Esta dissertação procura analisar as configurações do humano e de seus limites no conto Rútilo nada, de Hilda Hilst. A questão das fronteiras do humano foi estudada a partir de uma análise da abordagem de Hilda Hilst aos temas da morte e do amor, bem como de uma interpretação das imagens de animalidade presentes no texto. / This work seeks to analyse human configurations and its limits in Hilda Hilsts short story Rútilo nada. The issue of human boundaries was studied within an analysis of the themes of death and love, as well as from an interpretation of the animal images present within the text. The bibliographical referential employed comprehends mainly philosophy, psychoanalysis, and anthropology texts.

Esta dissertação procura analisar as configurações do humano e de seus limites no conto Rútilo nada, de Hilda Hilst. A questão das fronteiras do humano foi estudada a partir de uma análise da abordagem de Hilda Hilst aos temas da morte e do amor, bem como de uma interpretação das imagens de animalidade presentes no texto. / This work seeks to analyse human configurations and its limits in Hilda Hilsts short story Rútilo nada. The issue of human boundaries was studied within an analysis of the themes of death and love, as well as from an interpretation of the animal images present within the text. The bibliographical referential employed comprehends mainly philosophy, psychoanalysis, and anthropology texts.

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Background and objectives: Stress-related illness is a growing public health problem in Sweden and it is the most common reason for sick leave today. Stress-related illness causes suffering on a number of levels and affects the patient’s health and life in the long term. The stress-related ill health also leads to consequences for society, causing high costs for sick leave and health care as well as lost workforce since people partially or entirely lose their capacity to work. Research on stress-related ill health and rehabilitation often underline work-related conditions as crucial in dealing with the problem. There is also research that points out psychosocial factors in understanding stress-related ill health. What we know little about is the existential perspective of clinical burn-out. Therefore, it is of importance to investigate people’s existential experiences of clinical burn-out and the significance of an existential perspective in rehabilitation. Aim: The overall aim of this thesis is to gain insight into the existential experience of clinical burn-out as well as to highlight the significance of an existential perspective in rehabilitation. In addition, the thesis aims to reach a deeper understanding of clinical burn-out from an existential point of view and contribute to the field with knowledge of the existential dimension of health. Methods: The study, conducted in 2011, is based on qualitative interviews made with an inductive hermeneutic approach. Five patients and seven care givers were interviewed, focusing their existential experiences of clinical burn-out as well as their experiences of rehabilitation with an existential approach. A strategic selection was made of informants in the context of a rehabilitation program with an existential approach for people diagnosed with clinical burn-out. The data was analysed in two steps. In the first step the data was interpreted with an inductive hermeneutic approach. In step two of the analysis, the data was interpreted with a deductive hermeneutic approach, using Karl Jasper’s concept of limit situation as a way of interpreting the existential experience. Aaron Antonovsky’s concept sense of coherence was used as a tool for understanding components that can contribute to restoring health. Results: In this study, the patients describe clinical burn-out as a comprehensive existential experience that can be perceived as being in between life and death, in a shadow world, trapped in a dead end. It’s a situation characterized by being powerless. It creates a need to comprehend one’s situation in order to be able to regain control and manage it. It’s a struggle to make sense of the life situation. When not being met with understanding, the patients lose hope. Existential issues in terms of meaning, existence and life choices become urgent. Working with the existential perspective requires trust, openness from both caregiver and patient, distinctness, a way to communicate it and courage to take on the challenge of dealing with existential issues. The perspective also requires that the existential suffering can be contained. Dealing with existential questions leads to self-knowledge and insights that enables a possibility to make different choices and leave negative behavioural patterns. Also, it can lead to a discovery of spirituality and religion as a resource in life. Besides their personal struggle for meaning, the patients see an existential void in society, leaving people without tools to handle existential needs. This is understood as something that affects people’s ability to handle stressful times in life. The care providers understand burn-out as a manifestation of a way of living that is not sustainable. It is an existential experience embodied in body and mind that can be experienced as being drained of life. It’s an existential challenge, causing grief when realizing one’s limitations as a human being. Also, loss of meaning and sense of existential vulnerability due to an experience of being annihilated is crucial for understanding the deep existential crisis that clinical burn-out can induce. This situation makes the patient ask existential questions about identity, meaning, values and direction. In the burnout-process the patients have distanced themselves from their own self and therefore need to reconnect with themselves. This makes the existential questions central in the rehabilitation as a way to reconnect to inner strength and resources, which are prerequisites for starting a health promoting, sustainable process which is empowering, making it possible to see oneself as a human being who experience meaning, not only as a patient with a diagnosis. Instead of finding meaning in the diagnosis, the patient’s existential questions and the existential experience is a key to moving forward, out of the situation. Meaning-making is therefore important in the rehabilitation. A holistic-existential approach and view of man makes it possible to work with the complexity of the situation. The holistic-existential approach creates synergies and offers an extra tool both for the caregiver and the patient. Focusing on the patient’s resources and competence makes it possible to see the crisis as a way to learn from it. The existential perspective in health care and rehabilitation is enabled by competence, openness, reliance, empathy and respect when meeting the patient. It also requires courage to take on the challenge of dealing with existential issues. It can be hard for both the patient and the care giver to confront existential suffering. It is the responsibility of the care giver to enable the existential perspective by acknowledging and making the existential perspective possible to communicate and work it through. The care providers understands values in modern society as contributing to people’s experience of feeling alone with existential needs, which intensifies their existential aloneness. The care providers’ experience is that the biomedical paradigm aggravates an existential perspective. The perspective is not associated with the care situation. There is a lack of knowledge about and understanding of the value of the existential perspective, all the way from the decision-making level to the clinical meeting with the patient. In addition, the paradigm affects how the patients express their illness. Also, the perspective requires time. Existential perspectives, therefore, tend to be concealed in the health care context. Applying Karl Jasper’s concept of limit situation, clinical burn-out can be interpreted as a defining existential experience. It can be understood as a limit situation when humans realize their limitations and at the same time get insights that are crucial for their lives. It’s an experience they wish they had not gone through, but on the other hand, it has led to insights they do not want to be without. The meaning-making process is health promoting by recreating meaning, the fundamental part of sense of coherence, which is crucial for a salutogenic direction. Conclusion: The existential state that the clinical burnout patients go through can, using Karl Jasper’s concept, be understood as a limit situation. According to Jasper’s reasoning, the limit situation can be perceived as facing an abyss, making it clear one has limitations as a human being. At the same time, the experience can be perceived as reaching a limit where humans can get insights about human life that can enhance life. Clinical burn-out, using Aaron Antonovsky’s concept, can be understood as a loss of the components that create sense of coherence. Loss of meaning is particularly central for understanding burn-out. Consequently, it is crucial to acknowledge the existential challenge that the patient is facing, as well as the importance of the meaning-making process for facilitating a movement in a health promoting manner. It gives a deeper understanding of the challenges and needs of patients suffering from clinical burn-out. The existential dimension of health has been highlighted in health promotion, but gets little attention in practice. This is especially significant in the health care context. This points out the need for a discussion about how the existential health dimension can be used as a resource in health care and rehabilitation and how this resource for health can be applied in a better way in health promotion and public health.

Made available in DSpace on 2016-04-04T18:27:55Z (GMT). No. of bitstreams: 1 Ana Paula Gomes Moreira.pdf: 2034442 bytes, checksum: 75e3a66dafdd6737a6288c97989e7446 (MD5) Previous issue date: 2010-12-07 / This work is circumscribed within the framework of School Psychology, as a field of application, research and intervention. Its development tried to discuss the application of the concept of limit-situation, created by Ignacio Mart?n-Bar?, to the context of early childhood education. The limit-situation refers to the situation that somehow plays negative impact to the development of children. We believe the development process as a dynamic and historically process detailed, so the discussion is linked to notions of risk, protection, vulnerability and resilience. Based on the principles of Liberation Social Psychology and the Historical and Dialectical Materialism, we made an analysis of field diaries produced by professionals of psychology who worked in an Municipal Kindergarten School during 2008 and 2009. Then, we delimited the dimensions of everyday life or elements of reality that characterized the occurrence of limit-situations in the view of key agents involved with the Early Childhood Education: psychology professionals, educators and families and / or children. This elements emphasizes the dimensions of violence, conflicting relations between the educational team members and breakdown of education politics. / Este trabalho est? circunscrito nos marcos da Psicologia Escolar, enquanto ?rea de aplica??o, pesquisa e interven??o. A sua realiza??o buscou discutir a aplica??o do conceito de situa??o-limite, delineado por Ign?cio Mart?n-Bar?, ao contexto da Educa??o Infantil. A situa??o-limite refere-se ? situa??o que, de alguma forma, exerce impacto negativo sobre o desenvolvimento das crian?as. Entendemos o processo de desenvolvimento como din?mico e historicamente circunstanciado e, portanto, a discuss?o sobre situa??es-limite no ?mbito do desenvolvimento est? vinculada ?s no??es de risco, prote??o, vulnerabilidade e resili?ncia. Fundamentados nos princ?pios da Psicologia Social da Liberta??o e do Materialismo Hist?rico e Dial?tico, realizamos a an?lise dos di?rios de campo produzidos por profissionais de psicologia que atuaram em uma Institui??o Municipal de Educa??o Infantil no per?odo de 2008 a 2009. Delimitamos, por meio de um processo construtivo-interpretativo, grandes categorias referentes aos elementos da realidade que caracterizassem a ocorr?ncia de situa??es-limite na vis?o dos principais agentes envolvidos com a Educa??o Infantil: os pr?prios profissionais de psicologia, os educadores e a as fam?lias e/ou crian?as. A elabora??o de tais categorias demonstra que estes elementos referem-se, prioritariamente, ? dimens?es de viol?ncia, rela??es conflituosas entre os membros da equipe educativa e desagrega??o das pol?ticas de educa??o.

The purpose of the present study is to examine the signification of identitary discourses in the novel Sefarad: Una novela de novelas by Antonio Muñoz Molina and determine to what extent these discourses represent and respond to identitary discourses in contemporary Spanish society. The analysis focuses on three principal questions: how is the narrative constructed, what is conveyed as a result, and what is the aim of the narrative. Identity is understood as a social construction, an individual and continuous process of assuming, defining, negotiating and maintaining cultural identities, elements of the surrounding world that provide the individual with a sense of meaning (Fromm 1956; Castiñeira 2005; Marsella 2008). The novel consists of different stories that manifest the social impact of the totalitarian regimes in Europe during the twentieth century, told by a diversity of voices. First, the analysis deals with the structure of the text, examined through the model of mise en abyme (Dällenbach 1989). Secondly, the significations of transition, transgression (Lotman 1978) and, analogically, stigmatization are deduced (Goffman 1972), processes that are related to the effects of the frontier as a metaphor (Pratt Ewing 1998) and to limit situations (Jaspers 1974). Thirdly, the study stresses the representation of the past, in which trauma, melancholy and mourning are significant (Benjamin 1992; Freud 1986). The conclusions confirm the claim that the novel corresponds to humanity’s treasure of suffering (Leidschatz), a cultural possession that thematizes the processes of memory and oblivion (Assmann 1999), represented through stories told by the victims of intolerance at different levels. The text is accordingly conceived as a mirror through which the narrator constructs his identity as a writer and transmits meaning to the reader by providing the opportunity to reflect upon identity issues today.

The purpose of the present study is to examine the signification of identitary discourses in the novel Sefarad: Una novela de novelas by Antonio Muñoz Molina and determine to what extent these discourses represent and respond to identitary discourses in contemporary Spanish society. The analysis focuses on three principal questions: how is the narrative constructed, what is conveyed as a result, and what is the aim of the narrative. Identity is understood as a social construction, an individual and continuous process of assuming, defining, negotiating and maintaining cultural identities, elements of the surrounding world that provide the individual with a sense of meaning (Fromm 1956; Castiñeira 2005; Marsella 2008). The novel consists of different stories that manifest the social impact of the totalitarian regimes in Europe during the twentieth century, told by a diversity of voices. First, the analysis deals with the structure of the text, examined through the model of mise en abyme (Dällenbach 1989). Secondly, the significations of transition, transgression (Lotman 1978) and, analogically, stigmatization are deduced (Goffman 1972), processes that are related to the effects of the frontier as a metaphor (Pratt Ewing 1998) and to limit situations (Jaspers 1974). Thirdly, the study stresses the representation of the past, in which trauma, melancholy and mourning are significant (Benjamin 1992; Freud 1986). The conclusions confirm the claim that the novel corresponds to humanity’s treasure of suffering (Leidschatz), a cultural possession that thematizes the processes of memory and oblivion (Assmann 1999), represented through stories told by the victims of intolerance at different levels. The text is accordingly conceived as a mirror through which the narrator constructs his identity as a writer and transmits meaning to the reader by providing the opportunity to reflect upon identity issues today.

The overall purpose of this thesis is to illuminate meanings of living with severe chronic heart failure (CHF) in palliative advanced home care (PAHC) as disclosed through patients’, close relatives’ and nurses’ narratives. This thesis comprises four papers that illuminate the phenomenon from various perspectives and with different focus. In paper I four patients with severe CHF in PAHC were interviewed. In paper II three of their close relatives were interviewed. In paper III one man and his wife in PAHC were interviewed at 3-5 month intervals over a 4.5-years period. In paper IV 11 nurses in PAHC were interviewed. In all papers narrative interviews were conducted and the text was interpreted using a phenomenological-hermeneutic method. The result shows that meanings of living with severe CHF in PAHC is to be ‘knocking on death’s door’ yet surviving. This means never knowing what to expect of tomorrow as one suffers from a complex array of unpredictable, interwoven symptoms. The course of the illness forces sufferer to ride a symbolical ‘roller coaster’, an ongoing oscillation between ‘ups and downs’. Being offered a safety belt in the ‘roller coaster’ by the PAHC team means feelings of safety (I). Meanings of being a close relative of a person with severe CHF in PAHC is to be following the life- threatening ups and downs that the ill person goes through. It is like being a fellow passenger on the ‘roller coaster’ ride that is their loved one’s disease, with burdensome responsibility for easing the ‘downs’ and supporting the ‘ups’. This means being on primary call, always on standby to mediate security and pleasure. In the deepest downs it is also to call for the back-up call i.e. the PAHC team (II). Meanings of living the ‘ups and downs’ over time is being captive in a roller-coaster ride, side by side, with the ‘ups and downs’ caused by the illness. Living close to death is inescapable when recurrent periods of deepest ‘downs’ force one to face that one’s life together is coming to an end. The relationship between the spouses is severely tested but seems to withstand the strain and meaning is found in togetherness in life. Sharing the safety belt on the ‘roller coaster’, offered by the PAHC team, evokes feelings of security. However, the safety belt is adjusted to the man with severe CHF leaving the wife partly without comfort and at times uncertain, especially in the deepest ‘downs’ (III). Meanings of being a palliative nurse for patients with severe CHF in PAHC is being firmly rooted and guided by the values of palliative culture. Being a facilitator for the patient with CHF to live his/her everydaylife in the best way possible is difficult, challenging but overall positive. The nurses get into a tight corner when palliative culture values clash and do not correspond to nurses’ interpretation of what is good for the patient with severe CHF. There is a limit to nurses’ pliability to patients’ and close relatives’ will, as they are strongly convinced that resuscitation is not an option. Nurses have already made up their mind about that they do not perform heart- lung resuscitation (IV). The comprehensive understanding is that meanings of living with severe CHF in PAHC is being captive in a ‘roller-coaster’ life with varying periods between unpredictable improvement and deterioration of the body, for the rest of life. Living with the unpredictable, deteriorated body means to oscillate between enduring the suffering in ‘downs’ and enjoying life in ‘ups’ (I-III). Living with death so close over and over again i.e. being in a limit situation evokes feelings of uncertainty (I-IV) and confidence (I-III). Being positive dependent on PAHC facilitates a life as normal as possible in togetherness at home (I-IV). The comprehensive understanding of the four papers (I-IV) are discussed in the light of a theoretical framework from the German psychiatrist and philosopher Karl Jaspers thoughts about limit situation, the Danish philosopher K.E Lögstrup thoughts about the ethical demand, palliative theories and relevant empirical studies.