W OMEN W I TH MENTAL DI SORDERS AND MOTHERHOOD
Mar isley Vilas Bôas Soar es1
Ana Mar ia Pim ent a Car v alho2
Soar es MVB, Car valho AMP. Wom en w it h m ent al disor der s and m ot her hood. Rev Lat ino- am Enfer m agem 2009 set em br o- ou t u br o; 1 7 ( 5 ) : 6 3 2 - 8 .
Mot her s’ abilit y t o deliv er car e and t end t o t he needs of t heir childr en is consider ed t o gener at e an adequat e
p r ev en t i v e en v i r o n m en t f o r i n f an t p sy ch o l o g i cal d ev el o p m en t . Th i s st u d y d escr i b es t h e p h en o m en o n o f
m ot h er h ood fr om t h e per spect iv e of u ser s of a m en t al h ealt h ou t pat ien t clin ic in Ribeir ão Pr et o, SP, Br azil,
t hr ough Sy m bolic I nt er act ionism t heor et ical fr am ew or k. Ten w om en under t r eat m ent for at least one y ear and
w it h at least on e ch ild bet w een 7 an d 1 2 y ear s old w er e in t er v iew ed. Gr ou n ded Th eor y w as u sed f or dat a
analysis, w hich enabled t he developm ent of a t heor y t o explain t he phenom enon: “ of per ceiving oneself in such
a w ay as t o k eep f igh t in g” . Th e con clu sion is t h at t h ese w om en n eed t o deal w it h , r ecogn ize an d per ceiv e
t h em selv es in t h eir m at er n al r ole so as t o k eep on f igh t in g lim it at ion s im posed by t h e disease. Th at t h ese
w om en com e and see bey ond t heir condit ion of m ent al disor der pat ient s is anot her st ep t ow ar ds t he deliv er y
of m or e adequat e m ent al healt h ser v ices t o m eet t his dem and.
DESCRI PTORS: m ent al healt h; healt h ser v ices; psy chiat r ic nur sing
LAS MUJERES PORTADORAS DE TRASTORNOS MENTALES Y LA MATERNI DAD
Se consider a que la capacidad m at er na par a ofr ecer buenas condiciones de cuidado y r econocim ient o de las
n ecesidades del h ij o, gen er a u n am bien t e adecu ado pr ev en t iv o par a el desar r ollo psicológico del n iñ o. Est e
est udio buscó descr ibir el fenóm eno de la m at er nidad par a usuar ias de un am bulat or io de salud m ent al de la
ciudad de Ribeir ao Pr et o, SP, ut ilizando com o m ar co t eór ico el I nt er accionism o Sim bólico. Fuer on ent r evist adas
diez m uj er es, con, al m enos, un año de t r at am ient o y con por lo m enos un niño de 7 a 12 años. La Teor ía
Fundam ent ada en Dat os posibilit ó analizar los dat os, alcanzando una t eor ía que explica el fenóm eno: “ t r at ando
d e r econ ocer se p ar a p er m an ecer lu ch an d o” . Se con clu y e q u e esas m u j er es n ecesit an lid iar , r econ ocer y
r econocer se en su función m at er na par a per m anecer luchando con las lim it aciones im puest as por el t r ast or no.
Se t r at a de un paso m ás par a adecuar los ser v icios de la salud m ent al fr ent e a esa dem anda, par a que esas
m uj er es sean r econocidas no solo com o por t ador as de t r ast or nos m ent ales.
DESCRI PTORES: salud m ent al; ser v icios de salud; enfer m er ía psiquiát r ica
MULHERES PORTADORAS DE TRANSTORNOS MENTAI S E A MATERNI DADE
Consider a- se que a capacidade m at er na par a ofer ecer boas condições de cuidado e acolhim ent o às necessidades
d o f ilh o g er a am b ien t e ad eq u ad o p r ev en t iv o p ar a o d esen v olv im en t o p sicológ ico d a cr ian ça. Est e est u d o
buscou descr ever o fenôm eno da m at er nidade par a usuár ias de um am bulat ór io de saúde m ent al da cidade de
Ribeir ão Pr et o, SP, t endo com o r efer encial t eór ico o I nt er acionism o Sim bólico. For am ent r evist adas dez m ulher es,
com , ao m enos, um ano de t r at am ent o e no m ínim o um a cr iança de 7 a 12 anos. A Teor ia Fundam ent ada em
Dados possibilit ou analisar os dados, at ingindo um a t eor ia explicat iva par a o fenôm eno: “ t ent ando se enxer gar
par a per m anecer lut ando” . Conclui- se que essas m ulher es necessit am lidar , r econhecer e enx er gar - se em sua
fu n ção m at er n a par a per m an ecer lu t an do com as lim it ações im post as pelo t r an st or n o. Tr at a- se de m ais u m
passo par a adequação dos ser v iços de saúde m ent al fr ent e a essa dem anda, par a que essas m ulher es sej am
v ist as par a além de seu lugar de por t ador as de t r anst or nos m ent ais.
DESCRI TORES: saú de m en t al; ser v iços de saú de; en fer m agem psiqu iát r ica
Escola de Enfer m agem de Ribeir ão Pr et o, Univer sidade de São Paulo, WHO Collabor at ing Cent r e for Nur sing Resear ch Developm ent , Br azil: 1Psy chologist ,
Doct oral St udent , e- m ail: m ar isvbs@gm ail.com ; 2Psychologist , Ph.D. in Psy chologist , Facult y, e- m ail: anacar @eer p.usp.br.
I NTRODUCTI ON
F
am ily m em ber s play an im por t an t r ole in t he recovery of individuals w it h m ent al disor ders w hent he goal is t o include t hem in social life, w hich is view ed as a possible achievem ent . Thus, st udies have sought t o v er ify how m ent al disor der s im pact t he fam ily as
w ell as t he concept ions fam ily m em ber s hav e about m en t al d i so r d er s’ m an i f est at i o n s( 1 - 2 ). Ev en t h o u g h m any st udies focus on t he im pact of m ent al disor der s
o n f a m i l y m em b er s a n d ca r eg i v er s, so m e st u d i es inv er t t his r at ionale and giv e pr ior it y t o t he pat ient s’ p er sp ect i v e an d o n t h ei r sear ch t o b al an ce so ci al
dem ands and needs ar ising fr om t he disease. Accor d i n g t o t h i s n ew f ocu s, st u d i es h av e evidenced t he r elat ion of t hese disor der s t o var iables
and gender differ ences hav e pr ov ided som e ev idence t o guide pr event ive act ions and t r eat m ent s t aking int o account t he par t icular it ies found in t he incidence and
m an if est at ion am on g m en an d w om en( 3 ). Wom en ’s m ent al healt h, t hough, is an em erging issue w it h few Br azilian st u d ies in t h e f ield . n To ad d r ess w om en ’s
m e n t a l h e a l t h a n d s e e k u n d e r s t a n d i n g o f t h e con dit ion s t h at det er m in e it , gen der, pov er t y, social posit ion and various form s of violence against w om en
an d h ow t h ese affect t h eir h ealt h h av e t o be t ak en int o considerat ion. Am ong t he disor der s t hat can affect w o m e n o v e r l i f e , s u c h a s s y m p t o m s r e l a t e d t o
p r e m e n st r u a l sy n d r o m e o r t o m e n o p a u se , t h o se m a n i f e s t e d d u e t o t h e p u e r p e r a l p e r i o d a r e h i g h l i g h t e d , w h i c h i s w h e n i s s u e s r e l a t e d t o
m ot her hood also begin. To consider t he condit ion of w om en one has t o r efer not only t o concept s involving biological part icularit ies, but also t o t he com plex social
con st r u ct ion of w om en ’s r oles an d h ow t h ey act in t heir social cont ex t .
Re p r e s e n t a t i o n s a t t r i b u t e d t o w o m e n
concer ning t heir nat ur al r esponsibilit y for t ak ing car e of t he hom e and r aising t heir childr en find ev idence t hat inst it ut ionalizes t his t hink ing. Ther e ar e t heor ies
about social and hist or ical focus t hat consider ed t he s o - c a l l e d “ m a t e r n a l i n s t i n c t ” t o b e a r e s u l t o f ideological concept ions, engender ed fr om t he m id 18t h c e n t u r y i n Eu r o p e( 4 ). Ps y c h o a n a l y s i s e n d s u p r einfor cing a difficult aspect for w om en: guilt for t he m ish ap s an d d isap p oin t m en t s ex p er ien ced b y t h eir
ch i l d r e n . I t i s a l so i n t h i s p e r i o d t h a t t h e f a m i l y becom es a social cell t hat differ ent iat es ex per iences liv ed in t he public and pr iv at e spher es in w hich t he
form at ion of t he nuclear fam ily is cent ered on m at ernal
lov e t h r ou g h sh ar ed af f ect ion . Th u s, t h e d om est ic
env ir onm ent has a st r ong fem ale connot at ion. Wom en cur r ent ly face a ser ies of lim it at ions in balan cin g t h eir m u lt iple f u n ct ion s, r elat ed t o t h e
j ob m ar ket and also t o social behavior and “ per for m ing t hese r oles is not an easy and peaceful t ask because t hese roles st ill m ean a ‘violat ion’ of t he old m odel of
i n d i v i d u a l a n d f a m i l y b e h a v i o r ” ( 5 ). Ho w e v e r, t h e p e r f o r m a n ce o f so ci a l l y e x p e ct e d r o l e s, su ch a s m ot her and w ife, is st ill par t of t he fem ale ideal but
co m p e t e w i t h t h e d e si r e t o a ch i e v e p r o f e ssi o n a l r ealizat ion an d fin an cial in depen den ce.
To d eep en r ef l ect i o n s a b o u t t h e m a t er n a l
f ig u r e, t h e con cep t of p ar en t in g( 6 ) in clu d es sev er al fact or s t h at cr eat e in t h e in div idu al abilit ies t o car e for his/ her offspr ing: par ent s’ indiv idual psy chological
r esou r ces, ch ild r en ’s ch ar act er ist ics an d sou r ces of st r ess an d su p p or t p r esen t in t h e con t ex t in w h ich t h e y a r e i n s e r t e d . H o l d i n g t h i s c o n c e p t a s a
b a c k g r o u n d , a m o n g t h e n o t e d a s p e c t s t h a t c a n in f lu en ce w om en ’s ex pr ession , t h is st u dy addr esses w om en affect ed by m ent al diseases – m ent al diseases
af f ect , am on g ot h er t h in g s, t h e q u alit y of af f ect iv e and fam ily relat ionships. We m ust consider t hat t hese m o t h e r s w i t h m e n t a l d i so r d e r s ca n e m p l o y o t h e r
e l e m e n t s t h a t e n su r e t h e y e x e r ci se m o t h e r h o o d / par ent ing – in addit ion t o t he exclusive qualit y of t he m ot h er - ch ild r elat ion sh ip.
Th i s st u d y e x a m i n e s h o w w o m e n w i t h a diagnosis of m ent al disor der ex per ience m ot her hood an d per ceiv e t h em selv es as m ot h er s in v iew of t h e
com plex phenom enon of par ent ing, m ent al disor der s and how t hese ar e r elat ed t o each ot her.
METHOD
Th i s q u a l i t a t i v e s t u d y a d o p t e d Sy m b o l i c I nt eract ionism , w hose area of st udy is t he int eract ion b e t w e e n p e o p l e . I n t e r a c t i o n b e t w e e n p e o p l e i s
consider ed t o t r igger a dy nam ic pr ocess of indiv idual an d social ch an g e t h at p er m it s t h e t r an sm ission of som et hing fr om one per son t o anot her w ho per ceives,
int er pr et s, and act s again. I nt er act ion bet w een people is an in t er n al an d ex t er n al ev en t : occu r r in g w it h in oneself and t hr ough int eract ion w it h anot her, m ediat ed
by m ean in gs at t r ibu t ed by t h e in div idu al. Mean in gs ar e at t r ib u t ed by t h e in d iv idu al f r om t h e v iew t h at defines t he w orld for t he individual and int eract w it hin
w it h ot her individuals ( out er int er act ions) . I t leads t o
t he concept of per spect iv e, w hich is inher ent in t he i n t e r a ct i o n a n d sh a r e d b y i t . Th i s p e r sp e ct i v e i s defined t hr ough sever al r oles played by t he individual
and by m any ot her people w it h w hom s/ he int er act s; it enables m any “ point s of v iew ”. I n int eract ing w it h ot h er s, p eop le m ak e t h em selv es u n d er st ood w h en
t h ey ar e cap ab le of p lay in g t h e ot h er ’s r ole. Wh en on e sees t h in g s f r om t h e p er sp ect iv e of t h e ot h er, one is capable of t ransm it t ing t he m eaning of his/ her
act ion an d sh ar in g com m on m ean in g s, w h en su ch m eanings ar e im por t ant t o all t hose inv olv ed in t he in t er act ion .
Gr o u n d e d Th e o r y w a s c h o s e n a s t h e m e t h o d o l o g i c a l f r a m e w o r k b e c a u s e i t a l l o w s com pr ehending t he indiv idual’s ex per ience in r elat ion
t o t h e s t u d i e d p h e n o m e n o n t h r o u g h h u m a n in t er act ion s, sy m b olic ex ch an g es an d m ean in g s f or t h e i n t er act i on , w h i ch en ab l es t h e con st r u ct i on of
t heor ies about t he obj ect “ based on invest igat ed dat a, i n st e a d o f t e st i n g a n a l r e a d y e x i st i n g t h e o r y ”( 8 ). Gr ou n d ed t h eor y can g en er at e t h eor et ical con cep t s
capable of int er pr et ing act ion in it s cont ex t fr om t he per spect iv e of t he par t icipant s.
Th e f ollow in g in clu sion cr it er ia w er e u sed :
w om en w it h an y k in d of m en t al d isor d er f or m or e t h an on e y ear, w h o h ad at least on e 7 - 1 2 y ear - old child and w ho w ere being car ed for in a public m ent al
h ealt h ou t pat ien t clin ic in Ribeir ão Pr et o, SP, Br azil, r esid en t in t h is cit y, m or e sp ecif ically in t h e Nor t h dist r ict . We consider ed t hat t he differ ent backgr ounds
of t he differ ent t ypes of m ent al disor der s of t his gr oup a l l o w e d co l l e ct i n g d a t a ca p a b l e o f d e p i ct i n g t h e com p lex it y of t h e st u d ied p h en om en on . As f or t h e
num ber of par t icipant s, w e decided t hat as dat a w er e analyzed, w e w ould obt ain t he num ber of par t icipant s t h at cor r espon ded t o t h e r ich n ess an d v alor izat ion s
of sin g u lar asp ect s of t h e st u d y ob j ect d u e t o t h e sat ur at ion effect . The final num ber of par t icipant s of t his st udy w as t en.
Af t er cases w er e select ed t h r ou gh pat ien t s’ files, t hese w er e t elephoned or per sonally cont act ed, infor m ed about t he st udy and invit ed t o par t icipat e in
t h e st u dy. Af t er in div idu als’ agr eem en t , a t im e w as sch edu led, gen er ally on t h e w eek en ds, accor din g t o t h e i n t e r v i e w e e ’s a v a i l a b i l i t y, a n d t h e r e se a r ch e r
v isit ed t hem at t heir hom es. This pr ocedur e allow ed opt im izing dat a collect ion because only t he researcher had t o m ove and it also facilit at ed scheduling a m eet ing
w it h t he par t icipant s and m eet ing t hem at t heir hom e,
m any t im es w hile t hey w er e car r y ing out household
t ask s.
I nt er v iew s last ed an av er age of 4 0 m inut es an d w er e r ecor d ed an d t r an scr ib ed af t er f r ee an d
infor m ed consent w as obt ained fr om t he int er view ees. A sem i- st r uct ur ed int er view scr ipt w as developed and im proved t hrough a pilot t est , in w hich issues relat ed
t o m en t al d isor d er, m ot h er h ood an d social su p p or t w er e ad d r essed .
A f t e r t h e t r a n s c r i p t i o n s o f i n t e r v i e w s ,
Gr ou n d ed Th eor y g u id ed d at a an aly sis. Dat a w er e d i v i d e d i n t o sm a l l e r u n i t s, ca l l e d i n ci d e n t s, t h e n co n ce p t u a l i ze d a n d r e l a t e d a m o n g t h e i n ci d e n t s.
I n op en cod in g , t h e f ir st p h ase of an aly sis, in cid en t s w e r e c o d e d a n d c o m p a r e d s o t h e y c o u l d b e c a t e g o r i z e d u s i n g t h e d a t a ’ s o w n l a n g u a g e .
Su b cat eg or ies f or m ed a lar g er scop e of in f or m at ion f r om con n ect ion s m ad e b et w een op en cod es, w h ich con st it u t ed ax ial cod in g b ased on t h e p h en om en on
q u e s t i o n i n g : t h e c a u s e s o f t h e p h e n o m e n o n o ccu r r e n ce ; co n t e x t i n w h i ch i t h a p p e n e d ; w h a t p a r t i c i p a n t s d i d w h e n i t h a p p e n e d ( s t r a t e g i e s ) ;
w h at f acilit at ed or h in d er ed act ion s r elat ed t o t h e p h e n o m e n o n ( i n t e r v e n i e n t c o n d i t i o n s ) a n d t h e co n seq u en ces o f su ch act i o n s( 8 ).
Th i s n e w g r o u p i n g p e r m i t t e d t h e est ablishm ent of new r elat ions t hat for m ed a set of m o r e a b st r a ct e d a n d co m p r e h e n si v e ca t e g o r i e s,
capable of being ident ified in t he codes w e sought t o represent . Finally, w e reached select ive coding, w hich w as t he base for obt aining t he cent r al cat egor y w it h
w hich all t he r em aining cat egor ies ar e r elat ed and it w a s a t t h a t p o i n t w h e n a t h e o r y co n ce r n i n g t h e obt ained dat a em er ged( 8).
ETHI CAL ASPECTS
I n or der t o m eet t h e 4t h it em of Resolu t ion N o . 1 9 6 / 9 6 o f t h e N a t i o n a l H e a l t h Co u n c i l ,
aut horizat ions w ere asked from t he inst it ut ions w here t h e st u dy, in clu din g t h e pilot t est , w as goin g t o be c a r r i e d o u t a n d f r o m t h e Ci t y M e n t a l H e a l t h
Co o r d i n a t i o n a n d t h e Ci t y H e a l t h S e c r e t a r y. Aft er w ar ds, t he st udy w as subm it t ed t o t he Resear ch Et h i cs Co m m i t t ee a t t h e Un i v er si t y o f Sã o Pa u l o ,
Co l l e g e o f Nu r si n g a t Ri b e i r ã o Pr e t o ( EERP- USP, Pr o t o c o l N o . 5 5 4 / 2 0 0 5 ) . A c c o r d i n g t o r ecom m endat ions, all par t icipant s signed t he fr ee and
RESULTS
Par t icip an t s w er e on av er ag e 3 4 y ear s old , h ad co m p l et ed seco n d ar y sch o o l , h ad an av er ag e
o f t h r e e c h i l d r e n , 7 0 % w e r e i n a s t a b l e u n i o n ( i n c l u d i n g t h o s e o f f i c i a l l y m a r r i e d a n d c o h a b i t a t i n g ) , 5 0 % h a d a p a i d j o b a n d t h e
r em ain in g w er e eit h er h ou sew iv es or w er e on sick l e a v e ( r e c e i v i n g a g o v e r n m e n t b e n e f i t ) . Par t i ci p an t s w er e u n d er t r eat m en t f o r an av er ag e
o f t h r e e a n d a h a l f y e a r s a n d d i a g n o s e s w e r e p r ed om in an t ly f or af f ect iv e an d n eu r ot ic d isor d er s ( F3 0 , F4 0 ) in ad d it ion t o som e com or b id it ies.
Cen t r al cat egor y : “ per ceiv in g on eself in su ch a w ay as t o k eep fight ing”
[ ...] t o not go back t her e ( t o t he init ial st age of m ent al
disor der – aut hor ’s not e) , you have t o hang on, you know ? I t ’s like, you have t o look in t he m irror and be able t o see yourself. You have t o see your self r egar dless of ever yt hing else, not only your im age, but I guess t hat it ’s t he w hole y ou so y ou can keep fight ing, on your feet ( Mot her 1) .
I n t er v iew ees’ accou n t s r epor t ed t r aj ect or ies of lif e som ew h at sim ilar, am on g t h em u n ex pect edly
becom ing a m ot her, r esult ing in m ent al suffer ing. These w om en g en er ally sh ow ed m or e v u ln er ab ilit y t o lif e e v e n t s t h a t g e n e r a t e c r i s i s r e l a t e d t o h u m a n
d e v e l o p m e n t , w h i c h c o n s e q u e n t l y l e a d t o t h e dev elopm ent of new social r oles.
Accor ding t o t he nar r at iv es of t hese w om en,
t h e ph en om en on t h at gu ided t h eir ex per ien ces w as expressed as “ perceiving oneself in such a w ay as t o k eep fight ing” and, w hile in t his st at e of m ind, t hey
had no explanat ion for t he m ent al disor der t hey w er e affect ed w it h – and t his elem ent w as par t of t he cont ext i n w h i c h s u c h p h e n o m e n o n o c c u r r e d . H o w t h e y
evaluat ed t he bond t hey had w it h healt h ser vices and
h e a l t h p r o f e ssi o n a l s a l so co m p o se d p a r t o f t h e i r
disor der ’s back gr ou n d, becau se t h ese w er e sou r ces
o f i n f o r m a t i o n a n d cl a r i f i ca t i o n , o r e v e n g r e a t e r disor ient at ion, in r elat ion t o t heir new life m ar ked by t he m ent al disor der.
The ex per ience t hey had w it h help pr ov ided by t heir husbands, w ho w ould pr ov ide it or not , w as
al so an o t h er el em en t p r esen t i n t h ei r ex p er i en ce.
Their help, w hen t hey pr ov ided it , could be a sour ce o f s t r e s s b e c a u s e t h e s e w o m e n w e r e h i g h l y dem anding of t hem selves and consequent ly, of ot her s,
in r elat ion t o household t ask s.
Th e c o n t e x t o f t h i s p h e n o m e n o n w a s
com plem ent ed by t heir per cept ion of fam ily suppor t , w h ich r epr esen t ed a r ecollect ion of em ot ion al pain , ex per ien ced du r in g ch ildh ood, or su ppor t accor din g
t o w hat fam ily m em ber s w er e able t o pr ov ide. Am id t his realit y, as a causal condit ion of t he cen t r al p h en om en on , w as t h eir ow n ex p er ien ce of
becom ing sick, t he sear ch for an ex planat ion for t he
f act or s t h at p r ed isp ose t h e em er gen ce of a m en t al
disor der , and also, of t he fact or s t hat t r igger such a
disor der , w h ich en cou r aged t h em t o per sist in t h eir
sear ch t o see t hem selv es as cont inuing t o fight . St r o n g l y a sso ci a t e d w i t h t h i s a t t i t u d e o f
keeping fight ing is t he cat egor y w ishing t o be able t o d o ev er y t h i n g , w h i ch em er g ed w h en t h ey d i d n o t
accept help or ev en per ceiv e t hey needed it .
Anot her causal elem ent of t his phenom enon w as conflict s in t he m ar it al r elat ionship, since som e of t hem r epor t ed exper iences t hat gr eat ly w or e dow n
t h ei r r el at i o n sh i p , cu l m i n at i n g i n v i o l en t b r eak u p s ( phy sical and em ot ional) or, t um ult uous ex per iences am id m an if est at ion s of t h e m en t al d isor d er an d it s
co n seq u en ces.
Ex per iencing m ot her hood also em er ged as a
c a u s a l f a c t o r, b e c a u s e i t a s s u m e d a s e r i e s o f
r epr esent at ions, w hich r einfor ced social ex pect at ions and m eanings of m ot her hood, w hich t hey w ere unable t o co m p l y w i t h . Co n se q u e n t l y su ch e x p e ct a t i o n s
becam e a bur den – t he bur den of m ot her hood. Wit h r egar d t o t h is cat egor y, t h e par t icipan t s sh ar ed t h e co m m o n f a ct o f h a v i n g e x p e r i e n ce d a t l e a st o n e
unplanned pr egnancy, an ex per ience associat ed w it h t he ur gent need t o face and ex er cise m ot her hood.
These m ot her s w it h m ent al disor der s had t o
use st r at egies t o cope w it h t his phenom enon so t hey w ould be able t o k eep fight ing t heir disease despit e t he r oles t hey w er e supposed t o play and t he need t o
see t h em selv es in t h e con t ex t in w h ich t h ey w er e inser t ed w hile hav ing t o deal w it h t he abov e causal f act or s.
Th u s, t h ey st ar t ed copin g w it h t h eir m en t al disor der s and found t hem selv es bet w een adher ing t o
an d ab an d on in g t r eat m en t , r ev eal i n g a p at t er n of
accep t in g an d ab an d on in g h ealt h ser v ices. As t h ey
im pr ov ed t h eir k n ow ledge of t h em selv es, t h ey also developed t he capabilit y of know ing t he cour se of t heir
l i v e s, a sso ci a t i n g p e r so n a l e v e n t s w i t h cr i se s o r m o m en t s w h en t h ei r co n d i t i o n s w o r sen ed . At t h i s p oin t , t h ey u n d er st ood t h e cou r se of t h eir m en t al
Anot her r esour ce em er ged in seeking t o deal
w i t h t h e p h e n o m e n o n , h a v i n g o t h e r s o u r c e s o f suppor t , due t o w hich t hese w om en could dedicat e a
lit t le m or e t im e t o t hem selv es. They could count on
n ei g h b o r s t o b ab y si t t h ei r ch i l d r en an d so at t en d m e d i c a l a p p o i n t m e n t s o r h a v e t h e s u p p o r t o f pr ofessionals ( such as psychologist s) w ho helped t hem
t o u n d e r s t a n d t h e s p e c t r u m o f t h e i r c h i l d r e n ’ s dev elopm ent and also t hem selv es in r elat ion t o t heir d isor d er s.
They also sought t o include t heir occupat ion in t he cont ext of t heir m ent al disor der s, because t hey
saw it as a r esour ce t o w hich t hey could hang on and
t h u s f eel bet t er. How ev er, t h eir j obs an d dif f icu lt ies r em aining in t hem indicat ed t he sever it y of t he m ent al d isor d er s.
Ther e w er e condit ions t hat int er fer ed in t he a ct i o n s e m p l o y e d a s st r a t e g i e s t o co p e w i t h t h e p h e n o m e n o n a n d w h i c h w e r e n o t u n d e r t h e
par t icipant s’ cont r ol such as t he r eper cussions of t he m e n t a l d i so r d e r i n t h e i r d a i l y r o u t i n e s, a n d t h e y
r e a l i z e d h o w t h e m a n i f e st a t i o n s o f t h e i r m e n t a l
d i s o r d e r i n t e r f e r e d i n t h e i r d a i l y a c t i v i t i e s a n d r elat ionships. I n t his w ay, t he par t icipant s ended up f e e l i n g v u l n e r a b l e t o t h e i m p a ct o f t h e i r m e n t a l
disorders, fearing new crises and/ or living w it h despair
t hat ar ose fr om suicide at t em pt s.
Ad d it ion ally, as an in t er v en ien t f act or, an d
w h ich r ef lect ed on act ion s t ak en in r elat ion t o t h e p h e n o m e n o n o f t r y i n g t o f i n d t h e m s e l v e s i n a n in d iv id u al an d d aily st r u g g le, w as t h e con d it ion in
w h i ch t h e y p e r ce i v e d t h e st i g m a a sso ci a t e d w i t h t h eir m en t al d isor d er s. Fr om t h is p er sp ect iv e, t h ey
f aced t h e st ig m a an d a lack of com p r eh en sion f r om
p eop le close t o t h em , su ch as t h eir ch ild r en , p ar t n er a n d n e i g h b o r s. Th e se co n d i t i o n s g r e a t l y a f f e ct e d t h e p h e n o m e n o n i t s e l f, b e c a u s e t h e s e h i n d e r e d
t h ei r co p i n g st r at eg i es.
S t r a t e g i e s a d o p t e d t o d e a l w i t h t h e p h en om en on p r esen t ed as t h e cen t r al cat eg or y led
t o f u r t h e r p o t e n t i a l co n se q u e n ce s, a f f e ct i n g t h e condit ion such t hat t he m ent al disor der r eflect ed on t h ei r ch i l d r en Th ese m o t h er s p er cei v ed t h at t h ei r
condit ion int erfered w it h t heir children’ resources w hen t hey had t o deal w it h unex pect ed sit uat ions.
A consequence t hey expect ed of t heir act ions
w as sim ply t o be able t o lead t heir lives, and be w illing t o live w it h changes caused by t he disor der in addit ion t o developing w ays t o deal w it h pr ej udice against t hose
w ho ar e affect ed by a m ent al disor der.
We o b s e r v e d t h a t t h e p h e n o m e n o n w a s
per m eat ed by t he pr esent ed elem ent s in t he m ot her s’ m ovem ent of t r ying t o see t hem selves ( am id ext er nal and int er nal dem ands) so t hey could k eep fight ing –
as t he ident ified cent ral phenom enon, w hich reflect ed m ot her hood ex per ienced as m ent al disor der pat ient s.
DI SCUSSI ON
Dat a analysis enables reaching t he conclusion t h at m ot h er h ood f or w om en w it h m en t al d isor d er s d em an d s t h at t h ey m ob ilize t h e in t er n al r esou r ces
t h ey h av e so as t o r econ st r u ct t h eir iden t it y in t h e cont ex t of t heir liv es. Mot her hood as a phenom enon o f l i f e g a t h e r s m e a n i n g s a n d v a l u e s t h a t a r e
su b o r d i n a t e t o t h e a cq u i si t i o n a n d a t t r i b u t i o n o f f u n ct ion s an d ex p ect at ion s t h at f all on w om en an d w hich ex er t an im por t ant im pact on t he dy nam ics of
per sonal and fam ily life.
I n t h is r eg ar d , m ot h er h ood , as a w om en ’s i d eal , i s a so ci al co n st r u ct i o n b ased o n b i o l o g i cal
aspect s( 4,9) and w hich, even in t hese t im es, find echoes t o r ei n f o r ce t h e r o l e o f w o m en as car eg i v er s an d r esponsible for t ak ing car e of hom e. These ideas ar e
also ident ified in t he r epor t s of m ot her s w it h m ent al disor der s, w ho point t o m ot her hood as a “ st andar d” of adult life, t hat is, it ensures t hem t he realizat ion of a
social expect at ion relat ed t o t he fem ale gender( 10- 11). We v e r i f i e d t h a t t h e p a r t i c i p a n t s m o s t e m p h a t i c a l l y v e r b a l i z e d t h e d i f f i c u l t i e s t h e y
ex per ien ced in a br oad sen se ( in t h eir r elat ion sh ips w it h f am ily, w it h t h eir par t n er s, w it h daily r ou t in es p er m eat ed m en t al d isor d er ) . Wh en t h ey ad d r essed
m ot h er h ood t h ey t en d ed t o r ep r od u ce st er eot y p ed view s as can be per ceived by t he “ w ishing t o be able t o do ever yt hing”, t hough t hey also added t he “ bur den
of m ot h er h ood”. Du e t o t h e st igm a associat ed w it h m en t al d isor d er, m ot h er h ood f or t h ese w om en led t h em t o qu est ion t h em selv es an d societ y r egar din g
t heir abilit y t o per for m t he r oles t hey w er e supposed t o play( 10), seeking t o under st and t o w hat ext ent t hey d ealt w it h st r ess cau sed b y t h e sy m p t om s of t h eir
d i s o r d e r o r t h e d i f f i c u l t i e s o f t h e m o t h e r - c h i l d r elat ion sh ip .
Accor ding t o t he concept of par ent ing( 6), t he ab ilit y t o ex er t t h e m at er n al r ole is also b ased on sour ces of st r ess and suppor t pr esent in t he genit or ’s cont ext of life, w hich include: m arriage, social net w ork
These w om en included t heir part ners in t heir r e p o r t s i n t h e co n t e x t i n w h i ch t h e p h e n o m e n o n occu r r ed, w it h t h e f act or “ t y pe of h elp pr ov ided by t h e h u sb an d ”, w h ich assu m ed a b in ar y p ossib ilit y : occur or not occur. When t he par t ner act ively assum ed c a r e , h e w o u l d p e r f o r m h o u s e t a s k s n o l o n g e r p er f or m ed b y t h e m en t al d isor d er p at ien t an d also pr ov ide w h at w as n ecessar y t o m ain t ain t h e h ou se an d f am ily m em ber s.
There w ere cases in w hich t he m ent al disor der p r eci p i t at ed t h e en d o f an al r ead y f r ag i l e m ar i t al u n ion , an d t h e d isease w as t h e ex cu se n eed ed t o consum m at e it s r upt ur e. I n t his cont ext , t he fam ily of or igin becam e m or e su ppor t iv e, deliv er in g car e an d g iv in g su p p or t w h ich t h ese m ot h er s cou n t ed on t o have a m inim um level of organizat ion in t heir rout ine a n d h o m e . Th e f a m i l y a n d t h e i n f o r m a l su p p o r t n et w or k su ch as n eig h b or s r ep r esen t an im p or t an t in st r u m en t f or st r en gt h en in g an d deliv er in g car e in t h ese con dit ion s giv en t h e r est r ict ion s pr esen t ed by healt h services and, in a larger sphere, by t he lim it ed capacit y of public policies t o adequat ely m eet t hese dem ands( 12- 13).
A s o n e o f t h e e l e m e n t s t h a t c o n s t i t u t e p a r e n t i n g , i n r e l a t i o n t o t h e r e m a i n i n g f a c t o r s m ent ioned earlier, int ernal resources and t he m ot her ’s lif e h ist or y p r ov id e d at a ab ou t h ow m at er n al r oles w ill be dev eloped.
Th e p ar t icip an t s’ r ep or t s r ev ealed t h at t h e e x p e r i e n c e o f a n u n p l a n n e d p r e g n a n c y w a s concom it ant w it h t he disease m anifest at ions or ev en a g g r a v a t e d t h e m , i n d i c a t i n g t h a t a n u n p l a n n e d p r e g n a n c y a n d i t s r e c u r r e n c e a r e n o t a b l e a s d est ab ilizin g sit u at ion s in t h e in t er v iew ed m ot h er s’ in div idu al an d fam ily dy n am ics. Addit ion ally, w om en b e co m e m o r e su sce p t i b l e t o t h e d e v e l o p m e n t o f m ent al disor der s dur ing t he puer per al per iod due t o
t h e e f f e c t s o f h o r m o n a l a c t i o n s t r i g g e r e d b y
pr egnancy( 14- 15).
Th e c o n c l u s i o n i s t h a t t h e m o t h e r s w h o p ar t icip at ed in t h is st u d y, t h eir r ep or t s ab ou t t h eir
t r a j e c t o r i e s a n d h o w t h e y h a v e t r i e d t o r e s c u e t hem selves am id t hese event s, denot e t he need t hey h a v e t o r e c o g n i z e a n d s e e t h e m s e l v e s i n t h e i r
m at ernal role so t hey can keep fight ing t he lim it at ions im posed by t he m ent al disor der.
This is a specific realit y and at t he sam e t im e
com m on t o so m any ot her w om en. Specific because it ad d r essees a su b j ect lit t le ex p lor ed in Br azilian scient ific ar t icles, but not less im por t ant – giv en it s
pr event ive pot ent ial for car e relat ed t o m ent al healt h. Th e st u dy also poin t s t o t h e n eed t o adapt m ent al healt h services in t he face of t his dem and, so
t hese w om en see t hem selv es bey ond t heir condit ion as m ent al disor der pat ient s.
FI NAL CONSI DERATI ONS
We can asser t t h at t h e in clu sion of g en d er issu es in t h e m en t al h ealt h f ield w ill en ab le m or e adequat e car e deliv er y giv en t hat t he sick indiv idual – her e gener ically speaking – pr im ar ily is a m an or a w o m a n , o n w h o m r e s t e x p e c t a t i o n s a n d s o c i a l
at t r ib u t ion s t h at ar e p ar t of t h e elem en t s af f ect in g t h e h ealt h - disease pr ocess. I n t h is w ay, addr essin g t h e s e i s s u e s f o r w o m e n ’ s m e n t a l h e a l t h a n d m o t h er h o o d u n d er t h e m et h o d o l o g i ca l f r a m ew o r k u s e d i n t h i s s t u d y c o n t r i b u t e s t o o t h e r s t u d i e s pu blish ed in t h is per iodical t ow ar d t h e en lar gem en t of know ledge, w het her in t he m ent al healt h field or in
t er m s of st r at egies of scien t ific r esear ch , w h ich can be used in qualit at ive st udies( 8,15).
REFERENCES
1. Colver o LA, I de CAC, Rolim MA. Fam ília de doença m ent al:
a dif ícil con v iv ên cia com a dif er en ça. Rev Esc En f er m USP
2 0 0 4 ; 3 8 ( 2 ) : 1 9 7 - 2 0 5 .
2. Per eir a MAO. Repr esent ação da doença m ent al pela fam ília
d o p a ci en t e. I n t er f a ce – Co m u n i ca çã o , Sa ú d e, Ed u ca çã o
2 0 0 3 ; 7 ( 1 2 ) : 7 1 - 8 2 .
3 . An d r ad e LHSG, Vian n a MC, Silv eir a CM. Ep id em iolog ia
dos t r an st or n os psiqu iát r icos n a m u lh er. Rev Psiqu iat r Clín
2 0 0 6 ; 3 3 ( 2 ) : 4 3 - 5 4 .
4. Badint er E. Um am or conquist ado. 3ª ed. Rio de Janeir o
( RJ) : Nov a Fr ont eir a; 1 9 8 5 .
5 . Soar es JS, Car valh o AM. Mu lh er e m ãe, “ n ov os papéis”,
v elhas ex igências: ex per iência de psicot er apia br ev e gr upal.
Psi co l Est u d o 2 0 0 3 ; 8 : 3 9 - 4 4 .
6. Belsky J. The det er m inant s of par ent ing: a pr ocess m odel.
Ch ild Dev elop 1 9 8 4 ; 5 5 ( 1 ) : 8 3 - 9 6 .
7 . Ch ar on JM. Sy m bolic in t er act ion ism . 3 ª ed. New Jer sey
( NJ) : Pr en t ice Hall; 1 9 8 9 .
8. Cassiani SHB, Calir i MHL, Pelá NTR. A t eor ia fundam ent ada
nos dados com o abor dagem da pesquisa int er pr et at iv a. Rev
Lat in o- am En f er m ag em 1 9 9 6 ; 4 ( 3 ) : 7 5 - 8 8 .
9. Scav one L. Mat er nidade: t r ansfor m ações na fam ília e nas
r elações de gên er o. Rev ist a I n t er f ace- Com u n icação, Saú de
e Ed u cação 2 0 0 1 ; 5 ( 8 ) : 4 7 - 6 0 .
10. Diaz- Canej a A, Johnson S. The view s and exper iences of
se v e r e l y m e n t a l l y i l l m o t h e r s: a q u a l i t a t i v e st u d y. So c
Psy ch i at r Psy ch i at r Ep i d em i o l 2 0 0 4 ; 3 9 : 4 7 2 - 8 2 .
cl o se: m o t h er i n g w i t h ser i o u s m en t al i l l n ess. J Ad v Nu r s
2 0 0 6 ; 5 4 ( 1 ) : 2 0 - 8 .
12. Ser apioni M. O papel da fam ília e das r edes pr im ár ias na
r eest r u t u r ação d as p olít icas sociais. Ciên c Saú d e Colet iv a
2 0 0 5 ; 1 0 : 2 4 3 - 5 3 .
1 3 . Galer a SAF, Roldán MCB, O’Br ien B. Wom en liv in g in a
dr ug ( and v iolence) cont ex t : t he m at er nal r ole. Rev Lat
ino-am En f er m agem 2 0 0 5 ; 1 3 ( n º spe 2 ) : 1 1 4 2 - 7 .
1 4 . Ca m a ch o RS, Ca n t i n el l i FS, Ri b ei r o CS, Ca n t i n i l o A,
Gon sales BK, Br agu it t on i E, et al. Tr an st or n os psiqu iát r icos
n a g est a çã o e n o p u er p ér i o : cl a ssi f i ca çã o , d i a g n ó st i co e
t r at am en t o. Rev Psiq u iat r Clín 2 0 0 6 ; 3 3 ( 2 ) : 9 2 - 1 0 2 .
1 5 . Tu o n o V L, Jo r g e M H PM , Go t l i e b S LD , La u r e n t i R.
Tr a n st o r n o s m e n t a i s e co m p o r t a m e n t a i s n a s m o r t e s d e
m ulher es em idade fér t il. Epidem iol Ser viços de Saúde 2007;
1 6 ( 2 ) : 8 5 - 9 2 .
