Trente ans après la mort de Lacan, les conséquences concernant la cure tirées de son enseignement sur les psychoses méritent une révision pour la période 1981-2011. Aujourd'hui, de nombreux analystes lacaniens traitent des patients psychotiques et essayent de rendre compte des effets. Pourquoi la psychanalyse s'avère-t-elle opérante dans l'abord des psychotiques? Bien que les effets de l'abord analytique soient reconnus par les analystes, leur théorisation entraîne des paradoxes comme celui qui soutient qu'il n'y a pas de désir dans les psychoses. Dans la mesure où Lacan a promu une éthique analytique fondée sur la fonction du désir de l'analyste comme ressort du transfert, l'exil du désir psychotique de la théorisation est contradictoire avec l'idée d'une cure possible. Celle-ci risque de se transformer en une thérapeutique. Cette recherche propose de réintroduire le concept de désir dans la théorisation de la cure analytique des psychoses. Tout d'abord, cette thèse s'est révélée nécessaire pour élucider les modifications de la position subjective repérées dans des cas de patients mélancoliques dont la présentation mortifiée initiale a connu une réversion vers la persécution. Le passage d'un désir aboli à un essai d'instituer le désir dans l'Autre exige de considérer que la psychose aussi est une affaire de désir. La question ne serait pas celle de l'absence du désir, sinon celle des modalités de support du désir que chaque patient psychotique pourrait mettre en place. L'abord analytique démontre à ce niveau son efficacité, qui n'est pas toujours garantie car dépendante d'une rencontre entre le psychotique et le désir de l'analyste.

Adolescent pregnancy has been of longstanding societal concern primarily because of the inability of most young mothers to provide adequately for their infants. Depression often results in disengagement from mother-child interaction. Adolescent mothers identified as depressed are at increased risk of future psychopathology, with additional deleterious effects on their infants&rsquo / lives. The purpose of this study was to explore adolescent mothers&rsquo / experiences of motherhood and memories of feeling depressed during or after the birth of their babies. The first aim was to explore the young women&rsquo / s experiences of mothering, by focusing upon the practice of being a mother. The second aim was to explore the young women&rsquo / s experiences of depression, by focusing on their physical behaviour and emotional experiences. The third aim was to explore their perceptions of the causes of their depression. The rationale for this study was that these issues will further enhance the body of knowledge available to practitioners working with adolescent mothers. It will also provide a source of insights and hypotheses for preventive intervention research. The study was located within a feminist standpoint framework that begins from the perspective of women with the aim to explore women&rsquo / s accounts of their experiences in relation to depression as an important source of knowledge. A qualitative research design and methodology was employed in the region of the Western Cape. Eight adolescent mothers between the ages of 16 and 19 were recruited and interviewed. The interviews were semi-structured and consisted out of open-ended questions. Interviews were recorded, transcribed verbatim and thematic analysis of data was carried out. The findings of this research yielded some interesting areas for future research and implications for treatment and intervention with first-time adolescent mothers. The adolescent mothers in this study experienced similar depressive symptoms to adult mothers in previous research. All the participants revealed that they feared their parents&rsquo / disappointment in them for being pregnant. This factor contributed to their depression, because they received very little (if any) support from their parents or the father of their baby. The participants discussed that their pregnancy or giving birth was linked to various aspects of themselves that they had lost as an adolescent. Before they received counselling, none of the participants understood why they experienced depressive symptoms or what was happening to them at the time after their pregnancies.

A presente dissertação é resultante da experiência em distintos espaços clínicos com pacientes psicóticos e, em especial, em oficinas terapêuticas de música. A escrita busca investigar os possíveis efeitos do trabalho com a música na clínica da psicose. Para tanto, a primeira parte do trabalho trata de entrar em compasso com o leitor, situando-o com relação àquilo que entendemos por estruturação psicótica desde a perspectiva psicanalítica. É desde essa mesma perspectiva que situamos o campo de experiência e o método da pesquisa. Nesse sentido partimos de duas questões principais: uma delas diz respeito à narração, enquanto possibilidade de transmissão da experiência do inconsciente; a outra, ao caráter ficcional do que se produz a partir da experiência clínica. Apoiados em Freud, principalmente através do texto Construções em Análise, de 1937, é que sustentamos a forma de apresentação do que intitulamos “Memórias da Clínica”. Três fragmentos da experiência clínica colocam em relação as questões centrais do trabalho: a clínica da psicose e a música. A primeira memória acontece em uma oficina de música, inserida em um CAPS da cidade de Porto Alegre. No dilúvio de palavras de Julia escutamos o aprisionamento à palavra do Outro e a possibilidade de que, através da música, o sujeito possa tomar a palavra, colocando-se mais em consonância com o tempo do Outro e dos outros A segunda, surgida em um acompanhamento terapêutico, nos coloca a seguinte pergunta: como calar o Outro? Aqui também foi através da música que essa possibilidade surgiu. E, finalmente, a terceira memória cujo contexto é a escuta individual de uma paciente em uma clínica-escola. Nessa cena a voz, enquanto puro objeto, assegura uma função de presença. As memórias nos levaram aos caminhos da constituição do sujeito. Tendo a psicose e a música como guias, nos aventuramos por um percurso de pesquisa que reuniu operadores conceituais essenciais na aposta de que um sujeito pode advir, tais como: pulsão invocante, o fort-da, o espelho, alíngua. Trabalhar com a espera e com a abertura de intervalos é um desafio constante na escuta de psicóticos. Em nossa experiência, a música mostrou-se uma via potente nesse trabalho de criar intervalos. Através das variações do objeto da pulsão invocante que a música coloca em jogo, a palavra pode voltar a circular. Dar a palavra ao sujeito: não é disso que se trata na psicanálise? E que efeitos pode ter a música nessa operação? Dessa análise decanta a questão do silêncio, enquanto um elemento essencial na direção do tratamento nas psicoses. / The present dissertation is the result of trials in different clinical spaces with psychotic patients and, especially, in therapeutical music workshops. The writing seeks to investigate the possible effects of the work with music in the psychosis clinic. For such, the first part of the work tries to explain the reader, what we understood as a psychotic structuring under the psychoanalytic perspective. It is from that same perspective that we explain the field of experience and the research method. In that sense, we start from two main subjects: one of them concerns the narration, as a possibility of transmission of the unconscious experience; the other, the ficcional character that is produced starting from the clinical experience. Based on Freud, mainly through the Constructions in Analysis text, from 1937, we sustain the presentation form entitled “Memoirs of the Clinic.” Three fragments from the clinical experience which relate the central subjects of the work: the psychosis clinic and music. The first memory happens at a music workshop, inserted in a CAPS (Psycho-social Service Center) of the city of Porto Alegre. In the flood of Julia´s words we heard the imprisonment to the word of the Other and the possibility that, through music, the subject may take the word, becoming more in consonance with the time of the Other and the other ones. The second, appeared in a therapeutic assistance, places the following question: how to silence the Other? Here it was also through music that this possibility appeared. And, finally, the third memory whose context is the individual listening of a patient in a school clinic. In that scene, the voice, as a pure object, takes a presence function. The memoirs took us to the paths of the constitution of the subject. Taking the psychosis and the music as guides, we ventured in that primordial operation, through subjects as the invoking pulsion, fortda, the mirror, the language: essential concepts and operations in the hope that a subject may come. To work with the waiting and with the opening of intervals is a constant challenge in the listening of psychotics. In our experience, the music has appeared as a potent path in that work of creating intervals. Through the variations of the object of the invoking pulsion that the music turns on, the word circulates again. To give the word to the subject: isn’t that dealt with in psychoanalysis? And what effects may the music have in that operation? From that analysis upsurges the subject of silence, as an essential element in the direction of the psychoses treatment.

A presente dissertação é resultante da experiência em distintos espaços clínicos com pacientes psicóticos e, em especial, em oficinas terapêuticas de música. A escrita busca investigar os possíveis efeitos do trabalho com a música na clínica da psicose. Para tanto, a primeira parte do trabalho trata de entrar em compasso com o leitor, situando-o com relação àquilo que entendemos por estruturação psicótica desde a perspectiva psicanalítica. É desde essa mesma perspectiva que situamos o campo de experiência e o método da pesquisa. Nesse sentido partimos de duas questões principais: uma delas diz respeito à narração, enquanto possibilidade de transmissão da experiência do inconsciente; a outra, ao caráter ficcional do que se produz a partir da experiência clínica. Apoiados em Freud, principalmente através do texto Construções em Análise, de 1937, é que sustentamos a forma de apresentação do que intitulamos “Memórias da Clínica”. Três fragmentos da experiência clínica colocam em relação as questões centrais do trabalho: a clínica da psicose e a música. A primeira memória acontece em uma oficina de música, inserida em um CAPS da cidade de Porto Alegre. No dilúvio de palavras de Julia escutamos o aprisionamento à palavra do Outro e a possibilidade de que, através da música, o sujeito possa tomar a palavra, colocando-se mais em consonância com o tempo do Outro e dos outros A segunda, surgida em um acompanhamento terapêutico, nos coloca a seguinte pergunta: como calar o Outro? Aqui também foi através da música que essa possibilidade surgiu. E, finalmente, a terceira memória cujo contexto é a escuta individual de uma paciente em uma clínica-escola. Nessa cena a voz, enquanto puro objeto, assegura uma função de presença. As memórias nos levaram aos caminhos da constituição do sujeito. Tendo a psicose e a música como guias, nos aventuramos por um percurso de pesquisa que reuniu operadores conceituais essenciais na aposta de que um sujeito pode advir, tais como: pulsão invocante, o fort-da, o espelho, alíngua. Trabalhar com a espera e com a abertura de intervalos é um desafio constante na escuta de psicóticos. Em nossa experiência, a música mostrou-se uma via potente nesse trabalho de criar intervalos. Através das variações do objeto da pulsão invocante que a música coloca em jogo, a palavra pode voltar a circular. Dar a palavra ao sujeito: não é disso que se trata na psicanálise? E que efeitos pode ter a música nessa operação? Dessa análise decanta a questão do silêncio, enquanto um elemento essencial na direção do tratamento nas psicoses. / The present dissertation is the result of trials in different clinical spaces with psychotic patients and, especially, in therapeutical music workshops. The writing seeks to investigate the possible effects of the work with music in the psychosis clinic. For such, the first part of the work tries to explain the reader, what we understood as a psychotic structuring under the psychoanalytic perspective. It is from that same perspective that we explain the field of experience and the research method. In that sense, we start from two main subjects: one of them concerns the narration, as a possibility of transmission of the unconscious experience; the other, the ficcional character that is produced starting from the clinical experience. Based on Freud, mainly through the Constructions in Analysis text, from 1937, we sustain the presentation form entitled “Memoirs of the Clinic.” Three fragments from the clinical experience which relate the central subjects of the work: the psychosis clinic and music. The first memory happens at a music workshop, inserted in a CAPS (Psycho-social Service Center) of the city of Porto Alegre. In the flood of Julia´s words we heard the imprisonment to the word of the Other and the possibility that, through music, the subject may take the word, becoming more in consonance with the time of the Other and the other ones. The second, appeared in a therapeutic assistance, places the following question: how to silence the Other? Here it was also through music that this possibility appeared. And, finally, the third memory whose context is the individual listening of a patient in a school clinic. In that scene, the voice, as a pure object, takes a presence function. The memoirs took us to the paths of the constitution of the subject. Taking the psychosis and the music as guides, we ventured in that primordial operation, through subjects as the invoking pulsion, fortda, the mirror, the language: essential concepts and operations in the hope that a subject may come. To work with the waiting and with the opening of intervals is a constant challenge in the listening of psychotics. In our experience, the music has appeared as a potent path in that work of creating intervals. Through the variations of the object of the invoking pulsion that the music turns on, the word circulates again. To give the word to the subject: isn’t that dealt with in psychoanalysis? And what effects may the music have in that operation? From that analysis upsurges the subject of silence, as an essential element in the direction of the psychoses treatment.

Orientador: Rosana T. Onocko Campos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T19:40:46Z (GMT). No. of bitstreams: 1 Miranda_Lilian_D.pdf: 2517064 bytes, checksum: 99dc6b8d562306951aca789b7bac4470 (MD5) Previous issue date: 2009 / Resumo: Esta tese se sustenta num método qualitativo e participante, baseado na hermenêutica gadameriana e no paradigma construtivista. Nosso objetivo foi analisar o arranjo denominado "equipes ou profissionais de referência", em relação ao tratamento de pacientes psicóticos, no contexto dos Centros de Atenção Psicossocial, no que diz respeito às suas funções clínicas e organizacionais. A coleta de dados foi feita através de dois ciclos de grupos focais constituídos por profissionais, usuários e familiares de usuários dos 6 CAPS da cidade de Campinas/SP, bem como por entrevistas em profundidade, desenvolvidas com usuários desses serviços. O material construído mostra que todos os CAPS se organizam através de equipes de referência, cujos profissionais se ocupam de um acompanhamento próximo e regular dos pacientes, configurando-se como profissionais de referência e se responsabilizando pelos projetos terapêuticos e a discussão coletiva dos casos. Essa organização é avaliada positivamente por todos os sujeitos da pesquisa. Para os usuários e seus familiares, os profissionais de referência são percebidos como centrais para a viabilização do tratamento. Eles destacam a confiabilidade como um dos eixos centrais da relação terapêutica e consideram que esta se constrói através das conversas, da sensação de serem percebidos em suas necessidades singulares e do suporte que obtém para a resolução de problemas práticos. Os trabalhadores ressaltam a potencialidade das equipes de referência para o compartilhamento e a co-responsabilização dos casos. Reconhecem a singularidade e a intensidade da relação entre profissionais de referência e usuários, mas apontam alguns paradoxos inerentes ao arranjo, tais como as tensões entre cuidado e tutela; atenção constante ao paciente e controle; proximidade afetiva e identificação narcísica. Através do referencial psicanalítico, apresentamos uma discussão acerca de algumas das necessidades emocionais dos pacientes psicóticos e da potencialidade do arranjo para respondê-las. Destacamos que a fertilidade desse trabalho depende de sua sustentação coletiva, a ser construída entre diversos atores que envolvem o usuário e o serviço, mediante permanente esforço de análise crítica. Para tanto, propomos a reflexão acerca de um posicionamento ético baseado na capacidade de o profissional envolver-se genuinamente com seus pacientes, podendo, ao mesmo tempo, abster-se e deixá-los traçar os sentidos do tratamento / Abstract: The present thesis applies a qualitative and participative method based on Gadamer?s hermeneutics and the constructivist paradigm. Our goal was to analyze an arrangement called staffs or professionals of reference for the treatment of psychotic patients at Psychosocial Attention Centers regarding its clinical and organizational functions. Data collection was carried out in two cycles of focus groups consisting of professionals, users and their relatives in the six Psychosocial Attention Centers located in Campinas (SP), as well as through in-depth interviews of the users. The elaborated material shows that all the Psychosocial Attention Centers are organized by staffs of reference. Their professionals monitor patients closely and regularly, configure themselves as professionals of reference and take on the responsibility for therapeutic projects and the collective discussion of the cases. This type of organization was assessed positively by all the subjects of the research. Users and their families consider the professionals of reference as crucial for the development of the treatment. They highlight reliability as one of the main pillars of the therapeutic relationship and further state that this relationship is built up through conversations, the feeling that their specific needs are being perceived, and the support they get to solve practical issues. The workers point out the potential of the staffs of reference for the sharing and co-responsibility of the cases. They recognize the uniqueness and intensity of the relationship between professionals of reference and users, but also draw attention to some paradoxes inherent to the arrangement, such as the tensions between care and tutelage, permanent attention given to the patient and control, as well as emotional closeness and narcissistic identification. Based on the psychoanalytic referential, this thesis presents a discussion about some of the emotional needs of psychotic patients and the potential of the arrangement to meet them. We point out that the success of that work depends on the collective support it gets, which is to be built by the different participants that involve the user and the service in an ongoing effort of critical analysis. We therefore suggest a reflection on an ethical position based on the ability of the professional to get genuinely involved with his/her patients and, at the same time, to step back and let them trace the meanings of the treatment / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

Trente ans après la mort de Lacan, les conséquences concernant la cure tirées de son enseignement sur les psychoses méritent une révision pour la période 1981-2011. Aujourd’hui, de nombreux analystes lacaniens traitent des patients psychotiques et essayent de rendre compte des effets. Pourquoi la psychanalyse s’avère-t-elle opérante dans l’abord des psychotiques? Bien que les effets de l’abord analytique soient reconnus par les analystes, leur théorisation entraîne des paradoxes comme celui qui soutient qu’il n’y a pas de désir dans les psychoses. Dans la mesure où Lacan a promu une éthique analytique fondée sur la fonction du désir de l’analyste comme ressort du transfert, l’exil du désir psychotique de la théorisation est contradictoire avec l’idée d’une cure possible. Celle-ci risque de se transformer en une thérapeutique. Cette recherche propose de réintroduire le concept de désir dans la théorisation de la cure analytique des psychoses. Tout d’abord, cette thèse s’est révélée nécessaire pour élucider les modifications de la position subjective repérées dans des cas de patients mélancoliques dont la présentation mortifiée initiale a connu une réversion vers la persécution. Le passage d’un désir aboli à un essai d’instituer le désir dans l’Autre exige de considérer que la psychose aussi est une affaire de désir. La question ne serait pas celle de l’absence du désir, sinon celle des modalités de support du désir que chaque patient psychotique pourrait mettre en place. L’abord analytique démontre à ce niveau son efficacité, qui n’est pas toujours garantie car dépendante d’une rencontre entre le psychotique et le désir de l’analyste. / Thirty years after Lacan’s death, the consequences around the cure derived from his teaching on psychosis deserve a review for the period 1981-2011. Today, many Lacanian analysts treat psychotic patients and try to account the effects. Why psychoanalysis appeared to be operative addressing psychotics? Although the effects of the analytical approach are recognized by analysts, their theory leads to paradoxes such as the one which states that there is no desire in the psychoses. Insofar as Lacan has developed an analytical ethic based on the function of the desire of the analyst as the essence of transference, the exclusion of the psychotic desire from the theory is contradicts to the idea of ​​a possible cure. This could turn into a therapeutic treatment. This investigation suggests that the concept of desire should be integrated in the theories concerning the analytic treatment of psychoses. First of all, this hypothesis seems to be necessary to account for changes in the subjective position identified in cases of melancholic patients whose initial mortification had a reversion to persecution. The passage of an abolished desire to a restitution of desire in the Other implies the statement that psychosis is also a matter of desire. The point is not the absence of desire, but the ways that every psychotic subject can implement for support of the desire. The analytical approach demonstrates its effectiveness at this level, but this effectiveness is never guaranteed because it depends always on a meeting of the psychotic with the analyst’sdesire.

Magister Psychologiae - MPsych / Adolescent pregnancy has been of longstanding societal concern primarily because of the inability of most young mothers to provide adequately for their infants. Depression often results in disengagement from mother-child interaction. Adolescent mothers identified as depressed are at increased risk of future psychopathology, with additional deleterious effects on their infants’ lives. The purpose of this study was to explore adolescent mothers’ experiences of motherhood and memories of feeling depressed during or after the birth of their babies. The first aim was to explore the young women’s experiences of mothering, by focusing upon the practice of being a mother. The second aim was to explore the young women’s experiences of depression, by focusing on their physical behaviour and emotional experiences. The third aim was to explore their perceptions of the causes of their depression. The rationale for this study was that these issues will further enhance the body of knowledge available to practitioners working with adolescent mothers. It will also provide a source of insights and hypotheses for preventive intervention research. The study was located within a feminist standpoint framework that begins from the perspective of women with the aim to explore women’s accounts of their experiences in relation to depression as an important source of knowledge. A qualitative research design and methodology was employed in the region of the Western Cape. Eight adolescent mothers between the ages of 16 and 19 were recruited and interviewed. The interviews were semi-structured and consisted out of open-ended questions. Interviews were recorded, transcribed verbatim and thematic analysis of data was carried out. The findings of this research yielded some interesting areas for future research and implications for treatment and intervention with first-time adolescent mothers. The adolescent mothers in this study experienced similar depressive symptoms to adult mothers in previous research. All the participants revealed that they feared their parents’ disappointment in them for being pregnant. This factor contributed to their depression, because they received very little (if any) support from their parents or the father of their baby. The participants discussed that their pregnancy or giving birth was linked to various aspects of themselves that they had lost as an adolescent. Before they received counselling, none of the participants understood why they experienced depressive symptoms or what was happening to them at the time after their pregnancies. / South Africa

The current study utilized structural equation modeling (SEM) to examine the factor-to-factor relations and temporal associations between disturbances in negative affect (NA) and positive symptoms of psychosis (PP). Data were drawn from a large, public-domain data set (MacArthur Violence Risk Assessment Study). A dimensional approach was used to conceptualize and identify latent variables of NA (depression, anxiety, and guilt) and PP (hallucinations, delusions, and thought disorder) among individuals with a diagnosis of primary psychotic disorder. Results showed that anxiety, guilt, and depressed mood modeled an NA latent variable, and that hallucinations and unusual thought content modeled a PP latent variable. As predicted, results revealed strong, significant cross-sectional (synchronous) associations between NA and PP at each measured time-frame, suggesting that NA and PP occurred concurrently within the sample. Contrary to predictions, no significant cross-lagged effect between NA and PP was identified (10 weeks and 20 weeks respectively).

A diagnostic classification of Borderline subgroups was developed for the purpose of reducing the current ambiguities existing in the range of pathologies between the psychoses and neuroses. This classification is a questionnaire of forty items and is intended to be used in treatment settings as a measure of object relations, i.e., of ego development and arrest. The criteria which define the Borderline subgroups were derived from the normative developmental data of Mahler, Pine, and Bergman (1975). In Experiment I, raters used the Mahler criteria as operational definitions of the developmental stages and sorted 180 items taken from Benjamin's structural Analysis Social Behavior (SASB) into the four Mahler substages. Those items which were reliably sorted eight out of nine times into the same Mahler stage or substage were retained as critical items to be administered in Experiment II to three groups of subjects. These groups consisted of nineteen schizophrenic inpatients, eighteen outpatients, and twenty nonpsychiatric volunteers. These subjects rated each item of the SASB questionnaire on a scale of 0 to 100; means for each type of psychiatric group according to sex were submitted to a repeated measures 2 (sex) X 3 (group) X 4 (Mahler substage) Analysis of Variance.

Background: It is known that both severe mental illness and violence have genetic components. Multiple genes play a role in the cause of violent behaviour. Violence is one of the leading causes of death for young people in South Africa and yet little is known about its prevalence in state patients and their family members. Aim: This study aimed to investigate the prevalence of violence and mental illness in the families of state patients, to what extend these coincide and to compare schizophrenia and mood psychosis in that context. Setting: The study included 60 state patients' folders, all of whom were diagnosed with a psychotic disorder, in accordance with DSM5 criteria. The subjects were divided into two groups: those who have committed violence and those who have not committed violence. Method: Patients' folders were selected by purposive sampling. These folders were then reviewed by the researcher and a questionnaire was completed. Results: Violent patients had more first-generation relatives with violent convictions (68.2%), compared to 36.4% of non-violent patients. Only 3.3% of non-violent patients witnessed domestic violence, whereas 13.3% of violent patients witnessed domestic violence. A significantly higher proportion of patients with bipolar disorder had been convicted of physical assault (p=0.035). 17.6% of violent schizophrenia patients had a family history of violence and mental illness, compared to 18.2% of violent patients with mood psychoses which is not statistically significant. Conclusion: It was found that violence runs in families and that mental illness and violence was prevalent in the described group. Of further concern was that more violent patients witnessed domestic violence compared to non-violent patients, emphasising the idea that the cause of violence is multifactorial (genetic, environmental), and that identification of not only high-risk patients but also high-risk families need to be implemented.