Types of interviews

the weak and the orphaned are deprived of justice all the foundations of the earth are shaken. Ps. 82.3–5 Leininger (1988) maintains that caring is the essence of humanity and is essential for human growth and survival. She contends that care is one of the most powerful and elusive aspects of our health and identity and must be the central focus of nursing and the helping and healing professions. Similarly, Roach (1987) claims that care is the basic constitutive phenomenon of human existence and thus ontological in that it constitutes man as man. She points out that all existentials used to describe Dasein’s self have their central locus in care. Roach states, “When we do not care, we lose our being and care is the way back to being. Care is primordial, the source of action and is not reducible to specific actions” (1987, p. 15). Although Roach (1984) claims that caring is the human mode of being, she wonders how convincing the view is that caring is the natural expression of what is authentically human when there is so much evidence of lack of caring, both within our personal experiences as well as in the society around us. Roach points out that we live in an age where violence is commonplace and where atrocities are committed against individuals and communities everywhere. To compound the effect of such violence on the broader social body, many incidents enter our living rooms through the press, radio, and television often as quickly as they occur. As a result, modes of being with another in our world involve both caring and uncaring dimensions. What, then, are the basic modes of being with another? By analyzing two of my own studies on clients’ (patients’ and students’) perceptions of caring and uncaring encounters (Halldorsdottir, 1989, 1990), as well as related literature, I have determined that there are five basic modes of being with another as follows: life-giving (biogenic), life-sustaining (bioactive), life-neutral (biopassive), life-restraining (biostatic), and life-destroying (biocidic) (see Figure 12.1 and Table 12.1). In this chapter, I describe the five basic modes of being with another through examples of caring and uncaring encounters in hospitals as experienced by former patients, my co-researchers in the former study (Halldorsdottir, 1989). The phenomenological perspective of qualitative research theory guided the methodological approach to the studies analyzed, involving the use of theoretical sampling, intensive unstructured interviews, and constant comparative analysis. TABLE 12.1 Five Basic Modes of Being With Another Life-destroying (biocidic) mode of being with another is a mode where one depersonalizes the other, destroys the joy of life, and increases the other’s vulnerability. It causes distress and despair and hurts and deforms the other. It is transference of negative energy or darkness. Life-restraining (biostatic) mode of being with another is a mode where one is insensitive or indifferent to the other and detached from the true center of the other. It causes discouragement and develops uneasiness in the other. It negatively affects existing life in the other. Life-neutral (biopassive) mode of being with another is a mode where one does not affect life in the other. Life-sustaining (bioactive) mode of being with another is a mode where one acknowledges the personhood of the other, supports, encourages, and reassures the other. It gives the other security and comfort. It positively affects life in the other. Life-giving (biogenic) mode of being with another is a mode where one affirms the personhood of the other by connecting with the true center of the other in a life-giving way. It relieves the vulnerability of the other and makes the other stronger and enhances growth, restores, reforms, and potentiates learning and healing. FIGURE 12.1 The caring/uncaring dimension or continuum. Nine former patients participated in the former study and data were collected through 18 in-depth, open-ended interviews. Nine former nursing students participated in the latter study and data were collected through 16 in-depth, open-ended interviews. In both studies, interviews were tape-recorded and transcribed verbatim for each participant. The excerpts used from the former study will be referred to as “modes of being with a patient,” and for the sake of clarity, the feminine will be utilized in reference to the nurse and the masculine in reference to the co-researcher/patient/client. In the text, however, “nurse” and “co-researcher/patient/client” can refer to both males and females. Evidence from literature, that has a bearing on this matter, will also be given. The life-destroying, or biocidic, mode is the most inhumane mode of being with another in the list as given and is represented by violence in all its forms. It means hurting, harming, or deforming the other. This destructive mode manifests in numerous ways as follows: making people dependent or fostering infantilism; being threatening; involving manipulation, coercion, hatred, aggression, and humiliation; involving various kinds of abuse; and often involving an evident lust for power, followed by dominance and depersonalization of the other. Hardheartedness or coldheartedness also may be present here. This mode of being with another most often changes the other to the worse, the harm done depending on the other’s strength to endure. It involves the transference of negative energy or darkness to the other. It is the frost the human flower has a hard time enduring without loosing its luster, petals, leaves, and life. In many respects, the history of humankind is not a positive affirmation of the sanctity of human life as Roach (1987) has rightly pointed out. There seems to be no end to how destructive and brutal the human being can be. Roach also argues that perhaps the greatest threat against human life in our age lies in the erosion of sensitivity toward its value, particularly where the taking of human life becomes part of everyday experience. Roach claims that the public at large has become less and less sensitive to all overt killings—genocide, fratricide, homicide, suicide, and feticide. As described, the life-destroying, or biocidic, mode of being with a patient is the most severe form of indifference to the patient as a person, involves harshness and inhumanity, and is characterized by various forms of inhumane attitudes. Although I will not tell their entire stories here, four out of the nine co-researchers in the study under discussion had a biocidic experience. Of those four co-researchers, three asked me whether I had seen One Flew over the Cuckoo’s Nest and claimed that their nurse was very much like nurse Rachet, as portrayed in that film. None of the co-researchers knew each other. Although all co-researchers held a unanimous perception that uncaring encounters with nurses were very discouraging and distressing experiences for them as patients, their reactions to such encounters were many sided. Several major themes were identified in their accounts as follows: initial puzzlement and disbelief, which is followed by anger and resentment. Because of the patient’s vulnerable circumstances, however, the patient is most often unable to act out the feelings of anger and resentment, and these strong negative feelings seem to develop into despair and helplessness. Being uncared for in a dependent situation develops feelings of impotence, a sense of loss, and a sense of having been betrayed by those counted on for caring. If, on top of that, the patient is treated by the nurse as somewhat less than human, the patient’s feelings soon develop into feelings of alienation and identity loss. The patient feels he has no value as a person, that he is indeed less than a person—“a side of beef,” “an object,” or “a machine.” Furthermore, experiencing uncaring increases the patient’s own feelings of vulnerability within the hospital setting. Numerous co-researchers alluded to the threat of dehumanization within today’s hospitals. It was their unanimous perception that they felt vulnerable and in need of caring when they were in the hospital. Some suggested that this makes patients more sensitive to caring and uncaring. One such former patient stated that, I would expect that people being ill makes them vulnerable, so that when they have an uncaring transaction, like someone treats them rudely, they are more deeply wounded in that circumstance than if they were healthy and walking the street and someone on the corner said something stupid or insulting. I mean that they can shrug off and ignore, but here they are sick and in need, and probably feel weak in spirit, and weak in body, and so it hits home harder, any such transaction hurts them more. Other co-researchers related that they perceived uncaring as a transference of negative energy that affected their well-being and delayed or even prevented their recovery. This perceived negative effect on well-being and healing is illustrated in time and again in their accounts. Furthermore, it was their unanimous perception that the uncaring encounters made such an indelible impression on them and had a longer lasting effect than caring encounters that they tended to be both acid edged and memorable experiences. Some co-researchers referred to the “memories of uncaring encounters” as scars, and although they seem to be trying to understand or make sense of the experience, they are most often still angry and even have nightmares about the nurses perceived to be uncaring. Some co-researchers identified how the uncaring experience prompted them to think about ultimate realities vis-à-vis death, affected their view of the hospital, and how it continued to even dictate their decisions within the health care system today. Although most co-researchers had tried to forgive the uncaring nurse, some co-researchers related that that was probably more a result of forgetfulness than forgiveness. These co-researchers sometimes expressed a longing to return and confront the uncaring nurse, if, for nothing more, than to relieve themselves of their anger. At the same time, however, they realized that the nurses perceived to be uncaring were probably unaware of their influences on the patients and would, therefore, not recognize their stories. Hildegard of Bingen, a remarkable 12th-century abbess, scientist, artist, poet, musician, and mystic, talks about the dryness of carelessness and injustice. She claims that dryness and coldness together make hardness of heart and that drying up destroys our creative powers, marking the end of all good works, and the beginning of laziness and carelessness. She maintains that if we lack an infusion of heavenly dew, we will be turned into dryness and our souls will waste away. From Hildegard’s point of view, the ultimate uncaring occurs when we become cold and hardened to injustice. Hildegard (1985) wrote to one churchman: “When a person loses the freshness of God’s power, he is transformed into the dryness of carelessness. He lacks the juice and greenness of good works and the energies of his heart are sapped away” (p. 64). The life-restraining, or biostatic, mode of being with another involves negatively affecting life in the other by restricting or disturbing the energy already existent in the other. It means being insensitive or indifferent to the other, causes discouragement, and develops uneasiness in the other. It often involves imposing one’s own will upon the other, dominating, and controlling the other. It sometimes appears as fault finding, anger, blaming, accusing, and being unfriendly. It is that very coldness and strong wind the human flower has a hard time enduring. The life-restraining, or biostatic, mode of being with a patient involves the patient feeling strongly that the nurse does not care and is blind to his feelings by way of negative feedback from nurse to patient. Here, the nurse often treats the patient as a nuisance, that is, if it were not for the patient, the nurse’s life would be a lot easier. The patient starts to feel that he is bothering the nurse when asking for help, finds the nurse often cold and unkind, and the nurse’s presence destructive in some way. This nurse approach is partly illustrated in the following accounts. The second one [uncaring nurse] was cold, and I can at least give her that much because I interacted with her enough. The first one, I would just say I was … what?, I don’t know, a piece of dust on the floor, I mean, I can’t, I was a bother … The people in that room were just beds, that’s all, you know, beds. She had prescriptions, she had a checklist of what she had to do, you know, your heart, etc., and that’s all it was, for everybody, not just for me, you know. I had experiences of being in another ward for three days, and there was a tremendous high percentage of noncaring nurses. Actually, this is a nice description saying noncaring nurses, they were completely like … cold … cold human beings, like computers. It’s like, sometimes I was worried, I was … was wondering if they really even noticed that I was there. Dossey (1982) asserts that a patient-as-object approach to care delivery is destructive because it violates the oneness and wholeness that are necessary for healthy, viable living systems. Similarly, Gadow (1985) has pointed out that in addition to the domination by apparatus and by experts that can accompany the use of technology, patients can be reduced to objects in a more fundamental way than by the use of machines in the view of the body as a machine. Gadow states, “such reduction occurs because regard for the body exclusively as a scientific object negates the validity of subjective meanings of the person’s experience. Those meanings are categorically nonexistent in the scientific object” (p. 36). Furthermore, Gadow (1988) has pointed out that the exercise of power always increases the vulnerability of the one over whom it is exercised, no matter what benevolent purpose the power serves. The life-neutral, or biopassive, mode of being with another occurs when one is detached from the true center of the other and when there is no effect on the energy or life of the other. This lack of response, interest, and affect derives from inattentiveness or insensitivity to the other. It refers to the lack of a positive or caring approach rather than the presence of something destructive. Although it has no real effect on the life in the other, it sometimes creates a feeling of loneliness, because there is no mutual acknowledgment of personhood, no person-to-person contact. Furthermore, many seem to experience this apathetic inattention not only as lack of care but as noncaring or uncaring. The fundamental characteristic of the life-neutral, or biopassive, mode of being with a patient is perceived apathy, which refers to the approach in which the nurse is perceived to be inattentive to the patients and their specific needs. The co-researchers emphasized that the nurse seemed to care about the routine, the tasks she was supposed to perform, but not about the patient as a person. The nurse is sometimes perceived by the patient as insensitive, absentminded, tired, dissatisfied in her job, or lacking in some caring quality, for example, warmth of voice. Furthermore, the co-researchers perceived these nurses as either unwilling or unable to connect with, or develop attachment to, the patient. The co-researchers’ perceptions of detachment are seen clearly in their accounts. In fact, one co-researcher stated, Aahm … the way she looked at you … like you are not a part of her world … or that she doesn’t want to attach—you can feel that there is no emotional attachment there. Bermejo (1987) asserts that a person is essentially characterized by a necessary openness to another. He contends that a person closed in upon and withdrawn into his or her self, hardly deserves the status of person, for this withdrawal, he argues, goes counter to the very core of man’s being, which is clamoring first for an opening, and then, based upon that opening, for a total gift of self to another. Bermejo states, “A rejection of this essential, radical opening and the ensuing personal communion would unavoidably have a crippling effect on the fulness of the human person. A man half open is only half a man” (p. 46). Hildegard of Bingen (1985) states in one of her many books that too often human actions are weak and lukewarm and emerge from people who are more asleep than awake. She claims that in this way people “make themselves weak and poor who do not wish to be busy about justice or about rubbing out inju