Ocupar-se nas ruínas: uma etnografia em um centro de atenção psicossocial álcool e drogas na zona oeste do Rio de Janeiro

Abstract

At the Psychosocial Care Centers (CAPS)—strategic components of the Psychosocial Care Network (RAPS) in Brazil—the provision of mental health care does not occur in isolation but is deeply embedded in the local community. This local context is not merely the setting for the social determinants of health, but a living field of interactions where daily care and engagement emerge from the dynamic, situated encounter between the force of structural inequalities and the survival strategies of individuals within their real-life contexts. This study sought to understand the occupational experiences of people who receive care at a CAPS AD and live in contexts of extreme vulnerability in the West Zone of Rio de Janeiro. Theoretically, it integrates the transactional perspective on occupation based on John Dewey’s pragmatism with Anna Tsing’s ecological anthropology, exploring precariousness as an inherent dimension of human existence and as a condition of late capitalism that forces people to “live among the ruins,” thereby stimulating the emergence of ecologies and vital arrangements where there are no promises of a guaranteed future. It is characterized as qualitative research with an ethnographic approach, with fieldwork conducted between March and August 2024. The empirical data were collected through field notes, semi-structured interviews, and focus group discussions. The analysis involved organizing, coding, and categorizing the data, relating the observed scenes to the socio-spatial context and the study’s analytical framework. The empirical findings reveal the complexity of care and the occupational experiences woven into a territory marked by socio environmental degradation, a lack of urban infrastructure, and violence. The ethnography shows that health care provision at the service is guided by the ethics of harm reduction, shifting the focus from substance use to meeting fundamental human needs, which are expressed through occupational experiences. In the face of the destabilization of daily life, CAPS AD functions as an anchor and vital source of support, where users engage with their own existence by accessing meals, workshops, and other activities that expand opportunities for social participation. The study reveals that occupational experiences emerge as practical arrangements for survival and the invention of daily life amid the city’s ruins. Actions viewed as ordinary or mundane—such as negotiating a night’s rest under a bank’s awning, improvising shelters from the rain, collecting recyclable materials, walking to the beach, wandering through the neighborhood, or hosting poetry readings in the square—constitute adaptive responses and vital arrangements in contexts of degradation. It follows that viewing these occupations as transactional and situated experiences implies recognizing that the subjects themselves are situated and bear the marks of inequality on their body-territories, yet they are not passively reduced to them. In devastated territories, occupations serve as mechanisms for shaping worlds and sustaining existence. This research contributes to Occupational Science, Occupational Therapy, and Public Health by demonstrating that, in the face of the barrenness of daily life, “keeping oneself occupied” goes beyond individual functional adaptation, revealing itself as an act of persistence and political resistance in creating the conditions to continue existing and to claim the fundamental right to live—and to live well.