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Autonomy has become the highest value in our society, and while it is having an impact on the debate on a future law on medical assistance in dying, it is also opening the door to a reflection on vulnerability. Although seemingly unaffected, at least initially, psychiatry could join the field of this reflection and bring out the avenues of renewal.

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Resumo: Este artigo pretende analisar e discutir a dimensão sociopolítica do sofrimento presente nas narrativas de três mulheres brasileiras revertidas à religião islâmica. As reflexões são oriundas de uma pesquisa clínico-qualitativa que, por meio de trabalho de campo e de entrevistas abertas, busca compreender as concepções e experiências de muçulmanas brasileiras em relação à saúde mental e tem como um de seus eixos emergentes os atravessamentos de questões sociais sobre o psiquismo dessas mulheres. As interlocutoras desafiam as concepções reducionistas e individualizantes da saúde mental, evidenciando que o adoecimento psicológico mantém estreita relação com a violência, a negligência, o desamparo e a exclusão, aos quais estão constantemente submetidas.

Abstract: This study analyzes and discusses the socio-political dimension of suffering revealed in the narratives of three Brazilian Muslim women. A clinical-qualitative research was conducted by means of fieldwork and interviews to understand Brazilian Muslim women's views and experiences concerning mental health and to investigate the influence of social issues on their psyche. The interviewees challenge the reductionist and individualistic perspective on mental health, showing that psychological illness is closely related to the violence, negligence, helplessness, and exclusion to which they are constantly exposed.

Résumé : Cet article analyse et discute la dimension sociopolitique de la souffrance dans les récits de trois femmes musulmanes brésiliennes. Une recherche clinique-qualitative a été menée par le biais des études sur le terrain et des entretiens pour comprendre les conceptions et les expériences des femmes musulmanes brésiliennes concernant la santé mentale et pour étudier l'influence des questions sociales sur leur psychisme. Les interviewées remettent en question le réductionnisme et l'individualisation de la santé mentale en montrant que la maladie psychique entretient un rapport étroit avec la violence, la négligence, l'impuissance et l'exclusion dont elles sont victimes.

Resumen: Este estudio tuvo como objetivo analizar y discutir la dimensión sociopolítica del sufrimiento en las narrativas de tres mujeres brasileñas revertidas al Islam. Los datos provienen de una investigación clínico-cualitativa que utilizó trabajo de campo y entrevistas abiertas para comprender las concepciones y las experiencias de mujeres musulmanas brasileñas con relación a la salud mental, y tuvo como uno de sus ejes centrales la influencia de las cuestiones sociales en el psiquismo de estas mujeres. Las participantes critican concepciones reduccionistas e individualizantes de la salud mental mostrando que la enfermedad psíquica tiene estrecha relación con la violencia, la negligencia, la indefensión y la exclusión a la cual se ven sometidas.

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Resumo: Este artigo busca problematizar como o discurso sobre a depressão, nas três primeiras edições do Manual diagnóstico e estatístico de transtornos mentais , efetuou a apropriação da contradição sofrimento-patologia. Para tanto, a análise foi orientada pelos princípios da análise de discurso francesa, de Michel Pêcheux, desenvolvida, no Brasil, por Eni Orlandi. O estudo salienta que: 1) as duas primeiras edições do manual apresentavam a depressão como efeito; a partir da terceira há um entendimento da depressão enquanto causa; 2) nas duas primeiras edições do manual, sofrimento e patologia são um único e mesmo objeto, já na terceira edição ocorre uma cisão entre essas esferas; 3) o mecanismo discursivo da antecipação pode contribuir para a compreensão do processo de apagamento do sujeito da enunciação pelo sujeito do enunciado nos manuais diagnósticos.

Abstract: This paper problematizes how the discourse on depression upheld by the first, second and third editions of the Diagnostic and Statistical Manual of Mental Disorders appropriated the distress-pathology contradiction. Based on the principles of Michel Pêcheux's French Discourse Analysis, developed, in Brazil by Eni Orlandi, the study emphasizes that: 1) the manual's first and second editions understood depression as an effect, whereas the third depicted it as a cause; 2) in the first and second editions distress and pathology were one and the same, but the third edition splits them into two different spheres; 3) anticipation, as a discursive mechanism, can help to comprehend the process by which the subject of enunciation is suppressed by the subject of the statement in the diagnostic manuals.

Résumé : Cet article problématise la façon dont le discours sur la dépression soutenu par les trois premières éditions du Manuel diagnostique et statistique des troubles mentaux s'est approprié la contradiction souffrance-pathologie. Basée sur les principes de l'analyse du discours français de Michel Pêcheux, développée au Brésil par Eni Orlandi, l'étude souligne que : 1) les deux premières éditions du manuel considèrent la dépression comme un effet, alors que la troisième la décrit comme une cause ; 2) dans les deux premières éditions, la souffrance et la pathologie sont une seule et même chose, tandis que la troisième édition sépare ces sphères ; 3) l'anticipation, en tant que mécanisme discursif, peut aider à comprendre les processus par lequel le sujet de l'énonciation est supprimé par le sujet de l'énoncé dans les manuels diagnostiques.

Resumen: Este artículo busca problematizar cómo el discurso sobre la depresión, en las tres primeras ediciones del Manual Diagnóstico y Estadístico de los Trastornos Mentales , se apropió de la contradicción sufrimiento-patología. Para ello, el análisis se guio por los principios del análisis del discurso francés, de Michel Pêcheux, desarrollado por Eni Orlandi en Brasil. El estudio destaca que: 1) las dos primeras ediciones del manual presentaban la depresión como un efecto, a partir de la tercera hay una comprensión de la depresión como causa; 2) en las dos primeras ediciones del manual, el sufrimiento y la patología son un mismo objeto, por otro lado, en la tercera edición hay una escisión entre estas esferas; 3) el mecanismo discursivo de anticipación puede contribuir a la comprensión del proceso de supresión del sujeto de la enunciación por el sujeto del enunciado en los manuales diagnósticos.

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Neste artigo propomo-nos a construir uma reflexão teórico-prática sobre os modos de vulnerabilidade produzidos ou desencadeados nas dimensões territorial, econômica, histórica, social, cultural e psicopolítica da experiência humana, cujos efeitos se entrelaçam nas histórias dos sujeitos no interior da escola. Para tal discussão, apresentaremos alguns autores que abordam o conceito de vulnerabilidade. Em seguida, proporemos um conceito de vulnerabilidade que a diferencia do fenômeno do desamparo, mas que com ele se relaciona. A partir disso, apresentaremos algumas vinhetas oriundas de uma pesquisa científica1 que nos permitiu indagar como tais fenômenos se apresentam dinamicamente no contexto escolar. Concluímos que a vulnerabilidade se apresenta na escola como atualizações do desamparo, matizadas pelas condições ambientais e pelo desejo do sujeito, o qual busca modos de enfrentamento do paradoxo entre alienação e desalienação.

Resumos In this article we propose to make a theoretical-practical reflection on the modes of vulnerability that can be produced or triggered in the territorial, economical, historical, social, cultural, and psychopolitical dimensions of human experience, whose effects are intertwined with the stories of the subjects inside the school. For such a discussion, we will present some authors who approach the concept of vulnerability. Then, we will propose a concept of vulnerability that differentiates it from the helplessness phenomenon, but is related to it. From this, we will present some vignettes from a scientific investigation that allow us to investigate how such phenomena dynamically present themselves in the school environment. We have concluded that the vulnerability presents itself at school as new forms of helplessness, nuanced by environmental conditions by the subject's desire, whom seeks to find ways to face the paradox between alienation and disalienation.

Dans cet article, nous nous proposons de construire une réflexion théorico-pratique sur les modes de vulnérabilité produits ou déclenchés dans les dimensions territoriale, économique, historique, sociale, culturelle et psychopolitique de l'expérience humaine, dont les effets sont imbriqués dans les histoires des sujets à l'école. Pour cette discussion, nous présenterons quelques auteurs qui ont abordé le concept de vulnérabilité. Nous proposerons ensuite un concept de vulnérabilité qui se différencie du phénomène d'impuissance, mais qui lui est apparenté. Sur cette base, nous présenterons quelques vignettes issues de la recherche scientifique qui nous ont permis d'étudier la façon dont ces phénomènes se présentent de manière dynamique dans le contexte scolaire. Nous concluons que la vulnérabilité se présente à l'école comme des actualisations de l'impuissance, nuancées par les conditions environnementales et le désir du sujet, qui cherche des moyens de faire face au paradoxe entre l'aliénation et la désaliénation.

En este artículo nos proponemos construir una reflexion teórico-práctica sobre los modos de vulnerabilidad que pueden ser producidos o desencadenados en las dimensiones territorial, económica, histórica, social, cultural y psicopolítica de la experiencia humana, cuyos efectos se entrelazan en las historias de los sujetos dentro de la escuela. Para esta discusión, presentaremos algunos autores que abordan el concepto de vulnerabilidad. Luego, propondremos un concepto de vulnerabilidad que la diferencia del fenómeno de la indefensión, pero que se relaciona con él. A partir de ello, presentaremos algunas vinetas oriundas de una investigación científica que nos permitan indagar cómo tales fenómenos se presentan dinamicamente en el contexto escolar. Concluímos que la vulnerabilidad se presenta en la escuela como actualizaciones de la indefensión, matizadas por las condiciones ambientales y por el deseo del sujeto, el cual busca modos de enfrentamiento a la paradoja entre alienación y desalienación.

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The decision to become a donor is an altruistic one. It allows infertile couples wishing to have a child to realize their dream. Although there have been developments in recent years concerning the lifting of donor anonymity, there is still progress to be made. Joseph Geantet is one of the people who have chosen to donate sperm. He shares his experience.

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The emotional load and the confrontation with the end of life and death that health professionals regularly endure are occupational health and public health issues. Understanding their deleterious effects on the health of caregivers is only a first step, which must be followed by the identification of the various levers of action that can be mobilized.

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The right to deep and continuous sedation maintained until death was introduced by the law known as the Claeys-Leonetti law. It is no longer a question of reversible sedation, but of maintaining the patient in a deep sleep, without waking, until death. It can be put into care in specific cases. The  borderline between euthanasia and this sedation implemented at the end of life lies in the intentionality of the medical act.

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Caring for people at the end of life is a risk for the caregiver: he or she is touched by the person's suffering and his or her own powerlessness is revealed. The team is the essential link in this support and communication must be liberated so that fears can be expressed.

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Nursing students are confronted with the mysteries of the patient encounter during their internship in psychiatry. From this discovery, questions and enigmas remain to be solved. This ephemeral primary relationship, in a time span of a few weeks, is a source of frustration for them. In this context, the presence and professionalism of the team are precious assets that the student must seize. Discovery of the profession of psychiatric nurse illustrated by the testimonies of two students.

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Neste artigo analisamos a forma pela qual a "agressividade infantil" foi incluída nos sistemas de classificação do DSM ao longo de suas sucessivas edições. Primeiramente, identificamos as transformações significativas no uso desse signo clínico. Em seguida discutimos as consequências clínicas e políticas dessas transformações, tanto na formulação de uma psicopatologia própria à infância quanto na definição social dos quadros de normalidade e de desvio em relação à conduta. Observamos, por fim, que a pretensa regulação da infância pela produção de discursos normativos a respeito da agressividade foi acompanhada pelo incremento das vias agressivas como forma privilegiada de expressão do mal-estar e de subjetivação do sofrimento. Nossa hipótese é que tal produção é reforçada pelas exigências neoliberais de performance, ignorando assim as demandas sociais e subjetivas de reconhecimento.

In this article, we analyze how "child aggressiveness" was included in the classification systems of the DSM throughout its successive editions. First, we identified the significant transformations in the use of this clinical sign. Then, we discuss the clinical and political consequences of its transformations, both in the formulation of a psychopathology specific to childhood and regarding the social definition of normality and conduct deviations. Finally, we observed that the alleged regulation of childhood by the production of normative discourses about aggressiveness was followed by the increase of aggressive expressions of discontent and subjectivation of suffering. Our hypothesis is that such production is reinforced by neoliberal demands of performance, thus ignoring social and subjective demands for recognition.

Dans cet article, nous analysons la manière dont "l'agressivité infantile" a été intégrée dans les systèmes de classification du DSM tout au long de ses éditions successives. Tout d'abord, les transformations significatives dans l'usage de ce signe clinique. Ensuite, nous discutons les conséquences cliniques et politiques de ces transformations, à la fois dans la formulation d'une psychopathologie propre à l'enfance et dans la définition sociale des cadres de normalité et déviation de la conduite. Nous observons enfin que la prétendue régulation de l'enfance par la production de discours normatifs sur l'agressivité s'est accompagnée de l'accroissement des voies d'agressivité comme formes d'expression du malaise et de subjectivation de la souffrance. Notre hypothèse est qu'une telle production est renforcée par des exigences de performance néolibérales, ignorant ainsi les exigences sociales et subjectives de reconnaissance.

En este artículo analizamos la forma en que la "agresividad infantil" fue incluida en los sistemas de clasificación del DSM a lo largo de sus sucesivas ediciones. Primeramente, identificamos los cambios significativos en el uso de ese signo clínico. Luego discutimos las consecuencias clínicas y políticas de estos cambios, tanto en la formulación de una psicopatología propia a la infancia como en la definición social de los cuadros de normalidad y de desviación de la conducta. Observamos, por fin, que la pretendida regulación de la infancia por la producción de discursos normativos respecto a la agresividad estuvo acompañada del aumento de formas agresivas como forma privilegiada de expresión del malestar y de subjetivación del sufrimiento. Nuestra hipótesis es que dicha producción se ve reforzada por las demandas neoliberales de performance, ignoran así las demandas sociales y subjetivas de reconocimiento.

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The evocation of the meaning of the patients' suffering and their quest for appeasement refocuses the reflection on the missions of the psychiatric hospital around reception and accompaniment. It reminds us above all of the role of the carers in psychiatry, between availability, listening and benevolence. The maintenance of the link between the caregiver and the patient, in an atmosphere of trust, is essential to the care and quality of the accompaniment. We must not forget this.

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Being a victim of violence and neglect during childhood can expose minors to significant health repercussions on the physical, psychological, psycho-affective and neuro-developmental levels.. Self- and hetero-aggressive violences in all age groups are now considered to be possible consequences of these severe adverse experiences. The place of the body is essential in this context. The body, often considered as the only tangible and opposable marker of violence, has a singular and integral place in the psyche and overall health. It is an important vector in order for professionals to have access to the child. The examination of the body allows the expression of violence and its formulation from a very young age, especially during clinical examinations in situations of possible danger. It also "speaks" in situations of malaise, growth disorder, self or heteroaggressive acts. During the adolescence, it can also be attacked by scarification, dietary restrictions, mutilations, early and risky sexual activity, prostitution.. By taking jointly both the body and the psyche, children and adolescents find a unity, are no longer fragmented. It is this unity that will allow the continuation of more specific care and more specifically child psychiatric support. This joint concern of paediatricians, general practitioners, child psychiatrists and psychologists will also ensure, particularly during adolescence, the continuation of health monitoring. It is essential to think about these collaborations from the first meeting with children and adolescents who are victims or perpetrators of violence. Encountering child and adolescent victims of violence confronts practitioners with a reality that is difficult to see and to conceive. Although the continuum between suffered violence and perpetrated violence seems to be better known today, these different situations remain difficult to understand and to manage. We believe that the violence that is perpetrated can be a screen for the causes of the violence and for the response to the needs of minors, particularly in terms of health. For practitioners, going to meet children and adolescents who are perpetrators of violence entails to be able to take a "step aside" from the classical representations of aggression or aggressiveness, whether they are directed towards third parties or towards the minor himself. Access to the somatic examination and medical history of these children or adolescents must be fully integrated from the first meeting. Associating health in all its aspects (somatic, psychic and social) then allows for specific care to be provided, regardless of their nature and place. This initial integrated practice allows us to take care of children and adolescents and highlights the notion of otherness that is undermined in situations of violence or neglect, particularly when they occur in the family environment. This initial joint somatic and psychological care in a single unit enables re-establishment of a dialogue with the minors and their parents. The shared competencies and the links that unite these different professionals together constitutes already therapeutic care. By reintroducing a dialogue about the children and adolescents and their overall health, the response to their needs can be perceived as a common and reachable objective that inscribes the minor in the temporality and extracts him or her from the immediacy of a punctually repressed act.

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Working in a palliative care unit raises a number of questions for carers relating to suffering and death. This case study of a Catholic nurse investigates the link between spirituality and caregiving by exploring her subjective relationship to the work of caregiving.

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Often ignored, reduced or refuted by caregivers, the patient's spiritual dimension should be fully integrated into the support offered to him. In no way reducible to religion, it relates to what is most profound as a singular being, and as such, the intervention of the psychologist can be particularly helpful.

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Accompanying newborns in palliative care remains difficult for professionals. Representations, fears and real difficulties are all factors that put them to the test. Supervision in conjunction with a pediatric palliative care resource team could be an effective way to prevent burnout and improve the quality of care.

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The life of young girls and boys with congenital breast and thoracic malformations is more a matter of survival than of living, burdened by severe body image damage. Positively changing their lives is what these girls or young men are calling us to do. Our duty is certainly to understand their malformation, but also to understand its repercussions and thus to draw the most appropriate treatment. It is in this perspective that this report should be read.

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Esta avaliação participativa junto a trabalhadores dos Centros de Atenção Psicossocial Infantojuvenil de um município de grande porte do sudeste brasileiro enfoca o processo de trabalho e sua relação com o sofrimento institucional, na perspectiva de René Käes. O curso ofertado para tal envolveu a construção e validação de narrativas junto a trabalhadores, pactuação de indicadores de avaliação e um guia de boas práticas. Os trabalhadores expressaram modalidades de sofrimento institucional relacionadas com: condições de trabalho, relações na instituição, falta de espaço de diálogo e formação permanente, como a supervisão clínico-institucional. Manifestaram ainda uma importante identificação com os valores das reformas sanitária e psiquiátrica e com a história peculiar das políticas de saúde no município, que contribuiu para a manutenção do que Onocko-Campos denomina "ilusão institucional".

Resumos This participatory evaluation involving workers from Psychosocial Care Centers for Children and Adolescents in a large city in southeastern Brazil addresses the work process and its relationship with institutional suffering from the perspective of René Käes. A course was offered to workers that involved the construction and validation of narratives, an agreement on evaluation indicators and a guide to good practices. Workers expressed different types of institutional suffering that was related to working conditions, relationships at the institution and lack of spaces for dialogue and permanent training, such as institutional clinical supervision. They also showed that they are highly identify with the values of the health and psychiatric reforms, as well as with the city's peculiar history of health policies, which contributed to keep up what Onocko-Campos calls "institutional illusion".

Le travail fait partie d'une évaluation participative avec des travailleurs des Centres de Soins Psychosociaux pour Enfants et Adolescents dans une grande ville du sud-est du Brésil, où nous abordons le processus de travail et son rapport avec ce que René Käes conceptualise comme souffrance institutionnelle. Un cours a été proposé qui impliquait la construction et la validation de récits avec les travailleurs, un accord sur des indicateurs d'évaluation et un guide de bonnes pratiques. Les travailleurs expriment de différents types de souffrances institutionnelles qui sont liées aux conditions de travail, aux rapports dans l'institution et au manque d'espaces de dialogue et de formation permanente, comme la supervision clinique institutionnel. Ils manifestent également une identification importante avec les valeurs des réformes sanitaires et psychiatriques, ainsi qu'avec l'histoire particulière des politiques de santé de la municipalité, ce qui a contribué à la préservation de ce que Onocko-Campos appelle « l'illusion institutionnelle ¼.

Esta evaluación participativa con los trabajadores de los Centros de Atención Psicosocial para Niños y Adolescentes de un gran municipio de la región sureste de Brasil se enfoca en el proceso de trabajo y en su relación con el sufrimiento institucional, desde la perspectiva de René Käes. Para este fin, se ofreció un curso que incluía la construcción y validación de narrativas con los trabajadores, el consenso sobre los indicadores de evaluación y una guía de buenas prácticas. Los trabajadores expresaron diferentes tipos de sufrimiento institucional relacionados con: las condiciones de trabajo, las relaciones en la institución, la falta de espacios de diálogo y de formación permanente, así como con la supervisión clínica institucional. También manifestaron una importante identificación con los valores de las reformas sanitaria y psiquiátrica, y con la peculiar historia de las políticas de salud en el municipio, que contribuyeron al mantenimiento de lo que Onocko-Campos denomina "ilusión institucional".

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El trabajo hace un recorrido por los avatares sufridos por las familias, los niños y los adolescentes durante la pandemia y sus consecuencias psíquicas. También plantea el lugar de los psicoanalistas y la necesidad la escucha del sufrimiento infantil y adolescente, así como la importancia de que se pueda transformar lo vivenciado en historia. Se hace hincapié en la importancia de sostener lazos sociales para amparar a niños y adolescentes en situaciones de catástrofe sostenida AU

The written work goes through the vicissitudes of lives suffered by families, children and adolescents during the pandemic and its psychological consequences. It also frames the position of psychoanalysts and the need to listen to child and adolescent suffering, as well as the importance of transforming what has been experienced into history. Emphasis is placed on the importance to hold social ties to protect children and adolescents in situations of sustained catastrophe AU

L'ouvrage fait le tour des péripéties subies par les familles, les enfants et les adolescents pendant la pandémie et ses conséquences psychologiques. Elle pose aussi la place des psychanalystes et la nécessité d'écouter la souffrancede l'enfant et de l'adolescent, ainsi que l'importance de transformer ce qui a été vécu en histoire. L'accent est mis sur l'importance du maintien du lien social pour protéger les enfants et adolescents en situation de catastrophe durable AU

A trabalho escrito faz um percurso pelas vicisitudes sofridos pelas famílias, as crianças e adolescentes durante a pandemia e suas consequências psicológicas. Também levanta o lugar do psicanalista e a necessidade de escutar o sofrimento da criança e do adolescente, bem como a importância de transformar o vivido em história. Ressalta-se a importância de manter laços sociais para proteger crianças e adolescentes em situações de catástrofe sustentada AU

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OBJECTIVE: To compare two portable lactate devices, Lactate Scout and StatStrip Xpress, to a laboratory reference device by assessing the concordance of cord blood lactate values at birth. METHODS: We conducted a single-center prospective validation study in a level 3 maternity hospital. For all cord samples taken at birth, we analyzed lactates on the reference device (GEM4000®) and on two portable devices Lactate Scout and StatStrip Xpress. We compared the lactate values from each of the two handheld devices to the reference device. RESULTS: A total of 101 samples were collected. Each was analyzed by all three machines. The average lactate value obtained by the different machines was 3.7mmol/L. The mean difference between the Lactate Scout and GEM4000® apparatus was 0.0mmol/L±0.8mmol/L. Between these two devices at lactate threshold of 4.8mmol/L, the negative predictive value was 96,2% (76/79) and the area under the curve was 0.98 (95% CI 0.96-1]. The mean difference between StatStrip Xpress and GEM4000® was 0.1mmol/L±0.7mmol/L. Between these two devices at the lactate threshold of 4.8mmol/L, the negative predictive value was 97,4% (76/78) and the area under the curve was 0.95 (95% CI 0.86-1). CONCLUSION: There is a good correlation between the lactates obtained by the reference device and the two portable devices Lactate Scout and StatStrip Xpress.

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Sickle cell disease is a chronic pathology which can be expressed as early as the first few months of life. There are many psychological repercussions, linked to the effects of the disease itself, to its impact on the patients' relational life and, for some, to exile and cultural differences. Psychological support is useful for both the patient and his or her family, particularly at key moments in the treatment process.

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