Reinvenção da loucura: uma proposta dedespatologização do fenômeno de ouvir vozes / Reinvention of madness: a proposal to depathologize the phenomenon of hearing voices

O fenômeno de ouvir vozes nem sempre foi considerado critério diagnóstico de um quadro psicopatológico, legitimando o estigma social da loucura através do discurso médico hegemônico. A eliminação das vozes enquanto única possibilidade de tratamento empobrece a dimensão integral do ouvidor e a inscrição das vozes em sua vida, através de práticas medicamentosas ainda pautadas numa visão biologicista em saúde mental. Este artigo percorre por aspectos socioculturais em torno do fenômeno, bem como no diálogo teórico entre Psiquiatria, Psicopatologia e Psicanálise. Tratase de uma revisão narrativa, de caráter exploratório, articulada a um relato de experiência de um grupo de Ouvidores de Vozes, baseado no Movimento Intervoice, que visa a propor um espaço de compartilhamento do fenômeno. Por meio da protagonização dos sujeitos, é possível propor a despatologização enquanto movimento importante às pautas antimanicomiais.

The phenomenon of hearing voices has not always been considered a diagnostic criterion for a psychopathological condition, whose assumption legitimizes the social stigma of madness through the hegemonic medical discourse. The elimination of those voices as the only possibility of treatment impoverishes the integral dimension of the voice hearer and the inclusion of those voices in his life, through medicalization practices still guided by a biologist view at mental health. This article runs through the socio-cultural aspects surrounding the phenomenon, as well as the theoretical dialogue between Psychiatry, Psychopathology and Psychoanalysis. This is an exploratory narrative review, linked to an experience report of a group of Voice Hearers, based on the Intervoice Movement, which aims to provide a space for sharing the phenomenon. Therefore, through the protagonization of voice hearers, it's possible to propose a depathologization as an important movement to anti-asylum guidelines. Keywords: Hearing Voices. Mental Health. Normality. Psychopathology.

Cancer mortality in Common Mental Disorders: A 10-year retrospective cohort study.

PURPOSE: Individuals with Common Mental Disorders (CMDs) may have a higher cancer mortality. The purpose of this study was to examine cancer-related mortality among patients with CMDs and verify which cancer types are predominantly involved. METHODS: We used the Regional Mental Health Registry of the Emilia-Romagna region, in Northern Italy to identify patients aged ≥ 18 years who received an ICD 9-CM diagnosis of CMDs (i.e., depressive and neurotic disorders) over a 10 year period (2008-2017). Information on cause of death was retrieved from the Regional Cause of Death Registry. Comparisons were made with data from the regional population without CMDs. RESULTS: Among 101,487 patients suffering from CMDs (55.7% depression; 44.3% neurotic disorders), 3,087 (37.8%) died from neoplasms. The total standardized mortality ratio (SMR) was 1.82 (95% CI 1.78-1.86) while the SMR for all neoplasms was 2.08 (95% CI 2.01-2.16). Individuals of both genders, with both depressive and neurotic disorders had a higher risk of death from almost all cancers compared with the regional population. CONCLUSION: Patients with CMDs have considerably higher cancer mortality risk than the general population. Higher mortality was observed for a broad range of cancers associated with different aetiologies. It is imperative to promote cancer awareness, prevention and treatment for people with CMDs.

O florir da violeta: um estudo de caso em avaliação terapêutica / The flowering of violet: a case study in therapeutic assessment / La flor de la violeta: un estudio de caso en evaluación terapéutica

A Avaliação Terapêutica (AT) é um processo avaliativo e interventivo proposto para ser semiestruturado e colaborativo com o objetivo de promover mudanças positivas no cliente, que é convidado a ter uma participação ativa durante o processo. Na AT, os resultados dos testes psicológicos padronizados ganham destaque como facilitadores do processo de autoconhecimento do cliente. Desse modo, usualmente, integram-se os achados de testes psicológicos de autorrelato com os métodos projetivos para gerar informações que possam ampliar a visão que o cliente tem de si. Neste artigo, buscou-se compreender o potencial de uso dos testes psicológicos e da relação colaborativa a partir de um caso atendido na perspectiva da AT. A participante, Violeta (nome fictício), foi atendida em 10 sessões com duração entre 60 e 115 minutos. Foram utilizados os testes psicológicos Escala de Bem-Estar Psicológico (Ebep), Escala de Vulnerabilidade e Estresse no Trabalho (Event), Bateria Fatorial de Personalidade (BFP), Método de Rorschach e Inventários de Habilidades Sociais 2 (IHS-2). Observou-se que, durante o processo, Violeta ampliou sua autopercepção, o que possibilitou mudanças no modo de agir em seus relacionamentos amorosos e na reflexão sobre como sua postura era vista por si e por seus colegas de trabalho. Acredita-se que a AT cumpriu com o objetivo de estabelecer uma experiência terapêutica que possibilitasse mudanças positivas para a cliente. Este estudo de caso contribuiu para ampliar a compreensão sobre a importância e o uso dos testes psicológicos neste modelo de avaliação psicológica.(AU)

The Therapeutic Assessment (TA) is an evaluative and interventional process proposed to be semi-structured and collaborative with the objective of promoting positive changes in the client, who is invited to have an active participation during the process. At the TA, the results of standardized psychological tests are highlighted as facilitators of the client's self-knowledge process. In this way, the findings of psychological self-report tests are usually integrated with projective methods to generate information that can broaden the client's view of themselves. In this article, understanding the potential use of psychological tests and of the collaborative relationship from a case treated from the TA perspective was sought. The participant, Violet (fictitious name), was assisted in 10 sessions lasting between 60 and 115 minutes. The psychological tests Psychological Well-Being Scale (EBEP), Vulnerability and Stress at Work Scale (EVENT), Personality Factorial Battery (BFP), Rorschach Method and Social Skills Inventories 2 (IHS-2) were used. It was observed that, during the process, Violet increased her self-perception, which allowed changes in her way of acting in her love life and in her reflection on how her posture was seen by herself and herco-workers. It is believed that TA fulfilled the objective of establishing a therapeutic experience that would enable positive changes for the client. This case study contributed to broaden the understanding about the importance and use of psychological testing in this psychological assessment model.(AU)

La Evaluación Terapéutica (ET) es un proceso de evaluación e intervención que se propone ser semiestructurado y colaborativo, con el objetivo de lograr cambios positivos en el cliente, quien es invitado a tener participación activa durante el proceso. En la ET se destacan los resultados de las pruebas psicológicas estandarizadas como facilitadoras del proceso de autoconocimiento del cliente. Los hallazgos de las pruebas psicológicas de autoinforme suelen integrarse con métodos proyectivos para generar información que pueda ampliar la visión que el cliente tiene de sí mismo. En este artículo se buscó comprender el uso potencial de las pruebas psicológicas y de la relación colaborativa a partir de un estudio de caso tratado desde la perspectiva de la ET. Atendieron a la participante Violeta (nombre ficticio), en 10 sesiones que duraron entre 60 y 115 minutos. Se utilizaron las pruebas psicológicas Escala de Bienestar Psicológico (EBEP), Escala de Vulnerabilidad y Estrés en el Trabajo (EVENT), Batería de Factorial de la Personalidad (BFP), Método de Rorschach e Inventario de Habilidades Sociales 2 (IHS-dos). Se observó que, durante el proceso, Violeta amplió su autopercepción, lo que permitió cambios en la forma de actuar en sus relaciones amorosas y en el reflejo de como ella y sus compañeros de trabajo veían su postura. Así, se cree que ET ha cumplido el objetivo de establecer una experiencia terapéutica que permitió cambios positivos a la cliente. Este estudio contribuyó a ampliar la comprensión sobre la importancia y el uso de las pruebas psicológicas en este modelo de evaluación psicológica.(AU)

Um capítulo esquecido na história da psicologia? sexualidades desviantes, psicopatologia e normalidade / A forgotten chapter in the history of psychology? deviant sexualities, psychopathology, and normality / ¿Un capítulo olvidado en la historia de la psicología? sexualidades desviadas, psicopatología y normalidad

Este artigo tem como objetivo produzir uma análise histórica sobre as intersecções entre Psicologia e sexualidade desviantes da norma no Brasil, de fins do século XIX a meados da década de 1980. Esta temporalidade foi escolhida por abarcar o surgimento das pesquisas científicas sobre sexualidade e desvios sexuais, a consolidação dos estudos psicológicos sobre a temática e o processo mais recente de despatologização da homossexualidade. Em termos teóricos e metodológicos, foram adotados os pressupostos da História Social da Psicologia e da historiografia das homossexualidades no Brasil. Desse modo, buscou-se compreender como as ideias, concepções e práticas psicológicas foram mudando ao longo do tempo, em conexão com as transformações socioculturais e políticas que ocorreram durante o século XX. Para isto, foram utilizadas fontes primárias e secundárias de pesquisa com vistas à produção de interpretações sobre as conexões entre as ideias, os atores e os eventos narrados. Argumenta-se, ao longo do artigo, que as ideias e práticas psicológicas estão intrinsecamente conectadas aos contextos socioculturais e políticos de seu tempo, sendo os movimentos dinâmicos e os conflitos presentes nesses contextos fatores determinantes para a sua constituição.(AU)

This article aims to produce a historical analysis of the intersections between Psychology and sexualities that deviate from the norm in Brazil, from the late 19th century to the mid-1980s. This period was chosen because it encompasses the emergence of scientific research on sexuality and sexual deviations, the consolidation of psychological studies on the subject and the most recent process of de-pathologization of homosexuality. Theoretically and methodologically, the assumptions of the Social History of Psychology and the historiography of homosexualities in Brazil were adopted. Therefore, we sought to understand how psychological ideas, conceptions and practices have changed over time, in connection with the sociocultural and political transformations that occurred throughout the 20th century. For this, primary and secondary sources of research were used to produce interpretations about the connections between the ideas, the actors and the narrated events. It is argued, throughout the article, that the psychological ideas and practices are intrinsically connected to the sociocultural and political contexts of their time, being the dynamic movements and conflicts present in these contexts determining factors for their constitution.(AU)

Este artículo tiene como objetivo realizar un análisis histórico de las intersecciones entre la Psicología y las sexualidades desviadas de la norma en Brasil desde finales del siglo XIX hasta mediados de la década de 1980. Esta temporalidad fue elegida por abarcar el surgimiento de las investigaciones científicas sobre sexualidad y desvíos sexuales, la consolidación de los estudios psicológicos sobre el tema y el más reciente proceso de despatologización de la homosexualidad. En el marco teórico y metodológico, se adoptaron los presupuestos de la Historia Social de la Psicología y de la historiografía de las homosexualidades en Brasil. De esta manera, se pretende comprender cómo las ideas, concepciones y prácticas psicológicas han cambiado a lo largo del tiempo, en conexión con las transformaciones socioculturales y políticas ocurridas durante el siglo XX. Para ello, se utilizaron las fuentes de investigación primarias y secundarias con miras a generar interpretaciones sobre las conexiones entre las ideas, los actores y los eventos narrados. Se argumenta, a lo largo de este artículo, que las ideas y las prácticas psicológicas están intrínsecamente conectadas a los contextos socioculturales y políticos de su tiempo, y los movimientos dinámicos y los conflictos presentes en estos contextos fueron los factores determinantes para su constitución.(AU)

Grupo multifamiliar em transtornos alimentares durante a primeira onda da pandemia de covid-19: transição para a modalidade online / Multifamily group on eating disorders during the first wave of the covid-19 pandemic: transitioning to the online modality / Grupo multifamiliar de trastornos alimentarios durante la primera ola de la pandemia de la covid-19: transición a la modalidad en línea

As restrições impostas pela pandemia de covid-19 levaram os serviços de saúde a reorganizarem seu funcionamento, ajustando-se à modalidade remota. A transição repentina e sem o devido preparo técnico impôs desafios adicionais para usuários e profissionais. Para aprimorar as estratégias assistenciais, torna-se imprescindível dar voz aos usuários dos serviços, para que narrem suas experiências e possam manifestar suas facilidades e dificuldades com essa passagem. Este estudo tem como objetivo investigar como os principais cuidadores familiares de pessoas com transtornos alimentares vivenciaram a transição do grupo de apoio para o formato remoto e identificar vantagens e desvantagens percebidas nesse modelo. Estudo clínico-qualitativo, exploratório, realizado em um serviço de atendimento especializado de um hospital terciário. O cenário investigado foi o grupo de apoio psicológico aberto a familiares que, desde o início da pandemia de covid-19, passou a ser oferecido na modalidade online. Participaram do estudo cinco mães e três pais presentes em 13 sessões grupais consecutivas. Entrevistas individuais foram aplicadas com a Técnica do Incidente Crítico logo após o término de cada encontro grupal, totalizando 26 entrevistas audiogravadas, transcritas e submetidas à análise temática. A transição para o online foi vivenciada pelos participantes como um recurso válido para permitir que o grupo funcionasse em tempos de grave crise sanitária. Como vantagens, foram mencionadas: a continuidade do cuidado, maior acessibilidade e facilidade em relação à logística da participação. Como limitações do formato online, foram destacadas: nem todos os familiares contam com conexão de internet de qualidade e possível dificuldade para manusear a tecnologia digital. Apesar dos desafios impostos pela súbita mudança para a modalidade online, na perspectiva dos usuários do serviço os esforços de adaptação foram bem-sucedidos, possibilitando a continuidade do cuidado à saúde mental.(AU)

The constraints imposed by the COVID-19 pandemic led health services to reorganize their operation, adjusting to the online modality. The sudden and unprepared technical transition has imposed additional challenges for both users and professionals. To improve care strategies, it is essential to give voice to services users, so that they can narrate their experiences and express their facilities and difficulties with this transition. This study aims to investigate how main family caregivers of people with eating disorders experienced the transition of the support group to the remote modality and to identify perceived advantages and disadvantages in this model. This is a clinical-qualitative, exploratory study carried out in a specialized care service of a tertiary hospital. The investigated setting was the psychological support group open to family members, which since the beginning of the COVID-19 pandemic has been offered online. Five mothers and three fathers who attended 13 consecutive group sessions participated in the study. Individual interviews were carried out with the Critical Incident Technique shortly after the end of each group meeting with all members, totaling 26 audio-recorded interviews. Data were subjected to thematic analysis. Transition was experienced as a valid resource to maintain the group active in times of a severe health crisis. As advantages of the remote modality were mentioned: continuity of care, greater accessibility, and ease in relation to the logistics of participation. As limitations of the online format were highlighted: not everyone has a good-quality connection to the internet, and difficulty in handling the digital technology. Despite the challenges imposed by the sudden shift to the online modality, from the service users' perspective the adaptation efforts were successful, enabling continuity of mental health care.(AU)

Las limitaciones que impuso la pandemia de la COVID-19 llevaron a los servicios sanitarios a reorganizar su funcionamiento adaptándose a la modalidad remota. El súbito cambio y sin la preparación técnica adecuada implicó retos adicionales a los usuarios y profesionales. Para mejorar las estrategias de atención es fundamental dar voz a los usuarios de los servicios, para que puedan narrar sus experiencias y expresar sus facilidades y dificultades con esta transición. Este estudio pretende investigar cómo han vivido los cuidadores de personas con trastornos alimentarios la transición del grupo de apoyo presencial al formato remoto e identificar las ventajas y desventajas percibidas en este modelo. Se trata de un estudio clínicocualitativo, exploratorio. El escenario investigado fue el grupo de apoyo psicológico abierto a los familiares en la modalidad en línea. Cinco madres y tres padres participaron en 13 sesiones de grupo consecutivas. Se realizaron entrevistas individuales con la técnica de incidentes críticos inmediatamente después de cada reunión del grupo, con un total de 26 entrevistas grabadas en audio, transcritas y sometidas a análisis temático. La transición a la red fue experimentada como un recurso válido para permitir que el grupo funcione en tiempos de crisis sanitaria grave. Las ventajas de la modalidad remota fueron conexión segura en tiempos de confinamiento físico, continuidad, mayor accesibilidad y facilidad en relación con la logística de la participación. Las limitaciones del formato en línea fueron la falta de una conexión de calidad a Internet y la posible dificultad de manejo de la tecnología digital. A pesar de las dificultades impuestas por el cambio repentino a la modalidad en línea, desde la perspectiva de los usuarios del servicio los esfuerzos de adaptación fueron un éxito, lo que permitió seguir con la atención de salud mental.(AU)

Prevenção do suicídio: esquecimento do ser e era da técnica / Suicide prevention: forgetfulness of being and technical era / Prevención del suicidio: olvido del ser y la era de la técnica

Martin Heidegger, em sua ontologia, destaca uma característica específica da atualidade que atravessa o comportamento humano, na filosofia, na ciência ou no senso comum: o esquecimento do ser. O filósofo diferencia a época atual das demais épocas históricas. O horizonte histórico contemporâneo se desvela por meio do desafio e da exploração, da tentativa de controle e domínio dos acontecimentos, ao modo da disponibilidade e em função da produtividade. O filósofo esclarece que todo esse desenraizamento do homem atual está atrelado ao esquecimento daquilo que é o mais essencial, qual seja, a existência. A questão que norteia este estudo é apurar, por meio das referências de Heidegger e dos estudos sobre suicídio, o quanto a interpretação da morte voluntária nos dias atuais está atravessada por tal esquecimento. Pretendemos investigar o quanto as ações de prevenção desenvolvidas pela suicidologia se encontram atravessadas por tal esquecimento do ser do homem e, dessa forma, acabam por estabelecer relações entre ser e ente em uma consequente redução ao ente como invariante e atemporal. O caminho para investigar a questão iniciará por abordar, em maiores detalhes, a analítica existencial, a questão da técnica e o movimento de esquecimento do ser apontados por Heidegger a fim de problematizar as perspectivas científicas atuais sobre o suicídio em sua prevenção para, então, estabelecer uma compreensão fenomenológica e existencial sobre o referido fenômeno.(AU)

Martin Heidegger, in his ontology, highlights a specific characteristic of the present moment that crosses human behavior, in philosophy, science, or common sense: the forgetfulness of being. The philosopher differentiates the current age from other historical ages. The contemporary historical horizon is unveiled by the challenge and the exploration, from the attempt to control and dominate events, to the mode of standing reserve and in terms of productivity. The philosopher clarifies that all this uprooting of the current man is linked to the forgetfulness of what is the most essential, namely, the existence itself. The question that guides this study is to investigate, via Heidegger's references and studies on suicide, to what extent the interpretation of voluntary death today is crossed by such forgetfulness. We intend to investigate to what extent the prevention actions developed by suicidology are crossed by such forgetfulness of the human's being and, in this way, they end up establishing relationships between being and entity in a consequent reduction to entity as an invariant and timeless. The path to investigate the issue will start by addressing, in greater detail, the existential analytics, the question concerning technique and the movement of forgetting the being pointed out by Heidegger to problematize the current scientific perspectives on suicide and its prevention to, then, propose a phenomenological and existential understanding about the referred phenomenon.(AU)

Martin Heidegger en su ontología destaca una característica específica del presente que atraviesa el comportamiento humano, ya sea en la filosofía, la ciencia o el sentido común: el olvido del ser. El filósofo diferencia la época actual de otras épocas históricas. El horizonte histórico contemporáneo se devela el desafío y la exploración, el intento de controlar y dominar los eventos, en la modalidad de disponibilidad y en términos de productividad. Y así aclara que todo este desarraigo del hombre actual está involucrado en el olvido de lo más esencial, que es la existencia misma. A partir de las referencias a Heidegger y de los estudios sobre el suicidio, este estudio busca saber hasta qué punto la interpretación de la muerte voluntaria hoy está atravesada por este olvido. Pretendemos investigar en qué medida las acciones de prevención desarrolladas por la suicidología se encuentran atravesadas por el olvido del ser del hombre y, de esta manera, terminan por establecer relaciones entre el ser y el ente, en una consecuente reducción al ente como invariante y atemporal. Para investigar el tema se abordará inicialmente, con mayor detalle, la analítica existencial, la cuestión de la técnica y el movimiento del olvido del ser señalado por Heidegger para problematizar las perspectivas científicas actuales sobre el suicidio y su prevención y, luego, proponer una comprensión fenomenológica y existencial sobre el referido fenómeno.(AU)

Tiros na escola: algumas referências para a psicologia na assistência à comunidade escolar / School shotting: some references for psychology in school comunity support / Tíros em la escuela: algunas referencias para la psicología em la asistencia à comunidad escolar

A atuação em situações de emergências e desastres apresentam-se como um dos grandes desafios na atuação dos profissionais da Psicologia, demandando intervenções singulares, desde o primeiro contato com as vítimas e o com entorno afetado pelo ocorrido, passando pelo trabalho interdisciplinar e interinstitucional junto aos órgãos públicos de segurança, justiça, assistência e saúde. O presente artigo tem como objetivo apresentar, por meio da experiência na assistência às vítimas na Escola Estadual Raul Brasil, as particularidades e adversidades enfrentadas durante o primeiro semestre de intervenções emergenciais que antecederam a contratação de psicólogos por parte do poder público municipal para continuidade das ações. Por meio de relatos de experiência em intervenções psicológicas, obtidos em diferentes instituições para a assistência às vítimas, este trabalho também visa apresentar alternativas que possam servir de referências para a intervenção do psicólogo e da psicóloga em situações de emergências e desastres, especialmente ocorridas na comunidade escolar. Observou-se que a realização do trabalho interdisciplinar e interinstitucional somado à participação da direção da escola no planejamento das ações e a realização de plantões psicológicos e rodas de conversa junto à comunidade escolar foram fundamentais para a assistência às vítimas do ocorrido.(AU)

Timely response to emergency and disaster situations is a major challenge for Psychology professionals and require particular interventions, from initial contact with the victims and the affected environment to interdisciplinary and interinstitutional collaboration with public security, justice, assistance and health agencies. Based on the experience of providing assistance to the victims of the State School Raul Brasil, this paper presents the adversities and specificities faced during the first semester of emergency interventions implemented before psychologists were hired by municipal officials for the continuity of care. By analyzing experience reports on psychological interventions obtained from different institutions for victim assistance, this paper proposes alternatives to be used as reference for psychological intervention in emergency and disaster situations, especially those experienced by the school community. Interdisciplinary and interinstitutional collaboration with the school board for planning actions and offering psychological services and conversation circles for the school community was fundamental to assist the victims.(AU)

La actuación en situaciones de emergencias es uno de los grandes desafíos a los profesionales de la psicología, pues demanda intervenciones singulares desde el primer contacto con las víctimas y con el contexto afectado por lo ocurrido, pasando por la interdisciplinaridad e interinstitucionalidad junto a los organismos públicos de seguridad, justicia, asistencia y salud. Este artículo tiene como objetivo presentar, por medio de la experiencia de la asistencia a las víctimas del colegio estadual Raul Brasil (en São Paulo, Brasil), las particularidades y adversidades enfrentadas durante el primer semestre de las intervenciones de emergencia que antecedieron la contratación de psicólogos por parte del municipio para continuidad de las acciones. Por medio de reportes de experiencia en intervenciones psicológicas, obtenidos en diferentes instituciones para la asistencia a las víctimas, este estudio también pretende presentar alternativas que puedan servir de referencia en la intervención de psicólogos y psicólogas en situaciones de emergencia y desastres, especialmente ocurridas en la comunidad escolar. Se verificó que la realización del trabajo interdisciplinar e interinstitucional, la participación de la dirección del colegio en la implementación de acciones y la realización de guardias psicológicas y círculos de conversación con la comunidad escolar fueron fundamentales para una asistencia a las víctimas.(AU)

Clínica del vacío y testimonio en la serie Euphoria / Clinic of the void and testimony in the series Euphoria

Introducción: Este artículo ejemplifica el discurso psicoanalítico lacaniano de Massimo Recalcati en las dos primeras temporadas y en los episodios especiales de la serie Euphoria (Levinson et al., 2019-presente). Metodología: En este artículo se analiza cómo esta serie televisiva retrata una nueva clínica, propia de las nuevas generaciones, que Recalcati denomina clínica del vacío y que distingue de la clásica clínica de la falta engendrada por la neurosis. Resultados y discusión:Dentro de los nuevos síntomas narcisistas, Rue, la protagonista de la serie, nos permite verificar la descripción que Recalcati hace del malestar de la cultura y de la metapsicología propia de nuestro tiempo, que él define -frente al diagnóstico más pesimista del mero narcisismo- mediante el “complejo de Telémaco”. Además, en determinados momentos de la serie, también podemos identificar escenas e incluso capítulos de especial resonancia que ponen en evidencia que el “testimonio” -usando la expresión del mismo autor- es lo que se requiere tanto en la psicoterapia como en la educación para vertebrar de nuevo al sujeto. (AU)

Introduction: This article sets out Massimo Recalcati’s Lacanian psychoanalytic discourse as exemplified in the first two seasons and in the special episodes of the series Euphoria (Levinson et al., 2019-present). Methods: In this article Euphoria series is analyzed. his teen drama television series portrays a new clinic typical of the new generations, which Recalcati refers to as the clinic of the void and which he distinguishes from the classical clinic of the lack engendered by neurosis. Results and discussion: Within the new narcissistic symptoms, Rue, the series’ protagonist, allows us to confirm Recalcati’s description of the discomfort of culture and of the metapsychology of our time, which he defines by means of the “Telemachus complex”, rather than the more pessimistic diagnosis of narcissism. Moreover, at certain moments in the series, we can also identify scenes and even episodes of special resonance that show that “testimony” –to use Recalcati’s expression– is what is required both in psychotherapy and in education to give the subject a new moral axis. (AU)

Clinic of the void and testimony in the series Euphoria / Clínica del vacío y testimonio en la serie Euphoria

Introduction: This article sets out Massimo Recalcati’s Lacanian psychoanalytic discourse as exemplified in the first two seasons and in the special episodes of the series Euphoria (Levinson et al., 2019-present). Methods: In this article Euphoria series is analyzed. his teen drama television series portrays a new clinic typical of the new generations, which Recalcati refers to as the clinic of the void and which he distinguishes from the classical clinic of the lack engendered by neurosis. Results and discussion: Within the new narcissistic symptoms, Rue, the series’ protagonist, allows us to confirm Recalcati’s description of the discomfort of culture and of the metapsychology of our time, which he defines by means of the “Telemachus complex”, rather than the more pessimistic diagnosis of narcissism. Moreover, at certain moments in the series, we can also identify scenes and even episodes of special resonance that show that “testimony” –to use Recalcati’s expression– is what is required both in psychotherapy and in education to give the subject a new moral axis. (AU)

Introducción: Este artículo ejemplifica el discurso psicoanalítico lacaniano de Massimo Recalcati en las dos primeras temporadas y en los episodios especiales de la serie Euphoria (Levinson et al., 2019-presente). Metodología: En este artículo se analiza cómo esta serie televisiva retrata una nueva clínica, propia de las nuevas generaciones, que Recalcati denomina clínica del vacío y que distingue de la clásica clínica de la falta engendrada por la neurosis. Resultados y discusión:Dentro de los nuevos síntomas narcisistas, Rue, la protagonista de la serie, nos permite verificar la descripción que Recalcati hace del malestar de la cultura y de la metapsicología propia de nuestro tiempo, que él define -frente al diagnóstico más pesimista del mero narcisismo- mediante el “complejo de Telémaco”. Además, en determinados momentos de la serie, también podemos identificar escenas e incluso capítulos de especial resonancia que ponen en evidencia que el “testimonio” -usando la expresión del mismo autor- es lo que se requiere tanto en la psicoterapia como en la educación para vertebrar de nuevo al sujeto. (AU)

Gozo, segregação e trauma na civilização neoliberal / Enjoyment, segregation, and trauma in the neoliberal civilization / Jouissance, ségrégation et traumatisme dans la civilisation néolibérale

O real, em Lacan, aparece como um resto que escapa inevitavelmente à ordem simbólica e tem um efeito traumático. O sintoma responde ao traumático preservando algo dele, mas ao mesmo tempo o disfarçando. Para isso, ele alia-se à fantasia, na qual o gozo que assinala a irrupção do traumático é projetado no Outro. Na sociedade repressiva da época de Freud, sintoma e fantasia forneciam ao sujeito uma válvula de escape que velava o trauma estrutural. Na sociedade neoliberal contemporânea, o imperativo do gozo torna isso mais difícil e o trauma estrutural mostra-se de maneira mais evidente. Além disso, a segregação em termos de tipo de gozo ou de possibilidade de acesso ao gozo reforça o elemento traumático. O establishment psiquiátrico, contudo, tende a desresponsabilizar o sujeito (e a sociedade na qual ele vive) pelo trauma.

The real, in Lacan, appears as a rest that inevitably escapes the symbolic order and has a traumatic effect. The symptom responds to the trauma by preserving something from it while disguising it. For that, it articulates itself to fantasy, in which the enjoyment that marks the irruption of the trauma is projected onto the Other. In the repressive society of the times of Freud, symptom and fantasy provided the subject with an escape valve that veiled the structural trauma. In contemporary neoliberal society, the imperative of enjoyment hinders this mechanism, thus the structural trauma appears more evidently. Moreover, segregation in terms of the type of enjoyment or the possibility of access to enjoyment reinforces the traumatic element. The psychiatric establishment, however, tends to exempt the subject (and the society where he lives) from responsibility for the trauma.

Le réel, chez Lacan, apparaît comme un reste qui échappe inévitablement à l'ordre symbolique et a un effet traumatique. Le symptôme répond au traumatisme en en préservant quelque chose, mais en le masquant en même temps. Pour cela, il s'allie au fantasme, dans lequel la jouissance qui marque l'irruption du traumatique est projetée sur l'Autre. Dans la société répressive du temps de Freud, le symptôme et le fantasme fournissaient au sujet un exutoire qui voilait le traumatisme structurel. Dans la société néolibérale contemporaine, l'impératif de jouissance rend cela plus difficile et le traumatisme structurel apparaît plus clairement. De plus, la ségrégation en termes de type de jouissance ou de possibilité d'accès à la jouissance renforce l'élément traumatique. L'établissement psychiatrique a cependant la tendance à exonérer le sujet (et la société dans laquelle il vit) de la responsabilité du traumatisme.

A propósito de un caso de neurosis obsesiva: coordenadas psicoanalíticas del tipo clínico / About a case of obsessive neurosis

La neurosis obsesiva es un tipo clínico que se ubica en el grupo de las neurosis de transferencia. Se destaca por las acciones compulsivas y/o ideas obsesivas que se imponen creando un tipo de personalidad bien característica donde predominan la actitud timorata, el repaso mental de escenarios posibles o temidos por un lado, y la perspectiva de un otro significativo que impone una serie de demandas que se cancelan- por la contradicción con otras- sumiendo a quien las padece en un estado de inacción.

Variantes da neurose tipo / Variations of type neurosis / Variantes de la névrose type

Na obra de Sigmund Freud, é possível localizarmos outra teoria da neurose que não está ancorada na existência de sintomas oriundos do processo defensivo próprio ao recalque, como pudemos verificar na constituição da neurose de caráter e das neuroses atuais. A evidência de tal problemática, presente já na elaboração teórica freudiana, nos leva à atualidade de nossa clínica. Na prática psicanalítica contemporânea, nos deparamos, cada vez mais, com fenômenos sintomáticos que não correspondem a sintomas propriamente ditos. O fenômeno da obesidade para alguns sujeitos evidencia uma forma de defesa inconsciente primária, mais arcaica, sem a produção de conflito psíquico e não sendo possível a satisfação da pulsão por meio do sintoma. A obesidade pode ser localizada como uma variante da neurose.

In Sigmund Freud's work it is possible to locate another theory of neurosis that is not anchored in the existence of symptoms arising from the defensive process at work in repression, as we could see in the constitution of the character neurosis and in the current neuroses. The evidence of such a problem, already present in the Freudian theoretical preparation, takes us to the present day of our clinic. In contemporary psychoanalytic practice, we are increasingly faced with symptomatic phenomena that do not correspond to symptoms themselves. The phenomenon of obesity for some subjects is evidence of a primary, more archaic form of unconscious defense, without the production of psychic conflict, and in which it is not possible to satisfy the drive through the symptom. Obesity can be located as a variant of neurosis.

Il est possible de localiser, dans l'œuvre de Sigmund Freud, une autre théorie de la névrose qui n'est pas ancrée dans l'existence de symptômes issus du processus défensif propre au refoulement, comme nous avons pu vérifier dans la constitution de la névrose de caractère et des névroses actuelles. L'évidence d'une telle problématique, présente déjà dans l'élaboration théorique freudienne, nous conduit à l'actualité de notre clinique. Dans la pratique psychanalytique contemporaine, nous sommes confrontés, de plus en plus, à des phénomènes symptomatiques qui ne correspondent pas à des symptômes proprement dits. Le phénomène de l'obésité pour certains sujets met en évidence une forme de défense inconsciente primaire, plus archaïque, sans la production de conflit psychique, n'étant pas possible la satisfaction de la pulsion par le symptôme. L'obésité peut être localisée comme une variante de la névrose

Peculiarities of personality adaption to psychological traumas in neurotic disorders.

BACKGROUND AND AIM: It is known that anticipatory processes play a leading role in the regulation of behavior. These processes act as a leading mechanism of the link in the mental regulation of behavior and activity. Violation of processes anticipates to a mismatch in the work of the adaption system, and, as a result, to maladaptive behavior. However, many issues related to the detection of anticipation disorders in various manifestations of diseases have been insufficiently studied. The features of individual prognosis depending on diseases are studied here. MATERIALS AND METHODS: As part of the work, 29 people were examined, of which 25 (86.2%) were women and 4 (13.8%) were men with a diagnosis of "adaptive reaction disorder" from the ICD-10 section "Neurotic and stress-related disorders" (F43.2) at the age of 20-65 years. Clinical-psychopathological and experimental-psychological research methods were applied (V.D. Mendelevich's test of anticipation, L.A. Regush's "Ability to predict" test, Lazarus' coping test, clinical questionnaire for the identification and evaluation of neurotic states). Statistical analysis was carried out using the program "IBM SPSS Statistics 25." The Shapiro-Wilk criterion, Pearson's chi-squared test, Fisher's exact criterion, Student's t-criterion, Mann-Whitney U criterion, Kruskal-Wallis H criterion, Pearson correlation, Spearman's correlation, and diagrams (columnar and span) were used. RESULTS: The presence of solvency in general anticipation reduced the severity of coping strategies «distancing¼ (P = 0.048, r = -0.371) and «escape - avoiding¼ (P = 0.048, r = -0.370), also personal-situational anticipatory consistency reduced severity of «escape - avoiding¼ (P = 0.017, r = -0.438). CONCLUSION: The anticipatory abilities and coping strategies in disorder of adaptive reactions were correlated. Patients with developed anticipation abilities are less likely to use no constructive coping strategies.

Distinguishing between neurosis and psychosis: discourses on neurosis in colonial Korea.

This article analyses the origins and formation of medical and social discourses on neurosis in colonial Korea. With the introduction of Western medicine after the Opening of Korea in 1876, neurasthenia and hysteria began to be understood as neurotic diseases, and their importance was further highlighted during the colonial period of 1910-45. The article also addresses the role of neuropsychiatry in forming discourses on neurosis. In medical communities during the colonial period, the main source of these discourses gradually shifted from internal medicine to neuropsychiatry. In particular, Korean neuropsychiatrists distinguished between neurosis and psychosis as a way to reinforce their authority. Neuropsychiatrists tried to explain the temperamental and environmental factors of neurosis from a psychoanalytic standpoint.

Do desencadeamento psicótico à retomada do laço social: a Rede de Atenção Psicossocial (RAPS) como dispositivo estratégico / From the psychotic triggering to the return to the social link: the Psychosocial Care Network (RAPS) as a strategic device

A estrutura clínica da psicose tem colocado novos desafios à saúde mental na atenção psicossocial, sobretudo no que tange a particularidade dos sujeitos psicóticos em se colocarem no mundo. Entender as especificidades destes como o que são, destinos subjetivos possíveis, modos diferentes - não déficits - é condição sine qua non para a atenção em saúde mental. Diante do exposto, e em conformidade com o saber analítico, considera-se contraproducente negar as diferenças, devendo, pois, reconhecê-las e respeitá-las de modo que essas circulem e falem em nome próprio. A RAPS aparece como importante recurso para que essa condição seja efetivada na medida em que sua aposta seja a de superar a cultura do isolamento e modificar as relações da sociedade com o diferente, promovendo vínculos, o exercício de direitos e o fortalecimento de laços que se configuram como uma fundamental direção no cuidado em saúde mental.

Complaints of dyspnea and their associations with personality traits in patients referred to psychotherapy in a day hospital.

BACKGROUND: Breathing difficulties are present in different medical conditions, yet seem to be underresearched in psychiatric patients. AIM: Assessment of prevalence of dyspnea complaints and their associations with personality traits in patients with neurotic or personality disorders referred to psychotherapy. METHODS: Retrospective chart review of medical records of 2450 patients with diagnoses F4-F6 (ICD-10). Analyses of associations between dyspnea reported in a symptom checklist SCL-O and pathological scores in the Neurotic Personality Questionnaire were carried out using univariate and multivariate regression analyses with ORs and 95%CI estimated with licensed STATISTICA 13 (StatSoftPL) software, and R version 4.1.0, RStudio version 1.4.1717 software. RESULTS: Dyspnea was reported by 46.3% women and 36.6% men (14.5% and 10.1% respectively assessed it as severely burdensome). Univariate regression analysis revealed several significant associations between reporting dyspnea or its extreme intensity and pathological scores in the NPQ. Multivariate regression analyses in women confirmed the importance of impulsiveness and exaltation for dyspnea occurrence, and feeling of being dependent on the environment, demobilization, and narcissistic attitude for its extreme intensity. In men impulsiveness, sense of being in danger, irrationality, and ponderings were associated with the presence of dyspnea, and sense of being in danger and envy with its extreme intensity. CONCLUSIONS: Complaints of dyspnea were pretty frequent. Several personality traits measured by the NPQ questionnaire were predictors of their occurrence and feeling of extreme burden.

Mood and neurotic disorders among youth with prenatal substance exposure: A longitudinal register-based cohort study.

BACKGROUND: Prenatal substance exposure is associated with mood and neurotic disorders but this association is complex and understudied. This study investigated the recorded use of specialised healthcare services for mood and neurotic disorders among youth with prenatal substance exposure in comparison with an unexposed matched cohort. Furthermore, the influence of adverse maternal characteristics and out-of-home care (OHC) is investigated. METHODS: This longitudinal register-based matched cohort study included 594 exposed and 1735 unexposed youth. Cox proportional hazard regression models were applied to study the first episode of mood and neurotic disorders in specialised healthcare from 13 years of age, and the influence of adverse maternal characteristics and OHC. Mediation analysis was applied to study the mediating effect of OHC on the association between prenatal substance exposure and the disorders. RESULTS: The exposed cohort had a two-fold higher likelihood of being treated at specialised healthcare for mood and neurotic disorders compared with the unexposed cohort (HR 2.34, 95% CI 1.86-2.95), but this difference was attenuated to non-significant levels (AHR 1.29, 95% CI 0.92-1.81) following adjustments with adverse maternal characteristics and OHC. OHC mediated 61% (95% CI 0.41-0.94) of the association between prenatal substance exposure and youth's mood and neurotic disorders. LIMITATIONS: Register data likely include more severe cases of disorders, and as an observational study, causality cannot be assessed. CONCLUSION: Mood and neurotic disorders are more common following prenatal exposure to substances and interlinked with significant adversities in the postnatal caregiving environment and OHC.

Relationships between treatments received in the Nottingham Study of Neurotic Disorder over 30 years and personality status.

We compared the drug treatments and health service contacts of anxious and depressed patients separated by personality disturbance in 200 patients over 30 years. Contact details with health professionals at 5, 12 and 30 years were recorded and analysed by multilevel models at all time points. Over 30 years, patients with dependent and anankastic personality disturbance and cothymia (the general neurotic syndrome) were 2.27 times more likely to receive selective serotonin reuptake inhibitors (SSRIs) and new antidepressants (95% confidence interval [CI]: 1.22-4.24), particularly paroxetine, and were 1.6 weeks (95% CI: 1.2-2.3) longer on the drug than those without the syndrome. Similar results with SSRIs and new antidepressants in patients with personality disorder fell short of significance after adjusting for age, sex and DSM status. Most patients had a DSM diagnosis at follow-up points, and these had increased psychological treatment, psychiatric admissions, multiple drugs, SSRIs and new antidepressants. At later follow-up, most drug treatments decreased apart from psychological treatment, SSRIs and new antidepressants, and baseline personality disorder had little impact on treatment histories compared with others. We conclude that the (Galenic) general neurotic syndrome is associated with greater use of treatments in the long term, showing that combined personality and symptomatic pathology overcomes that of personality disorder alone.

Representativeness of survey participants in relation to mental disorders: a linkage between national registers and a population-representative survey.

Introduction: Surveys and registers have provided important insights into the mental health of the community. However, both sources have strengths and limitations. While participation in surveys has been shown to be lower among those with mental disorders, misclassification and limited information on confounders are typical issues for registers. Objectives: To examine if participants of the Central Denmark Region's 2017 How are you? survey were representative of the general population in terms of mental disorder diagnoses. Methods: By linking data from the Central Denmark Region's 2017 How are you? survey with the Danish national registers, we compared the frequency of mental disorder diagnoses among (a) participants in the survey (n = 32,417), before and after applying non-response weights, and (b) the entire population who were eligible to participate (n = 1,063,082; 16 years of age or older on 10th January 2017 and registered as living in the Central Denmark Region). Using logistic regression models, we estimated associations between being diagnosed with any mental disorder and nine general medical conditions to assess whether selection into the survey appeared to bias these associations. Results: Based on register data, 10.4% (n = 110,492) of the eligible population had received a diagnosis of any mental disorder prior to the date of this survey. Among the unweighted survey sample, 8.2% (n = 2,648) had received a diagnosis; once non-response weights were applied, this corresponded to 9.5%. Representativeness varied by sex, age and type of mental disorder. For example, people with organic disorders or substance use disorders were generally underrepresented among survey participants of all ages; however, representativeness of common disorders such as mood or neurotic disorders was generally good. With respect to the association of any mental disorder and general medical conditions, we found that estimates were similar for survey samples (both weighted and unweighted) compared to the entire eligible population. Conclusions: People with a previous diagnosis of a mental disorder are slightly underrepresented in the survey. However, this selection bias was minimized when non-response weights were applied. Associations between mental disorders and general medical conditions did not appear to be affected by selection bias. With the application of non-response weights, the survey provided a sample representative of the general population in terms of mental disorder diagnoses.