Evolution and Emotions

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ANNOUNCEMENTS
Diary Study write up due today. Hand in at end
of class. Remaining classes 4/22
Stigma/Being a patient 4/29 Patient / provider
communication 5/01 Review session OR
Movie? 5/13 Final Exam 1145-245 Instructor
Evaluation http//sakai.rutgers.edu
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Being at Once Hyper-visible and Invisible
Hypervisible Everyone notices you because of
the markthe facial disfigurement, the
radiation-treatment hair loss, the wheel
chair. Invisible But people still seem to not
see you. I am invisible, understand, simply
because people refuse to see me. ...it is though
I have been surrounded by mirrors of hard,
distorting glass. When they approach me they see
only my surroundings, themselves, or figments of
their imaginationindeed, everything and anything
except me. Ralph Ellison, Invisible Man, 1947
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Stigma Corrodes Self Esteem The Darkened
Looking Glass
One of the most direct effects of stigma is
threat to self-esteem. -- Defined in terms of
stigma -- Avoided, shunned, ostracized --
Non-stigmatized features are overlooked Self-stig
matizinginternalizing other's negative view of
oneself. Not just that one is fat or gay or
blind or alcoholic, but rather that one is
therefore fundamentally flawed as a personsick,
weak, immoral, or evil. In Goffman's terms, one
has "a spoiled identity".
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How Disability Can Change Self Schema
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Stigma Deprives Person of Vital Information The
Absent Looking Glass
We depend on other's reactions to make sense of
things, and of ourselves, when there is no other
source of info. Stigmatized don't get this info.
Why not?
a. Shunned, so don't see how others
respond. b. Get a constant reaction to selves,
either constantly (and falsely) positive or
constantly negative. Stigma becomes a wall that
blocks social information.
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Creating New Reference Groups
After acquiring a stigma (cancer, AIDS,
paraplegia, etc.) it can help to develop ties to
others with similar condition. Why?
a. Social comparison b. Recognition of one's
own non-stigmatized features. c. Recognizing
difference from others who share stigma.
BUT, important to not belong ONLY to community of
stigmatized. Why?
a. Need to re-enter mainstream. b. Need to get
feedback from "markers", which may be more
realistic
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In-Between Stigma Status
Some people are not fully stigmatized, not fully
"normal" Partially deaf, partially blind
Loss of one limb, but otherwise can walk These
people are not fully accepted by mainstream, but
also not fully accepted by the stigmatized
group. The "unblinded"--and their unexpected
social challenges.
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GUESS THAT PERSON
Mystery Person 1 Assigns readings Grades
exams Conducts lectures The person
is a _____________________ Mystery
Person 2 Works with a variety of woods Uses
hammers, nails and saws Builds cabinets and
frames houses The person is a
_____________________ Mystery Person
3 Confined to small space Required to follow
instructions or face severities Little control
over meals or socializing The person is a
_____________________
Teacher
Carpenter
Hospital patient
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Class 23 Being a Patient
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Experience of Being a Hospital Patient
Emotional State
Anxiety over condition Nature of problem?
Pain Loss of
functioning Will I die? Real world
worries Job Family Etc. House, car,
pets, bills
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First Encounters with Hospital
Patient enters hospital scared, hurt, anxious.
What does he want to hear upon admission?
What does he hear upon admission?
Do you have insurance?
Hospital garb Why?
Ease of access
How do you look to others?
Childish, infirmed, low-status
How does garb affect how you feel about yourself?
Weak, embarrassed, dependent
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Whos the Fighter?
How does garb affect fighting spirit and morale
of patients? How does this relate to psychosocial
resources, stress, and coping? Could there be an
alternative?
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Hospitalization from Patients Perspective
Fragmented care Many different staff, doing
different tasks Minimal
contact Patient transformed from person to
object A broken arm to be X-Rayed A Body
due its pain meds. Information is often
withheld from patients. Why?
You wish!
Staff too busy to answer questions Staff,
specialists, dont communicate Staff
deliberately withhold information Pat.
wont understand pat will freak-out, require
more care Lack of information one of patients
biggest complaints. Why?
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Reactions to Being Hospitalized
Main points of hospital situation Strong
negative emotions fear, worry, pain,
confusion Stripped of authority, dignity,
identity Lose clothes, bossed by nurses
MDs, become a thing Reminded of 1000 ways
fate depends on kindness of strangers Deprived of
vital information Expected to be cooperative,
passiveseen but not heard
Dependent, needy, controlled, ignorant is like
being a ________
Child
Leads to regression attempt to get needs met
by pleasing others Stockholm Syndrome, Patty
Hearst, cults
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Hospital Patient Role
Hospital wants patients to do as told a.
Reduce chances of things getting worse b.
Increase chance of recovery c. Reduces
demands on over-taxed staff
Patients often want to be good patients. Why?
a. Appease powerful staff, MDs 1. Staff
dictate daily life 2. Staff have power of
life and death.
b. Curry favor, to get more/better attention
c. Superstitious faith in power of medical
institutions and providers 1. Healers have
god-like power to heal, save life 2. Variant
on just world beliefs
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Is There Truth to Good Patient Beliefs?
You are hospitalized, feel staff is not fully
attending to you. Should you be a nice
patient or a strongly assertive patient?
Patients report, and there is some evidence to
suggest, that troublesome" patients are --
Overmedicated -- Ignored -- Discharged
prematurely
http//www.youtube.com/watch?vRGRD6JBnHrU
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Reactance
What percent of patients fall into good patient
role?
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____ Good patient
____ Average patient (minor complaints)
____ Bad patient seriously
ill and complain, not ill but complain anyway
50
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Very bad patients harass nurses, violate
hospital rules, self- sabotage (dont take meds,
risk own health). Why?
Reactance People have basic need for personal
freedom. Work to regain freedom taken in ways
that appear unfair. Hospitals can induce
reactance by being arbitrary, withholdng info,
treating pats. like children.
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Why Hospitals Demoralize
Hospitals want to help patients. Why do they
cause patients to fall into good patient role,
or reactance?
Biomedical Model
Body is a machinefix the parts, the body is OK,
job is done. "Person" is irrelevant.
Real world constraints
Hospitals forced to do more with less. HMOs,
cost cutting, related pressures.
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Improving the Patient Experience
Irving Janis ideal anxiety approach (1958)
Hospital hires Janis (social psych) to reduce
patient stress Janis redefines situation
Some anxiety is good. Why?
No anxiety person not prepared for difficult
outcomes. Too much anxiety
person is flooded, cant take in information.
Recommends providing pats. with enough info to
emotionally prepare.
Egbert study (1964) Works with pats. undergoing
abdominal surgery Patients either told / not
told what to expect post-surgery (pain,
recovery, severity, etc.) Result Informed pats
need less narcotics, leave hospital sooner.
Highly replicated finding.
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Social Support and Surgical Recovery
You are about to undergo surgery. Would you
prefer your hospital roommate to be
someone ____ About to undergo same
surgery ____ In recovery from same surgery
___ No Roommate ___Same/Pre-op ___
Diff/Pre-op ___Same/Post-op ___Diff/Post-op
Kulik Mahler study (1996)
Patients pared with roommate who is
undergoing same / different surgery
Pre-operative /
post-operative What matters in
terms of patients recovery?
X
X
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Effects of Responsibility and Care-Giving on
Patient Outcomes Rodin Langer, 1977
Ss are nursing home elderly. Cond. 1 Reminded of
their own responsibilities, and given a plant to
care for. Cond. 2 Reminded of staff
responsibilities to them, and given a plant that
staff care for. 18 months later Staff ratings,
mortality
1
Cond ___ More positive staff ratings
(happier, more sociable Lower
mortality (more likely still alive)
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Animal Assisted Therapy
Animal Assisted Therapy (AAT) Specially
trained animals plus handlers visit
hospitalized patients. Dog lies on patient's
bed, is petted. Cute, but does it
work? Experiment by Kathie Cole, RN, UCLA
Medical Center 77 heart-failure patients (ave.
age 57) receive 12 minute visit from
either a. Dog b. Human volunteer c. No
visit
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Results of AAT Study The Paws that Refreshes
Anxiety Dog Down 24 pts Human Down 10
pts Epinephrine Dog Down 17 Human Down
02 Control Up 07 Blood pressure Dog Down
10 Human Up 03 Control Up 05
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Elephant-Assisted Therapy South Africa
Dolphin-Assisted Therapy Israel, Florida,
Ukraine
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Children in Hospitals
Hospitals are frightening to children.
a. Place associated with pain b. Weird looking
people c. Sad/Scary looking patients d.
Parents are not in control
Emotional reactions
a. Fear, anxiety b. Anger, rebellion c. Shame
(esp. at adolescence)
Being left overnight in hospital esp. upsetting.
a. "Setting" anxiety
b. Age 3-6 fear rejection
c. Age 4-6 develop new fears (e.g.,
darkness) d. Age 6-10
free-floating anxiety e.
Separation anxiety deserted? punished?
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Social-Psychological Tx for Hospitalized Children
Social Support a. Parental visits study
(Branstetter, 1969) Cond 1. Mom at visiting
hours only Cond 2. Mom for extended
periods Cond 3. Surrogate mom b. Kids in Cond
2 3 do better than Cond 1 c. Hospitals now let
parents stay with kid all times d. Story
telling Psychological Control a. Kid in hosp.
movie --gt less anxiety b. In gen., informed
kids show less anxiety c. Encourage kids to ask
questions d. Provide kids with coping skills
Self-talk Relaxation skills