Vulnerability, survival and shame in Nina Raine’sTiger Country

Abstract

Shame in healthcare remains relatively underexplored, yet it is commonplace and its impact is significant. This paper explores shame in healthcare using Nina Raine's 2011 play Three manifestations of shame are explored, namely (1) shame in relation to professional identity and survival in the clinical workplace; (2) shame and illness as experienced by both patients and doctors; and (3) the systemic and organisational influences on shame within healthcare systems. I suggest that the theatre is particularly well-placed to elucidate shame, and that demonstrates the prevalence and impact of shame on clinical work. Shame has a fundamental and overlooked relationship with damaging and well-documented phenomena in healthcare, including moral distress, ethical erosion, compassion fatigue, burnout, stress and ill health. Attention to shame is essential for those interested in medicine and healthcare and must, I propose, include the experiences and perceptions of those who provide care, as well as attending to those who receive care.

Häpeä organisaatioilmiönä – satunnainen tunnekokemus vai systemaattinen vallan ja sosiaalisen kontrollin mekanismi?

“…Tutkimukset, jotka saivat vähintään viisi pistettä (kyllävastausta) kymmenestä tuli vat suoraan valituiksi. Seitsemästä tutkimuk sesta ainoastaan yksi tutkimus (Bowman 2017) jäi pistemäärän alle, sillä tutkimuksessa ei tuoda esille, millä menetelmällä aineistoa on analysoi tu. Koska katsauksemme aihetta käsitteleviä tutkimuksia on niukasti, päätimme pitää myös kyseisen tutkimuksen aineistossa mukana.…”

Addressing shame: what role does shame play in the formation of a modern medical professional identity?

“…8,28 It also causes withdrawal from colleagues and patients, dishonesty, narcissism, unthinking compliance and humiliation of patients. 5,29,30 A hefty toll.…”

Shame as a moral mood in medicine

“…They are dynamically shaped and channelled through discourse, relational norms, technical modes of interacting and acting on the body, and other practices and structures 4 . These multifactorial matrices that shape and reshape emotional possibilities within local biomedical contexts–what can be called affective arrangements 5 –are shot through with shame, with detrimental impact on biomedical actors 6,7 . Yet I draw on anthropologist Throop's concept of a moral mood 8 to provide a more ambiguous picture of shame's endurance and impact.…”

“…4 These multifactorial matrices that shape and reshape emotional possibilities within local biomedical contexts-what can be called affective arrangements 5 -are shot through with shame, with detrimental impact on biomedical actors. 6,7 Yet I draw on anthropologist Throop's concept of a moral mood 8 to provide a more ambiguous picture of shame's endurance and impact. As I will show, first-person experiences of shame as a persistent cognitive and affective state are commonplace and compulsory.…”