The medical field is not where my own career path exists. I came to know the field from another point of view – from being the daughter of an ALS patient and a member of a family who has had many unfortunate diseases, from cancers to mental illnesses and life-altering poisoning cases. I have witnessed incredibly talented and kind physicians and nurses in the Finnish healthcare system, for which I am forever grateful. However, I have also witnessed harsh and shaming treatment from the professionals who are supposed to care for people in distress.
I remember in 2017 when my beautiful 57-year-old mother was deteriorating fast from ALS. By then, she had lost her ability to talk, walk and swallow. She was able to stay in home-care with my father almost until the end, but around three months before she passed, she had to move to palliative care in our local hospital. During that year, we were forced to learn about patience, humility, and painful powerlessness like never before. We had to learn how to make our mother feel as comfortable as possible and make the best out of the most heartbreaking situation. It took a lot of time and even nerves to understand what my mother needed in each situation. We also needed to tend to our own emotions, which was sometimes the most challenging part. So when the day came that our mother had to be taken to hospital care, I remember thinking that I wasn’t worried that staff would not take good care of her. Instead I was spiralling with the thought that it would be catastrophic if there were problems in the hospital’s work environment that might prevent them from giving my mother the patient care she needed.
By then, I already had been reading studies about shame, and I understood that shame is one main factor that diminishes people’s ability to undertake perspective taking and, most notably, diminishes their ability to feel empathy towards others. Shame also affects people’s mental and social health. While humiliation can lead to people to feeling shame, it can also cause people to retaliate with anger. Unfortunately, this anger is sometimes targeted to an innocent third party such that the humiliated person feels they hold some form of power. Furthermore, by reading the classic articles from Lazare (1987) and Davidoff (2002), I had this early understanding that shame and humiliation are very common, not only in medical encounters but also in the emotional life of the physician. It is now recognized in research that shame and humiliation are used as a tools of control, for example, in medical and social work organizations (Gibson 2016; 2019; Jarvis 2016). Shame can be caused by shaming and humiliating, especially when even minor errors of physicians and nurses are corrected in a humiliating way in front of other colleagues or patients. In hierarchical organizations, everyday talk can be non-relational and unequal, making especially younger professionals feel shame about their position. Physicians and nurses can of course feel shame about their behaviour and mistakes, but also colleagues’ behaviour. This is called vicarious shame, which they can feel when colleagues behave harshly towards the patient in their presence. There are also various cultural influences in healthcare that can deter specific human characteristics and vulnerabilities as shameful as being ill. These are just a few examples. While we are losing physicians to suicides worldwide, and as in Finland, losing well-qualified nurses to other, less stressful fields, at an accelerating pace, I thought the field of healthcare would benefit from addressing the effects of shame for both patients and healthcare workers.
One reason why I wanted to study shame and humiliation in Finnish healthcare is, of course, the wish to support the field to have the capacity to provide care with compassion and dignified treatment. The worry is that if physicians and nurses are continually navigating shame and humiliation in their workplaces, at some point, they might pass these emotions on to their patients. As a result, understanding shame and humiliation dynamics is necessary if we want to support the well-being of medical professionals and the care that they are giving. Especially when dealing with the most challenging and stigmatizing illnesses, shame and humiliation should not be around, as they can diminish caregivers’ well-being and empathy.
In 2009, I said goodbye to my grandmother, who passed away after suffering for years from Alzheimer’s disease. In my hometown, we have this tradition where the deceased’s coffin is taken by the funeral car to the most important places in the deceased’s life. That usually means places like home, one’s workplace, one’s wedding venue, and for my grandmother, the place she spent almost the last ten years of her life, her nursing home. As close relatives, my family was driving behind the funeral car, and as we turned into the street where the nursing home was, I saw one of the most touchings scenes in my life. In front of the tall building, seven nurses that cared for grandmother were all sobbing and crying. Even though my grandmother had not been able to speak or communicate with those nurses and had been in bed for years and years, she was not just a number in a patient chart but a fellow human being whose passing was worthy of tears.
What I think I saw on that day was a glimpse of our shared humanity. It is that humanity that we need to keep alive in medical and caring fields. It is for this reason that I think we must work hard to provide our helpers, physicians, and nurses, dignified work environments that are not full of shame and humiliation.
I am currently undertaking my PhD research at the University of Lapland, Finland. I aim to pursue an understanding of the systems and dialogues that humiliate or cause shame in healthcare work settings.
Ella Nygård
enygard@ulapland.fi / @EllaNygard
References:
Davidoff, F. (2002). Shame: the elephant in the room. BMJ, 324, 623-624.
Gibson, M. (2016). Constructing pride, shame and humiliation as a mechanism of control: A case study of an English local authority child protection service. Children & Youth Services Review, 70, 120-128.
Gibson, M. (2019). The role of pride, shame, guilt and humiliation in social work service organizations: A conceptual framework from qualitative case study. Journal of Social Service Research, 45(1), 112-128,
Jarvis, L. (2016). Shame and institutional stability – or – change in healthcare. Institutional Journal of Sociology and Social Policy, 36(3/4), 173-189.
Lazare, A. (1987). Shame and humiliation in the medical encounter. Arch Intern Med, 147(9), 1653-1658.
