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What does it mean to live and work within a culture of shame?

The speaking voice in my ears paused and then, with a soft breath, started to sing. I stopped in surprise. The daffodils I had watched peek through the peat and grow into spindly budded things were blooming bright yellow along the road. It was high springtime in Exeter and even after months of listening to stories recorded by physicians willing to share their thoughts and experiences, each tale brought something I did not expect.

What does it mean to live and work within a culture of shame? The Nocturnists Shame in Medicine podcast series is exploring this question through stories from health care workers around the world. The podcast team released a “Call for Voices,” inviting health care workers to record and share audio stories reflecting on experiences of shame and hundreds of individuals responded.  The stories of these health care workers create a remarkable tapestry of voices that illustrates not simply the culture of shame in medicine, but how health care workers share resilience, humor, pain, sorrow, and so much more through a community of storytellers. These ‘shame stories’ will be organised, interspersed with narration, into a ten-episode podcast series. Since the beginning of 2021, I have had the unique privilege of listening to and engaging with these stories and the podcast production process as a student intern with the Shame and Medicine Project during my year-long Fulbright fellowship at the University of Exeter.

When I applied for the Fulbright award to come from the United States to spend a year completing my MA in Criticism and Theory at the University of Exeter and learning from health humanities experts at the Wellcome Centre of Cultures and Environments of Health, I had no idea that my grant period would coincide with a global pandemic. My internship created a welcome way for me to feel not only part of the University and the Wellcome Centre, but of a project and a team. My plans for intellectual and community engagement as a visiting student were naturally changed as visions of joining volunteer groups and attending local poetry readings morphed into the simple pleasures of daily walks to watch the flowers grow. My walks became the perfect time to listen to the ‘shame stories,’ as I could let the voices wash over me with the fresh air (and often rain), free of distractions and open to unexpected connections.

My work with The Nocturnists Shame in Medicine podcast brought endless insights into my own fellowship research thinking about shame, temporality, and identity in memoirs of medical training. Engaging in critical conversation with the podcast team about shame and storytelling, and witnessing the stories shared by health care workers, thickened and texturised my commitment to my research and to the importance of addressing shame in medicine. Working on the podcast has been a fascinating experience of merging theory and practice into a creative and community-oriented body of work. The project is ‘led’ by the audio clips we receive as story submissions, which will make up the body of the podcast and express the culture of shame in medicine in an immediate and gripping fashion. Lived experience not only of the health care workers who generously and vulnerably share their stories but also of the production team members takes centre stage. But those experiences are organised and supported by the diverse perspectives of the team, brought from phenomenology, medical education, narrative theory, dance, theatre, and more.

The podcast team, and my own research, acknowledges that shame is essentially ubiquitous, if often invisible in society (Scheff 2014). For that reason, shame becomes deeply taboo, acknowledging and expressing shame can snowball into feeling greater shame. In creating a podcast addressing shame head-on, we are then challenged to support storytellers in breaking this taboo. We are also challenged to acknowledge the ubiquity of shame, and as argued by Dolezal and Lyons (2017) its particular relevance to healthcare, while also honouring the unique experience and voice of every storyteller. In the weekly podcast production meetings when the production team gathers to discuss audio submissions and work on episodes, we also grapple with how to keep the podcast enjoyable for future listeners. While the stories contain humour, moments of love, support, and hope for medicine, many are heartbreaking and the storytellers still reeling from the shame they experienced. And shame is an emotion tied to identity (Sedgwick 2002, Miles 2020) which means that to face and dismantle shame in medicine is to face and dismantle the deepset structural and system factors and inequities that exclude, omit, or venerate certain identities instead of others.

The production team still has several months of ahead before the podcast is published. For myself, I consider how I can approach with empathy and patience the stories of these health care workers, which reflect experiences that are, in the words of one of the memoirists I read for my fellowship research, “not narratable” (Holt 2014, 11). Such an idea reflects the ethical possibility that we cannot demand or expect a coherent, recognisable narrative from an Other (Butler 2001), that to do so undermines the ultimate alterity of that Other (Lévinas 1985). So, as I walk and listen, I seek to let these stories take space and simply be for me. I hope when the podcast is published they can be the same for other listeners, and for all our understandings of these stories and the culture of shame in medicine that they illustrate to change and grow, bigger and brighter as the flowers do.

 

The Nocturnists Shame in Medicine podcast series will be released in Spring 2022.

 

 

Penelope Lusk – PhD Candidate in Education, Culture, and Society, University of Pennsylvania

Email: plusk@upenn.edu

Twitter: @PenelopeALusk

 

 

Works Cited:

 

Butler, Judith. 2001. “Giving an Account of Oneself.”  Diacritics 31 (4):22-40.

Dolezal, Luna, and Barry Lyons. “Health-Related Shame: An Affective Determinant of Health?” Medical Humanities 43.4 (2017): 257-63. Print.

Holt, Terrence. 2014. Internal Medicine: A Doctor’s Stories. New York: Liveright.

Lévinas, Emmanuel. 1985. Totality and infinity: An Essay on Exteriority. Translated by Alphonso Lingis. Pittsburgh: Duquesne University Press.

Miles, Sandy. 2020. “Addressing Shame: What Role Does Shame Play in the Formation of a Modern Medical Professional Identity?”  BJPsych Bulletin 44 (1):1-5. doi: doi:10.1192/bjb.2019.49.

Scheff, Thomas. 2014. “The Ubiquity of Hidden Shame in Modernity.”  Cultural Sociology 8 (2):129-141. doi: 10.1177/1749975513507244.

Sedgwick, Eve Kosofsky. 2002. Touching Feeling: Affect, Pedagogy, Performativity. Durham: Duke University Press.

 





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