Life with an unwelcome guest - caring in a context of protracted bodily pain

Speechlessness: a Conceptual Framework

The phenomenon of speechlessness has hardly been considered in the literature from a psychological point of view. Previous research on speechlessness is limited to the fields of neurology, medicine or psychopathology. The present review aims to consider speechlessness from a psychological perspective distinct from pathology, and to highlight its observability and possible connections to existing research in the context of emotional cognition and processing. Search terms were developed and a comprehensive, systematic literature search was conducted in various databases based on previous scientific work on the understanding of non-speech, silence and speechlessness. Only results that examined the phenomenon of speechlessness from a non-pathological or non-neurological perspective were included. A total of N = 7 publications matching the inclusion criteria were identified. The results were used to develop a procedual model for the phenomenological definition of speechlessness. The developed model differentiates the observable phenomenon of speechlessness into a non-intentional, unconscious form and a intentional, conscious form. The present work suggests that meaningful emotions and their perception and processing is a core element in the emergence of speechlessness and provides a first, psychological, non-pathological explanation of speechlessness.

Patient-Initiated Pain Expressions: Interactional Asymmetries and Consequences for Cancer Care

Only minimal attention has been given to analyzing interactional moments when patients and providers talk about "pain" in general consultations and primary care, and no attention has focused on how pain gets managed during oncology interviews. Conversation analysis (CA) is used to examine a sampling of instances drawn from a collection of 146 pain instances across 65 video recorded and transcribed clinical encounters in a comprehensive cancer clinic. Specific attention is drawn to how pain descriptions are not static but malleable as cancer patients upgrade, downgrade, and produce combined orientations when making their experiences available to oncologists. In response, it is shown that doctors acknowledge patients' descriptions, but do not elaborate nor affiliate with, important pain disclosures. Three interactional environments are closely examined: 1) Reporting and responding to past pain/hurt incidents; 2) Doctor's missing assessments in response to good news announcements about patients' minimal pain; and 3) Patient-initiated pain responses to doctors' questions. These empirical findings confirm identified patterns of interactional asymmetries comprising pain events in UK consultations and USA primary care. Close examination of these social actions provides basic knowledge about how pain communication reframes historical understandings of individuals' pain experiences. Implications for future research are identified, and a protocol is described for how clinical practice and medical education can be improved by refining understandings of pain communication to promote increased sensitivities and more personalized responses to pain expressions.