Do estigma da psicose maníaco-depressiva ao incentivo ao tratamento do transtorno bipolar: a evolução da abordagem em dois veículos midiáticos nos últimos 40 anos

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Abstract

OBJETIVO: Investigar a evolução ao longo dos últimos 40 anos da assimilação midiática do transtorno bipolar. MÉTODOS: Foram pesquisadas referências sobre os termos "transtorno bipolar" e "maníaco-depressivo" na revista Veja e no jornal The New York Times e analisada uma amostra de 40 textos de cada veículo. Os textos foram divididos em dois grupos, o primeiro reunindo aqueles datados dos anos entre 1970 e 1999 e o segundo, 2000 a 2009. RESULTADOS: Entre os anos de 1970 e 1999 é mais utilizado o termo "maníaco-depressivo", porém na década de 2000-2009 a expressão "transtorno bipolar" predomina amplamente. Além disso, artigos mais antigos, que utilizam principalmente o termo "maníaco-depressivo", tendem a ser mais estigmatizantes e com menor pretensão informativa. Já artigos mais recentes, em que a expressão "transtorno bipolar" é mais utilizada, tendem a incentivar a busca de tratamento. CONCLUSÃO: Sugere-se que a abordagem midiática do transtorno bipolar, comparada ao tratamento recebido pela psicose maníaco-depressiva, é marcada pela maior assimilação do referencial biomédico.

Translated abstract

OBJECTIVE: To examine the evolution over the past 40 years of the midia approach to bipolar disorder. METHODS: A search was performed using the terms "bipolar disorder" and "manic-depressive" in the Brazilian magazine Veja and in American newspaper The New York Times. A sample of 40 texts from each source was analyzed. The texts were divided into two groups, one dated of the years between 1970 and 1999 and the second from 2000 to 2009. RESULTS: Between 1970 and 1999 it is most often used the term "manic-depressive", but in the decade of 2000-2009, the term "bipolar disorder" prevails widely. In addition, ol-der articles, which predominantly use the term "manic-depressive" tend to be more stigmatizing and less informative. Recent articles, on the other hand, feature more often the term "bipolar disorder" and tend to encourage treatment seeking. CONCLUSION: It is suggested that the midia approach to bipolar disorder, in comparison with the one given to manic-depressive psychosis, is characterized by a closer assimilation of the biomedical model.

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Jules Angst (2002)

The history of psychiatric classification is highly complex and this presentation must be restricted to a simplified overview. Guislain [Guislain, J., 1833. Traité des phrénopathies ou doctrine nouvelle des maladies mentales. Etablissement Encyclopédique, Brussels] and Zeller [Beil. Med. Corresp.-Bl. Würtemb. Arztl. Ver. 7 (1837) 321] established a unitarian concept of psychiatric disorder, permutations of which have survived until the present day. Kraepelin's [Kraepelin, E., 1899. Psychiatrie. Ein Lehrbuch für Studierende und Arzte (6th edn.). Johann Ambrosius Barth, Leipzig] dichotomy between "manic-depressive insanity" and dementia praecox was built mainly on Kahlbaum's [Kahlbaum, K., 1863. Die Gruppirung der Psychischen Krankheiten und die Eintheilung der Seelenstörungen. AW Kafemann, Danzig] classification, which took clinical symptoms, course and outcome into account. Kraepelin's well-accepted approach sought to provide a basis for diagnosis, prognosis, choice of treatment and causal research. Kraepelin's dichotomy came to be questioned on several grounds: (1) doubts about his unification of bipolar disorder [Gaz. Hôp. 24 (1851) 18] with melancholia, (2) doubts about the significance of Kraepelin's diagnostic groups for causal research [Z. Gesamte Neurol. Psychiatr. 12 (1912) 540], illustrated best by the work of Bonhoeffer [Bonhoefferm, K., 1912. Die symptomatischen Psychosen im Gefolge akuter Infektionen, Allgemeinerkrankungen und innerer Krankheiten. In: Aschaffenburg, G. (Ed.), Handbuch der Psychiatrie, 3. Abt., 1. Hälfte. Deuticke, Leipzig Wien], (3) the complex psychopathological descriptions and classifications of numerous subgroups of psychoses by Kleist [Monatsschr. Psychiatr. Neurol. 125 (1953) 526] and Leonhard [Leonhard, K., 1968. Aufteilung der endogenen Psychosen (4th edn.). Akademie Verlag, Berlin] and (4) description of the psychoses between affective and schizophrenic disorders (intermediate psychoses, mixed psychoses, schizo-affective psychoses) beginning with Kehrer and Kretschmer [Kehrer, F., Kretschmer, E., 1924. Die Veranlagung zu seelischen Störungen. (Monographien aus dem Gesamtgebiete der Neurologie 40) Springer, Berlin] and persisting up to the modern findings of a continuum between the two major groups of psychiatric disorders. Kraepelin's simplification has so far been more successful than the Kleist-Leonhard approach, but the modern and more descriptive trend in psychiatric classification favours the syndromal concept of Hoche and the concepts of continua between affective and schizophrenic disorders and between normal and pathological behaviour. Copyright 2002 Elsevier Science B.V.