what r the 3 dimensions of human emotionality
Interconnectedness of (i) consciousness, (ii) sense of self & (iii) emotional experience The interplay of these three dimensions of human being is rarely so alive and intrusive as it is throughout serious illness trajectories High risk during illness of experiencing very challenging emotions and (often existential) threats to one’s sense of self
what is fear
Physical response (in extreme cases): Rapid heart beat; palid skin; cold sweat; bristled hair; muscular tremors; rapid breathing; dryness of the mouth; trembling lips; husky voice Increased blood supply to heart & muscles Increased adrenalin levels Intense concentration Can become pathological
Fear and illness
Consider the ‘fight or flight response’ factor
Liminality: living in a state of uncertainty somewhere between sickness and health; living in a ‘liminal’ space – unable to flee & limited ‘fighting’ potential
Underlying state of anxiety related to uncertainty with fear surfacing from time to time in response to particular stimuli – eg a new symptom; a painful association; anticipation of test results
Fear and illness: cancer screening
Cancer screening research suggests that emotions relevant to attending for screening include embarrassment and fear (Consedine et al., 2007)
Originated as a form of food rejection
Basic forms of disgust are elaborated through social processes
Susceptible to process of moralisation
Moral emotions - eg guilt, shame, disgust
cultural evolution of disgust
Disgust in relation to foods based on their nature and origin
Disgust in relation to reminders of our animal nature – death, inappropriate sex, violations of the body boundaries
Disgust in the moral domain
The process through which an activity that was previously outside the moral domain enters into it.
Common in both individual development and cultural evolution.
disgust and illness
Moralisation of particular illnesses
Moral judgements - contamination - disgust Close association between disgust and shame
what is the problem of using metaphor in illness
Use of metaphors in meaning making in illness experiences – eg battle/fight metaphors commonly used in cancer; ‘miracles’ in end of life care
Can be challenging for people living in a liminal state
Current social metaphors tend to imply that cancer patients are weak or ineffectual people who have in some way participated in their disease--the so-called "Type C" personality, defined as passive, emotionally inexpressive, conforming and unassertive. "The cancer personality is regarded...with condescension, as one of life's losers," Sontag observes. It's hard for anyone in today's pop-psych, self-help American culture not to feel at least some sense of self- blame or shame over having a life-threatening illness.
what is shame and what is its function
Shame arises from seeing one’s self negatively from the point of view of the other.
Shame often precedes anger
1.Key component of conscience
2.Alerts us to a threat to the social bond - signals trouble in a relationship
3. Regulates the expression and awareness of all our other emotions
shame and illness e.g. parkinson's disease
A problem of public appearance
In the beginning he used to hold his hand ... behind his back. Or he held one hand with the other (Wife)
Sometimes I have to sign a cheque. Then I think ... these people must at least think I must have stolen the cheque ... it’s embarrassing
When you are in a room full of visitors ... and you have to stand up, it’s embarrassing
the role of nurses in emotions
- Being connected to another person at the level of subjectivity (below level of surface communication)
what is intersubjective connectedness
Emotions enable intersubjective connectedness
Attunement - joint attention and feeling in interaction
A sense of ‘attunement’ is the goal of most social interactions
Maintaining social bonds - crucial human motive
Communication system – through which individuals make known to each other their thoughts
Deference-emotion system – through which each person evaluates the other’s status.
what is attunement
Mutual understanding that is mental and emotional:
- empathic intersubjectivity (mind reading)
- occur in conflict & in cooperative interactions.
Successful face work leads to the state of attunement.
Unsuccessful face work - feelings of shame (embarrassment or disgrace shame) in one participant at least
Seeking attunement - the most basic component of all everyday interaction
Avoidance of shame - a high priority
Attunement and the nurse-patient relationship:
- Potential for loss of patient status
- Disgust -> shame - high risk
- Shame avoidance - a very high priority
- Unsuccessful attunement makes n/p encounters difficult
- Both nurse and patient working towards successful attunement
birth and uncertainty
Both always present in illness experiences where predicting the future precisely is usually impossible.
You might be surprised by the particular things people who are very ill tell you they hope for – if you ask them
Asking this question will make it possible for you to help them.
what is compassion, empathy, pity and sympathy
Compassion: sympathetic consciousness of others distress together with a desire to alleviate it.
Empathy: the act of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts and experiences of another without having the feelings, thoughts and experiences fully communicated in an objectively explicit manner
Pity: sympathetic sorrow for one suffering, distressed or unhappy
Sympathy: the act or capacity of entering into or sharing the feelings or interests of another.
compassion require 3 beliefs
A bridge between the individual and the community
Requires three beliefs:
1. That the suffering is serious, not trivial
2. That the suffering was not the result of the person' s own culpable actions
3. That the pitier could experience the same kind of suffering herself