Resoundings of the flesh: Caring for others by way of "second person" perspectivity

Opacity, difference and not knowing: what can psychiatry learn from the work of Édouard Glissant?

Martinican poet, novelist and cultural theorist Édouard Glissant (1928-2011) rejected contemporary simplistic notions of creole hybridity popularised in the 1980s and 1990s in favour of a unique and explicitly antiessentialist construct of Caribbeanness-a form of being that embraces place while shunning any associated ideas of rootednesss. Throughout his work, there is a constant tension between the local and the global, the particular and the universal, the essentialist and the homogenising, a tension that is never resolved but used creatively to stake out an emergent third position against a backdrop of a metaphorical Caribbean seascape. The purpose of this article is to shed light on a central idea developed by Glissant: the importance of acknowledging opacity in the encounter with the Other, in contrast to idealised notions of transparency as inherently desirable. This 'right to opacity' has been embraced in poststructural theory, postcolonial activism and contemporary art. However, I argue that opacity is also a highly relevant notion in clinical contexts, as an essential resource for understanding concepts such as first-person, second-person and third-person perspectives in the phenomenology of mental health and illness. For illustration, I point to a number of clinical tools and approaches-such as the Cultural Formulation Interview, Therapeutic Assessment and the employment of a not-knowing stance in mentalisation-based treatment-that successfully incorporate a respect for opacity as a core value in the clinician-patient encounter. This article is not an attempt to offer a definitive how-to guide on how to make use of the ideas of Édouard Glissant in the clinic; instead, I hope to inspire further discussion about how various notions of opacity and transparency come into play for mental health practitioners and how acknowledging alterity and difference may contribute to more fruitful and respectful ways of engaging with the patient-as-Other.

Mingled bodies and voices: Maternal reflections on caregiver expertise and intellectual disability

The risk of viral infection during the COVID-19 pandemic has caused many hospitals to prohibit all patient visitors, including family caregivers for people with intellectual disabilities. Drawing on a postmodern, intersubjective view of the body, as well as my experience as the mother of a young adult with profound disabilities, I argue that caregiver knowledge while unconventional within the medical paradigm must be viewed as essential expertise. People with profound intellectual disabilities often have concurrent, complex medical issues that are complicated by their inability to self-advocate. Optimal care rests upon the ongoing presence and expertise of their primary caregiver. Medical professionals risk patient care by excluding the essential expertise of family caregivers at any time, and specifically during COVID-19.

Helpful factors in a healthcare professional intervention for low-back pain: Unveiled by Heidegger's philosophy

Low-back pain can be invalidating physically as well as mentally. Despite professional help to treat and prevent low-back pain, the pain often persists, and so do the problems related to low-back pain. An intervention that made it possible for a significant part of patients with low-back pain to improve health and well-being raised the question: Why was it possible to help some and not others? The aim of the present paper was to achieve a deeper understanding of factors patients experienced as helpful in professional support related to low-back pain. This was explored using a hermeneutic-phenomenological approach while analysing 20 interviews with patients with low-back pain purposively chosen interviews conducted in relation to the intervention. An analysis was made using Ricoeur's interpretation theory. Data on both positive and negative experiences were read and reflected upon. We found that healthcare professionals' adoption of a narrative approach facilitating the patient's perspective was perceived as helpful. Patients experienced this as being taken seriously; an experience that could be explained at a deeper, more nuanced level using Heidegger's philosophy. Facilitating the patient's perspective was conditional not only on the professional obtaining access to the patient's perspective but also on understanding and acknowledging the patient's existence. The challenge for healthcare professionals in this respect is to bridge the gap between the consultation's fact-focused concern with the medical implications of low-back pain and the patient's concern with the implications low-back pain has for his or her personal identity and life. Listening to the patient's perspective in itself supports the subjective recovery process, while also supporting the quality of patient-centred support and strengthening the patient's trust in its helpfulness.

Ethical dilemmas embedded in performing fieldwork with nurses in the ICU

Background:

Background: In general, qualitative research design often involves merging together various data collection strategies, and researcher’s may need to be prepared to spend longer periods in the field to pursue data collection opportunities that were not foreseen. Furthermore, nurse researchers performing qualitative research among patients and their relatives often experience unforeseen ethical dilemmas.

Aim:

This paper aimed to explore aspects of ethical dilemmas related to qualitative nursing research among patients and their relatives in the intensive care unit (ICU).

Research design:

This paper is based on a qualitative researcher’s personal experience during a hermeneutic phenomenological study involving close observation and in-depth interviews with 11 intensive care nurses. Data were collected at two ICUs in two Norwegian university hospitals.

Ethical considerations:

The study was approved by the Norwegian Social Science Data Services (NSD). The Regional Committee for Medical and Health Research Ethics (REK) granted dispensation to the project regarding health personnels confidentiality of the patients who were present during the observation (2012/622-4).

Findings:

Close observation with nurses in the ICU requires the researcher to balance being a qualitative researcher, an ICU nurse and a sensitive fellow human being open to the suffering of the other—that is, being embodied, engaged and affected by sensitive situations and simultaneously constantly stepping back and reflecting on the meaning of those situations.

Conclusions:

The qualitative researcher’s ethical awareness also entails knowing and acknowledging his or her own vulnerability, which becomes apparent in the researcher-participant relationship and settings in which being a fellow human always overrules the researcher’s role in ethical dilemmas.

Being with others during physical activity: experiences of well-being among adults with severe obesity

BACKGROUND

The experience of physical activity is influenced by social relations and gendered roles. Group-based lifestyle interventions are considered effective in promoting physical activity, yet the experiences of being active with others are unknown among individuals with severe obesity.

PURPOSE

To explore how individuals with severe obesity experience being with others during physical activity.

METHODS

A qualitative hermeneutic phenomenological study of repeated single-gender focus group interviews was conducted with adults living with severe obesity during group-based lifestyle intervention.

RESULTS

Three themes were developed: 1) 'Enjoying safety, kinship and belonging among peers'; 2) 'Feeling like a failure is shameful: A sense of aversion'; and 3) 'Striving to feel at home in physical activity: Needing distance from others.' The themes were drawn into an overall meaning 'Achieving wellbeing may always be a challenge: not feeling at home in the group or in body.'

CONCLUSION

Intersubjective and spatial dimensions of experiences are central and influence how individuals with severe obesity can feel wellbeing and 'at home' in physical activity. Physiotherapists should be aware of the individuals' vulnerability regarding feelings of failure, aversion, and shame as well as awareness of gendered norms and roles.

To be present, share and nurture: a lifeworld phenomenological study of relatives' participation in the suicidal person's recovery

In today's health care, participation is acknowledged as important. However, there is limited research on how relatives of patients at risk of suicide experience their opportunities to participate in care during periods when their close ones are subject to inpatient care. The aim of this study was to describe the phenomenon of participation, as experienced by relatives of persons who are subject to inpatient psychiatric care due to a risk of suicide. The study was conducted through a reflective lifeworld research (RLR) approach, based on phenomenological philosophy. Eight relatives of patients receiving care from professionals in a psychiatric specialist health care context in Sweden participated in phenomenon-oriented interviews. Data were analysed to elucidate a meaning structure of the phenomenon. The findings show that the phenomenon of participation was more associated with patients' recovery processes than with the caring process, and means "being actively involved in a process in which the person regains the desire to live". The meaning of participation is further described by its meaning constituents: struggling for being able to be present for the person at risk of suicide, being able to share everyday life, and nurturing sources for vitality. These insights into the meaning of participation highlight the importance of allowing supportive relatives to be a part of the patient's life, while the person is cared for in an inpatient hospital setting. Thus, participation enables relatives to be acknowledged as resourceful human beings in the patient's recovery process, and thereby facilitates a sense of being able to manage and share life itself together with the person. This means that mental health nurses need to recognize individual variations of relatives' participation processes, and take on the responsibility of acknowledging relatives' lifeworlds.

Role of the first and second person perspective for control of behaviour: Understanding other people's facial expressions

Humans typically make probabilistic inferences about another person's affective state based on her/his bodily movements such as emotional facial expressions, emblematic gestures and whole body movements. Furthermore, humans deduce tentative predictions about the other person's intentions. Thus, the first person perspective of a subject is supplemented by the second person perspective involving theory of mind and empathy. Neuroimaging investigations have shown that the medial and lateral frontal cortex are critical nodes in the circuits underlying theory of mind, empathy, as well as intention of action. It is suggested that personal perspective taking in social interactions is paradigmatic for the capability of humans to generate probabilistic accounts of the outside world that underlie a person's control of behaviour.

Grasping the experience of the other from an interview: self-transposition in use

This article describes a part of the interview process that is never usually reported. Listening to what people say is the key to increasing our knowledge of human existences. Procuring knowledge about human experience is much more challenging. Although good sources on how to prepare and conduct an interview exist, the process of the interviewer's perception of the interviewee's message and meaning is less examined. Beyond the role of eliciting the data, the researcher endeavours to reproduce the interviewee's narration and not the voice of the researcher. By illustrating the process during the interview, further transparency and thereby validity may be achieved. To exemplify this, the perception of the interviewer is explored, and here Heidegger's work on self-transposition has proved to be helpful.