Possibility conditions for the creation of day hospitals in Argentina: the case of the Belgrano Hospital

Abstract

The present work is based on a more extensive investigation dedicated to the psychoanalytic treatment of psychoses in public institutions in the province of Buenos Aires after the restoration of democracy in Argentina in 1983. In particular, we investigate here the conditions of possibility that gave place for the creation of the day hospital of the Belgrano Hospital of Villa Zagala, San Martín’s municipality (Greater Buenos Aires). The device that constituted this hospital, between 1985 and 1999, became at that time a source of inspiration for the creation of other day hospitals as well as for the treatment of psychotic patients in general.

As regards the historic background, the day hospital emerges in the Soviet Union in 1933, under a shortage of hospitalization beds and unfavorable socioeconomic conditions, without major developments during the pre-war period. Correlative to the subsequent advance of the movement of antipsychiatry and mental health of the ‘50s and ‘60s, the device underwent a huge expansion and managed to insert itself in several scenarios, with varied purposes, based on diverse theoretical perspectives (sometimes not very defined) and aimed at different populations. However, although there is an extensive historiography on the expansion and transformations of the day hospital at the international level, at a local level the state of knowledge is scarce. Therefore, the incidences that these global phenomena may have had in Argentina are unknown, as well as their consequences on institutional practices (Stagnaro, 2004).

Hugo Duchêne (1961) points out that the modalities of care at a specific time and place are the result of three main factors: the theoretical conceptions of madness, the therapeutic resources available and the political and socioeconomic conditions of the place. This opens the question not only for the incidences of phenomena outside the country, but also for the unique framework in which the province of Buenos Aires was at that time, where day hospitals took root and diffusion as alternative devices to the asylum model for the treatment of psychosis.

After the restoration of democracy, Argentina went through a period of full institutionalization and the reception of Jacques Lacan's ideas permeated the training spaces and clinical practices. At the same time that psychologists found legal access to the field of psychopathology and the exercise of psychotherapies, the psychopathology services, which in most cases had been disarticulated during the dictatorship, began to be taken by young professionals, many of them formed by figures such as Jorge García Badaracco, Enrique Pichon Rivière, among others. This configurated a very particular shape that gave rise to the Belgrano Hospital’s Day Hospital.

Now, since the subject is part of a period that has been scarcely studied, its approach - from critical historiography- mainly includes the recovery of primary sources, with exegesis of written documents and interviews with qualified key informants. We believe that the study of these historical processes at the local level can account for the current situation in psi practices, where in addition the current Mental Health Law (Law 26657/10) urges the configuration of alternative devices to  treatments that are sustained in prolonged hospitalization, in order to avoid breaking the patient's social bond or to promote it.