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      Suicidio más allá del diagnóstico: un enfoque centrado en la persona y su circunstancia Translated title: Suicide beyond diagnosis: a person and their circumstances-centered approach

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          Abstract

          Resumen: Existe una pluralidad de enfoques sobre el suicidio. En la literatura científica y en el ámbito sanitario es hegemónico el modelo biomédico. En este trabajo se presenta un modelo alternativo, existencial-contextual, de estudio, comprensión, prevención y posvención del suicidio en el ámbito sanitario. El trabajo se divide en dos partes. La primera expone los tres elementos esenciales del modelo existencial-contextual: la noción de persona, el concepto de problemas de la vida y la práctica de la relación de cuidado y acompañamiento. La segunda desarrolla algunas de las diferencias asistenciales más importantes entre el modelo biomédico y el existencial-contextual del suicidio. Se concluye en la necesidad de superar el paradigma suicidológico biomédico tradicional y construir un espacio amplio transdisciplinar de reflexión suicidológica crítica a la altura de nuestro tiempo. Este cambio de paradigma requiere pasar de una lógica que prioriza lo patológico-biológico-farmacológico a otra socio-psico-política del suicidio que integre las aportaciones del modelo biomédico sin reducirse a ellas.

          Translated abstract

          Abstract: There is a plurality of understanding approaches to suicide. In the scientific literature and the healthcare field, the biomedical model is hegemonic. This paper presents an alternative existential-contextual model for the study, understanding, prevention and postvention of suicide in the healthcare field. The academic paper is divided into two parts. The first part sets out the three essential elements of the existential-contextual model: the notion of personhood, the concept of life problems and the practice of caring and supportive relationships. The second one develops some of the most important differences in care between the biomedical and the existential-contextual models of suicide. It concludes with the need to overcome the traditional biomedical suicidological paradigm and to build a broad transdisciplinary space for critical suicidological reflection that is up to date with our times. This paradigm shift requires moving from a logic that prioritizes the pathological-biological-pharmacological to a socio-psycho-political logic of suicide that integrates the contributions of the biomedical model without being reduced to them.

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          Most cited references106

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          The biomedical model of mental disorder: a critical analysis of its validity, utility, and effects on psychotherapy research.

          The biomedical model posits that mental disorders are brain diseases and emphasizes pharmacological treatment to target presumed biological abnormalities. A biologically-focused approach to science, policy, and practice has dominated the American healthcare system for more than three decades. During this time, the use of psychiatric medications has sharply increased and mental disorders have become commonly regarded as brain diseases caused by chemical imbalances that are corrected with disease-specific drugs. However, despite widespread faith in the potential of neuroscience to revolutionize mental health practice, the biomedical model era has been characterized by a broad lack of clinical innovation and poor mental health outcomes. In addition, the biomedical paradigm has profoundly affected clinical psychology via the adoption of drug trial methodology in psychotherapy research. Although this approach has spurred the development of empirically supported psychological treatments for numerous mental disorders, it has neglected treatment process, inhibited treatment innovation and dissemination, and divided the field along scientist and practitioner lines. The neglected biopsychosocial model represents an appealing alternative to the biomedical approach, and an honest and public dialog about the validity and utility of the biomedical paradigm is urgently needed. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Direct versus indirect psychosocial and behavioural interventions to prevent suicide and suicide attempts: a systematic review and meta-analysis.

            Psychosocial and behavioural interventions that address suicidal thoughts and behaviour during treatment (direct interventions) might be more effective in preventing suicide and suicide attempts than indirect interventions that address symptoms associated with suicidal behaviour only (eg, hopelessness, depression, anxiety, quality of life). To test this hypothesis, we did a systematic review and meta-analysis of psychosocial and behavioural interventions aimed at preventing suicide and suicide attempts.
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              A metapsicologia do cuidado

              A teoria e a clínica psicanalítica servem de base para o desenvolvimento de uma concepção geral do cuidado que possa ser compreendida e operada por agentes cuidadores em geral: mães e pais, médicos, enfermeiros, professores, assistentes sociais, fonoaudiólogos etc, sem exclusão dos próprios psicanalistas. As diversas faces do cuidar são apresentadas em termos daquilo que o cuidador faz como presença implicada - acolher, reconhecer e interpelar - e como presença reservada - dar tempo e espaço, esperar, manter-se disponível sem intromissões excessivas. Enfatiza-se a necessidade de equilíbrio dinâmico entre estas diferentes formas de presença e alerta-se sobre a possibilidade dos cuidados serem oferecidos em função das necessidades narcísicas do cuidador e em prejuízo dos seus objetos.
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                Author and article information

                Journal
                neuropsiq
                Revista de la Asociación Española de Neuropsiquiatría
                Rev. Asoc. Esp. Neuropsiq.
                Asociación Española de Neuropsiquiatría (Madrid, Madrid, Spain )
                0211-5735
                2340-2733
                December 2023
                : 43
                : 144
                : 47-71
                Affiliations
                [6] Cantabria orgnameInstituto de Investigación Marqués de Valdecilla (IDI-VAL) España
                [8] Madrid orgnameServicio Madrileño de Salud España
                [1] Asturias orgnameServicio de Salud del Principado de Asturias España
                [2] Asturias orgnameServicio de Salud del Principado de Asturias España
                [7] Madrid Madrid orgnameUniversidad Complutense de Madrid orgdiv1Facultad de Psicología Spain
                [4] Asturias orgnameServicio de Salud del Principado de Asturias España
                [5] Asturias orgnameServicio de Salud del Principado de Asturias España
                [3] Tarragona orgnameUniversitat Rovira i Virgili orgdiv1Departamento de Antropología, Filosofía y Trabajo Social España
                Article
                S0211-57352023000200003 S0211-5735(23)04314400003
                10.4321/s0211-57352023000200003
                5ebe22bd-cb18-4f0f-8508-eee10806b126

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 26 May 2023
                : 24 January 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 108, Pages: 25
                Product

                SciELO Spain

                Categories
                Artículos

                suicide,suicide prevention,contextual,existence,suicidio,existencia,prevención del suicidio

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