WHEN TRAINING MEANS FALLING ILL: POWER, NEOLIBERALIZATION, AND SUFFERING IN HEALTH RESIDENCY PROGRAMS

Abstract

Medical and multiprofessional residency programs within Brazil's Unified Health System (SUS) are shaped by structural tensions that contribute to psychological distress among both residents and preceptors. This theoretical essay examines these conditions through Michel Foucault's concepts of disciplinary power, biopolitics, governmentality, and dispositif, articulated with the understanding of neoliberalism as a historically evolving process proposed by Peck, Theodore, and Brenner. The Foucauldian notion of dispositif provides the analytical framework, understood as a heterogeneous network of discourses, institutions, norms, practices, and technologies of subject formation. We argue that psychological distress in residency programs is not an incidental consequence of intensive professional training but rather the product of an institutional rationality historically constituted through the intersection of disciplinary practices, biopolitical mechanisms, and neoliberal forms of governmentality that transfer risks to individuals, individualize responsibility, and normalize precarious training and working conditions. To support this discussion, an exploratory literature review conducted in the Virtual Health Library (VHL), using the LILACS database, identified 96 studies addressing the topic. After title, abstract, and full-text screening, only 28 met the inclusion criteria, and just one focused primarily on multiprofessional residents. Additional exploratory searches revealed a substantial disparity between the scientific literature on mental health in medical residency and multiprofessional residency programs, highlighting the persistent underrepresentation of the latter. The essay further examines the absence of consolidated mechanisms for reporting and monitoring workplace harassment, the reproduction of hierarchical relationships among residents across training years, the lack of systematic evaluation of preceptors, and the legal vulnerability arising from residents' status as trainees rather than workers. Finally, we argue that Permanent Health Education, informed by Foucault's ethics of care of the self and the concept of counter-conduct, in dialogue with Paulo Freire's critical pedagogy, may function as a collective space for critical reflection and institutional transformation, provided that it is not reduced to an individual strategy for adapting to prevailing organizational rationalities.