In her article Biomedicine Inside Out , sociologist Sky Gross argues that the emotional attitude of surgeons in the operating theatre is shaped by the architectures and rituals of surgical practices, and not merely by a professional desensitisation – as it is traditionally claimed. She takes point of departure in her own experience, entering the surgical space as a sociologist, witnessing the surgery of someone she considers a friend. Yet, trailing the surgeons, she tells us, she experiences the operation with curios attention to and aesthetical focus on restoring the biological body, more so than to the friend and person sedated on the other side of the surgical drapes; an attitude she finds mirrored in the surgeons around her.
Gross’ article is part of an ongoing debate about emotions in medical practice. Traditionally, two figures dominate these discussions: The rational, scientifically minded practitioner who acts according to evidence and outcome – crystallised in the emotional ideal coined as ‘clinical detachment’; and the empathetic, caring practitioner, who adjusts treatment in accordance with individual patient values and preferences. Both figures present compelling health professional virtues, yet they are often considered antithetical, and they are both subject to criticism. On the one hand, we may argue that while emotions are an integral part of human life, they sometimes get in the way – cloud our judgement or disturb our ability to concentrate on important tasks. In medicine, existential dilemmas and challenges surround a professional practice which should be unbiased, and where a momentary lack of focus can mean the difference between life and death; hence, it is best if clinicians stay detached. On the other hand, it is argued, empathy and compassion for the patient are ethically and epistemically necessary – clinicians cannot understand their patient’s ailments and needs if they are not sensitive to the inner life of the person they treat.
Gross’ article suggests that the ‘surgical coolness’ in the operating theatre with its shift away from the patient-person towards the anatomical body is not necessarily the expression of a general depersonalised attitude and that it may be neither a bad nor a universally good thing. Doing fieldwork for my PhD dissertation on aversive emotions in clinical practice, I had a similar finding: emotional adjustment in the clinic was context dependent and much more sensitive to variability of real-life clinical circumstances than the two classical figures let on. Notably, clinicians I interviewed evaluated their emotional adjustment – or failure of such – in reference to the progression of treatment rather than to a fixed professional emotional ideal, and hence, what was ‘good’ or ‘bad’ varied. In interviews, clinicians would tell me how empathy could sometimes numb them in critical situations; or how at other times, empathy – or medical curiosity – could help them overcome bodily reactions to, for example, unpleasant odours. One clinician recounted how she felt disgust the first time she gave CPR to a patient and the ribs cracked under the pressure of her hands, but that this emotion did not matter, because it did not stop her treatment. Another clinician told me how entering the hospital mortuary he would deliberately change his emotional attitude before opening the door.
Rather than come up with a recipe for ‘mixing’ the two existing ideals, the plasticity of appropriate emotions in the medicine encourages us to look for other ways of conceptualising what it means for emotions to be ‘good’ or ‘bad’. Here, we can find help in the work of the Marxist philosopher Henri Lefebvre – and his collaborator and wife Catherine Régulier – who argued that we need to think through rhythmicity rather than entity to understand everyday life. Thus, emotions in medicine become good or bad depending on whether they are a productive part of the ‘polyrhythmia’ of the hospital, that is, all the rhythms of medical practice, from the sleep patterns of patients, over rhythms of locking and unlocking doors, to the seasonal weather. Here emotions can exist as ‘eurhythmias’ – playing ‘in tune’ or even contributing to the rhythmical progression – or as ‘arrhythmias’ – disrupting and undoing the polyrhythmia – and hence the ability to coordinate and execute further steps in treatment. Importantly, what is a good (i.e., eurhythmic) emotion at one point, in one space, may not be so in another space or at another time; more patience may be needed at busy hours, less empathy in life-threatening situation, and so on. What is the proper professional emotion, depends on appropriate attunement more than a specific emotional stance.
After-thought
It is worth noting that sometimes, of course, the polyrhythmia of hospitals itself may be wrong, such as when digital registrations take too much time away from patient contact; here arrhythmic emotions – annoyance, for example – may on par with other rhythm-interventions, function as the first step towards changing the overall framework.
The blog is based on the article ‘Evaluation emotions in medical practice’ (2022)
Helene Scott-Fordsmand, Carlsberg international postdoc fellow, Department of History and Philosophy of Science, University of Cambridge,
12th September 2022
