You're joking: Exploring humour and humiliation as forms of shame and obstetric violence within medical encounters

Abstract

Despite medical guidelines delineating respect towards patients, many encounters between patients and clinicians are problematic, in which patients feel disrespected, unheard, shamed or abused. This article uses an anthropological lens to focus on the imbrication of humour and humiliation as forms of shame and obstetric violence within obstetric encounters. Humour as a form of speech play creates a substrate for the occurrence of humiliation and shaming of obstetric patients. Humour enhances patients' feelings of shame, making them vulnerable to verbal and physical forms of obstetric violence. Ethnographic methods of observation and interviews were performed in two hospitals in the Mexican city of Puebla to uncover clinicians' perceptions and narratives about their patients as problematic others. Narratives about patient worth underscored interactions. Humour and humiliation were centrally present within these interactions. Ultimately, both humour and humiliation functioned as shaming mechanisms that increased the presence of obstetric violence in these encounters. The article examines whether an understanding of shame can improve clinical practice and concludes with implications to clinical practice.

Philosophy and the clinic: Stigma, respect and shame

“…These important themes are developed further in this edition, which includes a special section on stigma, shame and respect. This section includes papers aimed at identifying, understanding and addressing discrimination in clinical settings 12–19 and on respect and shame in healthcare and bioethics 20–22 …”

“…71 The "Respect and Shame in Healthcare and Bioethics" Workshop Series ran in late 2021 and included scholars from various disciplinary backgrounds, who critically engaged with conceptual and phenomenological understandings of respect, disrespect and shame, and their significance to healthcare and bioethics debates. The contributions which make up this subsection Respect and Shame in Healthcare and Bioethics come from contributors to this workshop series, including Katharine Cheston 21 and Vania Smith-Oka, 22 and the section includes the contribution from Elizabeth Bromley. 20 The contributions published here ground their analyses from diverse disciplinary frameworks with a focus on the experiential aspects, particularly from shaming, shame and humiliating experiences.…”

“…This section includes papers aimed at identifying, understanding and addressing discrimination in clinical settings 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 and on respect and shame in healthcare and bioethics. 20 , 21 , 22 …”

“…The concluding section of the edition focuses on the closely related concepts of stigma, shame and respect and how these have an impact on health and clinical practice. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 …”

“…This section includes papers aimed at identifying, understanding and addressing discrimination in clinical settings [12][13][14][15][16][17][18][19] and on respect and shame in healthcare and bioethics. [20][21][22] The edition opens with a number of papers that address core issues in health philosophy, which have been the preoccupation of the philosophy thematic editions of this journal for over a decade. Authors raise pertinent and challenging questions concerning our understanding of the nature of health and disease, 23,24 diagnosis and the processes of clinical decision making.…”