Abraham Maslow s Theory Of Self Actualization - 901 Words

It was many years ago, when I first read about a man named Abraham Maslow. Maslow was an American psychologist who developed a pyramidal hierarchy of needs. At the base of his pyramid, Abraham Maslow placed the basic â€Å"physiological needs† such as: food, water, and sleep. The next layer of his pyramid was â€Å"safety†, which was followed by â€Å"love/belonging†, and then â€Å"esteem†. Although, my interest truly began when I reached the very top of the pyramid which was labeled â€Å"self-actualization†. Self-actualization was the term Maslow used to describe individuals who had fulfilled their full potential. My eyes twinkled with curiosity as I read. Could I really do it? I wondered. Could I reach a state of self-actualization? It was in that very moment that self-actualization became my ultimate goal. I would reach my full potential. I would become the best possible version of myself. Today, I will admit that I have not yet reached self-actualization; but at the age of only sixteen, I still have plenty of time to complete my journey towards self-actualization. Regardless of where I fit on Maslow’s hierarchy of needs, I live each and every day attempting to be a better person than I was the day before. Despite the fact that I am a teenager, I try my hardest to minimize laziness within my life. One of my greatest aspirations is to reach my full potential – which would be significantly more difficult to do if I slept until noon like many of my friends. I have clearly shownShow MoreRelatedHumanistic Theories Debate On Abraham Maslow And Carl Rogers1617 Words   |  7 PagesHumanistic Theories Debate Team B – Anthony Garcia, Becky Billison, Cher Keen, Britanie McKernan, Megan Groulx PSY/310 September 7, 2015 Dr. Sadie Fine â€Æ' Humanistic Theories Debate In the debate between Abraham Maslow and Carl Rogers, both whom are humanistic theorists that share a mutual interest in the teachings of self-actualization, will discuss the specifics of their individual theories regarding the main points, their contributions, and the criticism they have received about their theories. We willRead MoreMaslows Theory1321 Words   |  6 PagesBiography Abraham Harold Maslow, the founder of humanistic psychology, was born in New York City on April 1, 1908 and died at home in California in 1970 (Maslow, Abraham Hutchinson Encyclopedia of Biography, 2010) (Abraham H. Maslow: a Bibliography: Professional biography, 1970). He received his AB, MA, and PhD in psychology from the University of Wisconsin (1970). His work as a United States (U.S.) psychologist started in 1932 after he started working as a teaching fellow (1970). Maslow also taughtRead MoreMaslow s Theory Of Self Actualization772 Words   |  4 PagesIntroduction: The theory of self-actualization was introduced by psychologist Abraham Maslow. Maslow s famous work â€Å"Hierarchy of Needs† has drawn admiration and criticisms from supporters and opponents alike. For Maslow, man quest for self-actualization falls within five hierarchical orders set up in a pyramid style. To become everything that one is capable of becoming, Maslow, noted that the order in which these needs are fulfilled does not always follow the standard progression. FurtherRead MoreAbraham Maslow s Influence On The Human Psyche1660 Words   |  7 Pagespeople are Abraham Maslow. He is cited as one of the top ten psychologists of all time, which is not an easy task to achieve. Abraham Maslow was born on April 1 in 1908 in Brooklyn New York. He comes from a Jewish background with his parents coming from Russia as immigrants to the United States of America. Maslow’s childhood was not a good or easy one as one would think of such a successful person. His father and mother more times than not often ill treated him, which led to his poor self esteem.Read MoreAbraham Maslow Life Span Development and Personality1082 Words   |  5 PagesAbraham Maslow Life Span Development and Personality Abraham Maslow was born April 1, 1908 in Brooklyn, New York. Abraham Maslow grew up in Brooklyn, New York, the first of seven children born to his Jewish parents who emigrated from Russia. His parents were uneducated, but they insisted that he study law. Maslow later described his early childhood as unhappy and lonely, and he spent much of his time in the library immersed in books. At first, Abraham acceded to their wishes and enrolled in theRead MoreMaslow s Motivation And Personality1604 Words   |  7 PagesAccording to Robert Frager, editor of the third edition of Maslow’s Motivation and Personality, the theorist Abraham Maslow was born in 1908 in Brooklyn, New York. He was the first of seven children born to Russian - Jewish immigrants. While Maslow’s father was uneducated, he pushed his son academically and encouraged him to become a lawyer. Maslow began his extensive education at City College of New York but later told his father that he did not want to study law. In 1928, after marrying hisRead MoreAbraham Maslow s Theory Of Human Motivation1670 Words   |  7 PagesAbraham Maslow Abraham Maslow was always visually examining the greater scope of human nature. Whereas most of his counterparts of his day seemed to be more concerned with a narrower scope, Maslow s own vision was far-reaching. His lifetime of revelations in motivation and personality transcended academic psychology, and extended into the major business fields of management and marketing. Maslow additionally explored how and individual perceives their existence and beginning to display signs ofRead MoreConcepts Vs. Self Actualization1311 Words   |  6 Pagesâ€Å"Concepts vs. self-actualization- Instead of dedicating your life to actualize a concept of what you should be like, ACTUALIZE YOURSELF. The process of maturing does not mean to become a captive of conceptualization. It is to come to the realization of what lies in our innermost selves.† -Bruce Lee. As humans we are not perfect we are brought up in a world where we are thought by everyone to be what society expects us to be. Unfort unately, a lot of people never accomplish self-actualization and free themselvesRead MoreMaslow s Hierarchy Of Needs1388 Words   |  6 PagesMrs. Payton 2: Lens 1st Draft 24 September 2014 Abraham Maslow was an American philosopher who was born in the early 1990 s in Brooklyn, New York. He was one of the leading theorists that promoted humanistic psychology during his era. Maslow sought to understand what motivates and inspires individuals. He theorized that individuals possess and hold a group of motivation and incentive systems not related to plunder or insensible desires. Maslow declared that people are motivated and provoked toRead MoreAbraham Maslow s Influence On Society1241 Words   |  5 PagesBiography Abraham Harold Maslow was born on April 1, 1908 in Brooklyn, New York. Raised in the same city he was born in, he was also the oldest among his 7 siblings. he was the son of Samuel and Rose Maslow, Jewish immigrants from Russia. During his childhood, Maslow was the unique Jewish boy in his neighborhood. Therefore, he has always been targeted and this made him feel unhappy. Because of this, he solicited refuge and comfort in books. Likewise, he stated I was a little Jewish boy in the non-Jewish

The Hour of the Star Free Essays

â€Å"A sense of loss† and â€Å"The right to protest† A Lacanian reading of the film The Hour of the Star1 When Clarice Lispector wrote this ‘story with a beginning, a middle and a grand finale followed by silence and falling rain. ’ (HE, pp. 13) she hoped that it could ‘become my [her] own coagulation one day’ (HE, pp. We will write a custom essay sample on The Hour of the Star or any similar topic only for you Order Now 12). In fact, ‘her hour’ was near for she would soon die of cancer. The book emerged as an experimental novel gradually dialoguing with and producing illusions of itself, like images in mirrors, paradoxically portraying the invisible. Both her book and Susana Amaral’s cinematic adaptation seem extremely conscious of Lacan’s concept of subjectivity and adherent to his psychoanalytic theory that reinterprets Freud in structuralist terms, adapting the linguistic model to the data of psychoanalysis. What lies beneath the choice to attempt a Lacanian reading of The Hour of the Star is not the film’s patent openness to Lacan’s ideas on desire, lack and the language of the unconscious. Despite the theoretical suggestiveness of much of the analysis that is to follow, the aim of this essay is to analyse The Hour of the Star using the methodology developed by Lacan whilst criticising its very mechanisms, stressing the importance of issues such as ethnicity, marginality, and poverty, social, cultural and political alienation, left behind by his account of the development of the human subject. A fairly mainstream cinematic version replaces the avant-garde, subversive structure of the book. In the film things fall into place more handily in the name of coherence, and social issues (the chronic plight of a certain type of North-Eastern Brazilians who undertakes a journey to the great cities of the South in search of a better life) replace the major metaphysical meditations found in the book. In The Hour of the Star everything is subjected to a multiplicity of reductions, exaggerated to the minimum, a caricature in reverse that works in favour of a growing invisibility of things. Physical invisibility, abortion and repressed sexuality are highlighted in the film, depicting the drama of Macabea, a humble orphan girl from the backwoods of Alagoas, North Eastern Brazil, who was brought up by a forbidding aunt before making her way to the slums of Rio de Janeiro. In this city, she shares the same bed sitter with three girls and works as a typist. Centred on her (in)existence, the film explores Macabea’s marginality by placing her among the marginalities of the characters that populate the world of Rio de Janeiro. There is a strong focus on the relationships between the characters: Seu Raimundo and Seu Pereira (her bosses), Gloria (her colleague from work), Olimpico de Jesus Moreira Chaves (her ‘boyfriend’), and Madame Carlota (the fortune 1 Throughout the essay, A Hora da Estrela, (HE) will refer to Clarice Lispector’s novel (Portuguese version), while the title: The Hour of the Star (HS) will refer to the film, a Brazilian cinematic adaptation of Clarice Lispector’s book (The Hour of the Star, Dir. Susana Amaral, Raiz Producoes Cinematograficas, 1985). The dialogues in this work were translated and transcribed from the film, while the book excerpts were taken from the English translation of the novel: The Hour of the Star, trans. Giovanni Pontiero (Manchester: Carcanet, 1992). 1 teller). Macabea has poverty, inexperience, ingenuity, ill-health and anonymity written all over her. All she can afford to eat and drink are hotdogs and Coca-cola. Her only (unachievable) dream is to become a film star. Without any goals in life, her sole interest is listening to Radio Relogio (Radio Clock) that broadcasts the seconds, minutes and hours of the day along with random information about life. Olimpico, who she meets in the park one day, starts going out with her but ends up in Gloria’a arms, after the latter’s visit to the fortune teller. When Macabea decides to visit the fortune teller herself, her life seems about to change completely. The promise of abundance is followed by utter disappointment when Macabea, wearing her new Cinderella-blue dress, is run over by a car and dies alone, fantasising that she is running into the arms of the promised rich lover Hans, her long curly hair in the wind. Any Lacanian approach to this Cinderella-in-reverse story would proceed with reference to the unconscious, interpreting the text as a metaphor of the unconscious and the subject as a linguistic construct. Lacan is unequivocally clear when he states that: (†¦) the unconscious is structured in the most radical way like a language, hat a material operates in it according to certain laws, which are the same laws as those discovered in the study of actual languages (†¦)2 To the French psychoanalyst, the unconscious is constituted by a signifying chain, whereby the negative relations between the signifiers3 are never anchored in meaning: one signifier leads to another but never to the things it supposedly represents. Maca bea launches the play of signifiers in the film: the assemblages of signifiers clustered around her convey the elusiveness of the signified and the centrality of the unconscious. Her problem with the meaning of words stands for Lacan’s model which gives primacy to the signifier and not the signified. The audience feels somehow â€Å"oppressed† by the many unanswered questions and the violence of the oblique illusions of truth inside definitions. What follows is a dialogue between Macabea and Olimpico during one of their walks together: Macabea On Radio Clock they were talking about alligators†¦ and something about ‘camouflage’†¦ What does ‘camouflage’ mean? Olimpico That’s not a nice word for a virgin to be using. The brothels are full of women who asked far too many questions. Macabea Olimpico Where is the brothel? It’s an evil place where only men go. 2 Jacques Lacan, Ecrits: A Selection, pp. 234 2 ‘Just because people ask you for something doesn’t mean that’s what they really want you to give them’4, Lacan would argue, commenting on this dialogue. What Macabea desires from Olimpico is not exactly a word’s signification but something else implied in that same dialogue. She desires the meaning, yet lacks the meaning and that same lack structures her desire. Macabea asks others for definitions, but others are as ignorant as she is. The film’s plays on ambiguity, misunderstandings and misjudgments add to Lacan’s play of signifiers: Olimpico Macabea Olimpico Macabea Olimpico Macabea Olimpico Macabea Olimpico Macabea Olimpico Macabea Olimpico Macabea Olimpico Macabea Olimpico Macabea Well†¦ Well what? I just said well. But well what? Let’s change the subject. You don’t understand. Understand what? Oh my God, Macabea. Let’s talk about something else. What do you want to talk about? Why don’t you talk about you? Me? What’s the problem? People talk about themselves. Yes, but I am not like other people. I don’t think I am many people. If you are not people, then what are you? It’s just that I’m not used to it. What? Not used to what? I can’t explain. Am I really myself? Look, I’m off. You’ve no wits. How do I get wits? Insofar as the Lacanian analyst doesn’t take himself/herself as the representative of knowledge but sees the analysand’s unconscious as the ultimate authority, all these questions about the meaning of words are also metaphors of the unconscious. Macabea is under the illusion that meaning can be fixed and the illusion of stability destabilizes her. According to Lacan’s view of interpretation, meaning is imaginary and irrelevant: It is the chain of the signifier that the meaning insists without any of its elements making up the signification. 5 In one of the last scenes, Macabea is driven to the fortune teller by her colleague friend, Gloria, in an effort to fix her life. Madame Carlota divines everything about Macabea’s past, acknowledges 3 Lacan followed the ideas laid out by the linguist Saussure, who viewed the ign as the combination of a signifier (sound image) and a signified (concept). Lacan focuses on relations between signifiers alone. 4 J. Lacan, Ecrits: A Selection, Seminar XIII 3 the signs of the future but fails to interpret them. Macabea’s fate is consummated despite the fortune teller’s misinterpretations because, Lacanians might argue, understanding is irrelevant to the process. But, in this case, understanding becomes very relevant indeed for the Lacanian critics who argue that death represents the destiny of those who get hold of the Phallus. By misunderstanding the signs, Madame Carlota tells Macabea her supposedly brilliant future. As if ‘listening to a fanfare of trumpets coming from heaven’ (HE, pp. 76), Macabea learns that she is going to be very rich, meet a wealthy handsome foreigner named Hans, with whom she will marry, and become a renown famous star. Macabea believes every single word she is told, hence truly acknowledging that all her fantasies will come true that very day. Macabea’s desire to have the Phallus is now a reality. Once desire is extinguished, there are no more reasons to keep on living. This scene shows how Lacan’s view on interpretation as an easy reductionist task leading to imaginary understanding can rebound on him. The scene previously referred to is rooted in another depicting the beginning of the relationship between Macabea and Olimpico, which shows the essentialist views latent in Dr. Lacan’s theory of sexuation. Lacan’s concept of ‘object (a)’ is considered to be his most significant contribution to psychoanalysis. 6 ‘Object (a)’ is that which is desired but always out of reach, a lost object signifying an imaginary moment in time. According to his theory, people delve into relationships because they are driven by the desire to overcome Lack (consequence of castration). Because Lack is experienced in different ways by men and women, both sexes have different ways of overcoming their Lack: they either place themselves in relation to the Phallus (feminine structures) or the ‘object (a)’ (masculine structures). Lacan argues that in the sexual relationship7 the sexes are defined separately because they are organized differently with respect to language/to the symbolic:8 masculine structure limits men to Phallic ‘jouissance’ while feminine structure limits omen to ‘object (a)’ ‘jouissance’ and also allows them to experience another kind of ‘jouissance’, which Lacan calls the Other ‘jouissance’9. By jouissance Lacan implies what ‘is forbidden to him who J. Lacan, Ecrits: A Selection, Instance de la letter dans l’inconscient ou la raison depuis Freud’ In the preface to Ecrits, Lacan mentions ‘object (a)’: ‘We call upon this object as being at once the cause of desire in which the subject is eclipsed and as something supporting the subject between truth and knowledge. 7 It must be kept in mind that Lacan’s work on sexual difference crosses over the borderlines of biological distinction. He defines femininity and masculinity on the basis of psychoanalytic terms. 8 Lacan explains the alternative versions of castration: 6 5 (†¦) suggerer un derangement non pas contingent, mais essentie de la sexualite humaine (†¦) sur l’irreductibilite a toute analyse finie (endliche), des sequelles qui resultant du complexe de castration dans l’inconscient masculine, du penisneid dans l’inconscient de la femme. In ‘La signification du phallus’, Ecrits, pp. 85 9 When Lacan discusses the notion of another kind of â€Å"jouissance† (Other ‘ jouissance’), he explains that women (human beings structured by the feminine) are the only ones that have access to it, while men are limited to Phallic ‘jouissance’. According to Bruce Fink, this concept roughly implies that the phallic function has its limits and that the signifier isn’t everything. ’ B. Fink, The Lacanian Subject: Between Language and Jouissance, pp. 107) 4 speaks (†¦)’10, that is, that completion of being which is forever inaccessible to the split subject. To paraphrase Fink, insofar as a woman forms a relationship with a man, she is likely to be reduced to an object – ‘object (a)’, reduced to no more than a collection of male fantasy objects, an image that contains and yet disguises ‘object (a)’. He will isolate one of her features and desire that single feature (her hair, her legs, her voice, etc. ), instead of the woman as a whole. In a different way, the woman may require a man to embody the Phallus for her, but her partner will never truly be the man as much as the Phallus. Therefore, ‘il n’y a pas de rapport sexuel’ (Lacan’s famous remark) because the dissymmetry of partners is utter and complete. By lack of symmetry Lacan means what she/he sees herself/himself in relation to [either the Phallus or ‘object (a)’]. Going back to the film, the masculine and feminine realms seem to be clearly limited in terms of a traditional heterosexual system (the odd-one-out being the character of the fortune teller in whom we perceive traces of homosexuality). When Olimpico first meets Macabea in the park, she is holding a red flower in her hands. Olimpico draws nearer, asks her name and invites her for a walk. At a certain point he mentions her red flower, gently asks for her permission to pull out its leaves, and finally returns it to Macabea. Under Lacan’s eyes, insofar as she holds the flower, Macabea sees herself in terms of the Phallus, the flower being its metaphor, what she desires to hold in her hands. Olimpico is, in her eyes, the biologically defined man incarnating the Phallus (her true partner being the Phallus and not the man). As Lacan’s theory sets out to show, Olimpico belongs to those characterized by masculine structure. He will search within this woman’s features, a particular one and reduce her to ‘object (a)’ in his fantasy, trying to overcome the primordial Lack. However, it seems terribly hard to invest a precious object that arouses his desire in this particular woman: ugly, dirty and looking rather ill, there is nothing in her left to be reduced to a male fantasy object. Hence the customized flower: Olimpico invests what arouses his desire11 in the flower and not the girl. If we pursue Lacan’s theory a step further in terms of masculine/signifier and feminine/’signifiance’12, we will conclude that his work on sexuation rests on the belief that subjectification takes place at different levels in different sexuated beings: while the signifier refuses the task of signification, the ‘signifiant’ plays the material, non-signifying face of the signifier, the part that has effects without signifying: ‘jouissance’ effects. 13 This is displayed as the J. Lacan, Ecrits: A Selection, pp. 319 A similar flower will appear again in the film: Macabea has put it in a glass n her desk at work. Gloria, her colleague from the office, is getting ready for a first date with a man she never met before. She decides to wear the red flower in her bodice so that he can recognise her. Her appropriation of the flower symbolises her future appropriation of Olimpico’s fantasy (she will steal Macabea’s boyfriend, following the fortune teller’s advice) and her reduction to a male fantasy object. At the same time, the man she is about to go out with is reduced to his sexy voice. 12 Lacan’s concept of ‘letre de la signifiance’, found in Seminar XX, is explained by B. Fink in these terms: ‘I have proposed to translate it as  «signifierness », that is, the fact of being a signifier (†¦) the signifying nature of signifiers. When Lacan uses this term, it is to emphasise the nonsensical nature of the signifier, the very existence of signifiers apart from and separated from any possible meaning or signification they might have. ’ B. Fink, The Lacanian Subject: Between Language and Jouissance, pp. 118-9 13 B. Fink, The Lacanian Subject: Between Language and Jouissance, pp. 119 11 10 5 heoretical reason implying that the signifier of desire can be identified with only one sex at a time, meaning that Woman can never be defined as long as Man is defined. As Fink puts it, (†¦) the masculine path might then be qualified as that of desire (becoming one’s own cause of desire) while the feminine path would be that of love. 14 Watching this scene in isolation, one has the impression that love is for Macabea as desire is for Olim pico. This is not entirely the case, for in this scene and in the film in general, a woman (Macabea) is defined as long as a man (Olimpico) is defined. In a relationship where the partners are not identical (different feminine/masculine structures) both of them are ruled by desire. On the one hand, Olimpico desires all the attributes that Macabea sadly lacks, so he turns to Gloria, Macabea’s ideal imago (a version of what the latter wants to be, a version of herself that she can love). On the other hand, Macabea is not ruled by love. What she experiences with Olimpico is nothing compared to what she feels when Madame Carlota tells her about Hans: she feels inebriated, experiencing for the first time what other people referred to as passion. She falls passionately in love with Hans because the fortune teller had told her that he would care for her. Both Macabea and Olimpico are ruled by the desire to be loved and not by love. And if in this heterosexual relationship (which for Lacan is the norm) the dissymmetry is not entirely complete, what can we say of the homosexuality referred to by the fortune teller, who finds Macabea much too delicate to cope with the brutality of men and tells her, from experience, that love between two women is more affectionate? In fact, Lacan never theorized homosexuality very seriously, although his failure to account for it may be explained by the fact that the Symbolic is structured in favour of heterosexuality. In his theory of the Symbolic, the baby undergoes the mirror stage between 6 and 18 months old. By this time, the baby sees its own image in the mirror and enters the symbolic stage (realm of the imaginary: imaginary identification with the image in the mirror). As Lacan sets out to explain, This event can take place (†¦) from the age of six months, and its repetition has often made me reflect upon the startling spectacle of the infant in front of the mirror. Unable as yet to walk (†¦) he nevertheless overcomes the obstructions of his support and (†¦) brings back an instantaneous aspect of the image. For me, this activity retains the meaning I have given it up to the age of eighteen months. 15 Mirrors play an important role in Macabea’s life. Looking at her own reflection, she tries to find out who she is. After having used Gloria’s trick (making up an excuse to skip work), Macabea decides 14 15 Bruce Fink, The Lacanian Subject: Between Language and Jouissance, pp. 115 Jacques Lacan, Ecrits, A Selection, Chapter I: ‘The mirror stage as formative of the function of the eye as revealed in psychoanalytic experience. ’, pp. 1, 2 6 to spend her day off in her room, listening to Radio Clock, dancing and looking at herself in the mirror. The camera shows her reflection and what we see is a split image in the mirror: she stands between what she is, what she wants to be and what others want her to be. 6 When she tells the mirror: â€Å"I’m a typist, a virgin and I like Coca-cola† she complements her identity split with her mirage identity: Macabea is staging her identity by identifying with other people’s perceptions of herself. She is not eighteen months old but an eighteen-year-old in the middle of Lacan’s mirror stage, looking for models (which are the models in shop windows: the parental Other is absent), learning new words (at work as a typist, at home listening to the radio), looking at herself in mirrors. It is as if the Symbolic were staging ‘reality’ too late in the character’s life. During a walk at the Zoo, Olimpico accuses Macabea of being a liar: Macabea It is true. May God strike me dead if I’m not telling the truth. May my mother and my father drop dead right now. Olimpico Macabea You said your parents were dead. I forgot†¦ As Lacan would put it, we are watching how the Symbolic can bar the real, overwriting and transforming it completely, the reason for this being that the Symbolic is but a pale disguised reflection of the Real; the reason for this not being a basic assumption about the condition of being a child without living parents, that is, about the alienation caused by orphanage. This does not mean that Lacan did not reflect on the concept of alienation (check Fink, footnote 28, chapter 7, seminar XVI). In his opinion, that is what places the subject within the Symbolic. In alienation, the speaking being is forced to give up something as she/he comes into language. Lacan sees it as an attempt to make sense by trying to act coherently with the image one has about oneself. These attempts alienate the person because meaning is always ambiguous, polyvalent, betraying something one wanted to remain hidden or something one wanted to express. Lacan does not condemn or avoid alienation in his analysis. At a certain point, in Seminar XVI, he establishes a comparison between ‘surplus value’ (Marxist concept: the ‘jouissance’ of property or money that is the fruit of the employees’ labour, the excess product) and ‘surplus  «jouissance »Ã¢â‚¬â„¢ (what we seek in every relationship/activity but never achieve). While capitalism creates a loss aiming at ‘surplus value’ (the loss of the worker), our advent as speaking beings also creates a loss (the loss of ‘jouissance’ through castration). In Lacan’s economy of ‘jouissance’, both losses are at the centre of the development of civilisation, culture and market forces. At a certain moment in the film, we 16 In this respect, Lacan explains that ‘the only homogeneus function of consciousness is the imaginary capture of the ego by its mirror reflection and the function of misrecognition which remains attached to it. ’ In Ecrits, A Selection (1966) 7 watch Macabea handing over a certain ‘jouissance’ to the Other: she is told by her boss she has to work late. The consequence is that Gloria will meet Olimpico in the park, instead of Macabea. Following Lacan’s theoretical discourse, the scene depicts Macabea being forced to give up ‘something’ as she comes into language (as she finishes typing the documents). That ‘something’ is her love object. The scene can be read as a reference to the primordial loss – castration – by meditating on the importance of the sacrifice of ‘jouissance’ as it creates a lack17 and consequently gears life (the Symbolic/the plot) onwards: Gloria steals her colleague’s boyfriend and eventually gets a husband, following the fortune teller’s instructions; Macabea loses her boyfriend and ends up at the hands of the fortune teller who guides her towards her death. This analysis focuses on the ‘surplus  «jouissance »Ã¢â‚¬â„¢ and not on the Marxist concept of ‘surplus value’, therefore neglecting important class struggle/capitalist issues. Adopting a Lacanian frame in the analysis of alienation in The Hour of the Star involves losing what a Marxist concept of alienation might otherwise bring into light: the alienating effect society operates on Macabea as an exploited underpaid employee who finds herself working (sometimes after hours) for the employer’s enjoyment. The film, on the contrary, is quite clear in its portrait of an alienated subject working for less than the minimum wage in a decadent, poor-lit warehouse. A dialogue between Seu Raimundo and Seu Pereira suggests the capitalists’ attitude towards the proletarian Macabea: Raimundo Pereira Raimundo (†¦) Pereira: Raimundo Besides, she is really ugly. Like a shrivelled pomegranate. Where did you get her? Ok, she’s a bit clumsy. But a brilliant typist would want more money. It’s the new typist, Macabea. Maca what? -beia. Maca-bea. No one else was willing to do the job for less than the minimum wage. Adding to the notion of the film as a metaphor of the unconscious are: mirrors and their fragmented reflections, Radio Clock and its fragmented, dispersed bits of information and the gaze of the camera as the audience accedes to Macabea’s world through furtive gazings behind windows, doors, in the street. This gaze could be interpreted as belonging to Macabea’s wicked aunt who has died but still haunts her conscience. Macabea’s paradoxical fantasy, her dream to become a film star, is also hooked up to the circuit of the unconscious as the end term of her desire. Lacan explains that the unconscious, ruled as a language, is overpopulated with other people’s desires that flow into us via discourse. 18 So, our very fantasies can be foreign to us, they can be alienating. Macabea’s fantasy to become a film star could â€Å"Without lack, the subject can never come into being, and the whole efflorescence of the dialectic of desire is squashed. † In Bruce Fink, The Lacanian Subject: Between Language and Jouissance, pp. 103 17 8 be read as a way of answering other people’s desire: that she takes care of herself, eats better, dresses better, and works better. Interpreting Macabea’s dream as a response to her own desire (she wants to be loved; film stars are loved; therefore, she wants to be a film star) implies walking away from Lacanian theory. The subject is here very much implicated in the process. Others don’t seem to have had a hand in it. Olimpico laughs and humiliates her when she tells him about her dream and doesn’t encourage her to pursue it: Olimpico What makes you think that you’ve got the face or the body to become a film star? (†¦) Take a good look at yourself in the mirror. Lacan’s approach to the unconscious considerably reduces the sources from which one can carve out knowledge in relation to this film. Macabea’s ethnicity calls forth the analyst’s knowledge of Brazil’s North-Eastern structural roots of poverty (drought plagued agriculture, slums, human rights abuse in terms of health and education, the plight of street children, women’s issues in terms of class, race and land tenure). An informed reading of The Hour of the Star raises the question of marginality within the frameworks of location, gender, race, individual/social conscience, language and testimony. In the context of this film, the concept of marginality has to be addressed in the plural. There are different definitions of margin at stake, as well as different layers of marginal behaviours, each of them empowering the social/individual transgressions suggested by Macabea’s lack of attitude towards existence. The characters in this story are aware of their condition as outsiders. They are seen through their relation to Macabea: her apathy and emptiness are exquisitely painful in that they remind others of the collective pain felt in a dehumanised world. In the pyramid of the excluded, Macabea is victimised as a female and as a North easterner in search of her inner self. Her voluntary attempt, although grotesque and inarticulate, to question and witness her blunt existence stands as the last stance of her marginality. It is the hour of the tragic question: ‘Who am I? ’, echoing the major preoccupation of every mortal. Unlike the other characters, she fails in every sphere of her life but not in asking this question. She is aware of her inner otherness, although unable to verbalise or make sense of it. She witnesses it, tries to speak it, but never tells it, because what needs to be told is pure silence narrated from within. The title of the present study resonates with the limits of a psychoanalytic reading of The Hour of the Star. â€Å"A sense of Loss† and â€Å"The right to protest† are two of the fourteen titles19 advanced by 18 Lacan suggests that ‘it is in the reduplication of the subject of speech that the unconscious finds the means to articulate itself. ’, J. Lacan, Ecrits: A Selection, ‘A la memoire d’Ernest Jones: sur la theorie du symbolisme’ 19 List of titles found at the beginning of HE: The Blame is Mine or The Hour of the Star or Let Her Fend for Herself or The Right to Protest or . As for the Future or Singing the Blues or She Doesn’t Know How to Protest or A Sense of Loss 9 Clarice Lispector in her book A Hora da Estrela. They were chosen by me for two reasons. The first implies that analysing the film by giving the book behind it the cold shoulder would weaken the analysis. Another is the belief that choosing only one title would dramatically reduce the scope of this work of art. Macabea cannot escape looking at mirrors and gazing at a sense of loss that dazzles her in her opaque leading-nowhere-abstractions. But she is herself a mirror reflecting the social inequities of the Brazilian society in she lived. Taking a step further, we could add yet another title: â€Å"I can do nothing†, number eleven in Lispector’s title list. This one would eclipse the Other’s discourse, unconscious and unintentional, and give way to the informed discourse of a conscious audience viewing writing as a representative mirror of reality. Having said all this, one can only afford ‘A discreet exit by the back door’20 once a final, irrevocable question is posed. Is it still possible, having pointed out the missing dimensions of analysis and the resistances to a Lacanian approach of The Hour of the Star, to make sense of Lacan’s theoretical framework? On the one hand, answering with a ‘no’ would seem fatally solipsistic in what the existing quantities of written work on psychoanalysis are concerned, as Lacan’s work lies at the epicentre of contemporary discourses about otherness, subjectivity, sexual difference, to name just a few topics. Answering with a ‘yes’, on the other hand, would plainly simplify subject matters that are, as this work intends to show, very complex. Perhaps the question, in the fashion of all interesting questions, offers no answer insofar as a balanced account of the possibilities, limitations, meanings and implications of Lacan’s theory is not thoroughly considered. or Whistling in the Dark Wind or I Can Do Nothing or A Record of Preceding Events or A Tearful Tale or A Discreet Exit by the Back Door. 20 Final title in Clarice Lispector’s list of titles. 10 Primary Bibliography Lacan, J. Ecrits (Paris: Editions du Seuil, 1966) _______, Ecrits: A Selection, trans. Alan Sheridan (London: Routledge, 1977) _______, The Seminar of Jacques Lacan. Book II. The Ego in Freud’s Theory and in the Technique of Psychoanalysis, trans. Sylvana Tomaselli (New York/London: Norton Co. , 1991) _______, The Ethics of Psychoanalysis: The Seminar of Jacques Lacan Book VII, trans. D enis Porter (London/New York: Norton Co. , 1992) Lispector, C. , A Hora da Estrela, (Rio de Janeiro: Jose Olympio, 1977) __________, The Hour of the Star, trans. Giovanni Pontiero (Manchester: Carcanet, 1992) Freud, S. New Introductory Lectures on Psychoanalysis, ed. /trans. J. Strachey (London: Penguin Books, 1991 The Hour of the Star, Dir. Susana Amaral, Raiz Producoes Cinematograficas, 1985 Secondary bibliography Barry, P. , Beginning Theory: An Introduction to Literary and Cultural Theory (Manchester: Manchester University Press, 2002) Benvenuto B. Kennedy, R. , The Works of Jacques Lacan: An Introduction (London: Free Association Books, 1986) Cixous, H. , ‘The Hour of The Star: How Does One Desire Wealth or Poverty? ’, Reading With Clarice Lispector, ed. and trans. Verena Andermatt Conley (Minneapolis: University of Minnesota Press, 1990), 143-163 Daidone, L. C. Clifford, J. , â€Å"Clarisse Lispector: Anticipating the Postmodern†, Multicultural Literatures through Feminist/Poststructuralist Lenses, ed. Barbara Frey Waxman (Knoxville: The University of Tennessee Press, 1993), 190-201 Fink, B. , The Lacanian Subject: Between Language and Jouisssance (Princeton N. J. : Princeton University Press, 1995) Fitz, E. , ‘Point of View in Clarice Lispector’s A Hora Da Estrela’, Luso-Brazilian Review, 19. 2 (1982), 195-208 Lapsley, R. Westlake, M. , Film Theory: An Introduction (Manchester: Manchester University Press, 1988) _________, ‘From Cassablanca to Pretty Woman: The politics of Romance’, Screen, 33. 1 (1992), 27-49 Lemaire, A. , Jacques Lacan, trans. D. Macey (London, Henley Boston: Routledge, 1977) Klobucka, A. , ‘Helene Cixous and the Hour of Clarice Lispector, SubStance, 73 (1994), 41-62 Mitchell, J. Rose, J. (eds), Feminine Sexuality: Jacques Lacan and the Ecole freudienne (Houndsmill: Macmillan, 1992) Mitchell, J. , Psychoanalysis and Feminism (London: Penguin, 1990) Mulvey, L. ‘Visual Pleasure and Narrative Cinema’, The Sexual Subject: A Screen Reader in Sexuality (London New York: Routledge, 1998), 22-34 Nelmes, J. (ed. ), An Introduction to Film Studies, 2nd edn (London: Routledge, 1990) Patai, D. , ‘Aspiring to the Absolute’, Women’s Review of Books, 4 (1987), 30-31 Smith, J. Kerrigan, W. (eds. ), Interpreting Lacan (New Haven London: Yale University Press, 1983) Storey, J. , Cultural Teory and Popular Culture: An Introduction, 3rd edn (Dorchester: Dorset Press, 2001) Whatling, C. , Screen Dreams: Fantasising Lesbians in Film (Manchester New York: Manchester University Press, 1997) 11 How to cite The Hour of the Star, Papers

Essay Equity in Healthcare

Question: Write about the Essayfor Equity in Healthcare. Answer: Introduction The health has been recognised as a fundamental human right. The citizens of any country have a basic human right to be free from illness/ disease and lead socially and economically productive lives with complete physical, mental, social and spiritual well-being. Health equity means that all the citizens of a country will be taken care of their health needs and it is the responsibility of state to provide accessible, affordable and quality health services to its citizens. The concerns for health equity were first raised during Alma-Ata-Declaration of World Health Organisation. The inequitable access to healthcare services and increased out-of-pocket expenditures for seeking healthcare is a major challenge in low and middle income countries (Dwivedi, Pradhan 2017). The researchers have estimated that globally approximately 1.3 billion individuals are deprived of access to an equitable and affordable healthcare service (Leive, Xu 2008). Also on an average, households spend approximately forty percent of their income to treat their ill-health (Akazili et al, 2012). Equitable financial arrangements in health-care delivery are very important for achieving Universal Health Care. It is important to raise financial resources to overcome financial risks and barriers to universal health care; and also to provide equitable and efficient health services (Kutzin, 2013). In addition, healthcare reforms that promote equity in the distribution of financial resources may also increase utilisation of healthcare services (ibid). Equitable resource allocation may also require purchasing of resources from external sources or pooling of resources (McIntyre, Kutzin 2012). The governments should assure equitable distribution of resources. It is important to maintain horizontal equity as well as vertical equity while distributing health and financial resources. It means the individuals or areas with same needs must get same amount of resources and individuals or areas with more needs must get more amount of resources (McIntyre, Kutzin 2012). For this, it becomes important to access health needs of populations across levels of care (Primary, Secondary, Tertiary) as well as across geographical areas (Anselmi, Lagarde, Hanson, 2015). Further it becomes important to monitor health utilisation rates (ibid). Health Services system in India and Health Equity Healthcare system of India is a mix of public and private health services. Public health services system is a three tier system with primary health centres at the peripheral level with some basic health facilities. Secondary level of system comprises CHC (Community Health Centres), and district hospitals. Tertiary level of system comprises tertiary care institutions and apex institutions like AIIMS (All India Institute of Medical Sciences). Inspite of such a good architectural arrangement of health services system, the system is mostly dilapidated and public have to spend out-of-pocket to avail health services from private practitioners (Ruhil, 2015). For the first level of contact between community and health services system, the country has a chain of community health workers called ASHA. These are interface between people at community level and health services system. Primary care is provided at PHCs and patients are referred to CHCs for further treatment. There is one CHC over a population of 80,000 to 1,20,000. There is one surgeon, one physician, one gynaecologist and one anaesthetist at CHC level. For specialised treatment patients are further referred to district hospital which is one in each block or district. The patients which cannot be managed at secondary level are referred to apex institutes. India as a country needs special efforts to create equitable access to health-care services as majority of its pre-mature deaths happen from preventable causes (Joumard, Kumar 2015). Government of India needs to scale-up its public health-care spending with more number of professionals in public health services and improving the overall primary healthcare services system (ibid). In the absence of robust public health services system in the country, the out-of-pocket expenditure for health-care is more in the country and public have to largely rely on private health services. The country currently spends 5 percent of GDP on healthcare; out of which 4 percent is private expenditure or out-of-pocket expenditure and only 1 percent is government spending (ibid). The government needs to increase financial allocation to public healthcare and needs to strengthen its health services system to make it more equitable. Many sources of financing health-care services include taxation, social security schemes, health insurance and levying user charges (Amakom, Ezenekwe 2012). In India social security schemes are not robust enough to protect the citizens from the catastrophe of major health illnesses in the family (Dwivedi, Pradhan 2017). Health inequities are widely prevalent in the country and those who are most needful of healthcare services are most disadvantaged one in terms of access to healthcare services (ibid). Researchers have shown that there are regional disparities among various states of India, in healthcare spending (ibid). The states which are relatively backward and are most in need of healthcare financing have paradoxically least expenditures on health (ibid). It is imperative to reduce the burden of out-of-pocket health expenditures and provide equitable healthcare financing in India. India is currently facing huge health problems. India has high Infant mortality rates (IMR), Under-5 mortality rates (U5MR), and maternal mortality rates (MMR). Also the children who are born, majority have low birth weight (Drze, Sen, 2013). Among children nutritional deficiencies are high resulting in malnutrition and thus physical and mental retardation (ibid). The problems also have social roots where women have comparatively low social status and are treated as sub-ordinate to men. The women even if pregnant eat at last after serving food to all male members of family. The earning male members of family and elderly are given priority rather than women and children (ibid). The breastfeeding rates are also very low. The poor women do not secrete sufficient milk due to their own poor health status. Also women are busy in work; either earning or in household work; and thus do not get time and space to breastfeed their children frequently. The country also faces double burden of diseases where communicable diseases are still prevalent and new chronic life-style related problems such as cardio-vascular diseases, cancers and chronic respiratory diseases are adding to the burden (Patel et al, 2011). Tobacco use is also highly prevalent in India with about one-third of Indian population using tobacco (IIPS MoHFW 2009-10). Tobacco is a major risk factor for majority of communicable and non-communicable diseases including adverse reproductive outcomes. Also the problems of outdoor air pollution and indoor air pollution are high leading to heart diseases and respiratory diseases (IHME, 2013). The problem of open defaecation is also prevalent in rural villages of India and so the prevalence of diarrhoea and cholera especially in children (Spears, Lamba, 2013). The Swachcha Bharat Abhiyaan (Clean India Campaign) was started by govt. of India in October 2014; under which government is providing help for the construction of latrines. The aim of the campaign is to make India open defaecation free. The programme is getting wide appreciation. People are actively participating in making their villages, streets and cities clean. According to a study only 16 percent of population had any free access to public healthcare (Kumar et al, 2011). In few states like Tamilnadu and Kerala, the performance of public health services was satisfactory but in some other states like Bihar, Jharkhand, U.P.; the services provided by public healthcare system were NOT satisfactory (ibid). Distance of health-care facility from home, and total non-availability of health service at the designated point of primary health care were main reasons for dissatisfaction among public (Kumar et al, 2011). One report by Government itself reported that about 10 percent of PHCs (Primary Health Centres) do not have a physical presence of doctor (MoHFW, 2012). Also 37 percent of PHCs are without a physical presence of lab-technician and about 25 percent of PHCs did not have a pharmacist (ibid). Thus management of human resource for health is a huge challenge while providing equitable health services. In rural areas of India, access to healthcare is a major problem. Private practitioners do not want to practice in rural areas due to lack of lifestyle facilities in those areas. Thus majority of the time public health facilities are the only means of getting healthcare in rural areas. The PHCs in rural areas are shut most of the time and are without basic facilities like a qualified doctor, lab-technician, pharmacist, essential medicines, first-aid facilities, emergency services etc. (MoHFW, 2012). Similar is the state of urban slums. Majority of the health facilities are concentrated in urban city centres, including both the private facilities as well as government facilities. Taking advantage of dilapidated health services system in the country, corporate hospitals are mushrooming which are making profits from medical tourism instead of treating their own countrymen. A research reported that in 2012, India treated 0.2 million foreign patients which gave a revenue of USD 2 billion (Sachan, 2013). The private sector in India is largely unregulated. Although Clinical Establishments Act 2010 set some norms for private hospitals but its implementation is rather lethargic (ibid). Quereshi committee report revealed that these corporate hospitals have taken free land from government and still are not fulfilling basic conditions of treating a certain number of BPL patients for free of cost. Also the quality of treatment provided to free patients is very poor. Another important component of Indian Health Services System is Medical Pluralism (Ruhil, 2015). It includes coded as well as non-coded traditional systems of medicine (ibid). The coded systems of medicine include AYUSH (Ayurveda, Yoga, Unani, Siddha, Sowa-Rigpa, Homeopathy). The government of India has integrated these systems of medicine into mainstream state health services (ibid). The national health policy of 2017 has also recognised the importance of traditional medicine (Government of India, 2017). Government of India also celebrate International Day of Yoga each year on 21 June, which has made Guinnes World Record in 2015 with 35,985 people and 84 nations participated in it (Ruhil, 2015). At the level of CHC and district hospital a separate department of AYUSH has been created which recruit the AYUSH qualified health practitioners to provide its services. The government has also started some public insurance schemes like Rashtriya Swasthya Bima Yojana; but the effectiveness of these schemes is questionable and has been critically analysed by many researchers (Selvaraj, Karan, 2012). The other insurance schemes include Employee State Insurance Scheme (ESIS), Central Government Health Scheme (CGHS), Aarogyasri in Andhra-Pradesh, and Yeshaswini in Karnataka. The out-of-pocket expenditures are high and patients have to seek private facilities for diagnostics, x-rays, MRI, Ultrasound, laboratory diagnosis, and medicines as these facilities are lacking in public health facilities (ibid). Quality of care is also compromised in public health facilities (ibid). There are also differentials in quality of care given to government insured patients in private hospitals as compared to highly paid patients and NRI patients (ibid). Informal payments and use of influence to get treatment is also highly prevalent in public health facilities (Rao et al, 2009). There is always a large queue at public health facilities and then there are some influential people who get patronage over others. Also the people come out of cars with BPL (Below Poverty Line) cards to avail free services. This snatch the benefits from those people who are actually poor but could not get BPL card due to lack of contacts and lack of literacy. Thus actual implementation of pro-poor policies is highly inequitable and remains unsuccessful in addressing the issues related to health equity. The central government give grants to states to run public health services under National Health Mission (NHM) which started as National Rural Health Mission (NRHM) in 2005 and scaled up in 2013 to include urban areas as well. The NRHM further have several health schemes like, Janani Suraksha Yojana which is a conditional cash transfer scheme. The certain amount of money is transferred in to the accounts of pregnant mothers to take care of themselves and their new-borns (Joumard, Kumar, 2015). The proper management of human resource for health is also a great challenge (Rao et al, 2012). There is increased commercialisation of medical education in India with so many private players entering into it, producing a huge number of medical graduates each year who remain unabsorbed in to the mainstream health system and end up working on their own private clinic and the problem of health inequity remain unanswered (ibid). Conclusion The India as a country is in very advantageous position strategically with its economy among the fastest growing economies of the world and majority of its population young and productive i.e. below 35 years of age and ready to harness the benefits of demographic dividend. In such a scenario, achieving health equity is not a distant dream but requires political will, greater proportion of GDP to be spent to strengthen public health services system, maintaining quality standards in medical education and proper absorption of medical graduates passing each year from hundreds of medical colleges in the country. The social security schemes need to be formulated and implemented in such a way that its benefits reach the real poor and help address the problems of inequity especially health inequities in society. References Akazili, J., Garshong, B., Aikins, M., Gyapong, J., McIntyre, D. (2012). Progressivity of health care financing and incidence of service benefits in Ghana. Health Policy Planning, 27(1), i1322. Amakom, U., Ezenekwe, U. (2012). Implications of households catastrophic out of pocket (OOP) healthcare spending in Nigeria. J Res Econ Int Finance (JREIF), 1(5), 13640. Anselmi, L., Lagarde, M., Hanson, K. (2015). Equity in the allocation of public sector financial resources in low- and middle-income countries: a systematic literature review. Health Policy and Planning, 30, 528545. doi:10.1093/heapol/czu034. Drze, J., Sen, A. (2013). An Uncertain Glory India and its Contradictions, Princeton Press. Dwivedi, R., Pradhan, J. (2017). Does equity in healthcare spending exist among Indian states? Explaining regional variations from national sample survey data. International Journal for Equity in Health, 16, 15. DOI 10.1186/s12939-017-0517-y. Government of India. National Health Policy 2017. Policy document, MoHFW 2017, New Delhi. Institute for Health Metrics and Evaulation, IHME (2013), Global Burden of Disease 2010, Released March 2013, www.healthmetricsandevaluation.org/gbd. International Institute for Population Sciences (IIPS), Mumbai and Ministry of Health and Family Welfare (MoHFW). Government of India: Global Adult Tobacco Survey (GATS) India, 2009-10. New Delhi: MoHFW, Govt. of India; 2010. ISBN 978-81-920192-0-8. Available from: https://mohfw.nic.in/WriteReadData/l892s/1455618937GATS%20India.pdf. last accessed 5 January 2016. Joumard, I., Kumar, A. (2015). Improving Health Outcomes and Health Care in India. OECD Economics Department Working Papers, No. 1184, OECD Publishing. https://dx.doi.org/10.1787/5js7t9ptcr26-en. Kumar, A., Chen, L., Choudhury, M., Ganju, S., Mahajan, V., Sinha, A., Abhijit, S. (2011). Financing Health Care for All: Challenges and Opportunities. Lancet, 377, 66879. Kutzin, J. ( 2013). Health financing for universal coverage and health system performance: concepts and implications for policy. Bulletin of the World Health Organization, 91, 60211. Leive, A., Xu, K. (2008). Coping with out-of-pocket health payments: empirical evidence from 15 African countries. Bull World Health Organ, 86(11), 849856C. McIntyre, D., Kutzin, J. (2012). Revenue collection and pooling arrangements in financing. In: Smith RD, Hanson K (eds). Health Systems in Low and Middle Income Countries: An Economic and Policy Perspective. New York: Oxford University Press, pp. 77102. MoHFW (2012), Rural Health Statistics in India 2012, Statistics Division, Ministry of Health and Family Welfare, Government of India, March. Patel, V., Chatterji, S., Chisholm, D., Ebrahim, S., Gopalakrishna, G., Mathers, C., Mohan, V., Prabhakaran, D., Ravindran, R., Reddy, K. (2011). Chronic diseases and injuries in India. Lancet, 377(9763), 413-28. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21227486. [18 April 2017] Rao, K., Bhatnagar, A., Berman, P. (2012). So many, yet few: Human resources for health in India. Human Resources for Health, 10, 19. Rao, K., Saran, I., Srivastava, A. (2009). The Inequity of Informal Payments for Health Care in India. India Health Beat, 2(1), World Bank/Public Health Foundation of India. Ruhil, R. (2015). Medical Pluralism in India and its Integration into State Health Services System. AYUSHDHARA, 2(5), 309-314. Ruhil, R. (2015). The Roots of Brown Sahib Medical Mens Burden. Indian J Comm Health, 27(4), 429-434. Sachan, D. (2013). Tackling corruption in Indian Medicine. Lancet, 382(9905), e23 - e24. Selvaraj, S., Karan, A. K. (2012). Why publicly financed health insurance schemes are ineffective in providing financial risk protection. Economic Political Weekly, 47(11), 60-68. Spears, D., Lamba, S. (2013). Effects of Early-Life Exposure to Sanitation on Childhood Cognitive Skills: Evidence from Indias Total Sanitation Campaign. Policy Research Working Paper 6659, World Bank Sustainable Development Network, World Bank Publishing.