Voz y discurso en salud mental: esquemas diagnósticos en conflicto en un análisis de caso
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En este trabajo presentamos un caso de error de diagnóstico en salud mental que, iniciado en la entrevista de admisión, se prolongó durante un año de tratamiento. Para interpretar las causas de dicho error, y basados en un proceso colaborativo con el equipo de salud mental, utilizamos dos categorías teóricas: “discurso” (entendido como el conjunto de regularidades semióticas y semánticas que se corresponden con un campo social, como en “discurso médico”, etc.) y “voz” (entendida como el producto singular de la articulación entre múltiples discursos a lo largo de la trayectoria biográfica de una persona). Metodológicamente, empleamos las herramientas descriptivas del análisis de la conversación en un corpus heterogéneo que atraviesa las diferentes etapas del diagnóstico y el tratamiento. El análisis muestra el efecto del discurso psicoanalítico, que selecciona algunos aspectos de la voz de la paciente ignorando otros, arribando a un diagnóstico de trastorno de conversión (“histeria”) e impidiendo otro, de afasia progresiva. En el final, se discute el potencial de los estudios de la interacción para el proceso diagnóstico y algunas implicancias del caso para el campo del análisis del discurso.
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