CLAIRE HOOKER University of Sydney
Introduction: Good collegial communication and professional workplace behaviour are both crucial for patient safety and for the wellbeing of clinicians. Yet extensive evidence in several countries has established that many clinicians experience mistreatment and poor workplace behaviour from colleagues, and that this contributes to the significant levels of mental ill-health found in clinical workforces. Existing reporting and remediation systems have not reduced the problem. Therefore, culture change in healthcare workplaces is important.
Junior staff are especially likely to both experience poor workplace behaviour - and then in time, to reproduce it. Our research question was, how could we design a novel, positive intervention that could provide junior staff with immediate tools to ameliorate this situation and prevent its eventual reproduction, without placing the responsibility for change on those with least power to effect it?
We developed one creative response to this issue, the use of designed acting skills workshops that avoided role play and used non didactic and embodied practices to strengthen participants’
ethical professionalism. The workshops have been very positively evaluated by participants.
In this presentation we report on the theoretical framework that informed the design of the workshops. Its innovations were the outcome of a critical dialogical approach that enabled interdisciplinary collaboration.
Methods: Our primary method for developing an interdisciplinary, creative-arts based approach was iterative and dialogical (Farias et al, 2018). This stance enabled productive discussions from our multidisciplinary team, which included scholars from psychiatry, education, philosophy, nursing, medical humanities, critical sociology, population health and applied theatre.
Results: We developed four propositions to underpin our theoretical framework:
1. That workplace communication and interaction can be understood as micro systems, allowing for any change in input to affect the dynamics of the system
2. That the development of ethical professionalism required complex moral growth, well captured in the psychological construct of ‘differentiation of self’, the ability to maintain a strong sense of self in the midst of uncertain circumstances and intense emotional relationships (Beebe and Frisch, 2009)
3. That embodied practice was a key tool for increasing self awareness, reflexivity and as a result, differentiation, which we hypothesized to be of particular importance for our participants, as result of the enormous emphasis on purely cognitive performance and capacity in their training
4. That ‘acting the role’ of doctor could be pursued authentically and as an embodied practice.
‘Enacting professionalism’ is a theoretical framework that integrates these propositions. We theorized that professionalism would develop as an emergence from the embodied and interactive practices used by each individual to authentically perform being a doctor. Drawing from techniques used by professional actors to authentically develop a stage role, we hypothesized that enacting professionalism would improve reflexivity, increase capacity to communicate effectively, and support differentiation in professional development.
The workshops that we developed applied this framework through the use Boalian theatre-for-change techniques to encourage self awareness, and to facilitate insight into the dynamics of interaction.
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Discussion and Conclusions: The theoretical framework of ‘enacting professionalism’ was the successful product of an interactive, interdisciplinary process. This rich theoretical framework provides a basis for positive training programs that can achieve improved professionalism and support culture change in healthcare workshops. Empirical evaluation (reported elsewhere) provided proof-of-concept for the Grace under Pressure acting skills workshops. This approach underscores the value of process-focused creative arts components to medical humanities programs in medical education, in line with findings from theatre-based approaches in the UK and India.
Keywords: theatre and acting, professionalism, communication systems, microethics, embodied practice
References
Farias, L. and Rudman, D. L. 2019. “Challenges in enacting occupation-based social transformative practices: A critical dialogical study”. Canadian Journal of Occupational Therapy, 21.
https://doi.org/10.1080/11038128.2018.1469666.
Beebe, R. and Frisch, N. 2009. “Development of the Differentiation of Self and Role Inventory for Nurses (DSRI-RN): A tool to measure internal dimensions of workplace stress”. Nursing Outlook, 57, 5: 240-245, https://doi.org/10.1016/j.outlook.2009.04.001.
Macneill, P., Gilmer, J., Tan, C. H. and Samarasekera, D. D. 2016. “Enhancing Doctors’ and Healthcare Professionals’ Patient-Care Role through Actor-Training: Workshop Participants’
Responses.” Annals of the Academy of Medicine, Singapore, 45, 5: 205–211.
Scott, K. M., Caldwell, P. H., Barnes, E. H. and Barrett, J. 2015. “‘Teaching by Humiliation’ and Mistreatment of Medical Students in Clinical Rotations: a Pilot Study”. Medical journal of Australia, 203, 4: 185–185.
Scott, K.M., Berlec, Š., Nash, L., Hooker, C., Dwyer, P., Macneill, P., River, J. and Ivory, K. 2017.
“Grace Under Pressure: a drama-based approach to tackling mistreatment of medical students”.
Medical Humanities, 43: 68-70.
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‘It Would Be Crazy to Believe us without Evidence’: A Corpus Analysis of Online Support for Sufferers of Gangstalking
DANIEL HUNT
University of Nottingham ANDREW LUSTIG
University of Toronto GAVIN BROOKES
Lancaster University
Background: Gangstalking is a novel persecutory belief system in which sufferers believe they are being stalked and harassed by a large number of people. In clinical practice, sufferers are frequently diagnosed with psychotic illnesses. Gangstalking sufferers typically reject this diagnosis and seek support from like-minded others in online forums. Despite growing public interest, little is known about the nature of this condition nor the information circulated among sufferers online.
Methods: We collated a 225,000-word corpus of postings to a large online support community for gangstalking suffers, who self-identify as ‘targeted individuals’/’TIs’. The data was examined through corpus-based discourse analysis, a mixed methods approach that combines statistical and qualitative analyses of salient features in large datasets. Specifically, we combined keyword and collocation analyses with the manual examination of concordances to identify the discursive and rhetorical practices of TIs.
Analysis: The analysis reveals a discursive contest between two opposing worldviews in which gangstalking is either a widespread, coordinated system of persecution or a form of psychiatric disorder. In this paper we focus particularly on the first position, illustrating the linguistic means through which TIs represent gangstalking as a real phenomenon. We also demonstrate how TIs strategically attribute mental illness to community members whose accounts are deemed too extreme, thereby legitimising their own claims about the reality of gangstalking.
Conclusion: TIs’ linguistic practices co-construct an internally coherent persecutory belief system that explicitly rejects psychiatric intervention while offering support for sufferers. We conclude by examining the implications of this for clinical practice and the links between gangstalking and other online conspiracy theories.
Keywords: corpus linguistics, eHealth, gangstalking, online communication, schizophrenia
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