Die unvollendete kopernikanische Revolution:Psychoanalyse und das mehr-als-menschliche Andere

Mit der Entdeckung des Unbewussten und der damit einhergehenden Dezentrierung des Subjekts hatte sich Freud in die großen umstürzenden Theorien der Menschheit eingereiht und sich in eine Linie mit Kopernikus und Darwin gesetzt. Der französische Psychoanalytiker Jean Laplanche versteht diese kopernikanische Revolution bei Freud jedoch als unvollendet. Er radikalisiert Freud und bringt das menschliche Andere als weiteres dezentrierendes Moment im Subjekt ein. Insbesondere in Zusammenhang mit der Klimakrise, der unhintergehbaren Abhängigkeit von unserem Planeten, der Tatsache, dass wir diesen auch mit nicht-menschlichen und mehr-als-menschlichen Anderen teilen, dass wir als Subjekte auch durch andere Bedingungen als ausschließlich menschliche bestimmt sind, wird die Frage aufgeworfen, ob wir nicht auch und gerade die Psychoanalyse weiter im Sinne eines in den Geistes- und Sozialwissenschaften bereits breit diskutierten posthumanen bzw. postanthropozentrischen Denkens erweitern müssen. Dabei wird es auch um die Frage gehen, ob dieser Fokus auf das Nicht-Menschliche und Mehr-als-Menschliche das Ende der Psychoanalyse markiert, oder deren Weiterbestehen garantiert. Esther Hutfless ist Philosoph:in und Psychoanalytiker:in, Mitglied im Wiener Arbeitskreis für Psychoanalyse und der Internationalen Psychoanalytischen Vereinigung. Hutfless lehrt an der Universität Wien sowie an der Sigmund Freud Privatuniversität Linz. Forschungsschwerpunkte beinhalten: Körper, Geschlecht, Alterität, Dekonstruktion und poststrukturale Theorien, das Verhältnis von Queer Theory, Psychoanalyse und Philosophie sowie die Verschränkung von Psyche/Psychoanalyse und Gesellschaft. Neueste Publikationen: Von Identität zu Differenz zu Alterität. Jean Laplanche und das Denken nicht-normativer Geschlechtlichkeit in der Psychoanalyse (2022); Of Traces, Translations and Deconstruction. Reading Laplanche with Derrida (2021) sowie Queering Psychoanalysis: Psychoanalyse und Queer Theory – Transdisziplinäre Verschränkungen (2017, mit Barbara Zach).Esther Hutfless, Die unvollendete kopernikanische Revolution: Psychoanalyse und das mehr-als-menschliche Andere, lecture, ICI Berlin, 21 March 2023, video recording, mp4, 53:38 <https://doi.org/10.25620/e230321

Wider die Binarität – Psychoanalyse und Queer Theory

Wie Michel Foucault in seiner Analyse Sexualität und Wahrheit I gezeigt hat, ist die Kategorie «Homosexualität» Mitte bis Ende des 19. Jahrhunderts als diskursive Konstruktion entstanden. «Homosexualität» als Kategorie entwickelte sich also nicht als gelebte Identität, sondern zunächst als Markierungskategorie für deviante Subjekte. Die Psychoanalyse hat von Beginn an versucht, die Entgegensetzung von Abweichung und Norm aufzulösen, indem sie Homosexuelles im Heterosexuellen und die Perversion in jeder Sexualität verortet hat. Zugleich jedoch hat die Psychoanalyse diese Dichotomisierung mit einer Pathologisierung der Homosexualität auch fortgeschrieben. Konzepte innerhalb der Psychoanalyse, die die Unterscheidung von Homo- und Heterosexualität in Frage stellen, werden auch heute kaum aufgegriffen, während nach wie vor nach den Ursachen vor allem ersterer gefahndet wird. In meinem Beitrag möchte ich die Kritik an der binären Entgegensetzung von Homo- und Heterosexualität und die Entwicklung queerer Ansätze nachzeichnen und die Queer Theory mit der Psychoanalyse in einen produktiven Dialog bringen. Ansätze der Queer Theory können für eine nicht-pathologisierende Auseinandersetzung mit Homo-, aber auch Transsexualität in der Psychoanalyse wichtige Impulse liefern. 

Eine kritische Theorie im Interregnum: Rezension zu "Queere Theorien zur Einführung" von Mike Laufenberg

Mike Laufenberg: Queere Theorien zur Einführung. Hamburg: Junius 2022. 978-3-96060-329-

Use of case reports and the Adverse Event Reporting System in systematic reviews: overcoming barriers to assess the link between Crohn’s disease medications and hepatosplenic T-cell lymphoma

BACKGROUND: To identify demographic and clinical characteristics associated with cases of hepatosplenic T-cell lymphoma (HSTCL) in patients with Crohn’s disease, and to assess strength of evidence for a causal relationship between medications and HSTCL in Crohn’s disease. METHODS: We identified cases of HSTCL in Crohn’s disease in studies included in a comparative effectiveness review of Crohn’s disease medications, through a separate search of PubMed and Embase for published case reports, and from the Food and Drug Administration (FDA) Adverse Event Reporting System (AERS). We used three causality assessment tools to evaluate the relationship between medication exposure and HSTCL. RESULTS: We found 37 unique cases of HSTCL in patients with Crohn’s disease. Six cases were unique to the published literature and nine were unique to AERS. Cases were typically young (<40 years of age) and male (86%). The most commonly reported medications were anti-metabolites (97%) and anti-tumor necrosis factor alpha (anti-TNFa) medications (76%). Dose and duration of therapy were not consistently reported. Use of aminosalicylates and corticosteroids were rarely reported, despite the high prevalence of these medications in routine treatment. Using the causality assessment tools, it could only be determined that anti-metabolite and anti-TNFa therapies were possible causes of HSTCL in Crohn’s disease based on the data contained in the case reports. CONCLUSION: Systematic reviews that incorporate case reports of rare lethal events should search both published literature and AERS, but consideration should be given to the limitations of case reports. In this study, establishing a causative effect other than ‘possible’ between anti-metabolite or anti-TNFa therapies and HSTCL was not feasible because case reports lacked data required by the causality assessments, and because of the limited applicability of causality assessment tools for rare irreversible events. We recommend minimum reporting requirements for case reports to improve causality assessment and routine reporting of rare life-threatening events, including their absence, in clinical trials to help clinicians determine whether rare adverse events are causally related to a medication

A randomized trial provided new evidence on the accuracy and efficiency of traditional vs. electronically annotated abstraction approaches in systematic reviews

Abstract Objectives Data Abstraction Assistant (DAA) is a software for linking items abstracted into a data collection form for a systematic review to their locations in a study report. We conducted a randomized cross-over trial that compared DAA-facilitated single-data abstraction plus verification ("DAA verification"), single data abstraction plus verification ("regular verification"), and independent dual data abstraction plus adjudication ("independent abstraction"). Study Design and Setting This study is an online randomized cross-over trial with 26 pairs of data abstractors. Each pair abstracted data from six articles, two per approach. Outcomes were the proportion of errors and time taken. Results Overall proportion of errors was 17% for DAA verification, 16% for regular verification, and 15% for independent abstraction. DAA verification was associated with higher odds of errors when compared with regular verification (adjusted odds ratio [OR] = 1.08; 95% confidence interval [CI]: 0.99–1.17) or independent abstraction (adjusted OR = 1.12; 95% CI: 1.03–1.22). For each article, DAA verification took 20 minutes (95% CI: 1–40) longer than regular verification, but 46 minutes (95% CI: 26 to 66) shorter than independent abstraction. Conclusion Independent abstraction may only be necessary for complex data items. DAA provides an audit trail that is crucial for reproducible research

Relationship between B-type natriuretic peptide levels and echocardiographic indices of left ventricular filling pressures in post-cardiac surgery patients

<p>Abstract</p> <p>Background</p> <p>B-type natriuretic peptide (BNP) is increased in post-cardiac surgery patients, however the mechanisms underlying BNP release are still unclear. In the current study, we aimed to assess the relationship between postoperative BNP levels and left ventricular filling pressures in post-cardiac surgery patients.</p> <p>Methods</p> <p>We prospectively enrolled 134 consecutive patients referred to our Center 8 ± 5 days after cardiac surgery. BNP was sampled at hospital admission and related to the following echocardiographic parameters: left ventricular (LV) diastolic volume (DV), LV systolic volume (SV), LV ejection fraction (EF), LV mass, relative wall thickness (RWT), indexed left atrial volume (_iLAV), mitral inflow E/A ratio, mitral E wave deceleration time (DT), ratio of the transmitral E wave to the Doppler tissue early mitral annulus velocity (E/E').</p> <p>Results</p> <p>A total of 124 patients had both BNP and echocardiographic data. The BNP values were significantly elevated (mean 353 ± 356 pg/ml), with normal value in only 17 patients (13.7%). Mean LVEF was 59 ± 10% (LVEF ≥50% in 108 pts). There was no relationship between BNP and LVEF (p = 0.11), LVDV (p = 0.88), LVSV (p = 0.50), E/A (p = 0.77), DT (p = 0.33) or RWT (p = 0.50). In contrast, BNP was directly related to E/E' (p < 0.001), LV mass (p = 0.006) and _iLAV (p = 0.026). At multivariable regression analysis, age and E/E' were the only independent predictors of BNP levels.</p> <p>Conclusion</p> <p>In post-cardiac surgery patients with overall preserved LV systolic function, the significant increase in BNP levels is related to E/E', an echocardiographic parameter of elevated LV filling pressures which indicates left atrial pressure as a major determinant in BNP release in this clinical setting.</p

Challenges in Designing a National Surveillance Program for Inflammatory Bowel Disease in the United States:

This review describes the history of US government funding for surveillance programs in IBD, provides current estimates of the incidence and prevalence of inflammatory bowel diseases (IBD) in the United States (US), and enumerates a number of challenges faced by current and future IBD surveillance programs. A rationale for expanding the focus of IBD surveillance beyond counts of incidence and prevalence, in order to provide a greater understanding of the burden of IBD, disease etiology and pathogenesis, is provided. Lessons learned from other countries are summarized, as well as potential resources that may be used to optimize a new form of IBD surveillance in the US. A consensus recommendation on the goals and available resources for a new model for disease surveillance are provided. This new model should focus upon “surveillance of the burden of disease,” including 1) natural history of disease and 2) outcomes and complications of the disease and/or treatments

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs 1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury