Distant suffering: A concept analysis

BACKGROUND

Patients who are suffering may be commonly encountered in health care. The growing use of telehealth implies that encounters with patients who are suffering may increasingly take place at a distance. "Distant suffering" is a concept coined within sociology to describe the suffering of far-away others. It is conceptualized as a paradox, as distance changes the relation between the witness of suffering and the suffering encountered. Impacts may include a potential detriment to the sufferer and ethical implications for the witness.

OBJECTIVE

To explore the concept of distant suffering and any relevance, implications, or important avenues for potential research within the healthcare sciences.

DESIGN

Rodgers' evolutionary concept analysis.

DATA SOURCES

Databases of Web of Science, Medline, CINAHL and PsycInfo were searched for the terms "distant suffering" or "mediated suffering".

REVIEW METHOD

Attributes, surrogate or related terms, antecedents, consequences, and uses of the concept were extracted and synthesized.

RESULTS

Thirty articles published within the past ten years were selected for review from the search results. "Distant suffering" was characterized as comprising 1) mediated far-away suffering, 2) a "recognizer" or witness, and 3) a potential role of a moderator. Antecedents include shared understandings and socially-influenced responses. Consequences include responses like empathy, compassion, pity, also indifference, cynicism and compassion fatigue.

CONCLUSIONS

Further research to explore distant suffering from healthcare sciences' perspective could uncover valuable insights for those suffering, for healthcare workers, and any who are exposed to it. An improved understanding of how distant suffering is conveyed and moderated could enable targeted reduction of exposure or improve response to distant suffering. Such knowledge could help diminish negative consequences for those suffering, for healthcare workers who are caring at a distance for those suffering, or for others who encounter distant suffering in their occupations or in daily life via media, social media, or digital communications.

TWEETABLE ABSTRACT

New analysis finds that exposure to distant suffering may have important implications for health and health care.

Witnessing workplace bullying - protocol for a systematic review and meta-analysis of individual health and well-being outcomes

BACKGROUND

Most research on workplace bullying has examined the impact of the mistreatment on those exposed. Although bullying also is assumed to have significant ripple effects on bystanders, the empirical evidence for this line of research is highly fragmented and inconclusive. The overarching aim of this planned systematic review and meta-analysis is therefore to determine whether witnessing bullying of others at the workplace is associated with health problems and lower well-being among the observers. To achieve this aim, the review includes an assessment of which theoretical frameworks and methodological designs used in research so far and shed light on which confounders, mediators, and moderators that have been accounted for.

METHODS

A systematic review and meta-analysis will be conducted. Electronic databases will be searched using pre-defined search terms to identify relevant studies. Eligible studies should report empirical findings on any individual outcome variable assessed among witnesses to workplace harassment and bullying or any overlapping concept. Primary observational studies with cross-sectional or prospective research design, case-control studies, and studies with experimental designs will be included. Qualitative interviews and case studies will be excluded. The methodological quality of the included studies will be assessed with a previously established checklist for studies on workplace bullying. The quality of evidence for an association between witnessing bullying and potential outcomes will be evaluated in accordance with the GRADE system. A random effects meta-analysis will be conducted with the Comprehensive Meta-Analysis software, version 3.

DISCUSSION

We expect that findings on outcomes of bystanding to workplace bullying will provide practitioners with an understanding of the effects workplace bullying may have also on non-targets and the workplace as a whole. Such information is important regarding the development and implementation of effective measures and interventions against bullying. In addition, the review will increase our understanding of existing research gaps and enable us to make recommendations to address them. Our work aligns with the sustainable development agenda to protect workers and reduce inequalities at the workplace.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 342006.

'Measuring' Collective Trauma: a Quantum Social Science Approach

In the twenty-first century the world faces the stark reality that's far from any visions of an ideal world, accompanied by an epidemic of social inequality and global injustice. Many social and global issues such as the refugee crisis, climate injustice, racism, whitism, and terrorism are rooted in serious, untreated historical traumata. These traumata have been experienced by one or more members of a family, group, or community, and may have been passed down from one generation to the next through epigenetic factors. Phenomena of collective trauma can be described more understandably through its interpretation by the quantum social science of Wendt (2016). This interpretation provides a social pathology that offers methodological recommendations (methods of treatment) for social therapy. One potential example is the collective trauma integration process (CTIP) developed by Thomas Hübl (Hübl, T. (2020). Healing Collective Trauma: a process for integrating our intergenerational and cultural wounds. Boulder: Sounds True.), which is a method to restore fragmentation by addressing and integrating individual, ancestral and collective trauma. This paper focuses on one methodological consideration for building a new culture through the integration of collective and intergenerational trauma, which is a framework based on collective trauma research in psychology, sociology, and quantum social science.

Comparisons of violence exposure within and across contexts in predicting depression among Chinese children and adolescents

BACKGROUND

Existing research has identified violence exposure as a risk factor for depression among children and adolescents. To date, however, we know little about whether these associations are influenced by the forms (witnessing and victimization) of violence exposure across different contexts (family, school, and community).

OBJECTIVE

The present study thus aimed to compare the effects of two forms of violence exposure across and within three contexts. Sex and age differences were also tested in the above associations.

PARTICIPANTS AND SETTING

Participants (N = 906, 52.4 % boys, T1: M_age = 11.03) were children and adolescents recruited from elementary and junior schools in Zhejiang Province, China.

METHODS

All participants were asked to complete questionnaires about their experiences of various types of violence exposure and depression at two time points with a 12-month interval. SPSS and Mplus were used to analyze the data.

RESULTS

Considering the comparison within contexts, witnessing family violence was a more influential predictor than family violence victimization while school violence was the opposite. As for the comparison across contexts, no significant differences were found in the effects of different violence victimization, while the effect of witnessing family violence and community violence were more influential than witnessing school violence. No significant sex differences in the above associations were found. However, community violence victimization was more negatively related to depression among adolescents compared with children.

CONCLUSIONS

The associations between violence exposure and depression are influenced by the forms and contexts of violence as well as age groups.

On Coming Into Possession of Oneself: Witnessing and the Formulation of Experience

In this paper I use clinical theory and illustration to explore details of the formulation of experience, which depends upon the metamorphosis of experience from not-me to feels-like-me. I take the position that the movement from not-me to feels-like-me, with the accompanying possibilities for formulating new meaning that open at such moments, happens when we not only know or feel something, but also, and simultaneously, sense ourselves in the midst of this process-that is, when we know and feel that it is we who are doing the knowing and feeling. When these two events co-occur, which depends upon the process of witnessing and the breach of dissociation, we come into possession of ourselves. Witnessing of one person by another is a process of recognition, but it is also a kind of affirmation performed by "someone who is trusted and justifies the trust and meets the dependence" (Winnicott 1971, p. 60).

Witnessing: iteration and social change

At first thought, iteration seems banal. It is about repeating the existing; nothing is changing. But this special issue shows that, in an era obsessed with the new, it is often the repetition of the old that creates social change. Iteration fosters persuasion. It affords opportunities for critical and creative engagement with meaning, values and knowledge. It invites collaboration, though its apparent simplicity often belies a tremendous amount of individual and collective labour involved in the practices of iteration. Through its repetition of the existing, however, iteration also can be a mechanism for reproducing the status quo. Its pervasiveness and banality naturalises power, and its mimetic qualities shrink spaces for critical distance and care. The editors of this special issue have brought together a delightful and fascinating diversity of articles focussed on iteration in cultural production in the digital age. We hop across geographies to examine lockdown diaries, artists' books, socialist memes, fake news, the design of social media platforms and artificial intelligence, activism, film, social media forum moderation, news website reader comments and more. Iterating through the collection as a whole, across its many disciplines, is a commitment to theorising through empirical evidence, to explaining with critique, and to providing pathways to praxis. These characteristics of this special issue, and the many concepts and arguments it puts forward, make this collection of work exceptionally rich material for seeing iteration and how it shapes the world we live in today, as well as the world we want it to be. In this preface, I take a media sociology approach to show how iteration can be usefully understood as collaborative communication for change. I see this understanding of iteration, whose ascendancy is related to the ascendancy of computer science, as baked into the form of communication technologies-and thus as shaping the kinds of iteration that are possible when we use these technologies. This understanding also prompts us to focus on the connection between iteration and social change. To explore how this works, I analytically slow down the practice of iteration to show that it is a communication practice of transmission. That transmission practice is itself constituted of cognate communication practices-the reception, evaluation and production of knowledge-in which visibility and persuasion are key. In the latter parts of the preface, I illustrate this through the example of witnessing as iteration, as the high-stakes nature of witnessing make it a canary in the coalmine, more generally, for mediated communication in the digital age. I show how breaking the witnessing practice down into its various parts allows us to see how power enters and inflects who and what are iterated, when-and who and what are not. Thinking critically with iteration and against unequal power relations, the praxis this preface suggests is one-much in line with the rest of this special issue-of explaining how iteration might move the grassroots towards their goals.

Doctored Images: Enacting "Pain-Work" in John Berger and Jean Mohr's A Fortunate Man (1967)

This essay argues that Berger and Mohr's A Fortunate Man (1967) - comprising social observation and photographs of the rural practitioner, Dr. Sassall and his patients - enacts an embodied, intersubjective empathy called "pain-work." The book enacts "pain-work" through two strategies. Firstly, by conflating three ways of seeing - Berger's observation, Mohr's photography, and Sassall's medical gaze - it shows that the clinical encounter embodies objective vision through intersubjective pain. Secondly, it employs the concepts of recognition and witnessing to show how the subjectivity of the physician is distributed in his community. Thus, Berger and Mohr witness Sassall's witnessing of his patients; even as Sassall and his patients are constituted intersubjectively, so too are Berger, Mohr, and Sassall.

The Voices that Accompany Me

This essay begins with a metaphor describing who enters the field of humanities in medicine and healthcare and the types of work they do. The role of witness is discussed, underscoring tensions between witnessing and analyzing. The essay then turns to my own background as an example of how each professional in this field brings something distinct. I briefly describe the three basic principles of my work with narrative: the injunction to keep the stories in the foreground, the work of amplifying and connecting stories, and the need for generous interpretation. The second half of the essay tells three illness stories, describing their importance to me over several decades. These stories are by Audre Lorde, Reynolds Price, and Stewart Alsop, dealing with problems of silences imposed on ill people, problems caused by physicians' perceived lack of time, and dilemmas of the end of life, respectively.

Comparisons of Types of Exposure to Violence Within and Across Contexts in Predicting the Perpetration of Dating Aggression

It is widely accepted that adolescents exposed to violence are more likely to become perpetrators of dating aggression. However, it remains unclear whether the effects of exposure to violence on later perpetration of dating aggression vary based on the nature of the violence exposure (e.g., witnessing versus being a victim) and the contexts of exposure to violence. Thus, the relationships between two types of exposure to violence (witnessing and victimization) in early adolescence and perpetrating dating aggression in late adolescence were compared within and across three social contexts: the home, the community, and the school. Participants included 484 youth (51% females; 81% African-Americans, 18% European-Americans, 1% Hispanic or Other). Information on exposure to violence were collected at Waves 1 and 2 during early adolescence (Wave 1: M = 11.8 years old; Wave 2: M = 13.2 years old) and dating aggression data were collected during late adolescence (Wave 3: M = 18.0 years old). The results showed that across all contexts witnessing violence was a more consistent predictor of later dating aggression relative to victimization. Being exposed to violence in the home either via observation or victimization was a stronger predictor of physical dating aggression and threatening behaviors compared to being exposed to violence in the school. These findings provide a deeper understanding of the roles of various forms of exposure to violence during early adolescence in perpetrating dating aggression later in the life course.

Family Caregivers to Adults with Cancer: The Consequences of Caring

A person living with cancer will potentially have some degree of physical, cognitive, and/or psychological impairment, periods of unemployment, financial concerns, social isolation, and existential questions, any or all of which can impact the family and friends who surround them. In our current era of health care, patients with cancer receive invasive diagnostic studies and aggressive treatment as outpatients, and then convalesce at home. As such, cancer family caregivers are de facto partners with the healthcare team. The cancer family caregiver role is demanding and may lead to increased morbidity and mortality-in effect, the cancer family caregiver can become a second patient in need of care. This chapter discusses the consequences cancer family caregivers may accrue. The topics covered include caregiver mood disturbance and psychological impairment and some of the mutable factors that contribute to these states (i.e., sleep disturbance, decline in physical health, restriction of activities, and financial concerns), uncertainty, spiritual concerns, and caregiver witnessing. There is a discussion of the factors that influence the caregiving experience (caregiver characteristics, patient characteristics, and social supports). The chapter concludes with comments on intervention studies that have been conducted to ameliorate the burden of caregiving, and the state of caregiver research.

"It Is Not Wit, It Is Truth:" Transcending the Narrative Bounds of Professional and Personal Identity in Life and in Art

Taking inspiration from the film Wit (2001), adapted from Margaret Edson's (1999) Pulitzer Prize-winning play, this article explores the particularities of witnessing a cinematic cancer narrative juxtaposed with the author's own cancer narrative. The analysis reveals the tenuous line between death and dying, illness and wellness, life and living and the resulting identities shaped in the process of understanding both from a personal and professional lens. By framing these representations of illness experience within the narrative constructions of drama, time, metaphor and morality, the personal stories of intellectual knowledge converging with intimate and embodied knowing are revealed.

A Doctor's Testimony: Medical Neutrality and the Visibility of Palestinian Grievances in Jewish-Israeli Publics

This paper follows the testimony of Izzeldin Abuelaish, a Palestinian physician who bears witness to his experiences working, living, and suffering under Israeli rule. He presents his story as a doctor's story, drawing on his identity as a medical professional to gain credibility and visibility and to challenge the limited legitimacy of Palestinian grievances. In this paper, I explore his testimony as a medical voice that at once recounts the suffering and loss endured by the Palestinian people and also struggles to negotiate the values associated with being a "reliable" witness. Consequently, I ethnographically examine the social life and reception of his story in Jewish-Israeli publics. In comparison with most Palestinian narratives, Abuelaish's testimony achieved an extremely rare degree of visibility and sympathy, a phenomenon that calls out for analysis. I identify the boundaries that typically render Palestinian grievances invisible to Israeli publics and suggest how medicine's self-proclaimed ethos of neutrality served as a channel for crossing them. Finally, I reflect on the political possibilities and limitations of medical witnessing to render suffering visible and arouse compassion toward those construed as a dangerous/enemy Other.