Knowing and Managing the Emotions of the Patient, the Family Caregiver and the Operator

1. KNOWING THE EMOTIONAL ASPECTS

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According to the psychologists, the emotions were acute affective moods that manifest as a complex experience, both through psychological and physiological variations. They result as joy, surprise, psychic pain, anger, anxiety, sadness, embarrassment and fear.

When feeling an emotion, our brain is activated and it triggers a specific physiological and psychological response that helps releasing the energy generated. For example, our concern for a loved one could push us to call him to check if anything unpleasant happened to him, releasing therefore the tension produced by expectation and anxiety.

In fact, the affective states influence our thoughts, behaviors, psychological experiences and our physiology in an important way. For this reason, fear could make our heart beat faster and stimulate us to run or, otherwise, it can paralyze both our thoughts and our body.

This makes us understand how the emotional reactions represent an effective demonstration of the close interaction between psychological states and physiological functions. Understanding these interactions helps us better manage our emotions and others’.

1.1 Learning to Understand Each Other’s Emotions and Recognize Your Own

The emotions that I feel, but I do not recognize, greatly influence my attitude and therefore the answer to the emotional reaction of the other.

If, as an operator, I do not realize that I am angry, or that I am too emotionally involved in a situation, I will hardly manage to deal with those emotions.

At this point, it would be even more difficult to fully understand the patient’s feelings or those of the family caregiver, so how could I relate with them in the most appropriate way?

The same is valid for the patient who is experiencing a very difficult situation, whose quality and extent of the emotions experienced will affect, most likely, the interaction with his/her family and the operators.

Even the primary family caregiver, the relative who takes care predominantly of the very ill person, feels intense and diverse emotions that could pour, unintentionally, against their loved ones and against the operator to which he/she must report.

Given that emotions influence attitudes and behaviors, it is important to know them well. The more we know about our emotions, the more we can understand and manage them.

1.2 The Influence of the Emotional Moods

The sensations and emotions that we feel with the patient affect our relationship with him. If a patient transmits us sadness, we will probably react positively, stimulating him/her to improve their sense of humor or we will limit as much as possible the interactions, if that sadness is an excessive burden to bear for us.

This, of course, is just one example of the possible emotional repercussions that affect us in our relationship with the ill person, or in any case of which we have to take care.

But Which Are the Dynamics at the Basis of Emotions?

Since the second half of the eighteen century, many scholars began to take more interest in the connection between physiological reaction and thinking. They sought to understand whether these are physical changes, such as accelerated heartbeat, which makes us realize that we are afraid, or is the acknowledgement of an attacker in front of us, which makes us react at the physiological level. This creates another dilemma, if the emotions that we feel are universal or not.

Therefore, the study of emotions includes numerous research papers that have been developed over the years, often offering contradictory explanations. For some scholars (1884 James and Lange peripheral theory) the emotional experience arises from the physiological transformation, so I’m afraid because I realize that I’m shaking and not the opposite. Cannon (1927) and Bard (1929) refused this theory by saying that the perception of the stimulus produces somatic and behavioral changes through the activation of the hypothalamus. Therefore, according to these scholars, when I feel the stimulus as a dangerous one, the information is mediated at the level of the brain structures (hypothalamus) that trigger the physiological reactions and behavioral changes.

The Cannon Bard theory was corroborated by the brain studies conducted by Papez (1937, The circuit of Papez) and later on by Mc Lean (1949, The limbic system of Mc Lean); the research indicated specific brain areas that activated and controlled emotional processes, according to the authors.

Subsequently, since the 50s, the studies of cognitive psychologists showed that the emotional life is directly influenced by the way in which each person is mentally feeling what they are experiencing. So, in order to be able to feel an emotion, one must first interpret it mentally. Lazarus (1982) explained that the interpretation may be the cause of the emotion because each person carries out a very fast cognitive assessment also based on minimal information.

Unlike Lazarus, the scholar Zajonc (1984) argued that there can be an independence between the subjective sensations and cognitive assessments, given that sensations can be felt before, after or simultaneously with cognitive processes. He referred to an experiment of Wilson (1979) in which it was shown that emotions can also occur in the absence of cognitive processing.

As for the universality of the emotions, in his studies conducted mainly from the 70s until the 90s, Ekman says that emotions are innate and important for the individual’s survival. According to a research on facial expressions, the American researcher argues that the emotions which he calls primary or basic (joy, anger, sadness, surprise, fear, disgust, contempt), are lived and expressed in the same way by all the different cultures. What creates distinctions in the emotional experiences is given by the social rules that influence the mode of expression and the way it is handled the emotion, but not the expression itself. For example, in the Italian culture, to express anger is considered an unfriendly act, but the face of anger, if allowed to express, is the same for everyone. While the emotions called secondary (joy, envy, anxiety, hopelessness, shame, jealousy, hope, forgiveness, hurt, longing, regret, disappointment) arise from the combination of the primary ones and social influence.

Subsequent studies have challenged the universality of the emotions and the method by which Ekman’s research revealed them. Anolli (2002) states that there is an interdependence between the physiological reactions and cultural influences in the manifestation of emotions.

In conclusion, from the summary on the different studies investigating how and why we prove emotions, we can deduce that, as emotional experiences are highly subjective and contextual (for example, in some cases I am afraid even when I am alone), every theory may have its own part of truth.

What remains the same in most of the cases is that emotions include two different reaction systems, which are:

- The physiological reaction

- The psychological reaction that includes:

the cognitive processing

changes of the behavior

the inner experience

THE PHYSIOLOGICAL REACTION

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The physiological reaction relates to the changes that occur at the body, visceral, neurological, hormonal, organs level, etc. Basically, all those physical alterations of the person, such as the breathing, which becomes more difficult, the face that is paled, the difficulty of digestion, cold hands, just to name a few.

Most of the physiological reactions are felt by the subject and differ between individuals by the levels of intensity and to the ways in which they occur most.

For example, if I'm scared of the dog that is approaching, according to the intensity of my fear I can have the heartbeat accelerated, eyes wide open, I might lose the control of the bowel, etc. The bigger my fear, the more various symptoms I could have. Because the physiological reaction is subjective, some people are more predisposed to certain reactions than others with the result that, in the same situation of fear, some will lose control of their bowels and others will not.

Conversely, there are situations in which the emotions are activated following the physiological reaction. For fear I have peed on myself, but then I realized that I became wet in front of everyone, and I immediately felt embarrassed. In this case, the emotion of fear activates the physiological response that results in the loss of urine. In turn, such loss triggers the emotion of the social embarrassment.

It can also happen that the cognitive interpretation that creates the emotion is unconscious. For example: As I felt my face turning red I realized I was feeling very embarrassed. In this case, it would seem that the cognitive interpretation happened because of the physiological reaction. In fact, it is likely that, on a psychological level, there has already been developed a thought that led the person to be embarrassed, but he/she remained unconscious until the physical symptom made it clear and therefore conscious.

There are some physical symptoms below for the emotional cause. As you will notice, they are the same that occur even for diverse reasons (organic diseases, external agents). For this reason, when the symptoms are identified, they should never be underestimated or automatically declared as emotional reactions, but it is always recommended to consult a doctor. If, for example, a friend likes to scare me, it will be normal that at that time my respiratory rhythm will change, the heartbeat will be accelerated and my face might lighten up (turn white). The same thing can happen to me in a moment of great anxiety, but if these symptoms tend to repeat often, before archiving everything as an emotional state of an anxious person, I should consult my doctor.

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