Asylum in Us: The Present Challenges of Brazilian Psychiatric Reform in the Context of the History of Deinstitutionalization in the Global South.

During the 1960s, complaints of abuse against psychiatric patients emerged in several countries, driving movements for new treatment paradigms that prioritized reducing hospitalizations and reconfiguring mental health. In Brazil, psychiatric reform gained strength in the 1970s, influenced by events in Italy and developing amid the effervescence of social movements. The mental health workers' movement incorporated urgent demands of the time, such as the fight against the military dictatorship and the expansion of human rights. In this scenario, Health Reform and the Unified Health System (SUS) stood out, encompassing mental health with a focus on social security and universal access. This process unfolded into a) epistemological constructions of deinstitutionalization and b) democratic achievements of psychiatric reform.

With the expansion of Brazilian Psychiatric Reform and the implementation of substitutive services to the asylum, oriented toward care in freedom "outside the walls," psychiatry expands its borders, entering daily life and the private sphere, establishing new forms of self-governance. This process, however, is marked by a constant tension between hegemonic psychiatry, strongly influenced by imported practices from the Global North, and reform-oriented psychiatry, based on genuinely Brazilian practices. The latter resists the disqualification of thought produced in the South and the perpetuation of the asylum as a technology of control.

Considering this scenario, our proposal aims to rethink deinstitutionalization not as mere dehospitalization but as an ethical praxis within the political disputes inherent in psychiatric reform in Global South. Basaglia's (1968) proposition to put disease in parentheses reflects the contemporary use of the prefix "des" in our traditional care practices. This manifests in four interconnected fronts: a) the 'depsychiatrization' of vocabulary associated with suffering, b) the 'dediagnosis' of life experiences, c) the 'deprescription' of medications, and d) strategies for collective care actions.

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