Death at Work: Existential and Psychosocial Perspectives on End-of-Life Care (Studies in the Psychosocial)

"Kjetil Moen has written a book of depth, insight and significance. It is thrill to read. He writes of a world of paradoxes and contradictions, continual absurd realities and great sadness. Here is a book for a world-wide audience that is looking for direction as the human family experiences more aging."--Thomas M. Skovholt, Professor and Psychologist, University of Minnesota, USA; and author of The Resilient Practitioner 'A powerful, searing yet encouraging book. Vivid case studies bring to life the dilemmas and decision moments in which end-of-life professionals live ... Moen combines methodological clarity, detail and philosophic reflection: it concerns us all.' - Tom Wengraf, previously Middlesex University and Birkbeck Institute of Social Research, UK; and author of Qualitative Research Interviewing This important book shines a long-overdue spotlight on the call for a reflective space and self-knowledge of the professional working in end-of-life care ... and makes an empirically and clinically sound call for re-humanization of the way we relate to the dying person. - Gry Stålsett, PhD, Specialist Psychologist at Modum Bad Clinic in Vikersund, Norway This book explores how, in encounters with the terminally ill and dying, there is something existentially at stake for the professional, not only the patient. It connects the professional and personal lives of the interviewees, a range of professionals working in palliative and intensive care. Kjetil Moen discusses how the inner and outer worlds, the psychic and the social, and the existential and the cultural, all inform professionals' experience of work at the boundary between life and death. Death at Work is written for an academic audience, but is accessible to and offers insights for practitioners in a variety of fields Preface 7 Acknowledgements 14 Contents 17 1 Introduction 20 One No Longer Dies at Home 20 Questions of Social Importance 21 Professional Contexts in Focus 23 Empirical Setting and Criteria for Selection 24 Methodologial Considerations 25 Locating the Study Within a Broader Field 26 Personal and Professional Change 26 Secondary Traumatization 29 Psychosocial Studies 32 An Existential-Psychosocial Approach 35 References 35 2 The Narrative Subject—A Theoretical Positioning 41 Merging Theoretical Perspectives 41 Self—A Theorist’s Fiction? 43 Narrative Self—Constructed or Embedded? 44 Narrative Self and Experiential Self 46 Mandatory Basic Conditions 48 The Psychophysical Problem 48 A Question of Semantics 50 A Psychosocial Response 51 A Model for Thinking the Unthought 51 Projective Identification, Container-Contained, Negative Capability, and Reverie 52 A Merging of Perspectives: Existential Kinship-in-Finitude 54 Hermeneutics of Suspicion—And a Critique 56 References 58 3 Research Beneath the Surface—A Methodological Positioning 61 The Art of Living with “Wicked Questions” 61 A Matter of Hermeneutics 63 Being as Understanding 65 A Biographical Narrative Approach 68 Three Sub-Sessions 68 What to Ask: Forming a SQUIN 69 A Position of Not-Knowing 70 Responding to a Social Constructionist Perspective 71 The Social Construction of Data and BNIM 74 Embedded Narratives 75 Analysis: From Data to a Thin Sense of Subjectivity 77 Analytical Aim and Process 77 Interrelational Dynamics 78 The Use of Panels 80 Researching Under the Surface 81 The Particular and the General 83 A “Good Enough” Number of Cases? 83 Choosing Four Star Cases 84 First Case 84 Second Case 84 Third Case 86 Fourth Case 88 Ethics and Validity 88 Felt Dilemmas 89 Validity 91 Primary Criteria of Validity 92 Secondary Criteria of Validity 93 Anonymity 94 A Reader’s Map for the Star Cases 97 References 99 4 Jacob 102 Lived Life and Told Story 102 Setting the Scene 102 Lived Life—In Brief 103 Told Story—An Overview 103 Detailed Reading of the Narrative 105 A Professional’s Trajectory 105 Compartmentalizing Emotions 106 Conveying Messages of Death—A Fate Worse Than Death Itself 109 End-of-Life Decisions—A Conflicted Responsibility 111 Professionalism as Defense 114 Burdened by Being a Demi-God 116 Revisiting Dominant Themes 117 The Personal in the Professional—Crossing the Demarcation Line 118 A Thin Sense of the Situated Subjectivity 120 Reference 122 5 Eric 123 Lived Life and Told Story 123 Setting the Scene 123 Lived Life—In Brief 124 Told Story—An Overview 124 Detailed Reading of the Narrative 125 Death—From Paralyzing Fear to Natural Relation 125 Death at Work—Living in an Absurd Situation 129 The Impact of Encountering the Death of Others 130 The “Beauty” of Palliative Work 132 Formative Experiences of “The Transcendent” 134 Home—Already and not yet 136 A Thin Sense of the Situated Subjectivity 138 6 Karla 140 Lived Life and Told Story 140 Setting the Scene 140 Lived Life—In Brief 141 Told Story—An Overview 142 Detailed Reading of the Narrative 143 A Surprising Professional Turn 143 Gaining and Giving Voice 146 Frightened by the Dead, Terrified by the Dying 148 Regrets Concerning a Dying Patient in Incredible Pain 149 Trying to Master the Most Difficult 151 To Speak or Not to Speak the Truth—That Is the Question 152 The Dying and Death of a Young Mother—Truth-Telling Revisited 154 The Death of a Young Father—“Why Didn’t You Tell Me?” 156 Coming to One’s Senses 161 A Thin Sense of the Situated Subjectivity 164 7 Dina 166 Lived Life and Told Story 166 Setting the Scene 166 Lived Life—In Brief 167 Told Story—An Overview 167 Detailed Reading of the Narrative 168 What First Comes to Mind 168 A Threat of Non-Being 169 Setting Self Apart 171 Here and Now, There and Then 173 A Need to Be Apart 174 A Need to Be a Part 177 Death in Life 180 Death at Work 181 A Concern with Agency 183 Credo 184 A Thin Sense of the Situated Subjectivity 187 8 To Be or Not to Be—An Outline of Existential Concerns 189 Introduction 189 To Be or Not to Be Fearful of Death 190 No Room for Fear? 190 No Laments or Protests? 192 No Changed Outlook on Life? 195 Summary 198 To Be or Not to Be a Truth-Teller 199 Gaining a Voice 199 Giving Voice 202 Speaking Out or Holding Back? 205 Summary 207 To Be or Not to Be Guilty 209 A Sense of Extreme Visibility 209 An Internal Court of Justice 212 The Pain of Unwanted Care 215 Guilty of Surviving and Forgetting 215 Summary 217 To Be or Not to Be a Part or Apart 218 Set Apart by End-of-Life Care 218 A Social Anomaly 220 A Sense of Imprisonment 223 Being a Part 224 Summary 227 To Be or Not to Be Personal in the Professional 228 A Pressing Question 228 A Demarcation Line 228 Paradoxical Blind Spots 231 It Is Not My Pain 234 Summary 236 Final Remarks 237 References 238 9 An Existential-Psychosocial Reading 239 Introduction 239 First Concern—Fear of Death 242 Decrease in Fear of Death 242 A Matter of Defensiveness? 242 A Matter of Acceptance? 247 A Matter of “Feeling Rules“? 248 A Matter of the Experiential Burden? 251 A Matter of Death Not Being “at Hand”? 253 Concluding Remarks 256 Second Concern—Angst 257 A Matter of Stigmatization? 257 A Matter of “Familiarity” with “Forbidden” Death? 259 A Matter of Angst? 261 A Matter of Terror Management? 264 A Matter of Being Immersed in a Hero System? 266 A Matter of a Subordination of Professional Concerns to Managerial Imperatives 269 Being a Part 271 Concluding Remarks 272 Third Concern—Authenticity 273 Conspiracies of Silence 273 Inauthenticity 275 The “We” in the “I” 277 A Call for Authenticity 279 Homecoming 280 Concluding Remarks 284 Fourth Concern—Guilt 285 Moral Distress and Beyond 285 Guilt-Inducing Object Representations 286 Re-negotiations of Object Relations 290 The God Representation 291 A Guilt-Inducing Territory 294 Guilt as an Ontological Given 295 Concluding Remarks 298 Fifth Concern—The Good Object 299 A Matter of the Existential Situation? 299 A Matter of Care for Self and Others 301 A Matter of Care for “The Good Object” 303 A Matter of Negative Capability 305 Concluding Remarks 307 References 309 10 Implications for Research and Future Practice 316 A Call to Recognize the Existentially Concerned Professional 317 A Need for Habitable Professional “Worlds” 319 Polyphony Rather Than Monologism 320 Humanization Through Narration 322 References 323 Bibliography 325 Index 339 "Kjetil Moen has written a book of depth, insight and significance. It is thrill to read. He writes of a world of paradoxes and contradictions, continual absurd realities and great sadness. Here is a book for a world-wide audience that is looking for direction as the human family experiences more aging."--Thomas M. Skovholt, Professor and Psychologist, University of Minnesota, USA; and author of The Resilient Practitioner 'A powerful, searing yet encouraging book. Vivid case studies bring to life the dilemmas and decision moments in which end-of-life professionals live ... Moen combines methodological clarity, detail and philosophic reflection: it concerns us all.' - Tom Wengraf, previously Middlesex University and Birkbeck Institute of Social Research, UK; and author of Qualitative Research Interviewing This important book shines a long-overdue spotlight on the call for a reflective space and self-knowledge of the professional working in end-of-life care ... and makes an empirically and clinically sound call for re-humanization of the way we relate to the dying person. - Gry Stålsett, PhD, Specialist Psychologist at Modum Bad Clinic in Vikersund, Norway This book explores how, in encounters with the terminally ill and dying, there is something existentially at stake for the professional, not only the patient. It connects the professional and personal lives of the interviewees, a range of professionals working in palliative and intensive care. Kjetil Moen discusses how the inner and outer worlds, the psychic and the social, and the existential and the cultural, all inform professionals' experience of work at the boundary between life and death. Death at Work is written for an academic audience, but is accessible to and offers insights for practitioners in a variety of fields 'Kjetil Moen has written a book of depth, insight and significance. It is thrill to read. He writes of a world of paradoxes and contradictions, continual absurd realities and great sadness. Here is a book for a world-wide audience that is looking for direction as the human family experiences more aging.' - Thomas M. Skovholt, Professor and Psychologist, University of Minnesota, USA; and author of The Resilient Practitioner 'A powerful, searing yet encouraging book. Vivid case studies bring to life the dilemmas and decision moments in which end-of-life professionals live... Moen combines methodological clarity, detail and philosophic reflection: it concerns us all.' - Tom Wengraf, previously Middlesex University and Birkbeck Institute of Social Research, UK; and author of Qualitative Research Interviewing This important book shines a long-overdue spotlight on the call for a reflective space and self-knowledge of the professional working in end-of-life care... and makes an empirically and clinically sound call for re-humanization of the way we relate to the dying person. - Gry Stålsett, PhD, Specialist Psychologist at Modum Bad Clinic in Vikersund, Norway This book explores how, in encounters with the terminally ill and dying, there is something existentially at stake for the professional, not only the patient. It connects the professional and personal lives of the interviewees, a range of professionals working in palliative and intensive care. Kjetil Moen discusses how the inner and outer worlds, the psychic and the social, and the existential and the cultural, all inform professionals' experience of work at the boundary between life and death. Death at Work is written for an academic audience, but is accessible to and offers insights for practitioners in a variety of fields Front Matter ....Pages i-xxi Introduction (Kjetil Moen)....Pages 1-21 The Narrative Subject—A Theoretical Positioning (Kjetil Moen)....Pages 23-42 Research Beneath the Surface—A Methodological Positioning (Kjetil Moen)....Pages 43-83 Jacob (Kjetil Moen)....Pages 85-105 Eric (Kjetil Moen)....Pages 107-123 Karla (Kjetil Moen)....Pages 125-150 Dina (Kjetil Moen)....Pages 151-173 To Be or Not to Be—An Outline of Existential Concerns (Kjetil Moen)....Pages 175-224 An Existential-Psychosocial Reading (Kjetil Moen)....Pages 225-301 Implications for Research and Future Practice (Kjetil Moen)....Pages 303-311 Back Matter ....Pages 313-332