognizes the infinity and complexity of reality, thus depriving its linear representation as it is often proposed in contemporary scientific production. This way of proposed reality conception allows to overcome the one-dimensional causality often attributed to human phenomena and leads us to consider the symbolic and emotional dimensions of the same.

Therefore, it can be noted that the research is permeated by a constant process of knowledge construction that expresses itself in a creative way not only in relation to the new, but also in the contradictions that appear as one advances in theoretical construction and in the various resistances encountered in the field and in the relationship with the research participant. Thus, González Rey (2005b) states that the empirical moment is the result that comes from the confrontation between theory and what was studied during the signification cut carried out during the research.

This cut makes it possible, above all, to present the infinite possibilities of manifestation of the singular, leading us to processes that are full of meanings and senses that are being constructed during the life of the drug addict and that emerge in the course of research within the dialogical space created between researcher and researched.

Concomitantly, the theoretical model develops as it unfolds in hypotheses in the course of the research. It is important to emphasize that these can be challenged or modified according to the material that appears during the course of the research. This is the process of information construction, where the empirical and theoretical constitute the intellectual production of the researcher (González Rey, 2012c).

It is from this relationship between the theoretical construction process and the constant reorganization of the researcher's thought that the indicators emerge, considered the hypothetical sense-generator elements within the process of information construction. They lead to intelligibility about the studied phenomenon and favor the new scope of more concrete hypotheses that are built in the course of the research. This articulation is called configurational logic and from it, the various constructions weave themselves in a spontaneous, personalized and dynamic way (González Rey, 2005a; 2005b).

At this point, it is possible to emphasize dialogue as the core of the research, because it is through it that emerges - implicitly or explicitly - the different social or individual issues that permeate the participant's life (González Rey, 2005a).

Therefore, the relationship between researcher and collaborator is essential and determinant in the process of information construction, thus favoring the organization of social space and bringing up the possibility of the emergence of the subject in the course of the research. It is within this dialogical space that the subject can express himself symbolically and emotionally, hence bringing to the researcher the possibility of understanding the senses and the subjective configurations that allows understanding as to how the various processes of the person's life subject themselves in their daily life (González Rey, 2005a).

The fact of emphasizing the dialogical space and the relation with the research participant is intimately connected to the legitimization of the singular as a means of scientific knowledge, that comes from the information derived from the singular case and that brings significant contributions to the construction of the theoretical model (González Rey, 1997, 2005a).

Hence, the study of the singular represents the phenomenon conceived by the research participants themselves, which leads us directly to the construction of knowledge. To perceive the representation of such phenomenon in the field of drug addiction involves trying to understand the relational complexity that exists between the development of the psychoactive substance industry and the experiencing of the various individual and social aspects in the daily life of the drug addict.

 

Analysis and information construction

The case study carried out in this research was done through the conversational dynamics, an instrument where the "researcher moves from the place of the questions to integrate into the conversation dynamics" (González Rey, 2005a, p. 45). Therefore, going beyond the instrumental character of the interview, the conversational dynamics allows free and open expression, characterizing the processes of the existing relationship between researcher and subject.

Within this research, the conversation sessions were held at different times and were recorded for further analysis that was carried out by the researchers. In this paper, we will discuss Antonio's case - a fictitious name given to the participant to preserve his identity. He is 17 years old and is in a rehab clinic for crack and cocaine abuse, for a period of 5 years.

In the following section, Antonio tells us about his hospitalization process in a rehabilitation clinic:

I started using drugs very early. At 7 years old I already used marijuana in the house with my father and my brother. It was fun and it did not look like I was the youngest son. From there, at 8, I turned into a duffle bag boy for some of my father's friends who trafficked. I got involved in this life, I liked having my money and buying my stuff. And I was smarter than my brother and so I always had more work than him. Even though I was younger, I felt big. My mother did not know about all of this and when she found out, it became a problem, she sent each one of us to a clinic and went to live her life. It has been a while since I have been admitted and not seen the family. But I do not complain. It was many years in crime.

In the previous speech, we can observe that when talking about the issue of being admitted to a rehabilitation clinic, the question of drug addiction is not the only issue that appears. Antonio's speech presents an indicator of his family relations and the importance of work in his childhood, when facing his relationship with his brother. We have an indicator of subjective senses associated with the relationship with the father and how within this relationship the abusive use of psychoactive substances may have developed.

It is important to emphasize that, in the scars of the present society, the organization of the experiences of the abusive use of psychoactive substances involves - by and large - the traffic and the family rupture. It is known that in a contradictory movement, on the one hand, the use of psychoactive substances - within the current biomedical context - can be considered as a way of subversion for the traditional logic of elimination of pain proposed by medicine and the marketing system. On the other hand, it can also be considered as a negative reflection of the act of expropriation of health, where man fails to recognize in himself the potentiality to experience aspects of health and life, and begins to adopt pain in its various measures as synonym of illness, thus validating individual and social intolerance to what is not easy, quick and causes immediate pleasure.

So, we live in a culture that reverberates the incessant search for instant pleasures and denies the perplexities and adversities inherent to the human condition. The existence of the previously mentioned starts to belong to the pathological circle of what is considered abnormal. The restlessness of living gives way to the superficial wandering of a culture that starts to regulate its life by means of consumption, believing that for each problem a solution can be bought in the most diverse ways (Llosa, 2013; Bauman, 2001).

Antonio stands before the crimes committed by him, his admission in the clinic and rupture of contact with the family. In another moment of conversational dynamics, in relation to this, he says:

I was admitted I was only 12 years old. I had no formed opinion completely. My mother fought with me, put me in here, turned her back and left. I never saw her again. I do not know if this is good or bad, because I see the comrades in here meeting weekly with the family and there is a lot of suffering. I'd like to see my father and brother because we're in this together. But I never even knew what clinic they were in. Are they alive? If they left the clinic, did they continue or stop? I do not know; I think when I turn 18 I'm going to get out of here and get to work. I have lived in crime, I have done much that I regret and I do not want to go back into this life again. I don't think I'm that boy anymore. Because drug does that, it kills us a little every day.

In this section, we have indicators of how the research participant deals with his possible future. It is possible to see how aspects of social subjectivity - such as having the various types of independence at the age of 18 - are important for the unfolding of Antonio's individual processes.

Facing a society that lives on the constant promises of happiness, the chemical dependency is transformed not only into a lucrative enterprise that goes from the creation, naturalization, democratization and commercialization of specific substances, but also profitable for exclusive communities of the great industry of treatment on drugs based on the biomedical model. It becomes a complex lifestyle that sometimes seeks to contradict the existing hegemonic discourses and other times presents itself as a serious consequence of the aforementioned promises of happiness existing in current culture. Hence, after 5 years of admission and without making use of chemical substances, the research participant still affirms the fact that his life continues to change daily due to drugs.

It is necessary to realize, in this sense, that chemical dependence at social level requires attention on two levels: social macro and micro. In one, there is a need for investments in treatments, preventive campaigns, fight against trafficking and expenses with early retirement - for example. In another, there is direct involvement with family groups, the local community and the development of national realities in specific fields. This brings to light not only the complexity of the phenomenon, but the need to think of the processes of dependence from several levels: starting from the subjective genesis, passing through family nuclei and local communities, only then to talk about national issues, public health policies and to combat drug trafficking and the drug addiction industry.

I still have hope for a better life. Being in here, we know all kinds of people and life. I know I have the right to life. I don't want to be a part of this world of drugs, which is an industry, isn't it? You have to buy medicine, pay for treatment, buy clothes, and help colleagues to do everything right. This has become my family. I want to help people just as they helped me here.

At this point, Antonio emphasizes his new possibilities of life that match his singularity, bringing a new meaning to the one that previously only had the drug addiction as an existential resource.

Thus, throughout the research and the various moments of conversation, it was possible to perceive that the processes of subjective sense in relation to other people and to his own history have been reconfiguring, also through interaction and dialogue with researchers. This dynamic characteristic of the research in the context of Qualitative Epistemology allowed us to find elements that evidence the we need to continue working with the theme, considering the complexity of the chemical dependence phenomenon.

 

Final considerations

Reflecting on chemical dependency led us to think directly about the complexity of the phenomenon. Much more than working towards prevention and combatting abusive use of psychoactive substances and trafficking, it is necessary to understand in a local way what are the real experiences lived by the drug user, his family and his community, thus understanding relevant factors of the social subjectivity that the policies that are directed to the masses cannot reach.

When speaking of subjective production, one can then think of the characteristic of existing processes in the innumerable factors related to chemical dependence. In fact, in most studies and policies on drug promotion and prevention, the social, relational and individual are highlighted. But it is important to emphasize that the social is not seen as a production full of dynamicity and movement, the relational is perceived as a depository of relations of causality and as to the individual, it remains to be held hostage to the physical processes pertaining to the abusive use of psychoactive substances.

It is necessary, therefore, to consider the existence of subjective productions that are permeated by a symbolic-emotional character when thinking about the genesis and in the development of chemical dependence. Going far beyond the aforementioned causal conditions, one reflects here on the subjective configurations of the experiences of the chemical dependent, since it is known that a priori, it is not the experience itself that is responsible for the emotions and the symbolic unfolding, but the capacity to produce new subjective senses that allow the emergence of new options of subjectivation in the course of human experience, which is considered to be conflicting by its subjective character (González Rey, 2012b).

Based on these considerations, it is possible to emphasize the differentiated character of Qualitative Epistemology as a means of constructing knowledge, as well as of the constructive-interpretative method that brings heuristic contributions to the development of this research by enabling a differentiated approach of the empirical field when starting from the overcoming of hegemonic discourses related to the abusive use of drugs, as well as those considered to be pathological models congruent with the biomedical model and the biopsychosocial model.

Within the process of information construction, the study of drug addiction allows the elaboration of new resources and treatment models, as well as a new theoretical contribution that allows to develop a new field of education in public anti-drug policies that can be based on the social study at a local and national level.

In assessing the probability of emergence of the subject, in the context of chemical dependence, it is considered the possibility that the latter is not only recognized as a hostage of the drug addiction industry or of the treatments recognized within the biomedical model or the biopsychosocial model. To speak of this subject, in this sense, leads us to question how the processes of subjectivation of the individual are developed, how personal resources are developed to advance in a critical way and not only reproduce actions and thoughts in an unreflective way. It is always considered, in questions of subjectivity, the individual relating in a recursive way with the social (González Rey, 2011).

Within the context of the clinic of chemical dependency, overcoming the discourses of causality and linearity means, above all, to seek to understand the emotional historical character that permeates the life of the drug addict in its diverse contexts and relational fields, that is, the genesis of the use of psychoactive substances becomes a complex phenomenon that does not occur a priori from a single factor, but contains within itself the construction of various subjective processes that may be interrelated.

 

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Recebido em 29/08/2017
Aprovado em 20/11/2017

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