MEDICALIZATION AND UNIVERSITY DISCOURSE: for a policy of care and listening to the subject in education

We intend to discuss the prevalence of medical discourse in education – from school to university – as a device of control and exclusion of the subject - present in the demands of medicalization of mental and learning disorders, as well as the economic and political conditions that determine this phenomenon. To this end, we will deal with the intervention of medical discourse and the naturalization and medicalization of psychic phenomena, driven by the objective of problematizing psychic suffering in school. The central issue of our discussion concerns the political dimension of suffering in school, which finds medicalization as the main way of sustaining it. Our argument points out that, in the context of this way of enjoying, suffering always makes one think of a history and a social and political framework that needs to be themed in coping with daily school practices.

Keywords: Medicalization. University Speech. Subject. Education. Psychoanalysis in Extension.

Pretendemos discutir la prevalencia del discurso médico en la educación --de la escuela a la universidad-- como dispositivo para controlar y excluir al sujeto, presente en las demandas de medicalización de los trastornos mentales y del aprendizaje, así como las condiciones económicas y políticas que determinan este fenómeno. Para ello, abordaremos la intervención del discurso médico y la naturalización y medicalización de los fenómenos psíquicos, impulsada por el objetivo de problematizar el sufrimiento psicológico en la escuela. El tema central de nuestra discusión se refiere a la dimensión política del sufrimiento en la escuela, que encuentra en la medicalización el principal medio de apoyo. Nuestro argumento señala que, en sentido contrario a esta forma de disfrutar, el sufrimiento siempre nos hace pensar en una historia y un marco social y político que hay que abordar en el enfrentamiento de las prácticas escolares cotidianas.

Palabras clave: Medicalización. Discurso Universitario. Sujeto. Educación. Psicoanálisis en Extensión.

Pretendemos discutir a prevalência do discurso médico na educação – da escola à universidade – como dispositivo de controle e exclusão do sujeito - presente nas demandas de medicalização de transtornos mentais e de aprendizagem, bem como os condicionantes econômicos e políticos determinantes desse fenômeno. Para tanto, trataremos da intervenção do discurso médico e da naturalização e medicalização dos fenômenos psíquicos, movidos pelo objetivo de problematizar o sofrimento psíquico na escola. A questão central de nossa discussão diz respeito à dimensão política do sofrimento na escola, esse que encontra como via principal de sustentação a medicalização. Nossa argumentação pontua que, na contramão desse modo de gozar, o sofrimento faz pensar sempre numa história e num enquadramento social e político que precisa ser tematizado no enfrentamento das práticas escolares cotidianas.

Palavras-chave: Medicalização. Discurso Universitário. Sujeito. Educação. Psicanálise em Extensão.

"Who knows that time is running away, suddenly discovers the unique beauty of the moment that will never be" (Rubem Alves, 2016).

Many clinical and school situations can be called as auxiliaries in the referral of the issues thatraise those here, but we will be able to answer the analysis of three meetings held by us with graduate students in Education, freely discussing the suffering arising from the pandemic and social distancing, which occurred due to the new coronavirus. During July and August 2020, we propose, as an activity linked to an extension and research project,an¹experience of conducting a collective² device in which the lack of answers and thematic directions coincided with the collective experience of loss and suspension of daily life that the pandemic called. To this invitation answered about 15 students (out of a total of more than 150 students and students) of master's and doctorate in three free meetings and through remote means, lasting 1:30 h. each one.

There is much to say about the effects of this offer, but we will be aware of the predominance of the medicalizing discourse that broke out at the first meeting, when we found it at the very beginning of the meeting, in a blunt and blunt way, anguish and a certain hopelessness, as responses to the impact of the suspension of time and routine on academic production (already skewed by the feeling of impropertyand imposture, according to some participants). To this commonly harrowing experience of academic production is added to the surprise and uproar that the pandemic has imposed on all of us. Narrating a "willingness to give up", one of the graduate students does not disguise her suffering, right in the departure of the collective associations around the offer, which from this revealed anguish will revolve around the pandemic and its effects on productivity, impacting academic writing. Other reports also reveal this same feeling of imposture and the imaginary contagion that happens takes anguish as the main engine. What the Other will think of me is referred to as a direct question within the discourse and we take the Other here in question, in addition to the real experiences of these subjects (in their orientations and in their classroom experiences in graduate school) who tell us about their experiences. The Other, the University, the graduate, the professors, the government (in their multiple representations) in times of pandemic, the evaluators; all these others are questioned, showing us that the symptom is always social (VANIER, 2012) asking which real is alluded to in apparently individual suffering.

In this sense, pathologization and medicalization are, first of all,a matterof discourse and given the prevalence of university discourse allied to the discourse of the capitalist in university relations, the manuals of classification of mental diseases are the thermometer of this discursive force. As Eliane Brum (2013) pointed out, "we woke up sicker" after the new DSM-V update. The abnormality became the rule and all kinds of human experience (or those we know) became subject to cataloguing as pathologies. The journalist also reminds the journalist of a forgotten fact in the name of the alleged naturalization of mental illness: deciding on what is normal and what is not desecrates a position of great social power to a group or organizations and moves an unimaginable amount of capital, since: "for each new pathology, a new market opens for the pharmaceutical industry" (BRUM, Idem).

In a second moment, already in the second meeting, the participants come to talk about the improvement they are experiencing by hearing and speaking in this collective, and for the initiatives they had in the week that took place. Several participants narrated new activities, reorganization of the agenda and experiences never lived by seclusion at home and physical proximity to family members. The "climate" in the meeting and the flow in the discourse was one of agreement and identification. However, in the discursive countercurrent (or, in a turn in discourse), the representation alusive to suffering is firm. The discursive flow went in the opposite direction, and the signifiers referred to the overcoming were well represeated in identifications. The emphasis onsuffering, which resists even in attempts to adapt to the conditions that are presented to all of us during quarantine, shows us that the subject is always in the process of coming, sticking to the established discourse and rescuing a place of radical difference. References to psychiatric medicalization, in addition to other treatment measures, will soon appear in the collective, and the significant "depression" is called to the conversation. Thus, the tendency to make a doctor a descriptive discourse of the common life (which became more complex and devastating with the proximity of death, collectively experienced by the prevalence of the pandemic in Brazil) and the approach of this suffering as a symptom, with consequent medicalization, appears with force at work with this group, indicating a path of individualized resolution. A permanent tension between the individualization of mental suffering (through diagnoses) and the questioning of socio-historical conditions of suffering can also be found in the tendency to psychoquiatrization of childhood (for example in the prevalence of the diagnosis of attention deficit,which has reached higher levels in recent years, also increasing the use of antidepressants for children worldwide; nodinaiously in Brazil (CRUZ et all, 2016).

What suffering is it, enunciated within an activity proposed in a university collective? Could we take it as a symptom? Could we think of it as a social symptom that locates the Other in a moment of destitution?

1. Suffering, subject and the other: Diagnoses are powerful tools in school.

In another opportunity (PISETTA et all,2009) we discuss how the jerkto the medicalization of suffering, especially of school-age children, as well as the specific demand for health treatments, confines the causal complexity of the phenomena addressed as symptoms (in the article in question we discuss what is commonly classified as attention deficit hyperactivity disorder). At the time, we worked with data from a survey conducted with the Applied Psychology Service of the Catholic University of Petrópolis, which cataloged the frequency of the incidence of symptoms grouped under the diagnostic heading of ADHD, both in the demand for treatment and in the presence of psychotherapy treatment at that institution, in 2008/2.

At the time we considered that "the causal breadth involved in learning and its impasses has been, [however], currently denied by the growing pathologization of school failure, which has in the historically established alliance between medicine and education its greatest engine" (Idem, p. 2), already attentive to the strong predominance of university discourse allied to the capitalist discourse in the school universe. Dealing with the destinies of a schooling always arouses a series of challenges and impasses for the educational field and the differences found in this path are commonly named as deficient responses. Many areas contribute to the construction of the educational process (public policies for education, socio-cultural differences, diversity and languages, teacher training etc.; to say the least) but are daily submitted to a totalitarian perspective, which has in a biologicalist view its greatest expression and that is presented through diagnostic codes; taken as devices of social control.

The primacy of biologizing discourse is noted in the perspective according to which differences are woven as organically determined and thus the multiple conditions involved in the human phenomenon are thought and treated as genetic delimitations. Thus, socioeconomic and historical conditions are thought of as biological predispositions for certain disorders and not as existential and political contingencies of the social phenomenon. In this sense, the term medicalize says more than prescribing the use of a given medication for a specific pathology, but it is revealed with a discursive scope capable of governing social, political, economic, and historical behaviors (CRP, 2012).

Capitalist economic force cannot be overconsidered in a broad discussion of causations. Capitalist discourse is accentuated at this point, proposing pathologies and treatments, both in the "clarification" of psychopathological conditions, as well as in the proposition of drugs and therapies appropriate to this end. What makes the wheel of diagnostics spin as a device of social control is also the economic interest and monopoly of the pharmaceutical industry, which in Brazil has great penetration, as we know (BRASIL, 2011). But there is not only the proposition of what is pathological in this discussion. What is defined as normal finds a clear delimitation here. The normal is largely equivalent to what is demanded by the standard – for multiple reasons; and the pathological who does not respond to this (therefore, needs to be treated, medicated and excluded). Totalitarian discourses are fine-tuned to this premise and are well defended by institutions (FOUCAULT,2002), and the school still has a long way to go to separate itselfconsistently from this homogenizing position. As Zucolotto points out, (2007) not only the difficulties of school performance are taken as organic symptoms (and thought of as learning deficits), but also behavioral ones, which also carry the historicalburden and tendency of the school as a place of segregation of social differences since the Middle Ages (BARROS,1997).

Thus, who does not sufficiently respond to school expectations (and why not, discursive?) "door" an individual symptom, organically addressed and organically treated. It is not only a medical model, transposed to an institution that has in itshistory the marks of social segregation and violence (FOUCAULT, 2002), but a discourse that perpetuates itself in the formation of teachers and takes breath withthe resurgence of capitalism. To think about the suffering that is so strongly referred to (alluded to in the statements of the collective of graduate students, with which we work in this experience) we will also need to discuss the Other present in the symptom and in this sense, promote a criticism of reading symptoms as phenomena that do not present themselves without the theme of the Other. In this sense, the challenge of this reading is not only to problematize a subject who enjoys and suffers, alienated to the discourses that govern the university (beyond its behavioral dimension, in the presence of the unconscious and the singular determinations of the subject) but, especially with Lacan (1992), to think that another one is represented in this suffering. In these terms, taking the symptom under analysis from the malaise is a possible way to broaden the understanding of it, beyond the individual and phenomenological.

Dunker (2020) advocates that we work from a diagnosis that has to do with the being, in its relations with the other in the social bond and not only through a medicalizingvision, which thinks of the diagnosis as something apart from the world, confined in biological units and based on behaviors ideally constructed as parameters. In the medicalizingview, widely disseminated by the manuals of classification of mental disorders (such as DSM and ICD), the foundation of suffering (understood as a symptom) lies in the watertight biological, differentiated from the world and social and political relations. In this perspective, suffering is not suffering with the world, from the relationships built and under construction. Suffering is, in this context, suffering due to a body that suffers organically and that can (and should!) be molded through medication (only) or clinical treatments (individualizing) associated with it. Freud had already emphasized a counterpart with the proposition of the key reading of malaise (1930), when he supposes suffering as a measure of loss (singular and collective), resulting from the socio-historical ties that we have built over time (and which we also destroy). In this sense, Dunker (Idem) proposes that when we talk about symptoms, we emphasize psychic suffering, which always summons the fantasmatic motives of suffering (and historical, through narratives that are built in the composition of a new suffering, now more proper) beyond the biologizing categories and individually situated in behaviors that are devious of the norm.

To emphasize the suffering in the symptom was a work elaborated by Freud, in a way, when it points out the meaning of the symptom as referred to the substitute satisfaction and the recalcation. Let us remember that at first Freud (1916-17) articulates the symptom to the content of the symptom, but does not cease to articulate it to anguish (1926), perworking this relationship for a few years. In this regard, Vanier (2002) asserts that Lacan promotes a structural articulation of the symptom with the subject, from the conception that the subject and the Other articulate from the constitution of the former, to the extent that he ceases to emphasize only the meaning of symptoms in his reading of freudian work (from seminar X), delimiting, decisively, the relations between the symptom and anguish, in freudian work. In these terms, already in Freud (1926) the symptom represents a structural response to the anguish of castration, which is logically previous to him (PISETTA, 2008). The Freudian conceptual turn around the meaning of the symptom and its relations with recalcation is fundamental to ask the structural value of the symptom and its "fundamental value, not as a trace of an accident of psychogenesis, but as a radical witness to the constitution of the subject and the i" (VANIER, 2002, p. 206).

In these terms, thinking about suffering is not reduced to naming a term (and establishing diagnostic categories), but considering the unfolding of a singular history that does not articulate without the Other and culture. It is the work of psychoanalysis to make a crossing of the name (diagnostic terms reducing experience) to the narrative plot (which situates the suffering to the Other, building a web where the subject can be situated. In these terms, Dunker (Idem) stresses that the experience of the narrative of suffering is "collectivizing" (Idem), because it touches each of usdifferently, in a very different way from that commonly experienced in individual treatments. Both the diagnosis of psychopathological symptoms and the classic treatments, in this sense, place individuals in watertight places, with which others identify, at most, by exclusion.

In these terms, the work of psychoanalysis in extension favors the writing of the recognition of sufferings, through the construction of collectives, which are silenced in culture, due to politically sustained social weaknesses (VOLTOLINI,2018). It is then necessary to be always attentive to the intricacies of the question about the object of diagnosis and treatment (in the establishment of a metadiagnostic (DUNKER, 2020), so as not to fall into the alienating mesh of a stereotyped conduction around interventions (pedagogical and clinical) that perpetuate exclusionary discourses and identified with norms.

About this break with the language of knowledge, its price is to be excluded from the brotherhood that speaks. What defines a brotherhood – academic, religious or political – is its language. The orthodox use of this language has, as its primary function, not the communication of new knowledge, but the function of confirming that the speaker 'belongs' to the set (ALVES,R. 2011. p. 27).

Working with the collective of graduate students poses an important question in coping with the malaise at the university: what is the place of the subject in the written production in the university discourse? To whom is academic production in university discourse intended, for whom it constitutes itself as an object? What psychic sufferings are there beforehand announced?

Lacan (1992) delimits the importance of thinking about the limits of the framing of discourses and the malleability of the signifiers, convened differently in the contingency of each of the four social modes of bond ing around jouissance. With regard to university discourse, we take here the writing, which marks the membership of the brotherhood (ALVES, R. 2011) and the affiliation to the academic institutional power³.

In the university discourse, the starting point is knowledge as an agent, summoning another in place of the one who does not have knowledge, situated in a position of lack, complementary in relation to the place of knowledge. From this discursive relationship, there is a product, expected production from the control modes around knowledge. Lacan places in this place the barred subject in his enjoyment, encrypted by Lacan as $. Thus, the product carries incompleteness and division in its essence. Such a discourse thus constituted reserves (in a hidden way) a truth: the master in the place of truth (S1), with the proposition of a knowledge without limit, which takes subjectivity as a product. In this sense, from the prevalence of this discourse, we have a subjectivity excluded, purged, not considered and submitted. This is the hidden truth in university work, artificializing academic production.

In these terms, the four places marked in every speech - the place of the agent; the place of the other (the one who speaks); the place of production and the place of truth - they are revealed here in well-demarcated university practices, often exclusionary and painful from a subjective point of view. The complaints of our participants indicate a prevalence of this reality in their productions.

In these terms, how to produce something proper within a genre of discourse (BAKHTIN, 2010) that places the one who speaks in place of lack of knowledge, incompleteness, and insufficiency (LACAN, 1992)? This product, writing, is directly marked by the effect of the speech before it. Anguish tells this relationship, especially when social ties are suspended due to unprecedented trauma, such as the pandemic. The possibilities of bearing the weight of writing, collectively shared in school situations, were suspended or greatly reduced, due to social distancing, expanding loneliness and anguish before the task. In the free speech of someone who talks about his academic work, a speech can be heard and the alienations and sufferings that mark a subject appear. Impasses and scopes in writing can be thought of, as well as social symptoms and in these terms also tell about the conditions of this social bond. So we take some lines from our collective. There appears a desire togiveup, and some questions skewed with anguish: "AmI taking away someone's vacancy? "WillI be weak?

It is impossible to fail to obey the commandment that is there, in place of what is the truth of science - Go, go on. It won't stop. You still know, always more. Precisely by this sign, because the sign of the master occupies this place, every question about the truth is, speaking properly, crushed, silenced, every question precisely about what this sign – the S1 of the commandment Continues to know – can be sure, about what this sign, by occupying this place, contains of enigma, about what is this sign that occupies such a place (LACAN, 1969-1970/1992, p. 98).

As we discussed, Lacan situates the university discourse as the discourse in which the agent is scientific knowledge, which is placed as a vector of exchanges and ordering discourse. From there, it is possible to procced to any interaction. In this place, knowledge demands another that puts itself in place of lack of knowledge, expropriated from any power, based on some prior knowledge. In these terms, knowing as an agent demands lack of knowledge, which sustains you as knowledge. It is interesting here to think about the definition of object a, where Lacan places the other in university discourse. According to Dunker (2020) object a is what drills in its entirety (and our avidity for totality). In this sense, object a is "what you take out of a totality so that it can appear as a uniform, coherent and accessible whole". From this agency of the other as one that has a lack of knowledge, the subjects are products, also indicating the discursive force of capitalism allied to science. What is the place of the subjective brand in academic production? How to think a writing that is not proper and that does not bring something particular like a pure fitting of a totalitarian knowledge?

3. Political implications of psychoanalysis: on the buoyancy of productivity and academic writing.

The work with the collective of graduate students we performed points to a impasse commonly experienced in graduate studies (Machado, 2020): the obstacle of writing in a consistent and authorial way an academic text, widely complained in our collective as a very difficult task and producer of important subjective suffering. Machado (Idem) lists some points to broaden this discussion, among them, the lack of school (and university tradition, in particular) of writing development as a form of expression. The oral tradition, since early childhood education, as a privileged form of transmission and school relationship, also needs to be taken into account in this issue. Thus, even in graduation, the classes are basically based on the model in which the teacher speaks for a long time, recitatively. In another opportunity (PISETTA, 2013), when we discuss the impacts on the teaching of social changes around the fall of institutional authority in postmodernity (BAUMAN, 1998) and teacher disauthorization, we recall that:

Articulating discourse and reality, Bakhtin (1983) emphasizes that where knowledge is built there, social roles and modes of relationships are also built, since the word carries with it meanings prior to the act of saying them. Professor's discursive modes and commonacts such as reciting content sit out social expectations and unconscious determinations that produce possibilities of being (PISETTA, 2013, p. 38).

In these terms, moving from the listener's place to the author's place is neither a simple nor automatic task, since writing is an ethical act of authorization; act that unfolds in a series of small acts of approximation with the personal elaboration (unconscious, above all) of the questions that present themselves in the form of "object of study".

Machado (Idem) also points out that the scope of learning the Portuguese language at school does not include academic writing (nor literary, often), especially due to the daily distance between the subjects (students) and their own written expression. In this sense, oral expression also does not reach much school space, and we can thus have a larger dimension than a graduate student, now located as an author. The "will to give up" narrated in our collective also concerns the confrontation of this social symptom embedded in the conditions in which social bonds are established in school (master's discourse). What is expected of an academic text, at least necessary for the transmission of a completed research (aspects such as clarity in the exposition of ideas, description of the methodology, exposition of previous hypotheses and objectives in the more general work with a research object), as well as the demonstration of the distancing of ideologies and common sense that oppose academic work is, in many cases, concomitant with the first experience of personal writing. Often these experiences are accompanied by anguish and fear. In the collective that was constituted as a response to our invitation, all participants spoke of the impasse before writing, and anguish in the face of demand. We understand that this reveals much more than an individual issue in relation to writing and escapes any pathologizing perspective.

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MARIA ANGELICA AUGUSTO DE MELLO PISETTA holds a PhD and master’s degree in Psychology from Federal University of Rio de Janeiro (UFRJ), specialist in clinical and institutional psychology from State University of Rio de Janeiro (UERJ), professor of Education Psychology at the Faculty of Education and at the Graduate Program in Education of the Fluminense Federal University (UFF), member of the Group for Psychoanalysis, Education and Social Loop (Lapse), associate researcher of the Interdisciplinary Center for Research and Exchange for Contemporary Childhood and Adolescence (NIPIAC/UFRJ), of the International Observatory of Inclusion, Interculturality and Pedagogical Innovation (OIIIIPE). He conducted a postdoctoral study in Education at the University of São Paulo (USP).

1 This is an extension project From school to university: listening to malaise and psychological suffering, coordinated by Professor Luciana Gageiro Coutinho whom I thank the joint labor. The project in question seeks to group initiatives to develop new devices from psychoanalytic interventions in the school environment. The activity we will discuss here has been named as Encounters with the word: policy of care and listening of the subject in graduate school. In this activity we wanted to verify the importance of enabling the collective construction of a space of listening and care about the psychic suffering experienced by the interested parties. Based on the expectation that such psychic suffering can be enhanced by the experience of academic production and the relationship with the university, we studied the effects of this initiative in this regard. This is a work initiative vectorized by the "analyst discourse" in non-traditional group formations, in view of the remote environment. The participants received and signed the Informed Consent Form, according to the guidelines of the Research Ethics Committee of UFF and were previously informed about the research work that was added to the extension activity.

2 As you warn Agamben (2005) a device is a network that is constituted as a power strategy and that includes in its meshes modes of understanding and validation of the world. Language itself, in this sense, is a; here taken in this opportunity, to think about the flows and counterflows of discourse that we tension by offering, in the university domains of discourse, a proposal for free circulation of the word.

3 It is worth mentioning that Lacan (1992) discusses in this seminar four forms of social bond, unconsciously maintained and in circulation, calling on subjects to occupy certain places, mobilizing acts and products and concealing an uncomfortable truth. The author argues that discourses are also treatments of jouissance, in the sense that they compose ways of containing jouissance in the social bond (VANIER, 2012). They are: the university discourse, the master's discourse, the hysterical discourse and the analyst's discourse. The composition of these discourses requires taking as measures of analysis four places demarcated in every discourse (i.e.: the place of agent, the place of the other, the place of production and the place of truth) and four operators, who represent fundamental elements of the discourses; namely, the barred subject ($) (or constitutive subjectivity); S1 or the signifier masters; S2 or the knowledge and object which marks the symbolic lack (Lacan, 1992). The object the demarcations the structured subject and summons him in relation to the lack of (PISETTA, 2009).