“EU VI TUDO EM HIROSHIMA”: CORPO, SUJEITO E PSICANÁLISE

Ao se deparar com a angústia que o imagético propicia ao sujeito marcado pela falta e considerando o cinema como arte que opera pelos polos da contemplação e estranhamento, o objetivo deste artigo é tratar as nuances do plano imaginário de tudo ver como variante particular da posição de sujeito psicanalítico. Para tal, analisaremos recortes discursivos na materialidade do filme “Hiroshima, mon amour”[1] para operar gestos de interpretação de uma história ao mesmo tempo banal e singular de amor e de perda, de tudo e nada ver. Oscilando entre a inibição do sintoma pelo apaziguamento da angústia e a fragilidade desse apaziguamento (pelo surgimento de zonas de deriva), a ilusão de plenitude da pulsão esópica se desfaz frente à intervenção do discurso Outro. O caminho teórico é marcado pelos ensinos lacanianos e pela análise de discurso francesa. Trata-se, enfim, de acompanhar as elações de objeto deslizante, que se manifestam em zonas de transparência e opacidade

The ill person-body, the hospital and psychoanalysis: contemporary unfoldings?

A reflexão histórica sobre o corpo-doente apresentase como tema central na consideração da subjetividade do sujeito frente ao adoecimento e à hospitalização nos dias atuais. O entrelaçamento entre corpo, cultura, história e sociedade é relevante na produção de sentidos sobre o sofrer, demandando, por sua vez, uma releitura do desamparo e do mal-estar frente ao adoecimento. A psicanálise, cada vez mais, tem sido chamada a responder demandas institucionais de sujeitos em sofrimento. Consequentemente, o objetivo do artigo é articular o corpo-doente, o hospital na atualidade e a escuta psicanalítica afim de contribuir com o fazer, o saber e o pensar psicanalíticos no hospital. O corpo é analisado aqui pelo seu vértice pulsional, encadeando-o com as representações do corpo adoecido e hospitalizado. A interpretação, como método operador, possibilitou essa releitura pela via do desejo. A escuta do sujeito do desejo revelou o adoecimento como sendo um enunciador da condição intrínseca do ser humano, da condição psíquica de incompletude e essencialmente faltante, campo frutífero à imersão do sujeito em condição de análise.The historical reflection on the ill person-body is a central theme in the consideration of the subject's subjectivity regarding illness and hospitalization in current days. The intertwining among body, culture, history and society is relevant in the production of meanings about suffering, and demands, in turn, a reinterpretation of the helplessness and discomfort that are caused by an illness. The aim of this article is to articulate the ill person-body, the hospital in current times and psychoanalytic listening in order to contribute to psychoanalytic actions, knowledge and thinking in the hospital. The body is analyzed here from its driving dimension, which is linked with representations of the ill and hospitalized body. Interpretation, as an operating method, enabled this rereading through the path of desire. Listening to the desire's subject revealed that the process of becoming ill is an announcer of the intrinsic condition of the human being, the psychic condition of incompleteness, which is a fruitful field for the immersion of the subject in the analysis condition

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

The psychoanalytical body in the hospital

Considering that hospitalization implies in the emotional breaking of the ill subject because he/she is faced with vulnerability and abandonment before death and illness, the aim of this work is to make emerge the psychoanalytical body in the hospital through analysis of the psychic of the subject. We performed a reading of the ill-subject in current times, reflecting upon the contemporary knowledge and institutional postures that cross between themselves for the construction and social-cultural representation of the sick and hospitalized body. From the premises of the necessity of controlling the body it is reaffirmed by culture as well as by the institutions, caretakers and assented by the post modern man in search of perfection that mortifies, imposes a mold, that atrophies the feeling of doubt, hesitation, suffering and that even though we observe that this tentative to resist the encounter with doubt by paralyzing subjectivity processes, the actual body, as an announcement, seeks to remember the existence of the pulsional body disclosing the founding insatiability, revealing the suffering that is peculiar to humans, so then as to be born the being is conditions of analysis ,in identity crisis, emerging the subject of speech, the subject of desire. This is the place of the analyst and the analyzed: face to face with the psychoanalytical body. Psychoanalysis has in this work, the role of paraphrasing, a methodological instrument that looks beyond the socialcultural announcement. Psychoanalysis puts itself as an investigator of the logic of the production of meanings- which emerge or are already made up in an institution that treats the urgencies of the body: the public hospital, in the XXI century. The pulsional body is considered here as that one which produces and on which is produces representational fields in which are inserted subjects and is presumed that these fields are governed by specific logic because they are unconscious- and that they determine their relations: be them organic, institutional and subjective, being the subjects are dialectally also made up by them; as the body, at the same time, is the source and aim of the impulses. Two clinical cases studies were analyzed having as an essential operator, the psychoanalytical method which revealed from the transferential relationship of the posture interrogator-interpretant and analytical listening, the ascension of the subject of the unconscious- the subject of desire, psychoanalytic by excellence, reliving interventions that legitimately occupy the trade to which are destined: care for the psychoanalytical body through therapeutic function.Mestre em Psicologia AplicadaConsiderando que o processo de hospitalização implica uma desestruturação emocional do sujeito doente por fazê-lo deparar-se com sua vulnerabilidade e desamparo diante da morte e do adoecer, o objetivo deste trabalho é ver-fazer emergir o corpo psicanalítico na instituição hospitalar pela análise do sujeito psíquico. Realizamos uma leitura do sujeito-doente na atualidade, refletindo sobre os saberes contemporâneos e as posturas institucionais que se entrecruzam para a construção e a representação sócio-cultural do corpo adoecido e hospitalizado, partindo da premissa de que a necessidade de se controlar o corpo é reafirmada tanto pela cultura, quanto pelas instituições de cuidados com o corpo e assentida pelo homem pós-moderno, na busca de uma condição de perfeição que mortifica, que impõe um molde, que atrofia o sentimento de dúvida, de hesitação, de sofrimento e que, embora constatemos que essa tentativa de resistir ao encontro com a dúvida por meio de paralisação dos processos de subjetivação, o próprio corpo, como enunciação, procura retomar, procura relembrar a existência do corpo de pulsões, denunciando-lhe sua insaciabilidade fundante e revelando o sofrimento que é peculiar ao homem, para então nascer o ser em condição de análise , em crise identitária, emergindo o sujeito da falta, o sujeito do desejo. Eis aí o lugar do analista e do analisando: frente ao corpo psicanalítico. A psicanálise tem, neste trabalho, função de paráfrase, de instrumento metodológico que olha para além do enunciado sócio-cultural; posta-se como investigador da lógica de produção de sentidos emergentes ou os já constituídos, numa instituição que trata das urgências do corpo: o hospital, público, no século XXI. O corpo pulsional é considerado, aqui, como aquele que produz e sob o qual se produzem campos de representações nos quais se inserem os sujeitos e presume-se que sejam estes campos, regidos por lógicas específicas porque inconscientes é que determinam suas relações: sejam orgânicas, institucionais e subjetivas, sendo que os sujeitos são dialeticamente também constituídos por elas; visto que o corpo é, ao mesmo tempo, fonte e finalidade das pulsões. Dois casos clínicos foram analisados tendo como operador essencial o método psicanalítico que revelou, a partir da relação transferencial, da postura interroganteinterpretante e da escuta analítica, a ascensão do sujeito do inconsciente o sujeito do desejo, psicanalítico por excelência, revivificando intervenções que se ocupam legitimamente do ofício às quais se destinam: cuidados para com o corpo psicanalítico mediante função terapêutica

Psychologist in multidisciplinary residency program in health: position-subject, discourse analysis and Lacanian psychoanalysis

A residência multiprofissional em saúde é uma modalidade de ensino de pós graduação lato sensu, voltada para a educação em serviço. Emerge no contexto brasileiro como uma proposta complementar a fim de se atingir as metas e os princípios preconizados pelo sistema único de saúde (SUS), principalmente quanto à integralidade. Além de trazer implicações e lançar desafios ao exercício profissional do psicólogo, inserindo-o no entrelaçamento de campos densos e complexos (saúde, educação e políticas públicas), a modalidade propõe que profissionais com formações diferentes atuem num mesmo campo, com discussões e intervenções conjuntas. A questão que move a pesquisa é a posição-sujeito no programa de residência multiprofissional face ao modelo de educação-saúde vinculado. Assevera-se que a posição-sujeito é objeto discursivo deslizante (de tessitura simbólica) que toma em consideração o sujeito constituído no claudicar da linguagem e interpelado pelo inconsciente e que se manifesta como efeito de significantes em direção ao grande Outro. Para tal, vale-se da interface dos aportes teóricos da análise de discurso pêchetiana e da psicanálise lacaniana. A análise de discurso sustenta o discurso como efeito de sentidos mediados pela ideologia e ocupa-se, especialmente, da incursão da alteridade do discurso-outro sobre o mesmo. A psicanálise lacaniana, por sua vez, reitera a primazia do inconsciente estruturado como linguagem diante de um eu imaginário e versa para o sujeito marcado como falta que, dividido, faz do discurso o estatuto do significado. Assim, é proeminente na análise do objeto a metodologia indiciária dada ao caráter simbólico e cambiante da posição-sujeito no discurso. A análise se realizou mediante o dispositivo da interpretação como gesto analítico, que acompanha as elações próprias do objeto. O corpora é constituído por uma materialidade escrita e por uma oral. A escrita compõe-se de recortes de leis, portarias e resoluções que fundam a modalidade de residência multiprofissional e reforçam os ideias do sistema único de saúde; a materialidade oral compõe-se de recortes e fragmentos discursivos advindos da transcrição de supervisões realizadas mediante a prática clínica do psicólogo-residente na cena hospitalar. Da análise, conclui-se que a materialidade escrita se posta como campo-Outro que ordena a estrutura política da residência multiprofissional e direciona a manutenção da ordem e reprodução das relações hierárquicas mediante ideologia assujeitante. Essa materialidade, por sua vez, age como intradiscurso e reverbera-se na memória discursiva e na prática clínica. A posição-sujeito, no plano da articulação significante, faz deslizar e produzir sentidos que denotam ora a manutenção e reprodução de uma posição fusionada ao discurso médico, científico-positivista; ora a posição-sujeito é marcada pelo saber condicionado ao fetiche da mercadoria, deflagrando a ordem do capital nas insígnias da multiprofissionalidade e da educação permanente. O trabalho propiciou, enfim, acompanhar as transmutações da posição-sujeito, independentemente do indivíduo ou da naturalização de sentidos provenientes da função que exerce. O objeto posição-sujeito reiterou a construção da realidade a partir da condição faltante. É essa condição faltante e incompleta que outorga ao desejo o modo de o sujeito se posicionar desta e outra maneira - na formação, no trabalho, na vida.The multidisciplinary residency in health is a postgraduate modality of education, focused on the education service. It emerges in the Brazilian context as a complementary proposal in order to achieve the goals and the principles recommended by the Unified Health System (SUS), particularly as to the integrality. In addition to bringing implications and challenges for the psychology in professional practice, inserting it into the entanglement of dense and complex fields (health, education and public policy), the modality proposes that professionals with different backgrounds act in the same field, with joint discussions and interventions. The question that drives the research is the subject-position in multidisciplinary residency program in terms of the combined health-education model. It asserts that the subject-position is the sliding discursive object (symbolic texture) that takes into account the subject constituted in hobble of the language and questioned by the unconscious, and that manifests as significant effect towards of the great Other. For this, appraise the interface of the theoretical contributions of the Pecheutian discourse analysis and Lacanian psychoanalysis. The discourse analysis sustain the discourse as effect of senses mediated by ideology, and occupies, especially, of the incursion of otherness of the discourse-other about the same. The Lacanian psychoanalysis, in turn, confirms the primacy of the unconscious structured as a language face an imaginary self and seek for the subject marked as missing, that divided, makes of the discourse the statute of the meaning. Thus, it is prominent in the analysis of the object the circumstantial methodology given the symbolic and hobbling character of the position-subject in the discourse. The analysis was performed by the interpretation as an analytical gesture, accompanying the proper elations of the object. The corpora consists of a both written and oral materiality. The written consists of clippings of laws, ordinances and resolutions that found a modality of multiprofessional residency and reinforce the ideals of the unified health system; the oral materiality comprise of clippings and discursive fragments coming from the transcription of the supervision performed by the clinical practice of psychologist resident in the hospital scene. From the analysis, it is concluded that the written materiality stands as field-Other that ordains the political structure of multiprofessional residency and directs the maintenance of the order and reproduction of the hierarchical relations by the ideology. This materiality, in turn, acts as intradiscourse and reverberates in the discursive memory and in the clinical practice. The position-subject, in the plan of the significant articulation, slides and produce meanings that denote either the maintenance and reproduction of a position merged to the medical discourse, scientific-positivist; nevertheless the subject-position is marked by knowledge conditioned to the commodity fetish, triggering the order of the capital in the insignia of multiprofessionality and continuing education. The work led, finally, follow the transmutations of the position-subject, regardless of the individual or the naturalization of the senses from the function it holds. The object position-subject reiterated the construction of reality from the missing condition. It\'s that missing and incomplete condition that grants to desire the way that the subject will position in this and other way - in training, at work, in life

O corpo-doente, o hospital e a psicanálise: desdobramentos contemporâneos?

A reflexão histórica sobre o corpo-doente apresentase como tema central na consideração da subjetividade do sujeito frente ao adoecimento e à hospitalização nos dias atuais. O entrelaçamento entre corpo, cultura, história e sociedade é relevante na produção de sentidos sobre o sofrer, demandando, por sua vez, uma releitura do desamparo e do mal-estar frente ao adoecimento. A psicanálise, cada vez mais, tem sido chamada a responder demandas institucionais de sujeitos em sofrimento. Consequentemente, o objetivo do artigo é articular o corpo-doente, o hospital na atualidade e a escuta psicanalítica afim de contribuir com o fazer, o saber e o pensar psicanalíticos no hospital. O corpo é analisado aqui pelo seu vértice pulsional, encadeando-o com as representações do corpo adoecido e hospitalizado. A interpretação, como método operador, possibilitou essa releitura pela via do desejo. A escuta do sujeito do desejo revelou o adoecimento como sendo um enunciador da condição intrínseca do ser humano, da condição psíquica de incompletude e essencialmente faltante, campo frutífero à imersão do sujeito em condição de análise

Agrupamento multidisciplinar de acolhimento – AMA: Uma experiência de ensino-pesquisa-extensão aplicada ao cuidado da família no contexto hospitalar – doi: 10.5212/rev.Conexao.V.12.I1.0001

This descriptive article aims to report the experience of the teaching/research/outreach project of the Multidisciplinary Care Group– AMA in the Portuguese acronym, which provides care to families facing death/dying in a hospital context. The project has been active since October 2013, and it involves the Nursing and Psychology courses of the Federal University of Bahia in activities in a public hospital setting. The project aims to unveil the transpersonal-systemic support to the families of life risk patients using family records, monitoring visits, group activities and interactional dynamics. The results include: teaching - training students to carry out transpersonal-systemic care; research - developed with families and specific professionals; and outreach project - support and care to the family of the hospitalized person facing risk of death, as well as interaction and multidisciplinary hospital mobilization. The study concludes that the actions taken are relevant to contribute to a more comprehensive care towards those facing death/dying, and for the improvement of professional skills necessary to face this challenge.Este estudo descritivo objetivo relatar a experiência de ensino-pesquisa-extensão do Agrupamento Multidisciplinar de Acolhimento – AMA no cuidado à família que enfrenta a morte-morrer hospitalar. O projeto,iniciado em outubro de 2013, persiste em andamento, envolvendo os cursos de enfermagem e psicologia da Universidade Federal da Bahia no cenário de um hospital público, onde busca desvelar o cuidado transpessoal-sistêmico no processo de acolhimento a famílias com pessoas em risco de morte, utilizando: prontuário familiar, acompanhamento de visitas, grupos e dinâmicas interacionais. Os resultados envolvem: ensino – capacitação de estudantes para ações de Cuidado Transpessoal-Sistêmico; pesquisa – desenvolvidas junto às famílias e profissionais-alvos; extensão – acolhimento e cuidado à família da pessoa hospitalizada em risco de morte e interação e mobilização multiprofissional hospitalar. Concluímos que as ações implementadas são relevantes para contribuírem com um cuidado mais integral frente à morte-morrer, e ainda para o aperfeiçoamento de habilidades profissionais no direcionamento deste desafio.