"I Don't Really Know What Diabetes Is": A Qualitative Study Exploring the Experiences of Aboriginal and Torres Strait Islander Young People Aged 10 to 25 Years Living With Type 2 Diabetes in Northern and Central Australia.

OBJECTIVE: Our aim in this study was to gain an understanding of the experiences of Aboriginal and Torres Strait Islander young people aged 10 to 25 years with type 2 diabetes (T2D) living in Northern and Central Australia. METHODS: In this qualitative study we explored participants' experiences of T2D using a social constructionist epistemology and a phenomenologic methodology. Twenty-seven young people participated in semistructured in-depth interviews from 4 primary health-care sites. RESULTS: Three major constructs emerged. Young people experienced a normalisation-shame paradox in response to their diagnosis (partly related to that "everyone has diabetes," as well as the fear that friends "might judge [me]"), had suboptimal levels of understanding of T2D ("I don't really know what diabetes is. I just need somebody to explain to me a bit more") and experienced multiple barriers inhibiting their T2D management. These included complex lives ("I have a rheumatic heart disease […] then they told me that I have diabetes…I have two things") and the availability of support ("[I] talk to my mum…I talk to my aunty too…I don't talk to anyone else"). Successful management requires support from health professionals and family and includes strengthening social networks and educational opportunities. CONCLUSIONS: Our findings reinforce the need for alternative support systems tailored to the specific needs of young Aboriginal and Torres Strait Islander people with T2D. Enhanced models of care must be codesigned with young people and their communities and include a focus on shifting norms and expectations about youth T2D to reduce diabetes stigma and broaden social support and consider the delivery of health information in youth-friendly environments.

[The home care nurse, a resource to help combat intrafamily violence]. / L'infirmière à domicile, une ressource contre les violences intrafamiliales.

Every year in France, thousands of victims file a complaint for violence against their partner. These acts of violence are committed in the family environment, behind closed doors. Through her practice, the home care nurse can be a witness, support or a resource.

Acontecimento e ato: reflexões da psicanálise sobre as repercussões de Maio de 1968 / Event and act: reflections of psychoanalysis on the repercussions of May 1968 / Événement et acte: réflexions de la psychanalyse sur les répercussions de mai 1968 / Acontecimiento y acto: reflexiones del psicoanálisis sobre las repercusiones de Mayo del 1968

Resumo O artigo surge da inquietação de psicanalistas diante do sucesso ou fracasso dos movimentos sociais como resposta à atual crise institucional, política e social. Destacamos o dilema epistemológico e político presente na indagação que percorreu o movimento de Maio de 1968: as estruturas descem ou não para a rua? O caminho adotado é examinar os efeitos do movimento e cotejá-los com as concepções teóricas de Lacan. O saldo que obtemos desse balanço crítico foi considerar Maio de 1968 como um acontecimento que nos lembra de que é possível estruturar uma nova forma de política. Nomear a vergonha dos excessos nos laços sociais de nosso tempo pode conferir dignidade ao significante e produzir um ponto de basta pela dimensão da ética e da singularidade. Tal posição produz giro discursivo, incitado pela coragem de ter uma idéia e a possibilidade de reinvenção do laço social por sucessivas subversões e revoluções.

Abstract Our article results from the concern of psychoanalysts about the success or failure of social movements as a response to the current institutional, political and social crisis. We emphasize the epistemological and political dilemma present in the question that went through the May 1968 movement: after all, do structures reflect on the streets or not? To answer this question, we examined the effects of the movement a posteriori and compared them with Lacan's theoretical work. Based on this critical balance, we consider May 68 as a reminder that structuring a new form of politics is possible. Naming the shame of excesses in the social ties of our time may confer dignity to the signifier and produce a sufficient point by the dimension of ethics and uniqueness. Such a position produces a discursive twist, incited by the courage to have an idea and the possibility of reinventing the social bond by successive subversions and revolutions.

Résumé L'article découle de la préocupation des psychanalystes face au succès ou à l'échec des mouvements sociaux en réponse à la crise institutionnelle, politique et sociale actuelle. Nous soulignons le dilemme épistémologique et politique dans la question qui a traversé le mouvement de mai 1968: enfin, les structures descendent ou non dans la rue? La voie adoptée consiste à examiner les effets du mouvement a posteriori et à les comparer avec les conceptions théoriques de Lacan. Le résultat que nous obtenons de ce bilan critique a été de considérer mai 1968 comme un événement qui nous rappelle qu'il est possible de structurer une nouvelle politique. Nommer la honte des excès dans les liens sociaux de notre temps peut donner de la dignité au signifiant et produire un point de suffisance pour la dimension de l'éthique et de singularité. Une telle position produit un tournant discursif, encouragé par le courage d'avoir une idée et la possibilité de réinventer le lien social par des subversions et des révolutions successives.

Resumen El artículo surge de la inquietud de psicoanalistas frente al éxito o fracaso de los movimientos sociales como una respuesta a la actual crisis institucional, política y social. Se destaca el dilema epistemológico y político presente en la indagación que recorrió el movimiento de Mayo del 68: ¿las estructuras descienden o no a la calle? Para ello, se examinan los efectos del movimiento bajo la luz de las concepciones teóricas de Lacan. De ese balance crítico se considera el Mayo del 68 como un acontecimiento que recuerda que es posible estructurar una nueva forma de política. Al nombrar la vergüenza de los excesos en los lazos sociales de nuestro tiempo se puede conferir dignidad al significante y producir un basta por medio de la dimensión de la ética y de la singularidad. Esto produce un giro discursivo, incitado por el coraje de tener una idea y la posibilidad de reinventar el lazo social por sucesivas subversiones y revoluciones.

Language, politics and dreams: the challenges of building resilience in refugees.

This paper describes a case study of a 60-year-old Peruvian refugee in some detail, focusing on the importance of building emotional resilience in a patient in Spanish in order to create a space for learning the English language - the patient did not speak English after 20 years of living in Britain. The work was carried out with an interpreter and some of the literature on working with interpreters is referred to. The paper also briefly outlines the refugee journey in broad terms, which is a journey from the culturally known to the culturally unknown. The question of how well the literature on resilience, which sits firmly within a Western developmental perspective, can be applied to refugees, most of whom come from group and family-based cultures dominated by ideas of honour and shame, is discussed. The paper also touches on the importance of the receiving country enabling or not, as the case may be, a transitional space for refugees who have lost their home and are seeking to find a safe haven in a strange culture.

Cet article est une étude de cas détaillée d'un homme péruvien de 60 ans, réfugié. L'étude met l'accent sur l'importance de construire en espagnol une résilience émotionnelle, afin de créer un espace pour que le patient apprenne l'anglais - le patient ne parle pas l'anglais après 20 ans de vie en Grande Bretagne. Le travail s'est fait avec la participation d'un interprète, et une partie des écrits concernant le travail avec interprète est examinée. L'article s'appuie aussi brièvement sur d'autre cas cliniques, et aborde de manière générale le voyage du réfugié: un voyage allant du culturellement connu au culturellement inconnu. L'article soulève la question de comment les travaux sur la résilience, qui s'inscrivent clairement dans une perspective développementale occidentale, peuvent s'appliquer aux réfugiés, dont la plupart viennent de cultures de groupe et de cultures familiales dominées par l'idée d'honneur et de honte. L'article aborde brièvement l'impact important de l'attitude du pays d'accueil, selon qu'il offre ou non un espace transitionnel pour les réfugiés qui ont perdu leur « chez eux ¼ (home) et qui recherchent un havre de sécurité dans une culture qui ne leur est pas familière.

El presente trabajo describe en detalle, un estudio de caso de un refugiado Peruano de 60 años, haciendo foco en la importancia de construir resiliencia emocional en el paciente, en idioma Español, para poder crear un espacio para el aprendizaje del idioma Inglés - el paciente no hablaba inglés luego de 20 años de vivir en Gran Bretaña. El trabajo fue llevado a cabo con un intérprete y se discute cierta literatura sobre el trabajar con intérpretes. El artículo se basa también en otros estudios de caso, así como también en la discusión del viaje del refugiado en sentido amplio, el cual es un viaje desde lo conocido cultural hacia lo desconocido cultural. Se discute el modo en que la literatura sobre resiliencia, basada en una perspectiva desarrollista Occidental, puede aplicarse a refugiados, la mayoría de quienes provienen de familias y grupos culturales dominados por ideas de honor y vergüenza. El trabajo también plantea la importancia de que el país receptor posibilite o no, como puede ser el presente caso, un espacio transicional para refugiados que han perdido sus hogares y buscan un refugio seguro en una cultura extraña.

Displacement trauma: complex states of personal, collective and intergenerational fragmentation and their intergenerational transmission.

Originally presented at the Journal's one day conference entitled 'Displacement: Contemporary Traumatic Experience' held in London in November 2019, this paper expands on the author's theory of the implicit psychological organizing gestalt, an associated pattern of psychic functions which operate in an integrated way to simultaneously structure and organize our experience of self-cohesion and self-continuity. The gestalt, which implicitly links the formation of psychic skin, body image, cultural skin and both personal and cultural identity with place, functions as an emergent non-conscious permanent presence or background 'constant'. It develops over time and emerges out of embodied emotional experiencing with the total environment - both human and non-human. The author argues that it is the rupture of this gestalt and the disorganizing consequences of its loss which underlies the experience of displacement trauma. If disruptions in the formation of the gestalt and/or its later rupture remain unrecognized and unrepresented then the absence creates a void which can be intergenerationally transmitted. Case material is presented which describes this and which highlights the ways in which the gestalt can contribute to our understanding of collective displacement anxiety, cultural trauma and cultural complexes.

Cet article a été présenté initialement à la conférence du Journal intitulée « Le Déplacement: Une expérience traumatique contemporaine ¼ qui s'est tenue à Londres en novembre 2019. Il développe la théorie de l'auteur d'une gestalt implicite d'organisation psychologique, un schéma associé de fonctions psychiques qui opère de manière intégrée pour simultanément structurer et organiser notre expérience de cohésion de soi et de continuité de soi. Cette gestalt, qui relie implicitement la formation de la peau psychique, de l'image du corps, de la peau culturelle et de l'identité personnelle et culturelle avec le lieu, fonctionne comme une présence permanente, non-consciente et émergente, une « constante ¼ de fond: elle se développe au fil du temps et émerge à partir de l'expérience émotionnelle incarnée avec l'environnement total - humain et non-humain. L'auteur soutient que c'est la rupture de cette gestalt et les conséquences perturbantes de sa perte qui sous-tendent l'expérience du traumatisme de déplacement. Si des perturbations dans sa formation et/ou sa rupture ultérieure restent non-reconnues et non-représentées, alors l'absence crée un vide qui peut être transmis d'une génération à l'autre. L'article présente du matériel clinique décrivant ceci. Ce matériel souligne les façons dont cette gestalt peut contribuer à notre compréhension de l'angoisse collective de déplacement et du traumatisme culturel.

Presentado inicialmente en la Conferencia del Journal, titulada 'Desplazamiento: Experiencia Traumática Contemporánea' llevada a cabo en Londres, en Noviembre 2019, el presente trabajo amplía - sobre la base de la teoría de la autora sobre la Gestalt de organización psicológica implícita - un patrón asociado de funciones psíquicas, las cuales operan en un modo integrado para estructurar simultáneamente nuestra experiencia de auto-continuidad y auto-cohesión. La Gestalt, la cual implícitamente vincula la formación de la piel psíquica, la imagen corporal, la piel cultural y la identidad personal y cultural, con el lugar, funciona como una presencia permanente, emergente, no-consciente o un 'constante' contexto: se desarrolla a través del tiempo y emerge a partir de la experiencia emocional corporizada con la totalidad del medio ambiente - humano y no-humano. La autora argumenta que es la ruptura de esta Gestalt y las consecuencias desorganizadoras de su pérdida, la cual subyace a la experiencia de trauma por desplazamiento. Si las interrupciones en su formación y/o ruptura permanecen sin ser reconocidas y sin representación, entonces la ausencia crea un vacío que puede transmitirse intergeneracionalmente. Se presenta material de un caso que describe y subraya los modos en los cuales la Gestalt puede contribuir a nuestra comprensión sobre la ansiedad por desplazamiento colectivo y trauma cultural.

[Modesty in hospital and in care]. / La pudeur à l'hôpital et dans les soins.

Modesty is the expression of the fear of being seen in a position which the individual considers as strictly private. It is turned towards others and if it is breached, the individual experiences a feeling of shame. The hospital is a place where it is challenged.

Notes on the Evolution of the Relationship between Guilt and Shame in Psychoanalysis and Anthropology / Nota sobre evolução da relação entre culpa e vergonha em psicanálise e antropologia / Note sur l'évolution de la relation entre culpabilité et honte en psychanalyse et en anthropologie / Nota sobre la evolución de la relación entre culpa y vergüenza en psicoanálisis y antropología

The author examines evolution of the relationship between the concepts of shame and guilt in anthropology and in psychoanalysis between 1900 and 1980. He finds that three periods have succeeded; in a first period guilt was presented as more essential in symptom-construction than shame in occidental societies; in anthropology shame was mainly viewed as germane of primitive or non-occidental societies, and guilt was seen as an "occidental" feeling. He shows that this view has been criticized in the 1960ies, and that nowadays shame is recognized to be much more pervasive in occidental cultures and guilt is also present in non-occidental settings

O autor estuda a evolução da relação entre culpa e vergonha em psicanálise e antropologia entre 1900 e 1980. Devem-se distinguir três períodos: no primeiro, a culpa foi apresentada como mecanismo essencial na construção do sintoma nos indivíduos ocidentais e a vergonha, como prevalente nos não ocidentais. Essa concepção foi criticada nos anos 1960, e agora se reconhece que o sentimento de vergonha está muito mais prevalente do que se acreditava nos ocidentais, e que os sentimentos de culpa têm um significado importante nos sujeitos não ocidentais.

L'auteur examine l'évolution de la relation entre les concepts de honte et culpabilité en psychanalyse et en anthropologie entre 1900 et 1980. Trois périodes se sont succédées. Dans la première la culpabilité était vue comme plus essentielle que la honte pour la construction des symptômes en milieu occidental; en anthropologie, la honte était vue comme fréquente dans les sociétés non-occidentales «primitives¼. Cette notion a été critiquée dans les années 1960; actuellement on reconnaît que la honte est beaucoup plus présente dans les cultures occidentales et la culpabilité est également fréquente dans les milieux non-occidentaux.

El autor estudia la evolución de la relación entre los conceptos de culpa y vergüenza en psicoanálisis y en antropología, entre los años 1900 y 1980. El autor distingue entre tres periodos: en el primero, la culpa fue presentada como un factor más relevante que la vergüenza en la construcción del síntoma en sociedades occidentales; en la antropología la vergüenza fue vista, principalmente, como parte integrante de las sociedades primitivas o no occidentales, y la culpa fue vista como un sentimiento "occidental". El autor muestra que esta visión ha sido criticada en los años 1960, y que hoy en día se reconoce que la vergüenza está mucho más presente en las culturas occidentales y que la culpa también está presente en configuraciones no occidentales.

Der Verfasser analysiert in diesem Artikel die Entwicklung der Beziehung zwischen Scham- und Schuldgefühle in der Psychoanalyse und der Anthropologie zwischen 1900 und 1980, wobei zwischen drei Perioden unterschieden wird. In der Ersten wird angenommen, dass das Schuldgefühl in westlichen Gesellschaften viel stärker zur Symptombildung beiträgt als das Schamgefühl. Anderseits ordnet die Anthropologie das Schamgefühl hauptsächlich primitiven oder nicht-westlichen Gesellschaften zu, wobei das Schuldgefühl als „westliches" Gefühl eingestuft wurde. Diese Auffassung wurde in den 1960er Jahren revidiert und heutzutage wird anerkannt, dass das Schamgefühl auch in westlichen Gesellschaften weit verbreitet ist und dass Schuldgefühle auch in nicht-westlichen Gesellschaften zu finden sind.

An unhealable wound: left by suicide.

This article is about the author's experience of being left by suicide and the effect the experience had on her work as an analyst in the consulting room and as a member of psychological organizations. The effects are generalized to others who have been left by suicide based on the writings of those left, and on writings of authors who have researched the subject. Shame and the effects the judgments of society now and in the past have on the person who suffers this experience are central, as well as the positive and negative ways groups are used by a person left by suicide to find solace and to emerge from the darkness of such abandonment. There is a constant longing (often unconscious) for replacement of the lost one. The article seeks to help analysts and those who have been left by suicide understand the suffering and the indelible mark that is experienced when there is a suicide of someone close. Understanding by the analyst is important in order to modulate the shame of this experience.

[When the trap closes in]. / Quand le piège se referme.

The poignant testimony of Anne L. illustrates perfectly how the spiral of an abuser's hold closes around the victim. She describes how she met Charles and how their relationship, between passionate love and hate, hope and disillusion, progressed from psychological war to beatings, resulting in absolute domination. Supported today by a specialised network, even though she has managed to leave him, many questions remain for this victim and her scars are far from healed.

[Body marking in psychosis]. / Les marquages du corps dans la psychose.

Patients with psychosis speak of an uneasy relationship with their body. Between feelings of too little and too much, for them it is a matter of trying to suture an image which is not always unified, a body which they are not always sure they have. The attentive clinician will attempt to support the solutions of each psychotic patient to maintain their body, beyond the death drive which pushes them to tear it apart.

Por onde andam os heróis? / Where are the heroes?

Este artigo aborda a existência do herói, na atualidade, por meio de contraponto com o herói clássico que tinha como princípio o amor à vida ou a honra de seu ser. Percorre dois marcos decisivos para a alteração da concepção do heroico, ou seja, a democracia grega e os novos valores que propiciam a construção de políticas excludentes do sujeito, especialmente a partir da modernidade, repercutindo decisivamente na constituição da subjetividade contemporânea e nas relações entre os homens. A psicanálise é oaporte teórico nessa leitura do social. Mediante a análise das novas formas discursivas da atualidade, concluiu-se que o herói se caracteriza como ídolo de barro, desprovido de honra, vergonha e desbussolado, na crença de que tudo é possível e de que é preciso gozar sem limites

This article discusses the existence of the hero, nowadays, by means of counterpoint with the classic hero, whose principle was the love of life or the honor of his being. It goes through two decisive milestones for the change in the conception of the heroic, that is, Greek democracy and the new values that propitiate the construction of exclusionary policies of the subject, especially from modernity, having a decisive repercussion on the constitution of contemporary subjectivity and relations between men. Psychoanalysis is the theoretical contribution in this reading of the social. Through the analysis of the new discursive forms of the present time, it was concluded that the hero is characterized as a clay idol, devoid of honor, shame and bewilderment, in the belief that everything is possible and that it is necessary to enjoy without limits

Cet article discute l'existence d'un héros actuel, contrepoint du héros classique dont le principe est l'amour de la vie ou encore l'honneur de son être. Cette transformation passe par deux moments décisifs avant d'atteindre la conception actuelle de l'acte héroïque, il s'agit de la démocratie grecque et des nouvelles valeurs qui favorisent la construction de politiques d'exclusion du sujet, notamment la modernité, dont la répercussion est décisive sur la constitution de la subjectivité contemporaine et dans les relations humaines. La psychanalyse apporte une contribution théorique à cette lecture sociale. Ceci au moyen de l'analyse des nouvelles formes discursives. On a ainsi conclu que le héros actuel se caractérise comme idole d'argile dépourvue d'honneur et de honte, désorientée, croyant que tout est possible et qu'il est nécessaire de jouir sans limite

God of the hinge: treating LGBTQIA patients.

This paper looks at systems of gender within the context of analysis. It explores the unique challenges of individuation faced by transsexual, transgender, gender queer, gender non-conforming, cross-dressing and intersex patients. To receive patients generously we need to learn how a binary culture produces profound and chronic trauma. These patients wrestle with being who they are whilst simultaneously receiving negative projections and feeling invisible. While often presenting with the struggles of gender conforming individuals, understanding the specifically gendered aspect of their identity is imperative. An analyst's unconscious bias may lead to iatrogenic shaming. The author argues that rigorous, humble inquiry into the analyst's transphobia can be transformative for patient, analyst, and the work itself. Analysis may, then, provide gender-variant patients with their first remembered and numinous experience of authentic connection to self. Conjuring the image of a hinge, securely placed in the neutral region of a third space, creates a transpositive analytic temenos. Invoking the spirit of the Trickster in the construction of this matrix supports the full inclusion of gender-variant patients. Nuanced attunement scaffolds mirroring and the possibility of play. Being mindful that gender is sturdy and delicate as well as mercurial and defined enriches the analyst's listening.

Intimidade: o tanque no quarto / Intimacy: the tank in the bedroom / Intimidad: el tanque en el cuarto / L'intimité: le char d'assaut dans la chambre

Este trabalho aborda intimidade desde seu surgimento no desenvolvimento e nos apegos de primeira infância, e na medida em que é parte da forma como identidades, gênero e sexualidade se estabelecem ao longo do desenvolvimento. Na parte final, como uma parte integrante da violência social, a intimidade é explorada em circunstâncias de racismo e da violência, de iniciativa do estado, cometida por meio de tortura. O que liga estes aspectos da intimidade e da vida íntima compartilhada é um compromisso com uma abordagem psicanalítica que considera o intrapsíquico e o intersubjetivo interagindo de modo poderoso e próximo. A intimidade tanto é algo extremamente pessoal e particular, quanto é profundamente impregnada de forças sociais e políticas. A intimidade assim considerada - ou seja, como profundamente individual e, ao mesmo tempo, como regulada e constituída pelo Estado, pela cultura e pela família - aparece em diversas formações políticas, totalitárias, neoliberais e democráticas.

This essay considers intimacy as it arises in early development and attachment, and as it is part of how identities, gender and sexuality are regulated over the course of development. In the final section, intimacy as an integral part of social violence is explored in circumstances of racism and state-initiated violence through torture. What ties these aspects of intimacy and intimate life together is a commitment to a psychoanalytic approach that considered the intrapsychic and the intersubjective as powerfully and closely interacting. Intimacy is both highly personal and private and deeply imbued with social and political forces. This consideration of intimacy, as it is deeply individual and at the same time regulated and constituted by the state and the culture and the family, appears in various political formations, totalitarian, neo liberal and democratic.

Este trabajo aborda la intimidad desde su surgimiento en el desarrollo y en los apegos de la primera infancia, y a medida que es parte de la forma como entidades, género y sexualidad se establecen durante el desarrollo. Al final, como parte integrante de la violencia social, se explora la intimidad en circunstancias de racismo y violencia, iniciativa del estado, a través de la tortura. Lo que conecta estos aspectos de la intimidad y de la vida íntima compartida, es un compromiso con un enfoque psicoanalítico que considera lo intrapsíquico y lo intersubjetivo interactuando de un modo próximo y poderoso. La intimidad es algo extremadamente personal y particular, así como está impregnada profundamente de fuerzas sociales y políticas. La intimidad considerada de esta forma - es decir, como profundamente individual y, al mismo tiempo, como regulada y constituida por el estado, por la cultura y por la familia - aparece en diversas formaciones políticas, totalitarias, neoliberales y democráticas.

Cet essai considère l'intimité telle qu'elle se pose lors du développement et de l'attachement précoce, et comme une partie de la façon dont les identités, le genre et la sexualité sont réglementés au cours du développement. Dans la section finale, l'intimité en tant que partie intégrante de la violence sociale est explorée dans les circonstances du racisme et de la violence initiée par l'État au moyen de la torture. Ce qui relie ces aspects de l'intimité et de la vie intime est un engagement à une approche psychanalytique qui considère l'intrapsychique et l'intersubjectif comme une interaction puissante et étroitement interactive. L'intimité est à la fois très personnelle et privée et profondément imprégnée de forces sociales et politiques. Cette considération de l'intimité, car elle est profondément individuelle et en même temps réglementée et constituée par l'État, la culture et la famille, apparaît dans diverses formations politiques, totalitaires, néo-libérales et démocratiques.

Working with chronic and relentless self-hatred, self-harm, and existential shame: a clinical study and reflections (Paper 2 of 2).

This second of two papers focuses on the shame which emerged in the first 14 years of analysis of a woman who was bulimic, self-harmed, and repeatedly described herself as 'feeling like a piece of shit'. To explore this intense and pervasive shame I draw on Jung's and Laplanche's emphasis on experiences of unresolvable, non-pathological 'foreignness' or 'otherness' at the heart of the psyche. Images, metaphors, elements of clinical experience, and working hypotheses from a number of analytic traditions are used to flesh out this exploration. These include Kilborne's use of Pirandello's image of shame as like a 'hole in the paper sky' which, I suggest, points to a crack in subjectivity, and reveals our belief in the efficacy of the self to be illusory. Hultberg's observations on shame as having an existential mode (function) are also explored, as is the nature of analytic truth. Using these ideas I describe my patient's process of finding some small but freeing space in relation to her shame and self-hatred. Through enduring and learning from her shame in analysis she realized that it was part of a desperate unconscious attempt to draw close to her troubled father and so to 'love him better'.

[The shame cycle in obesity]. / Le cycle de la honte dans l'obésité.

INTRODUCTION: In Western countries obesity is currently a major public health issue. Part of a complex system, it should not be studied alone. Yet it is often seen only as the result of qualitatively and/or quantitatively deviant dietary-intake and is seldom questioned as a symptom in the psychoanalytic sense, i.e. as a part of a package that makes sense. OBJECTIVES OF THE STUDY: The purpose of this article is to highlight the importance of shame in the psyche of obese subjects as "subjective backup". The author questions the experience of shame in obese subjects as the cornerstone of this symptom in the psychoanalytic sense. METHODS: While reporting a clinical case, the author notes the occurrences of shame in the discourse of the patient. The subsequent analysis is presented based on the transferential and counter-transferential relationship. To carry out this study, the author drew on a device supporting catharsis. RESULTS: The author addresses successively: the complaint of obese subjects and the effect of shame, their shame as the alpha and omega of bulimic crises and lastly their body as a work of art by building a monstrosity. The author concludes with the social dimension of shame and how it is part of the symptom of body transformation in obese subjects. DISCUSSION: It appears that pathological shame reveals a difficulty to maintain a sense of existence. For this reason, it seems important to consider this effect and to establish a framework for the emergence of the latter in the consultations of patients with eating disorders. Under these conditions, the patient is able, on the pedestal of shame, to voice his shame of being and to support a subjectivity.

Working with chronic and relentless self-hatred, self-harm and existential shame: a clinical study and reflections.

This paper is the first of a two-part series which explores some of the theoretical and experiential reference points that have emerged in my work with people whose relationship to their body and/or sense of self is dominated by self-hatred and (what Hultberg describes as) existential shame. The first paper focuses on self-hatred and the second paper focuses on shame. This first paper is structured around vignettes taken from a 14-year analysis with a woman who was bulimic, self-harmed and repeatedly described herself as 'feeling like a piece of shit'. It draws together elements of Jung's concepts of the complex and symbol, and Laplanche's enigmatic signifier to focus on experiences of 'inner otherness' around which we are unconsciously organized. It also brings Jung's understanding that emotion is the chief source of consciousness into conversation with Laplanche's approach to the transference which is that by being aware that they do not 'know', the analyst provides a 'hollow' in which the patient's analytic process can evolve. These combinations of ideas are linked speculatively to emerging understandings of the neuroscience of perception and throughout the paper clinical material is used to illustrate these discussions.

Revisioning Fordham's 'Defences of the self' in light of modern relational theory and contemporary neuroscience.

This paper explores the evolution of Michael Fordham's ideas concerning 'defences of the self', including his application of this concept to a group of 'difficult' adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a 'self-care system' in the psychological material of early trauma patients (Kalsched ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual 'enactments' between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a 'real person' to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.

Vergonha: acrescentando um pouco de tempero / The shame: adding a little spice / La vergüenza: añadir un poco de sabor / La honte: en ajoutant un peu de piquant

O objetivo deste artigo é investigar, à luz do Seminário, livro 17: O avesso da psicanálise, de Jacques Lacan, o estatuto da vergonha na contemporaneidade. O conceito lacaniano de vergonha indica que esse sentimento tem uma relação intrínseca com significante-mestre. Lacan mostra que o sentimento de vergonha está desaparecendo. Essa afirmação nos intrigou e nos fez questionar o que está causando a ausência da vergonha em nossa sociedade. Observamos que houve uma mudança na sociedade: o gozo que antes deveria ser encoberto com o véu da vergonha passou a ser escancarado e desavergonhado. Paralelamente, ocorre uma mudança no estatuto do superego, que agora pode ser lido como portador do imperativo de gozo. Mesmo afirmando a ausência da vergonha, Lacan não deixa de apontar que esse é um sentimento importante para a sociedade, bem como para a experiência de análise, pois nos ajuda a lembrar de que temos um significante-mestre de onde provém o gozo. Lacan sugere que, durante uma análise, é desejável reconfigurar a vergonha de outra forma.

The purpose of this research paper is to investigate in the light of The seminar, Book 17: The Other Side of Psychoanalysis, by Jacques Lacan, the statute of the shame nowadays. The Lacanian concept of shame indicates that this feeling has an intrinsic relationship with the master signifier. Lacan shows that the sense of shame is disappearing. That statement intrigued us and made us to question what is causing the absence of shame in our society. We observed that there was a change society: the enjoyment that, before, should be covered with the veil of shame became blatant and shameless. In parallel, there is a change in the status of the superego, which can now be seen as having the imperative of jouissance. While affirming the absence of shame, Lacan does not fail to point out that this is an important sense for society, as well as for the analytic experience, because it helps us remember that we have a master signifier, hence the jouissance. Lacan suggests that It is desirable to configure the shame of another way, during an analysis.

El objetivo de este artículo es investigar, a la luz del Seminario, libro 17: El reverso del psicoanálisis, de Jacques Lacan, el estado de la vergüenza en la actualidad. Lo concepto lacaniano de vergüenza indica que este sentimiento tiene una relación intrínseca con el significante-amo Lacan muestra que el sentido de la vergüenza está desvaneciendo. Esa afirmación nos intrigaba y nos hizo cuestionar qué está causando la ausencia de vergüenza en nuestra sociedad. Hemos observado un cambio en la sociedad : el gozo que antes debería ser cubierto con el velo de la vergüenza se convirtió abiertamente y sinvergüenza. Al mismo tiempo, hay un cambio en lo estatuto del superyó, que ahora se puede leer como portador del imperativo gozo. Mismo afirmando la sinvergüenza, Lacan no deja de señalar que este es un sentimiento importante para la sociedad, así como la experiencia del análisis, porque nos ayuda a recordar que tenemos un significante-amo de donde viene el gozo. Lacan sugiere que este sentimiento debe ser reconfigurado durante el análisis.

L'objectif de cet article est réaliser une recherche à propos de la honte. Pour faire cette investigation, nous allons nous servir de Jacques Lacan, spécifiquement, Le Séminaire, Livre XVII : l'envers de la psychanalyse. Selon Lacan, la honte faite un rapport intrinsèque avec le signifiant maître. Cependant, la honte se trouve disparaissante dans la contemporanéité. Cette indication lacanienne nous a intrigués et nous a fait nous enquérir ce qui permet l'absence de la honte dans notre société. Ainsi, il y a eu lieu un changement dans la société qui concerne la jouissance. C'est-à-dire, si avant la jouissance était voilée par la honte aujourd'hui, la jouissance se trouve impudence. D'une manière parallèle, il y a aussi un changement qui concerne le statut du surmoi. Le surmoi est devenu l'impératif de la jouissance. Lacan indique que la honte est très importante, soit dans une expérience analytique, soit pour la société. C'est désirable de configurer la honte d'une autre façon, au cours d'une analyse.

O consumidor e a perversão / Consumers and perversion / Le consommateur et la perversion / El consumidor y la perversión

O texto considera a atualidade discursiva do capitalismo e seus vieses perversos, lembrando a aspiração sadeana de república regida pelo imperativo e singularidade do gozo, onde se imbricam os consumidores, todos proletários e na exigência do mais-de-gozar. Percorre a fantasia perversa, o desejo perverso e a fetichização de um objeto alçado à condição de causa de desejo, para além da estrutura perversa. Chega à solidão dos indivíduos reduzidos a seus corpos no predomínio dos gadgets, e ao mundo da falta de vergonha. A psicanálise lacaniana é a norteadora, e o Japão é exemplo que ensina.

This text discusses the present-day discourse on capitalism and its perverse aspects in the light of Sade's aspiration of a republic governed by the imperative and the singularity of jouissance. This system captures consumers, all of whom are proletarians, in the demand for surplus-jouissance. This is related to the fantasy of perversion, the perverse structure, perverse desire and the fetishization of objects that are attained through the cause of desire. We touch on the loneliness of individuals reduced to their bodies surrounded by gadgets and in a world of shamelessness. Lacanian psychoanalysis is the guide and Japan is an example that teaches.

Ce texte considère l'actualité discursive du capitalisme et ses biais pervers, tout en rappelant l'aspiration sadienne à une république régie par l'impératif et la singularité de la jouissance, où s'enchevêtrent les consommateurs, tous prolétaires et dans l'exigence du plus-de-jouir. Il parcourt le fantasme pervers, le désir pervers et la fétichisation d'un objet hissé à la condition de cause de désir, au-delà de la structure perverse. On arrive à la solitude des individus réduits à leurs corps sous l'emprise des gadgets et au monde du manque de honte. La psychanalyse Lacanienne sert de repère et le Japon est l'exemple qui nous enseigne.

El texto considera la actualidad del discurso del capitalismo y sus sesgos perversos, recordando la aspiración sadeana de república regida por el imperativo y la singularidad del goce, en donde se imbrican los consumidores, todos proletarios y en la exigencia del plus de gozar. El texto atraviesa la fantasía perversa, el deseo perverso y la fetichización de un objeto elevado a la condición de causa del deseo, más allá de la estructura perversa. Llega a la soledad de los individuos reducidos a sus cuerpos con el predominio de gadgets y el mundo de la desvergüenza. El psicoanálisis lacaniano es la guía y Japón el ejemplo que enseña.