Entre rios, territórios e encontros: cartografia das produções de cuidado em ato no CAPS-Ad de Parintins (AM)

Abstract

This dissertation aims to map the modes of care production in action at the Psychosocial Care Center for Alcohol and Other Drugs (CAPS AD) in the municipality of Parintins, Amazonas, Brazil, by following the processes that are constituted in the everyday work of mental health care, from an ethical, political, and relational perspective grounded in the Brazilian Psychiatric Reform and Harm Reduction approaches. Inspired by the cartographic method, understood as a research-intervention committed to accompanying processes in their living and constantly transforming dimension, this investigation is constructed through the intertwining of the researcher’s trajectory, the Amazonian territory, and the care practices produced within the service. The fieldwork was composed of lived experiences alongside CAPS AD workers, users, family members, and the care network, through cartographic devices such as field diaries, group discussions, and participant observation. The research takes place in a territory marked by Amazonian specificities, where rivers, distances, and urban-riverine dynamics produce singular modes of existence and organization of care. The findings reveal that mental health care is produced beyond prescriptions and protocols, being woven in everyday life through encounters, affects, negotiations, and inventions that emerge in living labor in action. Workers develop practices that articulate listening, bonding, and responsibility, sustaining care amid often precarious institutional conditions, marked by overload, lack of resources, and network fragilities. The cartography also shows that modes of care are traversed by social markers such as gender, sexuality, race/ethnicity, and territory, which directly impact forms of suffering and the possibilities of access to and continuity in services. Narratives of users, especially those in situations of greater vulnerability, such as people experiencing homelessness and LGBTQIAPN+ individuals, reveal trajectories marked by violence, exclusion, and discontinuities in care, while also pointing to the potential of encounters within the CAPS as spaces of recognition and the production of bonds. It is concluded that the CAPS AD constitutes a territory of disputes, inventions, and resistances, where care in freedom is produced in an unfinished manner, tensioned between institutional guidelines and the concrete demands of the territory. Cartography makes it possible to demonstrate that care is not limited to technical practices, but is configured as an ethical-political process sustained in encounters and in the capacity to affect and be affected. Thus, this research reaffirms the importance of strengthening territorialized, intersectoral practices committed to the singularity of subjects, contributing to the consolidation of a mental health approach grounded in the defense of life, rights, and the production of existence.