(Dis)trust in the care of work related mental health problems in Brazil: Between multiple systems and shared lifeworlds

Sociologists have understood trust in healthcare contexts chiefly in terms of how the patient relates understandings of the system and the professional, amid unfolding interactions and relations. This theorical framing, where trust is usually considered in relation to a relatively coherent healthcare system, tends to neglect the multiplicity of organisations, systems and institutions shaping patients' (dis)trust. Embedded within this ‘system’ is often a global-north-western typification of the benevolent, well-paid healthcare professional in stable employment. In this article we adopt a phenomenological approach to partially build upon these conceptual bases as a way of extending our understandings of (dis)trust amid healthcare constellations. We draw upon a study of (dis)trust in Brazilian contexts of work-related mental health problems (WRMHPs), within a highly fragmented network of multiple systems, where the mental health professionals themselves worked in low paid and often precarious work situations. Drawing on 14 in-depth interviews with patients with WRMHPs, and their psychological-therapists, we found the fragmentation of systems and distance between them was fundamental to analysing emerging relations of (dis)trust. In turn, these multiple system dynamics configured lifeworld structures of shared assumptions, shared critiques of biomedical models, shared precarity and negative experiences in the Brazilian labour market. These lifeworld structures formed the basis of professionals' trust in their patients and facilitated the listening and deeper communicative action which slowly built patients' trust. The Brazilian case of WRMHPs is useful in rendering more explicit the multiple abstract systems, epistemic traditions and organisational structures pertinent to understanding (dis)trust amid healthcare contexts, and the role of increasingly precarious professionals within these.