Objectives: To review concepts from both the fields of public health and psychoanalysis in order to confront the dilemmas of new health practices at the periphery of large cities in contemporary society

Castaño, G

Massuda, A

Onocko, R

Pellegrini, O

Valle, I

English

University of New Mexico

University of New Mexico
UNM Digital Repository
English Latin American Social Medicine
11-10-2009
Health and Psychoanalysis: Concepts Linked to
Create Strong Public Policies
R Onocko
A Massuda
I Valle
G Castaño
O Pellegrini
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Recommended Citation
Onocko, R; A Massuda; I Valle; G Castaño; and O Pellegrini. "Health and Psychoanalysis: Concepts Linked to Create Strong Public
Policies." (2009). https://digitalrepository.unm.edu/lasm_cucs_en/39
Documento CUCS # 6C 
 
SC20084(2)Onocko-Massuda (B) 
 
Onocko R, Massuda A, Valle I, Castaño G, Pellegrini O. Health and Psychoanalysis: 
Concepts Linked to Create Strong Public Policies. 
Salud Colectiva (Buenos Aires, Argentina) 2008 Mayo-Agosto; 4(2): 173-185. 
Objectives: To review concepts from both the fields of public health and psychoanalysis in 
order to confront the dilemmas of new health practices at the periphery of large cities in 
contemporary society.  
Methodology: Analytical interpretation. The authors review the concepts under the 
recommendations of Gadamer.  
Results: The authors describe new dilemmas at the periphery of large cities, such as 
violence, mobility, unemployment and mental suffering, as problems that impact consumers 
as well as members of health teams that serve them. To show how to fight these dilemmas in 
health practices, the authors review concepts from the psychoanalysis and public health 
fields. The concepts of psychoanalysis are categorized in three parts: imaginary significance, 
unconscious and narcissism. Imaginary significations maintain identity in a society. For the 
authors, the process of imaginary significance creates a societal image of those who utilize 
public health services as poor, helpless, degraded and worthless. Over time, this perception 
causes the team of health providers to actually feel that way. As for the unconscious, this 
consists of an imaginary significance in which individuals do not have total control. In this 
case, the authors find that a health providing team tends to give positive value to their work 
unconsciously. Finally, adherence to narcissism is the total identification of the health team 
with their work, so that if their work is lacking, the team adopts defensive strategies to 
alleviate the psychological suffering that such deficiencies cause, including idealization, 
somatization, bureaucratization, aggression or avoidance. Next, the authors review three 
notions of public health: vulnerability, clinic expansion and an active search. The first is the 
inclusion of the patient and their uniqueness in health activities. The second implies the 
overcoming of the biomedical paradigm and the support of autonomy through an emphasis 
on individuality and social networks. The third proposes epidemiologic surveillance by health 
care teams to identify cases and outbreaks of infection, and to anticipate demand for 
services in a non-bureaucratic way.  
So, in view of these two interlinked traditions, the authors found four dynamic strategies in 
medical practices. A) Vulnerability without listening, where a health team determines by itself 
the risk of subjective perception and the role of parental figures which prevent the patient 
from taking responsibility for their own health; the authors suggest the use of respectful 
listening, giving value to words, establishing agreements, not regulations. B) Active and 
objective search for solutions, employing patients’ own resources in order to start from their 
daily lives. C) Clinical expansion with less prescription, more negotiation and the use of 
effective therapy. D) Incidence of imaginary significance and the subjectivity of the team that 
maintains static images or perceptions of their patients by not observing changes in the 
patients suffering after receiving services. The authors propose the articulation of politics and 
clinic management, including the subjectivity of the health-care team.  
Conclusions: The concepts of psychoanalysis and public health contribute to overcoming 
some barriers in implementing public health policies. The authors conclude that teams should 
use less alienating devices in remote and disadvantaged regions of contemporary society. 
 


Health and Psychoanalysis: Concepts Linked to Create Strong Public Policies

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Health and Psychoanalysis: Concepts Linked to Create Strong Public Policies

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