Voice shame: Self-censorship in vocal performance

Voice shame is the uncomfortable feeling of being heard as ridiculous, worthless or ‘not good enough’. Voice shame arises when a subject becomes aware of an observer’s attention and believes the evaluation to be negative. It causes intensive monitoring of one’s vocal expression and of others’ perception of oneself. The effects of voice shame are largely hidden, since performers will tend to gravitate towards self-staging strategies that comply with conventions, in order to avoid shame. Worried attempts to prevent shame through self-monitoring and active control of one’s voice, body, and impact on others may cause serious difficulties with vocal performance. Voice shame can affect professional and non-professional voice users. Shame is a non-cognitive self-rejection. It presupposes internalized ideals and criteria of quality, learned through interaction with external authorities, such as parents, peers, mass media or music teachers. The self that judges and rejects itself is a product of social interaction; it is situated and reflects the demands and constraints posed by both tacit and explicit cultural values and educational traditions, ideals and methods. Triggers of, and thresholds for, shame differ between individuals, within frameworks that are largely common to members of a given subculture. Based on empirical studies of music students and professional pop, jazz and classical singers, we apply French philosopher Michel Foucault’s discourse-theory to the analysis of disciplinary mechanisms among vocal performers. The concept of voice shame is presented as a source of insight into the dynamics of singers’ self-regulation, self-staging and self-censorship, and hence as a useful tool for the voice teacher

Voice shame: Self-censorship in vocal performance

Voice shame is the uncomfortable feeling of being heard as ridiculous, worthless or ‘not good enough’. Voice shame arises when a subject becomes aware of an observer’s attention and believes the evaluation to be negative. It causes intensive monitoring of one’s vocal expression and of others’ perception of oneself. The effects of voice shame are largely hidden, since performers will tend to gravitate towards self-staging strategies that comply with conventions, in order to avoid shame. Worried attempts to prevent shame through selfmonitoring and active control of one’s voice, body, and impact on others may cause serious difficulties with vocal performance. Voice shame can affect professional and nonprofessional voice users. Shame is a non-cognitive self-rejection. It presupposes internalized ideals and criteria of quality, learned through interaction with external authorities, such as parents, peers, mass media or music teachers. The self that judges and rejects itself is a product of social interaction; it is situated and reflects the demands and constraints posed by both tacit and explicit cultural values and educational traditions, ideals and methods. Triggers of, and thresholds for, shame differ between individuals, within frameworks that are largely common to members of a given subculture. Based on empirical studies of music students and professional pop, jazz and classical singers, we apply French philosopher Michel Foucault’s discourse-theory to the analysis of disciplinary mechanisms among vocal performers. The concept of voice shame is presented as a source of insight into the dynamics of singers’ selfregulation, self-staging and self-censorship, and hence as a useful tool for the voice teacher.publishedVersio

Helsebegrepet : selvet og cellen

Ordet helse kommer av det oldnorske heill, som betydde ”hel, ubeskåren, uskadd”. Heill har gitt opphav til ordene hel, hell, hellig – og helse. Det friske og det sunne har aldri vært rent kroppslige eller materielle egenskaper, helse har alltid hatt en moralsk og spirituell betydning. På latin er ordet for helse salus, som også betyr frelse. Det som er godt for kroppen, sjelen og ånden forenes i ett ord. Det greske ordet for helse hadde betydningen ”det skjønne og det edle”, og for grekerne var helse vel så mye moral som biologi. Gresk sunnhet i antikken var en etisk og sosialfilosofisk måte å leve på, i harmoni mellom kropp, sjel, samfunn og natur. Det er et stykke derfra til vår tids tro på at helse skapes av vitaminpiller, helsestudioer og horder av ”helse”arbeidere. I denne artikkelen skal jeg nærme meg helsebegrepet fra to ytterkanter, henholdsvis fenomenologisk filosofi og psykonevroimmunologisk forskning, i forsøk på å skape en fortelling om helse med rom for både mening og materie, musikk og biologi

Forgetting the audible body. Voice awareness in teacher education

ABSTRACT. - Voice training and voice knowledge have all but disappeared from Norwegian teacher education, in a general decline of the standing of practical-aesthetical subjects in compulsory school. Yet the voice is a teacher’s primary tool for establishing authority, commanding attention, and for guiding, motivating and building a trusting relationship with students. Voice trouble is a major cause of health problems and professional dysfunction in teachers. In this article, “the audible body” denotes both voice physiology and the relational meanings that color production and perception of a human voice, within a matrix of social and cultural connotations of beauty, quality, normalcy and health. The study consists of interviews with six music student teachers having received voice lessons during their three-year bachelor program, concerning voice awareness and voice care during studies and as student teachers in practice periods. The students were able to identify the relational authority and attention-producing qualities inherent in a well-functioning voice, and had learned to prevent and remedy common voice problems. Findings from the interviews are contrasted with previous survey data from a student group exposed to a minimal amount of voice education. The article discusses the importance of teachers’ awareness of physiological, relational and emotional influences on voice function, and of strategies for dealing with the challenges of being the audible center of pupils’ attention, where pupils become the teacher’s “magic mirror”. The disappearance of voice training from teacher education conveys ignorance of the bodily and relational foundations of human functioning, and may negatively affect teachers’ professional functioning. Keywords: student teacher, the voice, the mirror-effect, self-censorship, voice shamepublishedVersio

Shame in medical clerkship: “You just feel like dirt under someone’s shoe”

Introduction This study explores how senior medical students’ experience and react to shame during clinical placements by asking them to reflect on (1) manifestations of shame experiences, (2) situations and social interactions that give rise to shame, and (3) perceived effects of shame on learning and professional identity development. Methods In this interpretive study, the authors recruited 16 senior medical students from two classes at a Norwegian medical school. In three focus group interviews, participants were invited to reflect on their experiences of shame. The data were analyzed using systematic text condensation, producing rich descriptions about students’ shame experiences. Results All participants had a range of shame experiences, with strong emotional, physical, and cognitive reactions. Shame was triggered by a range of clinician behaviours interpreted as disinterest, disrespect, humiliation, or breaches of professionalism. Shame during clinical training caused loss of confidence and motivation, worries about professional competence, lack of engagement in learning, and distancing from shame-associated specialties. No positive effects of shame were reported. Discussion Shame reactions in medical students were triggered by clinician behaviour that left students feeling unwanted, rejected, or burdensome, and by humiliating teaching situations. Shame had deleterious effects on motivation, learning, and professional identity development. This study has implications for learners, educators, and clinicians, and it may contribute to increased understanding of the importance of supportive learning environments and supervisors’ social skills within the context of medical education.publishedVersio

De-fuzzification of reflection in the education of health professionals

Our educational institutions are mandated to equip future physicians and other health care professionals with the scientific, craft, and inter-personal knowledge and skills to meet the demands of contemporary clinical practice. Clinicians must acquire advanced communication skills, develop the ability to manage complex situations, make appropriate use of medical knowledge and technology, and problem-solve through the exercise of refined judgment. The ability to reflect in and on situations of this nature is considered a necessary professional aptitude in order to ensure effective and compassionate whole person care. Notwithstanding the general acceptance of these premises, ‘reflection’ remains a fuzzy concept. It is a polysemous term that has proved difficult to define and has attracted to itself numerous false claims and unfulfilled promises. Excellence in reflective abilities is notoriously difficult to recognize in another individual and it may not be ‘teachable’. Furthermore, there have been recurring doubts as to the feasibility of meaningfully assessing reflection.We intend to explore these issues in this session. We will demonstrate how reflection can be role-modeled and inculcated. Instructional Methods This will be an interactive workshop. Learning Objectives     By the end of the workshop, participants will be able to:• clarify the concept of reflection and understand its application to the education of health professionals• discuss a framework, including specific methods, for the structuring and deployment of an educational program aimed at promoting reflection

"I wish I’d laid my hand on her shoulder". Fostering compassion in first-year medical students

In order to care for sick people as whole persons, health personnel need awareness of how sickness afflicts human beings, and how health professionals affect patients’ ability to deal with disease and suffering. In medical education there is a well-documented dearth of teaching and learning about emotions and relational healing mechanisms. Medical students are not systematically educated in the “existential anatomy” of persons, and how to deal productively with uncertainty, embarrassment and helplessness.In this highly participatory workshop, a concrete teaching method for first-year medical students, developed in Norway, will be shared. The method, called PASKON (“patient contact”) is anchored within a theoretical framework related to Whole Person Care, which is currently taught at McGill.Central to PASKON is the encounter between novice medical students and very sick volunteers, both in the patients’ homes and in the classroom. Having to enter the intimacy sphere of a stranger, and be acknowledged as a health professional without feeling like one, is an orchestrated rite of passage that generates strong emotions and a wealth of material for reflection. More experienced students coach the first-years and assess their reflective essays.The workshop will highlight the rationale for working with relationships, emotion and awareness in medical students. Participants will then be given roles as patients or students, and guided through a simulated session of PASKON, and reflections on the method and its potential applications

Shame in medical education: A mindful approach

Shame is a ubiquitous and potentially damaging emotion with many nuances (embarrassment, humiliation, disgrace, remorse, ridicule etc.). It can be defined as “a state of experiencing oneself as devalued, diminished and an object of derision in the mind of another or others, which when internalized textures a sense of oneself”. Shame regulates social behaviour by penalizing deviations from the norm, and rewarding conformity. The influence of shame on physicians and medical learners is conspicuously absent from the literature on emotional challenges in medicine. The dearth of research on shame is not surprising given that “it is shameful and humiliating to admit that one has been shamed and humiliated.” (Lazare, 1987) Existing literature highlights the harmful effects of shame on both physicians and learners. Humiliation is detrimental to student well-being and can lead to feelings of self-doubt, alienation and inferiority, triggers of perfectionism and loss of empathy. Practicing physicians are prone to shame if their authority is undermined, and may exhibit dismissive, defensive, or aggressive behaviors in the face of criticism, patient conflict or disagreements with colleagues. This workshop will explore mechanisms and implications of shame in medicine and medical education. We will present results from interviews with Norwegian medical students, and use an empirically validated approach called Mindful Practice to investigate challenging themes facing health professionals. This approach utilizes critical awareness (investigating the sources of shame), shared dialogue (reflecting on the personal impact of such experiences) and elements of appreciative inquiry (identifying individual qualities that mitigate negative effects)

Medisinsk profesjonalitet: Mestring av legeyrket

When the doctor uses theoretical knowledge, clinical skills, and clinical communication in a way that takes care of the patient, this may be called professionalism. The article aims to show that medical professionalism, in all specialities, may be understood and taught through the two complex concepts “leadership” and “patient-centred medicine”.The article is built on a literature-search with a selection of articles based on the authors’ experience in the field.Leadership is an implicit part of clinical work. The concept gives a perspective on the solution of clinical problems and gives a frame for understanding interaction in consultations and in other professional relations. The doctor personal leadership actualizes professional tutoring as part of the education.Models for patient-centred medicine have emphasized the doctor’s attitudes, skills, and use of linguistic means, and they have deepened the doctor’s understanding for exploring the patient’s problem. Newer models also discuss the doctor’s actions and therapeutic actions and underscorethe leader-role in series of decision-making moments in the consultation. Patient-centred clinical work should be based on an understanding of the doctor as an active co-editor and co-producer of the patient’s illness narrative.Professionalism, interpreted as patient-centred leadership, gives a direction for medical education that may help doctors to cope with their work

Stretching the Comfort Zone: Using Early Clinical Contact to Influence Professional Identity Formation in Medical Students

Purpose: To explore first-year medical students’ affective reactions to intimate encounters with severely sick patients in their homes, within a curricular innovation targeting the development of a patient-centered professional identity. Background: Early patient encounters create complex emotional challenges and constitute fertile ground for professional identity formation. The literature indicates that students often learn, largely through the hidden curriculum, to avoid and suppress emotion. This can culminate in mental health problems and loss of empathy. Method: A qualitative descriptive analysis of 28 randomly selected, mandatory, reflective essays focused on a home visit to a previously unknown patient, in an unsupervised group of 4 students, within the context of a structured course called Patient Contact—PASKON. Results: Students described a wide range of affect-laden responses, positive and negative, elicited by the home visits. The observations were typically related to loss of control, struggles to behave “professionally,” and the unmasking of stereotypes and prejudices. Conclusions: Medical students’ initial clinical encounters elicit emotional responses that have the potential to serve as triggers for the development of emotional maturity, relational skills, and patient-centered attitudes. Conversely, they can foreground uncertainty and lead to defensive distancing from patients’ existential concerns. The findings point to a role for structured educational strategies and supervision to assist students in the emotion work necessary in the transition from a “lay” to a “medical” identity.publishedVersio