COVID-19 fosters social accountability in medical education.

The COVID-19 pandemic has highlighted embedded inequities and fragmentation in our health systems. Traditionally, structural issues with health professional education perpetuate these. COVID-19 has highlighted inequities, but may also be a disruptor, allowing positive responses and system redesign. Examples from health professional schools in high and low- and middle-income countries illustrate pro-equity interventions of current relevance. We recommend that health professional schools and planners consider educational redesign to produce a health workforce well equipped to respond to pandemics and meet future need.

A Curriculum for Achieving Universal Health Care: A Case Study of Ateneo de Zamboanga University School of Medicine.

Introduction: Universal Health Care requires equal distribution of a health workforce equipped with competencies appropriate for local population needs. While health inequities persist in the Philippines, the Ateneo de Zamboanga University School of Medicine (ADZU-SOM) in Zamboanga Peninsula - an impoverished and underserved region - has demonstrated significant success retaining graduates and improving local health statistics. This study describes the qualitative evidence of ADZU-SOM students and graduates having positive impacts on local health services and communities, and the contextual factors associated with the school's socially-accountable mission and curriculum that contribute to these impacts. Methods: This qualitative study involved 41 one-on-one or group interviews conducted across seven participant groups (faculty, graduates, final-year students, health professionals, health workers, community members, community leaders). Gale et al's method for analyzing qualitative data in multi-disciplinary health research, WHO's "6 Building Blocks for quality health systems" framework and THEnet's social-accountability framework were used to organize and interpret data. Results: Local community members, community leaders, and health staff consistently reported examples of ADZU-SOM students and graduate doctors developing health infrastructure and providing health education, health promotion, and disease prevention activities accessible to all population groups. Students and graduates suggested these impacts were due to a number of factors, including how ADZU-SOM's sandwich model of longitudinal community-engagement culminating in 10-months continuous community placement in the final year helped them develop a strong motivation for community service, the teachings and curriculum activities that focused on public health and the social determinants of health, and faculty's commitment and ability to operationalize ADZU-SOM's mission and values. Staff also reported impacts were driven by integration of regional and national health priorities as core curriculum, and involving local stakeholders in curriculum development. Conclusions: This study provides qualitative evidence that ADZU-SOM's curriculum content and immersive community placements are training a medical workforce that is strengthening local health systems and health infrastructure across all 6 WHO "Building Blocks for quality health systems." These findings suggest ADZU-SOM has managed to evolve a consciousness toward community service among final year students and graduates, adding evidence to the assertion it is a fully socially-accountable health professions institution.

Training a Fit-For-Purpose Rural Health Workforce for Low- and Middle-Income Countries (LMICs): How Do Drivers and Enablers of Rural Practice Intention Differ Between Learners From LMICs and High Income Countries?

Equity in health outcomes for rural and remote populations in low- and middle-income countries (LMICs) is limited by a range of socio-economic, cultural and environmental determinants of health. Health professional education that is sensitive to local population needs and that attends to all elements of the rural pathway is vital to increase the proportion of the health workforce that practices in underserved rural and remote areas. The Training for Health Equity Network (THEnet) is a community-of-practice of 13 health professional education institutions with a focus on delivering socially accountable education to produce a fit-for-purpose health workforce. The THEnet Graduate Outcome Study is an international prospective cohort study with more than 6,000 learners from nine health professional schools in seven countries (including four LMICs; the Philippines, Sudan, South Africa and Nepal). Surveys of learners are administered at entry to and exit from medical school, and at years 1, 4, 7, and 10 thereafter. The association of learners' intention to practice in rural and other underserved areas, and a range of individual and institutional level variables at two time points-entry to and exit from the medical program, are examined and compared between country income settings. These findings are then triangulated with a sociocultural exploration of the structural relationships between educational and health service delivery ministries in each setting, status of postgraduate training for primary care, and current policy settings. This analysis confirmed the association of rural background with intention to practice in rural areas at both entry and exit. Intention to work abroad was greater for learners at entry, with a significant shift to an intention to work in-country for learners with entry and exit data. Learners at exit were more likely to intend a career in generalist disciplines than those at entry however lack of health policy and unclear career pathways limits the effectiveness of educational strategies in LMICs. This multi-national study of learners from medical schools with a social accountability mandate confirms that it is possible to produce a health workforce with a strong intent to practice in rural areas through attention to all aspects of the rural pathway.

Practice intentions at entry to and exit from medical schools aspiring to social accountability: findings from the Training for Health Equity Network Graduate Outcome Study.

BACKGROUND: Understanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions. METHODS: The Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet's Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent. RESULTS: Findings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds. CONCLUSIONS: These findings, from a diverse range of schools with social accountability mandates in different settings, provide preliminary evidence for the selection and training of a medical workforce motivated to meet the needs of underserved populations. These respondents are being followed longitudinally to determine the degree to which these intentions translate into actual practice.

Positive implications from socially accountable, community-engaged medical education across two Philippines regions.

INTRODUCTION: Hundreds of millions of people worldwide lack access to quality health services, largely because of geographic and socioeconomic maldistribution of qualified practitioners. This study describes differences between the practice locations of Philippines medical graduates from two 'socially accountable, community-engaged' health professional education (SAHPE) schools and the practice locations of graduates from two 'conventionally trained' medical schools located in the same respective geographic regions. Licensed medical graduates were currently practising in the Philippines and had been practising for at least 6 months. Graduates were from two Philippines SAHPE schools (Ateneo de Zamboanga University-School of Medicine (ADZU-SOM) on the Zamboanga Peninsula (n=212) and the University of the Philippines Manila-School of Health Sciences (SHS-Palo) in Eastern Visayas (n=71), and from two 'conventional' medical schools Methods: Current graduate practice locations in municipalities or cities were linked with their respective population size and socioeconomic income class, and geocoded using Geographical Information System software onto a geospatial map of the Philippines. Bivariate analysis compared the population size and socioeconomic class of communities where the SAHPE medical graduates practised to communities where 'conventional' medical school graduates practised. RESULTS: Thirty-one percent of ADZU-SOM medical graduates practised in communities <100 000 population versus 7% of graduates from the conventional school in the Zamboanga region (p<0.001), while 61% of SHS-Palo medical graduates practised in communities <100 000 population versus 12% of graduates from the conventional school in the Visayas region (p<0.001). Twenty-seven percent of ADZU-SOM graduates practised in lower income category communities (categories 2-6) versus 8% of graduates from the conventional school in the same region (p<0.001), while 49% of SHS-Palo graduates practised in lower income category communities (categories 2-6) versus 11% of graduates from the conventional school in the same region (p<0.001). CONCLUSIONS: SAHPE has contributed to increased medical coverage across rural and/or economically disadvantaged areas in two Philippines regions. The extensive community-based medical student placements associated with SAHPE likely play a significant role in graduates choosing to practice in rural and/or economically disadvantaged communities. Governments experiencing medical workforce maldistributions similar to those in the Philippines should consider SAHPE as a potentially cost-effective strategy in recruiting and retaining health graduates to underserved areas.

The safety of gliptins : updated data in 2018.

INTRODUCTION: Dipeptidyl peptidase-4 inhibitors (DPP-4is) are generally considered as glucose-lowering agents with a safe profile in type 2 diabetes. AREAS COVERED: An updated review of recent safety data from randomised controlled trials, observational studies, meta-analyses, pharmacovigilance reports regarding alogliptin, linagliptin, saxagliptin, sitagliptin, and vildagliptin, with a special focus on risks of hypoglycemia, pancreatitis and pancreatic cancer, major cardiovascular events, hospitalisation for heart failure and other new safety issues, such as bone fractures and arthralgia. The safety of DPP-4i use in special populations, elderly patients, patients with renal impairment, liver disease or heart failure, will also be discussed. EXPERT OPINION: The good tolerance/safety profile of DPP-4is has been largely confirmed, including in more fragile populations, with no gastrointestinal adverse effects and a minimal risk of hypoglycemia. DPP-4is appear to be associated with a small increased incidence of acute pancreatitis in placebo-controlled trials, although most observational studies are reassuring. Most recent studies with DPP-4is do not confirm the increased risk of hospitalisation for heart failure reported with saxagliptin in SAVOR-TIMI 53, but further post-marketing surveillance is still recommended. New adverse events have been reported such as arthralgia, yet a causal relationship remains unclear.

Socially accountable medical education strengthens community health services.

CONTEXT: Socially accountable health professional education (SAHPE) is committed to achieving health equity through training health professionals to meet local health needs and serve disadvantaged populations. This Philippines study investigates the impact of SAHPE students and graduates on child and maternal health services and outcomes. METHODS: This is a non-randomised, controlled study involving a researcher-administered survey to 827 recent mothers (≥1 child aged 0-5 years). Five communities were serviced by SAHPE medical graduates or final-year medical students (interns) in Eastern Visayas and the Zamboanga Peninsula, and five communities in the same regions were serviced by conventionally trained (non-SAHPE) graduates. FINDINGS: Mothers in communities serviced by SAHPE-trained medical graduates and interns were more likely than their counterpart mothers in communities serviced by non-SAPHE trained graduates to: have lower gross family income (p < 0.001); have laboratory results of blood and urine samples taken during pregnancy discussed (p < 0.001, respectively); have first pre-natal check-up before 4th month of pregnancy (p = 0.003); receive their first postnatal check-up <7 days of birth (p < 0.001); and have a youngest child with normal (>2500 g) birthweight (p = 0.003). In addition, mothers from SAHPE-serviced communities were more likely to have a youngest child that: was still breastfed at 6 months of age (p = 0.045); received a vitamin K injection soon after birth (p = 0.026); and was fully immunised against polio (p < 0.001), hepatitis B (p < 0.001), measles (p = 0.008) and diphtheria/pertussis/tetanus (p < 0.001). In communities serviced by conventional medical graduates, mothers from lower socio-economic quartiles (<20 000 Php) were less likely (p < 0.05) than higher socio-economic mothers to: report that their youngest child's delivery was assisted by a doctor; have their weight measured during pregnancy; and receive iron syrups or tablets. CONCLUSIONS: The presence of SAHPE medical graduates or interns in Philippine communities significantly strengthens many recommended core elements of child and maternal health services irrespective of existing income constraints, and is associated with positive child health outcomes.

A homossexualidade do psicanalista / The psychoanalyst's homosexuality

Em 1921, Freud recusou a ideia de que a homossexualidade em si fosse um obstáculo à admissão à formação psicanalítica. Passaram-se 80 anos até que a IPA, em 2001, finalmente adotou esse posicionamento. Quando se trata da homossexualidade do psicanalista, é impossível dissociar a maneira como essa questão é tratada social e politicamente do questionamento propriamente analítico. A homossexualidade era um delito, mas hoje o delito é a sua discriminação. O politicamente correto mudou de lado, podendo até atingir a psicanálise e atentar contra a sua liberdade de pensar a escolha de objeto homossexual

In 1921, Freud refused the idea that homosexuality in itself was an obstacle to being admitted to psychoanalytic training. Eighty years went by until 2001, when IPA decided to adopt that position. When it comes to the psychoanalyst's homosexuality, it is impossible to dissociate the way society and politics deal with it from its analytic approach. Homosexuality was a crime, but today it is a crime to discriminate against someone on that basis. The politically correct has changed sides, and it may even affect psychoanalysis and its freedom to think of the choice of homosexual object

En 1921, Freud rehusó la idea de que la homosexualidad en sí fuera un obstáculo a la admisión a la formación psicoanalítica. Han pasado 80 años hasta que la IPA, en 2001, por fin haya adoptado esa posición. Cuando se trata de la homosexualidad del psicoanalista, es imposible disociar el tratamiento social y político del cuestionamiento propiamente analítico. La homosexualidad era un crimen, ahora su discriminación es que lo es. El políticamente correcto ha cambiado de bando, incluso para por su vez llegar al psicoanálisis y minar su libertad para pensar la elección del objeto homosexual

O amor capturado pelas palavras / Love captured by words

O amor, as palavras, a análise, qual necessidade os conjuga? Quer se fale do amor pelo vértice do contrainvestimento em relação ao ódio primordial ou pelo vértice da ligação em oposição ao desligamento, define-se um modo de relação psíquica que mantém distância do inconsciente. Eros, esse grande unificador, seria então adversário da análise? Estaríamos esquecendo que Eros é também aquele que desliga, que dilacera os membros. O que aproxima e o que diferencia o dizer tudo da análise do dizer-se tudo do amor? O mais íntimo é mantido pela análise, pelas recusas de satisfação que constituem a condição de seu exercício no campo da palavra: dizer tudo, apenas dizer. E se essa limitação, longe de ser o que é, tivesse o papel inverso de uma fonte de excitação talvez inigualável?

Improving Community Health Using an Outcome-Oriented CQI Approach to Community-Engaged Health Professions Education.

Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement.

Performance assessment of a portable mass spectrometer using a linear ion trap operated in non-scanning mode.

RATIONALE: The desire for mass spectrometer portability provides the motivation for simpler, lighter electronics to deliver switched potentials applied to the electrodes of the linear ion trap operated in non-scanning mode. Using a novel method of modelling and theoretical analysis, we simulate the mass analyser performance under these unfavourable operating conditions. METHODS: The electrical fields are simulated using the Charge Particle Optics software which employs the boundary element method. The ion trajectories are computed from the ion cage of the EI source to the interior of the trap where the ions are confined. The spatial/temporal ion distributions during injection are calculated from the individual ion trajectories computed with constant time-steps. Due to geometric non-linearities, ßy = 0 lines close to the apex of the stability diagram have been computed for different initial positions with zero initial velocities in order to define the acceptable maximum axial extension. RESULTS: The DC potential well depth has been estimated at about 15 eV from the axial velocity distribution, and the minimum time of ion injection at 120 µs from the temporal ion distribution. To ensure a mass separation of one unit and the confinement of the whole of the injected ions, buffer gas cooling is necessary to reduce the trajectory excursion amplitudes to 0.1 and 15 mm in the radial and axial directions, respectively. CONCLUSIONS: The portable mass spectrometer is predicted to achieve a mass resolution of better than one mass unit providing that helium buffer gas is used. An additional cooling sequence has to be added prior to moving the operating point toward the apex. Copyright © 2016 John Wiley & Sons, Ltd.

Training for impact: the socio-economic impact of a fit for purpose health workforce on communities.

Across the globe, a "fit for purpose" health professional workforce is needed to meet health needs and challenges while capitalizing on existing resources and strengths of communities. However, the socio-economic impact of educating and deploying a fit for purpose health workforce can be challenging to evaluate. In this paper, we provide a brief overview of six promising strategies and interventions that provide context-relevant health professional education within the health system. The strategies focused on in the paper are:1. Distributed community-engaged learning: Education occurs in or near underserved communities using a variety of educational modalities including distance learning. Communities served provide input into and actively participate in the education process.2. Curriculum aligned with health needs: The health and social needs of targeted communities guide education, research and service programmes.3. Fit for purpose workers: Education and career tracks are designed to meet the needs of the communities served. This includes cadres such as community health workers, accelerated medically trained clinicians and extended generalists.4. Gender and social empowerment: Ensuring a diverse workforce that includes women having equal opportunity in education and are supported in their delivery of health services.5. Interprofessional training: Teaching the knowledge, skills and attitudes for working in effective teams across professions.6. South-south and north-south partnerships: Sharing of best practices and resources within and between countries.In sum, the sharing of resources, the development of a diverse and interprofessional workforce, the advancement of primary care and a strong community focus all contribute to a world where transformational education improves community health and maximizes the social and economic return on investment.

Uma neurose infernal / An infernal neurosis

A respeito de O homem dos ratos, Malraux dizia se tratar de um grande romance deste século. Freud queixa-se, contudo, de ter dado conta apenas imperfeitamente dessa grande obra de arte da natureza humana que é a neurose obsessiva. O homem dos ratos continua sendo, nos dias de hoje, o texto princeps sobre a neurose obsessiva. Ambivalência, conflito psíquico, erotismo anal, paixão pela contradição, primeira descoberta da contratransferência... a riqueza da escrita freudiana não perdeu nada de sua fecundidade, nem de sua atualidade. Avalia-se como a neurose em si, sem ser necessário evocar formas psicopatológicas mais graves, é o reino da violência da coisa psíquica.

Regarding the Rat man, Malraux used to say that it was a great novel of the century. Freud, however, used to complain having only imperfectly covered this great masterpiece of human nature that is the obsessional neurosis. The rat man is still, today, the most important text on obsessional neurosis. Ambivalence, psychic conflict, anal eroticism, passion for contradiction, first discovery of countertransference... the richness of Freud’s writings has lost none of its, neither its relevance. It is estimated how the neurosis itself, without having to evoke more severe psychopathological forms, is the realm of violence of the psychic thing.

A respecto del Hombre de las ratas, Malraux decía que era una gran novela del siglo. Freud se quejaba, sin embargo, de haber tratado sólo de manera imperfecta esta gran obra maestra de la naturaleza humana que es la neurosis obsesiva. El hombre de las ratas es todavía, hoy en día, el texto princeps sobre la neurosis obsesiva. Ambivalencia, conflicto psíquico, erotismo anal, pasión por la contradicción, primer descubrimiento de contratransferencia... la riqueza de la escritura de Freud no ha perdido nada de su fecundidad, ni de su relevancia. Se estima que la propia neurosis, sin tener que evocar formas psicopatológicas más graves, es el reino de la violencia de lo psíquico.

Impact of selection strategies on representation of underserved populations and intention to practise: international findings.

CONTEXT: Socially accountable medical schools aim to reduce health inequalities by training workforces responsive to the priority health needs of underserved communities. One key strategy involves recruiting students from underserved and unequally represented communities on the basis that they may be more likely to return and address local health priorities. This study describes the impacts of different selection strategies of medical schools that aspire to social accountability on the presence of students from underserved communities in their medical education programmes and on student practice intentions. METHODS: A cross-sectional questionnaire was administered to students starting medical education in five institutions with a social accountability mandate in five different countries. The questionnaire assessed students' background characteristics, rurality of background, and practice intentions (location, discipline of practice and population to be served). The results were compared with the characteristics of students entering medical education in schools with standard selection procedures, and with publicly available socio-economic data. RESULTS: The selection processes of all five schools included strategies that extended beyond the assessment of academic achievement. Four distinct strategies were identified: the quota system; selection based on personal attributes; community involvement, and school marketing strategies. Questionnaire data from 944 students showed that students at the five schools were more likely to be of non-urban origin, of lower socio-economic status and to come from underserved groups. A total of 407 of 810 (50.2%) students indicated an intention to practise in a non-urban area after graduation and the likelihood of this increased with increasing rurality of primary schooling (p = 0.000). Those of rural origin were statistically less likely to express an intention to work abroad (p = 0.003). CONCLUSIONS: Selection strategies to ensure that members of underserved communities can pursue medical careers can be effective in achieving a fair and equitable representation of underserved communities within the student body. Such strategies may contribute to a diverse medical student body with strong intentions to work with underserved populations.

The training for health equity network evaluation framework: a pilot study at five health professional schools.

BACKGROUND: The Training for Health Equity Network (THEnet), a group of diverse health professional schools aspiring toward social accountability, developed and pilot tested a comprehensive evaluation framework to assess progress toward socially accountable health professions education. The evaluation framework provides criteria for schools to assess their level of social accountability within their organization and planning; education, research and service delivery; and the direct and indirect impacts of the school and its graduates, on the community and health system. This paper describes the pilot implementation of testing the evaluation framework across five THEnet schools, and examines whether the evaluation framework was practical and feasible across contexts for the purposes of critical reflection and continuous improvement in terms of progress towards social accountability. METHODS: In this pilot study, schools utilized the evaluation framework using a mixed method approach of data collection comprising of workshops, qualitative interviews and focus group discussions, document review and collation and analysis of existing quantitative data. RESULTS: The evaluation framework allowed each school to contextually gather evidence on how it was meeting the aspirational goals of social accountability across a range of school activities, and to identify strengths and areas for improvement and development. DISCUSSION: The evaluation framework pilot study demonstrated how social accountability can be assessed through a critically reflective and comprehensive process. As social accountability focuses on the relationship between health professions schools and health system and health population outcomes, each school was able to demonstrate to students, health professionals, governments, accrediting bodies, communities and other stakeholders how current and future health care needs of populations are addressed in terms of education, research, and service learning.

Jean Laplanche: o trabalho da obra / Jean Laplanche: el trabajo de la obra / Jean Laplanche: the work of the literary work

A obra de Jean Laplanche é mais um fazer trabalhar do que um simples retorno a Freud. Chegou a hora de fazer trabalhar a obra do próprio Jean Laplanche. Que status tópico é atribuído ao complexo de Édipo e à angústia de castração? Podemos, com Jean Laplanche, recusar-lhes a dignidade do inconsciente? Podemos pretender construir uma teoria psicanalítica unitária que abrace a totalidade da vida psíquica? Como prolongar a pista de uma homologia entre a situação antropológica fundamental e a situação analítica? Da discussão à exploração, passando pela divergência, este texto prolonga anos de conversas e debates com Jean Laplanche(AU)

Jean Laplanche’s work is rather a way of working than a simple return to Freud. It’s time to put on Jean Laplanche’s work to work by itself. What’s the topic status given to the Oedipus complex and to the castration anxiety? Can we, with Jean Laplanche, refuse the dignity of unconscious? Can we intend to build an unitary psychoanalytic theory that embraces the totality of the mental life? How to extend the path of a homology between the fundamental anthropological situation and the analytical situation? From discussion to exploration, going through divergence, this paper extends years of talks and debates with Jean Laplanche(AU)

La obra de Jean Laplanche es más un hacer trabajar que un simples volver a Freud. Llego el momento de hacer trabajar a la obra del propio Jean Laplanche. Que status tópico es atribuido al complejo de Edipo y hacía la angustia de castración? Podemos, con Jean Laplanche, recusarles a la dignidad del inconsciente? Podemos pretender construir una teoría psicoanalítica unitaria que abrace a la totalidad de la vida psíquica? Como prolongar la pista de una homología entre la situación antropológica fundamental y la situación analítica? De la discusión hacía la exploración, pasando por la divergencia, este texto prolonga años de conversaciones y debates con Jean Laplanche(AU)

Jean Laplanche: o trabalho da obra / Jean Laplanche: el trabajo de la obra / Jean Laplanche: the work of the literary work

A obra de Jean Laplanche é mais um fazer trabalhar do que um simples retorno a Freud. Chegou a hora de fazer trabalhar a obra do próprio Jean Laplanche. Que status tópico é atribuído ao complexo de Édipo e à angústia de castração? Podemos, com Jean Laplanche, recusar-lhes a dignidade do inconsciente? Podemos pretender construir uma teoria psicanalítica unitária que abrace a totalidade da vida psíquica? Como prolongar a pista de uma homologia entre a situação antropológica fundamental e a situação analítica? Da discussão à exploração, passando pela divergência, este texto prolonga anos de conversas e debates com Jean Laplanche

Jean Laplanche’s work is rather a way of working than a simple return to Freud. It’s time to put on Jean Laplanche’s work to work by itself. What’s the topic status given to the Oedipus complex and to the castration anxiety? Can we, with Jean Laplanche, refuse the dignity of unconscious? Can we intend to build an unitary psychoanalytic theory that embraces the totality of the mental life? How to extend the path of a homology between the fundamental anthropological situation and the analytical situation? From discussion to exploration, going through divergence, this paper extends years of talks and debates with Jean Laplanche

La obra de Jean Laplanche es más un hacer trabajar que un simples volver a Freud. Llego el momento de hacer trabajar a la obra del propio Jean Laplanche. Que status tópico es atribuido al complejo de Edipo y hacía la angustia de castración? Podemos, con Jean Laplanche, recusarles a la dignidad del inconsciente? Podemos pretender construir una teoría psicoanalítica unitaria que abrace a la totalidad de la vida psíquica? Como prolongar la pista de una homología entre la situación antropológica fundamental y la situación analítica? De la discusión hacía la exploración, pasando por la divergencia, este texto prolonga años de conversaciones y debates con Jean Laplanche

O a posteriori transferencial dos traumas do início da vida

O a posteriori é uma das únicas noções psicanalíticas que permitem compreender os mecanismos da mudança psíquica. Muitas vezes confundida com uma simples significação de retrospectiva, trata-se, de fato, de noção complexa que envolve a concepção psicanalítica da temporalidade e a teoria do trauma. Em que medida o tratamento psicanalítico, a experiência da transferência, é capaz de pôr em jogo novamente os traumas do início da vida, de produzir sobre estes um efeito de a posteriori, e permitir mudança psíquica em relação às camadas mais primitivas do psiquismo?.(AU)

The transferential a posteriori of early traumas. The a posteriori is one of the few psychoanalytic concepts to allow understanding the mechanisms of psychic change. Often mistaken as a simple meaning hindsight, it is actually a complex concept that involves the psychoanalytic conception of temporality and the theory of trauma. To what extent is psychoanalysis, the experience of transference, able to bring early traumas into play, to produce a hindsight effect and to allow psychic change related to the most primitive layers of psyche?.(AU)