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Medium 9781855759107

2. Two ways of seeing

Margaret Cohen Karnac Books ePub

Two ways of seeing

… the traces of the storyteller cling to the story the way the handprints of the potter cling to the clay vessel.

Walter Benjamin, The Storyteller, 1999

When I applied for the child psychotherapy post at the neonatal intensive care unit of a large inner-city hospital, the part of the job description that caught my attention was that the post-holder would be expected to articulate the babies’ experience. I understood that I would also be required to be available to mothers, to fathers, to extended families, and to staff, that my job would be to listen and to try to understand their feelings. Although these latter things were difficult, I had some ideas about how to do them, some experience to fall back on. I was not too surprised that I felt rather superfluous in a busy unit, that I often wished I were a doctor and could be clear about what I should be doing and could do something useful, without feeling so full of ignorance and impotence. These are states of mind that psychoanalytically trained therapists are familiar with and learn to tolerate. But articulating these babies’ experience—that was something different. I rather fancied myself as knowing about babies; after all, I had had three of my own, and I had also done a two-year baby observation as part of my training and had supervised others doing such observations here in London and for many years in Italy. But these babies on the NICU I found hard to watch. I wondered what they were feeling and, dare one say, thinking. One doctor said to me: “We do such dreadful things to them, I just hope that they forget.’ Whether or not the baby forgets the experience, I wondered if it was ever going to be possible to imagine what the babies’ experience might be. I decided I had to sit and observe the babies and to get to know them, to know which baby belonged to which mother, and so on.

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Medium 9780253357090

12 Guinean Migrant Traditional Healers in the Global Market

Dilger, Hansjörg ePub

Clara Carvalho

West African traditional therapists, healers, and ritual experts have crossed national and continental borders, spreading their therapeutic knowledge and worldview along their migrant itineraries. Nowadays, in every southern European capital, West African therapists act professionally in different contexts and for a varied clientele, including African and non-African, immigrant and local patients. Being migrant workers themselves, they become cultural brokers, mediating circuits of information and power amongst their patients. Although this process is not a new one, it changed in scope and vitality in the 1990s, a decade marked by the imposition of structural adjustment plans (SAPs) on indebted southern economies, a measure that led to the liberalization of the markets but also increased the impoverishment of both the working class and the emerging middle class in Africa, contributing to the flow of migrants from the global South to the global North. Amongst these migrants seeking better lives were therapists, religious experts, and other professional healers practicing local traditions. The mobility of such traditional workers has long been noticed in different African settings at a regional level, as has their capacity to adapt their knowledge to different challenges and situations (Feierman 2006; West and Luedke 2006). In 1992, Feierman and Janzen drew attention to the changing patterns of health and healing in Africa. Nowadays patients have a varied set of options for diagnosis and treatment, and it is the reasons behind their choices that anthropologists try to understand when studying the concepts of health and disease from the patients’ point of view. Patients can choose amongst local healing traditions, both religious and biomedical, which have their own distribution in time and space. These different systems have their own dynamic, and (as medical anthropologists have stressed) so-called “healing traditions” have changed according to the new conditions of health and disease of their patients (Feierman and Janzen 1992; Nichter and Lock 2002). Different living conditions resulting from changes in political control and economic production, as well as new or newly widespread diseases (especially tuberculosis, malaria, and now HIV/AIDS), have led healing practices to change accordingly. This is particularly true for migrant populations, both within Africa and beyond. The intensification of the flow of migrants from Africa to Europe has made the movement of both people and ideas, including healing practices, along the migration routes more obvious, and created a new challenge for traditional healers.

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Medium 9781576759448


Laura van Dernoot Lipsky Berrett-Koehler Publishers ePub
Medium 9780253355270

6 Alternative Materialities

Stacey A. Langwick Indiana University Press ePub

Beginnings are especially dangerous. Both traditional and biomedical practitioners consider the first years of life to be particularly vulnerable. Mashetani love to play with young children. Wachawi, those who wish misfortune, favor attacks on infants who promise to extend the lineage and bring wealth. High infant mortality statistics justify this special attention and biomedical care in the first years of life. People in southern Tanzania engage in a wide range of activities to protect the lives and ensure the strength of their children.1 Kin rally medicine of the bush and medicine of the book around newborns to protect them from harm. Regular checkups and hospital treatment are free in government hospitals for children under five. How do these efforts distinguish forms of care, types of expertise, and kinds of threats? At what point do vulnerabilities come to be seen as dangerous, and by whom? How do practices of prevention and protection shape what is being threatened as well as what threatens?

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Medium 9781855751972

5. Of teeth and theft and Poe: non-Lacanian purloining

Richard Ekins Karnac Books ePub

Ronnie Bailie

In Charles Baudelaire, Edgar Allan Poe—newly dead and released at last from the insoluble problem of gratitude— founda dazzlingly eloquent and passionate advocate. In one memorable outburst, the great French poet denounced the “vampire-pedagogue” and called for a by-law “to keep dogs out of cemeteries” (Baudelaire, 1856). He had in mind in particular the violence done to Poe’s memory immediately after his death by Rufus Griswold and did not pause to reflect that Poe had—for reasons to which we will come—assiduously created enemies for the greater part of his short life. Viewed from the closing years of the twentieth century, the outburst has, notwithstanding, its posthumous justness. For while full-length biographies of Poe continue to appear (Myers, 1992; Silverman, 1991) and while he continues to be read and to provoke the extreme reactions in which he took no little pleasure, psychoanalysis, despite the auspicious beginning represented by the work of Marie Bonaparte (Bonaparte, 1933), has in the main—paradoxically—failed to do justice to a man whose life seems almost to have been created for psychoanalytic investigation. This has been, in essence—to continue Baudelaire’s metaphor—because his body has been stolen, which is to say, less fancifully, that it has dropped out of the question because the peculiar emphases of Lacanian psychoanalysis have, for some decades now, dominated psychological approaches to Poe.

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Medium 9781855752627

CHAPTER TWO. Cotard’s syndrome and depersonalization

Salomon Resnik Karnac Books ePub

Some years ago, I analysed a female patient whose symptoms were depersonalization and negation of her body; these symptoms brought to my mind some of the clinical features described by Jules Cotard (1882-1884). I feel it may be of some interest to draw a parallel between the phenomenological aspects of the classic description and the analytic experience.

In 1861, Baillarger (1890) drew attention to a particular form of hypochondriac delusion which included feelings of destruction or non-existence of parts of the body; he had encountered these in cases of general paralysis, and in fact had thought them typical of and belonging almost exclusively to this ailment.

In 1880, Cotard read to the Paris Societe Medico-Psychologique a paper in which he described a particular kind of hypochondriac delusion in cases of severe melancholia; he called it “delusion of negations”. For Cotard, this delusion was a feature of certain severe forms of chronic melancholic anxiety. He describes six major symptoms: melancholic anxiety; the ideas of damnation and of diabolic possession (demonopathy); disposition towards suicide or self-injury; analgesia; hypochondriac ideas of non-existence or destruction of organs or of the entire body, of the soul, of God, etc.; and ideas of immortality and enormity (hugeness).

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Medium 9781855754188

CHAPTER THREE: Amanda, Arnaud, Alice, Sandrine and Emma-somatisations and regressions

Jean Benjamin Stora Karnac Books ePub

“Somatic diseases generally stem from the individual's inadequacies with regard to the living conditions that he encounters”.

Pierre Marty (1990, p. 48)

When we examine somatic patients in a hospital setting at the request of doctors in the department, the conditions are different from those found in psychosomatic psychoanalytic institutions. The psychologist or psychoanalyst who is also a psychosomatician is in a difficult position because he is not conducting a psychiatric examination (with which somatician doctors are familiar) and he has to communicate the essential findings of his examination to doctors in a matter of minutes so as to assist in the patient's care in a way that complements the medicine being given. Beyond the difference in scientific approach, there is also the question of the terms in which the diagnosis is formulated: how are we to communicate the provisional findings of an examination to a doctor who has no knowledge of the psychosomatic and psychoanalytic models that form the point of reference? We can thus recognise the scale of difficulty surrounding the exchange and interaction between the various parties who are addressing problems of illness and health.

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Medium 9781605099798

Chapter 17: Aravind in America

Pavithra Mehta Berrett-Koehler Publishers ePub

The 2010 annual meeting of the Institute of Medicine of the National Academies, held in the United States, was themed around health care innovations. Dr. Kim Ramaswamy, retinal surgeon and chief medical officer of Aravind-Madurai, was asked to present on the Aravind model. His talk was followed by an animated panel discussion on how Aravind’s core principles could be transferred to the West. The panel included senior executives from both the National Health Service (NHS) in the United Kingdom and the United States Department of Health and Human Services.

The last slide in Kim’s presentation included a telling graph. It showed Aravind performing roughly 50 percent of the entire NHS’s ophthalmic surgical volume, while spending less than 1 percent of the 1.6 billion pounds expended annually by the United Kingdom for eye care delivery. As the audience erupted into thunderous applause, Kim returned to his seat and shot an apologetic smile at the NHS executive sitting next to him. The man leaned over with a grin and whispered, “Hey, it’s a good thing you didn’t compare your numbers against the U.S.—that computer screen would have blown out!”

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Medium 9781780642994

32 Food and Agriculture-based Approaches to Safeguarding Nutrition Before, During and After Emergencies: The Experience of FAO

Thompson, B., Amoroso, L. CABI PDF


Food and Agriculture-based Approaches to Safeguarding Nutrition Before, During and

After Emergencies: The Experience of FAO

Emergency and Rehabilitation Division (TCE),*†

Technical Cooperation Department (TC)

Food and Agriculture Organization of the United Nations, Rome, Italy


Standard food-based approaches to nutrition in emergencies are dominated by food aid and emergency feeding programmes. However, agriculture has an important role to play as part of a more integrated package to tackle nutrition in emergencies. In order to maximize the impact of agriculture-based responses, two ‘lenses’ are important. First, a ‘nutrition lens’ to ensure that projects and programmes are designed, implemented and monitored with nutritional outcomes in mind. Secondly, a ‘disaster risk management’ lens, which highlights the importance of reducing the impact of disasters through risk reduction and recovery actions in addition to standard response actions. FAO is involved in a range of emergency projects with assumed or measured nutritional impacts, and is striving to apply both ‘lenses’ to its interventions in emergencies; however, there are a number of challenges. Meeting these challenges requires a combination of activities that include: nutrition awareness raising between FAO and the food security ‘community’; incorporating nutrition-related objectives as well as required indicators for targeting and monitoring (e.g. dietary diversity for adults, diversity of complementary foods for children); building the evidence base on agriculture–nutrition linkages through improved monitoring and evaluation (M&E) and lesson sharing; advocating joint planning by agencies at country level using a shared conceptual and analytical framework for food and nutrition interventions; better articulation of Food Security and Nutrition clusters; and better enforcement of nutrition goals and mainstreaming in appeal programmes and project documents and monitoring. Support to sustainable food-based interventions in emergencies from a ‘right to food’ perspective is another area that requires a stronger focus.

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Medium 9781935476504

11 Ethical Issues in Neonatal Nursing

Connie M. Ulrich Sigma Theta Tau International ePub

–Elizabeth Gingell Epstein, PhD, RN

Assistant Professor University of Virginia School of Nursing

• Neonatal nurses encounter ethical issues every day and play an important role in preventing and resolving ethical conflict.

• One of the most pressing ethical concerns today in neonatal ethics is how nurses and other health care providers communicate with each other and with parents.

• Strategies for identifying and acting on common triggers of ethical conflict are provided.

Ethics is an inescapable aspect of neonatal nursing. Consciously or not, neonatal nurses practice ethics in some way on every shift. Balancing benefits and burdens; advocating for infants and parents; maintaining confidentiality; promoting privacy; and speaking carefully and truthfully with colleagues and parents—all require ethical judgment. Most encounters with ethics do not involve conflict. Instead, making judgment calls independently and speaking up for those who cannot speak take center stage. Supporting parents when they need support is also a frequent factor. Simply put, encounters with neonatal ethics situations involve respecting the dignity of human beings.

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Medium 9781855753228

1. Assessing Children with Communication Disorders

Emanuela Quagliata Karnac Books ePub

Maria Rhode

The children I shall discuss in this chapter suffer from autistic spectrum disorder, mutism, or a learning disability arising from a pervasive developmental disorder (PDD). I shall not be considering children who stammer, or the psychotic or borderline children discussed by Anne Alvarez (this volume) who may use words in idiosyncratic ways for purposes other than communication. However, some of the points Alvarez makes are highly relevant to the kind of child I shall discuss, such as the importance of assessing the symbolic level at which the child is operating at any moment. This is essential if we are not to misunderstand him, and if we are to be able to phrase our own communications in ways that he can hear.

Autistic spectrum disorder includes children with autism proper and with Asperger’s Syndrome. Children with autism may be completely mute, or may produce language ranging from single words to complete sentences. Sometimes their words are their own; often they are quotations from stories, songs and videos, or they may be echolalic reflections of someone else’s speech (Rhode, 1999). In Asperger’s Syndrome, language is well-developed though it is often used idiosyncratically (see Rustin, 1997; Youell, 1999). According to the criteria of DSM-IV, children with autism must demonstrate Kanner’s (1943) classic triad of impairments: affective, cognitive, and social, which must have been manifest by the age of three. Children with pervasive developmental disorder (PDD) satisfy some of these criteria, but not enough for a diagnosis of autism.

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Medium 9781780643328

11 Prevention and Control of Chronic Non-communicable Diseases: Lessons From High-income Countries

Aikins, A.de-C. CABI PDF


Prevention and Control of

Chronic Non-communicable

Diseases: Lessons from Highincome Countries




of Public Health, Academic Medical Centre, University of

Amsterdam, Amsterdam, Holland; 2Clinica Medica Generale e Cardiologia,

University of Florence, Florence, Italy; 3Universidade Federal de Sergipe,

Aracaju, Sergipe, Brazil; 4Center for Healthful Behavior Change, New York

University School of Medicine, New York, USA

11.1 Introduction

Non-communicable diseases (NCDs) are the leading causes of death worldwide.

Of the 57 million total global deaths in 2008, 36 million (63%) deaths were attributed to NCDs, primarily cardiovascular diseases (CVDs), diabetes, cancer and chronic respiratory diseases [1]. About a quarter of worldwide NCD-related deaths were among people below 60 years of age, clearly indicating the importance of the economic cost associated with NCDs, particularly for low- and middle-income countries (LMICs) [2]. Global estimates indicate that LMICs are the most affected, with nearly 80% (29 million) of all NCD deaths occurring in

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Medium 9781780646824

6: Missionaries of Death

Webber, R. CABI PDF

Missionaries of Death



John Williams, the great missionary from the London Missionary Society

(LMS), had achieved remarkable success in converting most of the Polynesian people to Christianity. Within just a few years, he had seen the transformation of these distant Pacific Islanders from war-mongering cannibals to passive Christians. Now he was to turn his attention to the much bigger challenge of the Melanesian (meaning ‘black’) Islands. He felt sure he was going to succeed: against all odds he had done so in Samoa (Fig. 6.1), he had

God on his side, soon he would be able to claim even greater numbers of converts to the religion he so believed in.

He had chosen to launch his crusade on the island of Tanna, part of what was then called the New Hebrides, so named by Captain Cook, who was probably thinking of places nearer home. Williams left a couple of his missionaries to learn the language and then proceeded to Erromanga

(now Erromango) to do the same. However, when he went ashore he was immediately clubbed to death, so it is not on the coral islands of Polynesia that the great missionary is buried, but on Erromanga that his grave is to be found. It is likely that he was thought to be a sandalwooder, one of the unscrupulous exploiters of the precious sandalwood, so landing unarmed made him easy prey.

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Medium 9781930538757

1 Infrastructure for Nursing Research in Clinical Settings

Christine Hedges Sigma Theta Tau International ePub

“There is no doubt that research is a vital part of the answer to the great challenges. And excellence in research requires excellent tools. A quality research infrastructure is just as important to research as an engine is to a car.”

–Morten Østergaard

Teri Wurmser


• The infrastructure for nursing research begins with strong and committed nurse leadership.

• Nursing staff with different educational backgrounds will have various levels of expertise, and you can capitalize on this diversity.

• Personnel and structural resources are available for nursing research. Find out how to take advantage of them.

Whether you are a clinical nurse in the front lines of care or a nursing leader in your organization, it is important to begin research in a supportive environment. Nursing leadership must provide the resources needed to support nurses in research and evidence-based practice (EBP) activities. The American Nurses Credentialing Center (ANCC) Magnet® Recognition Program has been a catalyst in helping organizations develop research-rich cultures with effective infrastructures. Structures and processes that should be in place include physical and human resources, access to nurse scientists and mentors, availability of nursing research councils, financial resources, and reward and recognition mechanisms. They motivate and support direct care nurses to get involved in nursing research activities. Providing the infrastructure that supports research and innovation in an organization will provide nurses with the ability to make substantial contributions to health care and the profession. This chapter describes the elements necessary for establishing an infrastructure for nursing research in a health care organization.

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Medium 9781855755185

CHAPTER ELEVEN. The silent child in school: teaching a child who does not talk, walk, or eat

Jeanne Magagna Karnac Books ePub

Sarah Dixon

As a teacher I am expected to provide learning experiences and to evaluate whether or not I have achieved my aim of helping students to use their mind to learn and to be curious. A teacher is an acknowledged guide in the process of learning.

There is a code of conduct in place to ensure that the students have the responsibility for meeting the expectation which the school, representing society, places on them in order that they can become responsible citizens in the society. When confronted with a non-speaking, non-walking, child, this point of view with regard to education is severely challenged. Initially, because the non-speaking, severely withdrawn child does not want to be present in school, he is not interested in what is being taught and is non-responsive to any questions (even via a nod), or not willing to engage in any school tasks. The teacher feels that the non-speaking, severely withdrawn child is not allowing the teacher to function as a teacher. If as a teacher you are faced with a student who does not comply with the code of behaviour, you would refer the student to the Head of Year to be sanctioned. None of this is relevant when working with a non-speaking, severely withdrawn child apart from expecting the child to be in the classroom. In the school in which I work, I have been presented with a number of severely withdrawn students who could not follow the code of conduct as they were not speaking and would not or could not participate in any school tasks even by looking at what was being presented. At the severe end of the spectrum of not-speaking, withdrawing, not eating, not walking would be those children who have been given the psychiatric diagnosis of pervasive refusal syndrome (Lask, 2004). I use this term in this chapter hesitantly, for refusal implies that the self has an active choice in rejecting others’ overtures, yet the way of behaving is much more like that of a terrified, traumatised child who feels helpless in the face of either or both an internal emotional experience or external trauma. We prefer to say that the child is pervasively retreating from life.

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