Introduction

Although psychoanalysis, since Freud, has a longstanding interest in culture, more than ever this discussion cannot be ignored. The development of psychoanalytic criticism of the contemporary period allows an understanding of the growth of pathologies such as bulimias, drug addictions and panic syndrome, conditions that are usual in our private practices, as symptoms of the weakness of social links. These criticisms also allow a break from psychoanalysts' timidity toward intervening beyond the traditional analytical setting. New strategies must be created so that psychoanalytic rigor is maintained in the field of the social.

In Brazil, there is a growing demand for psychoanalytic interventions in the public space. Many social institutions noticed that their actions were not enough to treat people and asked for psychoanalytical help. The challenge lies in the working out of psychoanalytic techniques for intervention in these new scenarios. Classically, the suffering individual has been the one who seeks treatment; now, it is institutions that "suffer" when confronted with the often-limited efficacy of their social work, in spite of the use of available resources. These institutions are concerned with the deleterious effects of contemporary society and they are searching, in their own way and manner, for creative solutions. However, there is a lack of theoretical resources to understand the changes being sought. As a result, there is growing interest in alliances between different fields of knowledge. The understanding that subjectivity is inseparable from the social justifies, on the part of psychoanalysts, the search for technical-theoretical developments that will provide answers in response to these new interests. For these reasons, psychoanalytic work is being requested in various social sectors in Brazil.

The Program for Psychoanalysis and Social Interface of the Brazilian Psychoanalytic Society of Rio de Janeiro (PROPIS/SBPRJ) unites the initiatives of its psychoanalysts in this field. At the moment, PROPIS consists of several projects, five of which are described in this field report.

1. Living the City

Project Living the City is a partnership of SBPRJ with the Association House of Arts for Education and Culture (Associação Casa das Artes de Educação e Cultura), an associated institution of a Cultural Point (Ponto de Cultura) by the Ministry of Culture of Brazil. It obtained UNESCO's official seal in 2005 and has been receiving partial financing from Furnas Centrais Elétricas, a Brazilian state company.

The project serves monthly 400 children between the ages of 5 and 15 and social leaders of 10 favela communities in Rio de Janeiro. Many of these children never, or rarely, leave the limits of their immediate neighborhood. This makes it difficult for them to acquire a diversified perception of reality. Feelings of shame for being who they are, of where they live, of not knowing their own and their family's worth constitute symbolic violence, which causes narcissistic injuries that frequently contribute to their not having any attachment to life or to the common good. They feel themselves to be invisible, destitute of humanity and of everything in them that is unique. It is impossible to maintain one's identity in the absence of feelings of belonging to a group or being visible to others.

Starting from this understanding of social "apartheid" in 2004, a set of alternative acts of social support based on psychoanalytic theory and on the methodology of art-education was created. The program includes operative groups for children and adolescents, guided visits to the city's cultural patrimony, seminars on emotional development and workshops for technical enhancement in art education for adults involved in the project. These activities represent an effort to stimulate the working out of creative solutions to deal with real existential situations, through the emergence of new narratives, with the aim of minimizing the symbolic violence of social exclusion.

2. Living and the Disease

The project Living and the Disease started in 2001, upon request to SBPRJ from the Associação Carioca de Assistência à Muscoviscidose (as Cystic Fibrosis is also known), with aid from the Instituto Fernandes Figueira of the Health Ministry of Brazil, reference hospital of the World Health Organization in the diagnosis and treatment of cystic fibrosis for children and adolescents up to 18 years, to deal with the anxiety that the diagnosis and treatment of cystic fibrosis brings.

The strategy of the program occurs in monthly two-hour meetings, in the hospital setting, in an operative group, called "The Wheel of Psychoanalysis", of the group members, with a non-fixed number of participants, between 10 and 30 adults. During the two-hour meeting, members are offered a psychoanalytic listening perspective that is, at the same time, a place of meeting and exchanging of experiences with peers, where doubts, anxiety and also competences can be expressed, as members weave their own histories of their illness.

The operative group functions as a protection against the traumatic effects of the discovery of cystic fibrosis in the family, enabling each participant, through the use of the word, to be voice and interpreter of his/her own suffering. In this way, patients gain or recover the capacity to deal more actively with the treatment process and to integrate the care that cystic fibrosis requires for the rest of their lives.

3. Social Agents for Freedom

In 2003, SBPRJ was asked to provide a group program for ex-prisoners of the penal system, participants of a project for social insertion and training proposed and financed by the city of Rio de Janeiro and administered by an NGO. The partnership with SBPRJ was maintained in this format until October 2005, when the NGO had its contract cancelled by the local government of the city of Rio de Janeiro. Since then, the operative group has continued with support from the Workers' Union in Telecommunications of Rio de Janeiro, which, besides providing physical space for the meetings, finances transportation for the ex-prisoners.

At present, 10 ex-convicts, trained by the program and exercising the function of multipliers, each one with 10 other ex-criminal offenders, participate in the operative group. In these three years, it is estimated that 70 ex-convicts have participated in this pioneer experience that has made it possible for these individuals, receiving psychoanalytic attention, to contain their destructive impulses.

Contacts with businessmen have been made to establish financial partnerships, and efforts are being made to include a law project in this program of social inclusion for ex-convicts. The re-offending rate in criminality declined from 80 (data supplied by the Ministry of Justice) to 13% for those who have participated in the program for social reinsertion. In the operative group coordinated by a psychoanalyst, the re-offending rate has been zero.

4. Infant-Parent Clinic

The Infant-Parent Clinic is a project connected to the Social Clinic of the Sociedade Brasileira de Psicanálise do Rio de Janeiro. Its activities take place at the head office of SBPRJ with the contribution of 16 psychoanalysts. Since April 2004, a bimonthly study group with the staff's psychoanalysts has been giving talks open to professionals involved with the first years of infancy. Joint psychotherapeutical consultation – from pregnancy to the baby's 18 months – was started in March 2005 and aims to be continuous. Sessions are immediate – given the urgency in this clinic – weekly, focal and short term.

The purpose of the Infant-Parent Clinic is to offer consultation to the low-income infant–parent population facing difficulties and/or suffering, giving priority to care and adopting a three-pronged approach: prevention, early diagnosis and therapy. The clinic also creates space for multidisciplinary discussion centered on this theme, with health professionals working with first infancy through study groups, lectures and courses from a psychoanalytic perspective.

The significance of this project is in offering pioneering treatment to a population that has never been the therapeutic focus of psychoanalysis. Further, the aim has been to promote a deeper understanding of this new therapeutic approach, and greater integration of the Psychoanalytic Society with the non-psychoanalytic professional community, including through obtaining data for study and research.

5. Listen and Think

The project Listen and Think is a partnership of Sociedade Brasileira de Psicanálise of Rio de Janeiro with the Radio of the Ministry of Culture of Rio de Janeiro. It was initiated in October 2001 and includes the transmission of recorded or live broadcasts on Radio MEC-RJ. The program touches on themes of everyday life: family, social and professional, in an accessible language, aiming to disseminate psychoanalytic views.

The radio program is structured in the format of a round-table discussion with a psychoanalyst and two guests, professionals from various areas, chosen by the staff, in affinity with the weekly topics. The program's broadcasts were selected and presented in congresses, national and international seminars, and papers were written and presented in round tables, posters (printed and auditory) and in a CD in four languages (Portuguese, English, French and Spanish). The program "Listen and Think" is available on the following sites: SBPRJ, SBPSP and the ONG Viva Rio, in charge of the broadcasting of the entire program through the community Radio Viva Favela.

Throughout the two years of the "Listen and Think" project, the program has been broadcast by the Supreme Court of Justice of Brasília. In 2008, transmission will also take place in the cities of Fortaleza, in the State of Ceará, and Fernandópolis, in the State of São Paulo, through local university radios.

Conclusions

The activities gathered together in the PROPIS pave the way for new scenarios and new actors, without giving up the rigor of the theoretical foundations of psychoanalytic research. We are aware that each activity presents its own specificity that ranges from theoretical-technical to ethical issues. What unites these projects and allows a common approach is the theoretical assumption that trauma is revisited in the conditions of contemporary society (Bastos, 2006a, p 58).

The psychoanalytic definition of trauma as a complementary series in which material/social reality as well as the possibility of psychic predisposition of the subject is implied allows us to perceive contemporary society as traumatogenic through its excess of excitements, its absence of response, the bombarding of images that make reflection difficult and unattainable ideals of perfection conveyed by the globalized market.

Besides the excess of drivenness, one observes in the subjects cared for by the PROPIS the engraved echoes of the traumatogenic society. Chronic and incapacitating diseases, infantile helplessness and conditions associated with poverty imply a greater vulnerability to traumatic excesses (Bastos and Proença, 2007, p 210).

The traumatic event is a conjunction of the "excesses" found in material reality, as well as in the psychical, maintained by repetition. Experienced pain is due to the absence of meaning and to the incapacity of representation. "The traumatic – in the condition of absence of form, absence of figure and meaning – is always on the watch on the external horizon of making sense, and, in the condition of the unrepresentable, produces intense psychic pain" (Figueiredo, 2006, p 80).

With regard to the traumatic, the psychoanalytic act seeks the creation of meanings. The analyst functions as a "containing excitatory membrane" that enables the subject to establish links and to transform the unrepresentable into the representable. The creation of meanings includes the bodily presence of the analyst, his/her acceptance, analytic listening and speech. The analyst is there, body and affect, offering him/herself as a "transitional analytic space," an "outside-inside". The "setting" is portable since it materializes in the analyst's live and vitalized presence in a face-to-face that allows healing narcissistic mirroring. This vitalization that emanates from the analyst creates the erotization that sets up representation (Bastos, 2006b, pp 119–187). Therapeutic work is established according to the conditions of the subjects and of their institutions. Thus, analytic doing can be carried out beyond the habitual frame of the consultation office – in any space, in groups or not, with the length and periodicity arranged according to every situation. Regularity and permanence allow the subjects to trust and to establish a transferential relationship that will permit changes through the creation of new meanings of existence.

In the various activities of the PROPIS, all of these conditions are taken into consideration. Even though the broadcasting programs and the edited books do not fit in the above description, we consider that these, too, are psychoanalytic tools that produce results. The analytic intervention invites the listener/reader to reflect, while suspending moral judgment about new meanings for feeling and living. This speech/writing is not to be compared with the pedagogic as it does not offer formulas or advice. The "analytic text" works as a social net of support, of acceptance and re-signification.

Besides the flexibility of technique and the maintenance of theoretical rigor, PROPIS, with its various projects, augments possibilities for the scope of action for psychoanalysts, emphasizing the ethical dimension of psychoanalysis and making of the psychoanalytic act a political act.

References

1. Bastos, L.A.M. (2006a). Exclusão Social: Aspectos Traumáticos da Violência. Revista Brasileira de Psicanálise 39 (4), pp. 57–60.
2. Bastos, L.A.M. (2006b). Corpo e Subjetividade Na Medicina: Impasses e Paradoxos. Rio de Janeiro: Editora UFRJ.
3. Bastos, L.A.M. and Proença, M.A. (2007). Psicanálise e Interface Social. Trieb V (2), pp. 205–220.
4. Figueiredo, L.C. (2006). A Questão do Sentido, a Intersubjetividade e as Teorias de Relação de Objeto. Revista Brasileira de Psicanálise 39 (4), pp. 79–88.

About the authors

Liana Albernaz de Melo Bastos is a Medical Psychology Professor in the Department of Psychiatry, Medicine College of Federal University of Rio de Janeiro (UFRJ), Brazil, Member of the International Psychoanalytical Association (IPA), Training Analyst of the Brazilian Psychoanalytical Society of Rio de Janeiro and Regional Editor of The Brazilian Journal of Psychoanalysis. She has published widely, with emphasis on the relationships between psychoanalysis and medicine and social sciences. She is the author of two books: The Ego and the Body in Freud (S. Paulo: Escuta, 1998) and Body and Subjectivity in Medicine: Impasses and Paradoxes (Rio de Janeiro: Editora da UFRJ, 2007).

Munira Aiex Proença is Medical Psychology Professor in the Department of Psychiatry, Medicine College of Federal University of Rio de Janeiro (UFRJ), Brazil, Member of the International Psychoanalytical Association (IPA), Full Member of the Brazilian Psychoanalytic Society of Rio de Janeiro and an Editor of Trieb, Journal of the Brazilian Psychoanalytic Society of Rio de Janeiro. She has published some articles focusing on the social interface of psychoanalysis.