The film “The name of the Care”, a medical-philosophical essay on the relationship between doctor and patient, check it out!

“The Name of Care”, a film that deals with the relationship between doctor and patient, based on the interpretation of a medical-philosophical text interpreted by Walderez de Barros and Oswaldo Mendes. LAPPIS, supporting the dissemination of the film, interviewed the creator of the medium-length film, Dr. Paulo Rosenbaum . The homeopathic physician answers questions about the film and about health and its representation in today’s society. Watch the movie trailer and then be sure to read the exclusive interview!                         

1- In one of the scenes, the character played by Walderez      de Barros reflects on the loneliness and great individualism present in members of contemporary society. How do you face this trend and what are the relationships it has with health, especially with homeopathy? In our society of information and express relationships, loneliness tends to increase dramatically, people live more alone, the number of people who live without a family, according to IBGE data from 2008 shows: the trend has exploded in the last decade. This is worldwide. On the other hand, individualism is not only present in the members of society, society is ideologically individualistic. That is: society – even in a more solidary and participatory regime – produces its “cohesion” in general at the expense of a side effect: the suppression of personal characteristics, dilution of unrepeatable unitswhich are the individual subjects. It is relatively simple to understand: to reach the average, singular traits are eliminated. There is less and less room in society for idiosyncrasies and singularities have to adapt – at the price of exclusion, marginalization or abandonment – ​​to social norms that are common to the average. Contemporary loneliness is not only a product of the inability to belong, but also the active rejection of a social environment that discriminates and segregates differences. I don’t know if there is a solution to this paradox. There is also a metaphysical loneliness, existential suffering for which, perhaps, there is no cure. Paul Ricouer says that misery is not coinciding with oneself. I believe in that. But how to recover these values ​​in an anomic society and without fair criteria? Homeopathy and integrative medicine are just medicine, right? Why should they propose to be agents of a broader transformation? What is this pretension? Which sociologist or philosopher granted this freedom to medicine? But the fact is that they played a broader social role than just eliminating diseases, they tried to develop criteria to assess each singularity as essential to a better understanding of the health and disease process and even a better understanding of society. Benoit Mure can always be cited as someone with these concerns. Like it or not, at least so far, the expansion of medicine’s horizon of action was a defeated project. Let the purists be shocked, but there are palpable elements that allow this reading to be made: the non-hegemonic areas did not get support, because even the doctors who use the other medical rationalities, the non-hegemonic ones, understand how they should inform society. Neither about the reasons for their existence, nor what new developments they propose in resisting the hardcore of gold standard research as the only ones that really qualify what is produced as benefits. In fact, the “resistance” that for a long time was even well calibrated to fix and reaffirm a research project that was still somewhat loose today became a justification for maintaining itself as an anachronistic cause. A very backward ideology that divides the world between allopathy and everything else. She, in addition to not dialoguing well, thinks she should challenge the medical corporation or blame the drug companies instead of bringing them to the debate. There are difficulties in having a minimum consensus to dialogue with the scientific community and when it does, it pays the price to disfigure the characteristics that underlie the method. We have, then, to ask the painful question: what is the point of all the struggle for reaffirmation if it is to accept a reduction that makes the novelty brought about by the perspective of an integrative practice, which is, without any naivety, a generous project unfeasible?                               

2- Nowadays, health assumed the definition of “not being sick”, instead of the classic definition of “being healthy”. In one passage, Oswaldo Mendes questions the patient about what he imagines when feeling pain. Visual expression is the explosion of a bomb, but how would you define it in words? The bomb is a metaphor whose idea came from the film’s director, Leo Lama, and which Paulo Prestes Franco captured and inserted very well into the film. She is efficient at saying something that reaffirms itself throughout the film. A bomb is the maximum violence, sometimes indiscriminate, most often irrational, which can be the symbolic synthesis of the modern statute of lack of delicacy. It is the absolute antithesis of care. All that counts is producing “effects” and “seeing” facts. The testimony, the narrative only appears and can only be validated by the images. She has the strength to tell those around her that he is a target. A target of injustice, a hostage of impatience, an object to be pulverized. So often the health sciences areas unfortunately objectify people who need treatment. In this sense, the metaphor has a triple hermeneutic: destruction of the “disease” thing, the “target” suffers an indiscriminate action against everything around it. The bomb, actually a scene of a guided missile hitting a target, also represents the desperate intensity of suffering, and finally a metaphor to compare what is sometimes difficult to verbalize in the soup of poverty of language. Finally, the image of destruction that, for those who get sick, makes no sense. Later, during a dialogue, the patient says to the doctor, reacting to a generalization that what he says is a society problem and not medicine, and the doctor answers: “society’s problems explode in the face of medicine”.         

3- Integrative medicine, particularly homeopathy, values ​​individualized care, giving the patient the necessary attention so that a cure can be obtained with greater quality. In your opinion, should this type of relationship between patient and doctor be integrated or should it be restricted to homeopathy only? If what you mean by “integrated relationship” is a radical relationship where the doctor captures the patient’s state and contextualizes it, and from this perspective, where he can enter into dialogical harmony with whoever is caring and vice versa , yes. Vice versa , as the dialogic relationship presupposes that the two are subjects in the consultation. Homeopathy is a specialty that has this structural feature in its episteme and as much as researchers try to dissect it, it is not possible to emancipate the medicinal therapeutic effect from the action and the force of action in therapeutic rapports . They are married and doomed to eternal fidelity to the chagrin of many. It is a big mistake to underestimate the value of conversation. Individualized care is not only about being attentive and available to the sick person, but valuing idiosyncrasies not only as positive details to identify symptoms, but also to understand and merge horizons with the author of the symptoms. In this case, the fusion of horizons is with the patient. This apprehension is not only important at that time, as guidance or counseling can always be based on very particular aspects of a particular person. If standard medicine could relearn how to listen to patients’ biographical and clinical histories, this would be a huge scientific and institutional advance . Care would approach a more careful practice and doctors and patients would be progressively disobjectified and this could work as a general reformulation of the very notion of the clinic. But that’s just a hope.                                                                                       

4- The choice of the subway as the interpretation scenario represents the collectivity that is responsible for equalizing citizens, oppressing individual characteristics. In one scene the patient screams, desperately, that he is feeling sick. As he demonstrates his despair, it is clear that no one among the many people around him is able to help him. In your opinion, does society lack solidarity? What is the relationship of this feeling with health practices? That’s a thought-provoking statement. In fact, the cry of pain is a cry in emptiness, besides being deaf it is a dead cry. He issues his despair to whom? Is there anyone listening? Is there someone to take care of it? Helplessness is a serious condition; he is the voice of abandonment and carelessness. He is the in-law of solitude. That’s why she screams so loud and insists on making herself heard. The film seeks to welcome and examine the malaise . As I said above, society is not, by nature, solidary. Much less the State, which in general is violent, repressive and, when saying that it is concerned with taking care of the “masses”, may not promote anything other than homogeneous measures for people with completely different needs, regardless of the protocol applied. Epidemiology is just beginning to learn the practical value of diversity. Sometimes, most of them sacrifice the individual in the name of a collective good. No one is trying to deny the value of biostatistics or effectiveness. For example, you cannot place individual seats on public buses in a way that everyone is respected in the way they would like to sit. But medical action is different and health care needs attention that focuses on the particular way in which the person becomes ill and heals. Standardization is not possible even though protocols and their efficiency rates can be accepted. This is just one facet of therapeutic interference. The other side of the coin is that if a treatment protocol is effective in the indiscriminate application of a successful guideline on a given pathology, imagine how much more effective it would be if it could simultaneously assess the overall impact on each subject and fine-tune person to person ? This is the greatest and greatest asset of a correct conception of integrality. The singular and unique way each expresses what only it can express. Maybe we wouldn’t have to be discussing at length a pleonasm as the “humanization of medicine”. Certainly there are segments of research in the scientific mainframe that are properly concerned with this issue, but the path is slow and long. As the song said: it is a long way !                                         

5- The scene in which the character expresses not wanting to know about the diagnosis, whether right or wrong, represents the individual’s disregard for the medical process, wanting immediate cure, regardless of the causes of the disease. Is this a general trend in today’s society?                                                 Can homeopathy, as it has an approach aimed at the individual, serve as an example as a solution to this tendency? I don’t know if I would read it that way although that’s exactly the richness of the movie. A hermeneutic documentary like “O nome do Conhecimento” intends to show that this fusion takes place with the different perspectives of those who see it and thus can be better explored in public debates. And that’s our effort. By the way, it called our attention to the almost absolute lack of support for this initiative, which we had to fund with personal resources and with the help of friends. No association, university or research group was involved in the project. I don’t complain. I just try to see how a vital question like this is encapsulated and overlooked. Which for me only increases the desire to publish the documentary and start a second filmic investigation. It is an ineffective discussion and precisely because it does not arouse institutional interest, we must insist on discussing “why does this issue cause so much trouble? What does it raise? We renounce any crude denunciation, to adopt the language of art, metaphoric and poetic, to give voice to problems. Applying hundreds of millions of reais to implement service centers, humanization programs and the regulation of integrative medicine in the Brazilian state may not be enough. Without a discussion carried out the ultimate consequences of what type of medicine is desirable and what is the most priority and how the training of human resources is taking place for this immense demand – both in the SUS and in private medical practice – and still without taking into account the kind of malaise that is spreading in contemporary society does not seem to me that we can go very far. There is a moment in the film when the doctor says “there is a gigantic social pathology and it seems that people don’t realize that these things are also symptoms” . 6- Finally, the movie trailer, right at the beginning, raises a question: “Which medicine does society need?”. Could you answer it? I think society needs to discuss which medicine it wants. It’s a question and no one can claim to give answers alone. But I have an intuition and that’s what I’m going to talk about. I think that at least most people do not know what medicine is or that it has several possibilities for intervention. Who will say what the integrative cut medicines are. If there is a model medicine? Is there a model that should be hegemonic?                                                                                         

      I do not believe. We urgently need to transcend the idea that one formula will replace another. The various forms of intervention make sense and relate to specific models of cultures and diversities: ethnic, racial, religious, geographic. There are, however, some generic topics: I believe in bringing the idea to users and consumers that a service in which the quality of presence is in evidence is good. A medicine in which listening is more generous and the patient is not a passive object, but an interactive subject who is also present, putting all his instruments at his disposal. Everything so that you can reach states closer to happiness. A health manager might turn up his nose and say: this is impossible. As long as I’m a doctor, I can still – or want to – have the luxury of believing.      

To contact Dr. Paulo Rosenbaum , send an email to rosenbau@alumni.usp.br.

To see the teaser:
http://www.youtube.com/watch?v=3vUXVhOudCc