Dehumanization in medicine: Wait, empathy IMPROVES clinical problem-solving?

[00:00:00] Speaker A: Hi, I'm Kim Neely, and this is the trauma informed SLP. It is a podcast where we learn how to promote safety and empowerment to build resiliency in everyone we know, including ourselves. I actually don't have too much of a trigger warning today. I might bring up some things in passing maybe that could be potentially triggering. So if I do happen to mention anything, like anything that comes up in my mind as examples as I'm recording, if you start feeling any level of upset or challenging emotions that come up, feel free to pause and do what you need to do. Check out my regulation episode for some ideas on how to help you process through that. So what we're talking about today, last episode we did Dehumanization and Science. Now we're doing Dehumanization and Medicine, which is probably in the title of this episode. So you are probably aware of that we're not 100% always medicine, right? I know. SLPs especially when we work in the schools, we tend to not think of ourselves as being a medical profession, like offshoot. But we really are, right. We still have a lot of training based in that medical model of apprenticeship where we do our clinical rotations and our clinical fellowship, and we're always getting that input from mentors and such. So we do have a lot that we've adopted from the medical model when it comes to training and how to think of things objectively and how to problem solve and things like that, right? And as such, sometimes those ideas around what makes an effective clinician are actually dehumanizing to our clients. So that's what we're going to talk about today. And that's what I just want you to think about as I go through some things, how we're going to go through this. This is the organization for the episode, just to set your expectations and get your brain all primed up and ready to go. I have two primary articles we're going to be going through in this episode. The very first one is by Huck and Wyatt's. It's from 2012. It's called dehumanization in medicine. Causes solutions and functions. And I'll definitely link it in the show notes as well. So this one is a really good paper, and at first when I read it, I was like, oh, this is all really great stuff. I used it in my Asha presentations. But I actually encountered when I was researching further into dehumanization medicine, I encountered another paper from 2014. So this paper is called Dehumanization and Organizational Settings subscientific and Ethical Considerations by Kalina Kristoff in 2014. And I will also, of course, include a link below. So this paper brought up some counterpoints to some of the Huck and Wyatt's paper. So as the two main papers that we're going to be going through, I'm going to actually do kind of a point counterpoint kind of thing because Huck and Wyatt's, they divided dehumanization in their paper into non functional causes and functional causes. [00:03:20] Speaker B: So we're going to go through the. [00:03:21] Speaker A: Non functional causes first from the Huck and Wyatt's paper. That's the next section. And then I'm going to use the Kalina Kristoff's paper not necessarily as a counterpoint to it, but more as an expansion on what they say. And then in the next section, we'll go through the functional causes from Huck and Wyatt's and then the counterpoints from the Christoph paper. And then at the tail end, that counterpoint from the Christophe paper is actually going to dovetail very nicely into introducing the concept of emotional labor. So I'm probably going to go ahead and just define what that is and give some introductory knowledge on emotional labor and how it gets written about, because that is something that we're going to talk about, I think. At the next episode because this is starting to actually dovetail fairly nicely into professional burnout and signs of traumatic stress. [00:04:14] Speaker B: In us, in the professionals actually doing. [00:04:17] Speaker A: The caregiving, which I wanted to get to anyway. And I'm so excited that somehow my little ADHD research hole actually ended up organically getting me to the point where we really need to start talking about that because there are ways that doing the dehumanization, doing an emotional labor, there are ways that this impacts us psychologically. [00:04:37] Speaker B: And so it actually leads into that pretty well, honestly. [00:04:41] Speaker A: So that'll be fun. Look forward to it. That's what we're going to do. Let's go ahead and get into these nonfunctional causes and get the ball rolling on dehumanization and medicine. Let's go. All right. So nonfunctional causes of dehumanization in medicine, per Huck and Wyatt's 2012 Lit Review type paper. In their background of this paper, they put in a really nice quote that I think summed up kind of the reason why they needed to talk about this. So they said, Dehumanization in medicine does not necessarily result from malicious intent on the part of caretakers. Rather, unconscious, unintentional dehumanization of patients can occur as a byproduct of the way humans evolved minds interact with present widespread social practices and functional requirements in hospitals. [00:05:35] Speaker B: And that's true. [00:05:37] Speaker A: That's why I want to talk about this. So the three nonfunctional causes they give in this paper are de individuating practices. [00:05:46] Speaker B: Impaired patient agency, and dissimilarity. [00:05:51] Speaker A: So the first one they go through, let's go through de individuating practices. They're talking about the individual becoming immersed in a group or somehow otherwise or otherwise anonymized. Sorry. Or otherwise anonymized that is like a tongue twister or otherwise anonymized, otherwise anonymized. I tripped over that a lot when recording this. [00:06:10] Speaker B: Okay, so what they're talking about with. [00:06:13] Speaker A: This, they're mainly talking about the professionals themselves being kind of becoming immersed in a group, essentially. So, like, if you work at a hospital, there might be certain nursing wears one colored of scrubs. Surgeons wear a different color, right. They can be a bit like a uniform kind of, right? So it kind of distinguishes who you are and you're just kind of becoming part of this group who shows up to take care of this person instead of actually being an individual in your own right. Using highly professional clothing, I guess in schools a cardigan would probably be the equivalent, right? Wearing like the teacher cardigan, SLP cardigan. But essentially by using this kind of like uber professional attire or maybe slight uniformity in the way we dress sometimes, it kind of creates this separation between us and the people we're serving and the patients and the families, right? So they see the white coat that the physician is wearing, they see the surgeon scrubs, they see the teacher cardigan. I don't know, even though obviously families can wear cardigans, too. Basically that's the case of a student or a patient or whoever dehumanizing you as the clinician, essentially not seeing you as a human, which is kind of an interesting thing. We don't often think of that. [00:07:33] Speaker B: Right. And I think I mean, you can. [00:07:35] Speaker A: Definitely see it in schools when students just assume you live there. They don't have any idea that you have a life outside of school. Even high schoolers are pretty bad at thinking that people actually do something outside of being in school. I mean, to be fair, they have homework and stuff. So for them, school is probably more amount of time than even for us when we're super crazy busy. But nonetheless, it's just something to think about. You don't really think about the fact that our position, the fact, I guess in a school it would be like if you happen to have a closet sorry, if you happen to have an office, what a slip of the tongue school SLPs. How many times has my office been a closet? There we go. I happen to have my own personal closet where I work, basically. But nonetheless, you have your own space where the kids go to. You have your own desk, you have your own computer. This is all ways that they see. [00:08:28] Speaker B: You as an authority figure. [00:08:30] Speaker A: They see you as a teacher. They don't really see you as a person. [00:08:32] Speaker B: Right? [00:08:32] Speaker A: So that's kind of interesting. I think that naturally gets broken down a little more in our practice, like versus physicians, for example, or even nurses. So much of our work is literally just sitting and communicating with the person we're with. So I think it's probably less likely they see us as not an individual. The further on we go with our sessions, they're going to get to know us as people just because of the nature of our job. [00:08:57] Speaker B: But I guess don't be afraid of that. [00:08:58] Speaker A: I guess that's the thing. Don't be too afraid to be seen as a person because them not seeing you as a person is actually them dehumanizing you. And that doesn't really help build rapport or relationship. [00:09:08] Speaker B: I guess that's a good takeaway from that. [00:09:12] Speaker A: The next one they talk about is impaired Patient Agency. Now, this is something that comes about because particularly if you're thinking of hospitals or rehabilitation, maybe even do outpatient rehab, whatever it is, if you're working in the medical area, we're dealing with people. [00:09:28] Speaker B: Whose abilities to plan to complete activities. [00:09:32] Speaker A: Of daily living, right? That stuff has become impaired due to some kind of injury or illness, right? So because of that, we are at higher risk of dehumanizing those people in an animalistic way. Per the Haslam article, the 2006 that we talked about, the last episode, animalistic dehumanization, meaning like, if you're kind of seeing them as less than capable of certain human interactions or certain human mental processing, right? Infantilization kind of like thinking of somebody as just not really fully an adult anymore can definitely be part of that. [00:10:08] Speaker B: The solutions they propose would be really. [00:10:12] Speaker A: Always focusing on the patient's ability to choose. And I think this is true for us too, focusing on even with toddlers and like preschoolers, you can give them a choice, right? Give them choices and then honor those choices that they make, you know what I mean? [00:10:27] Speaker B: And also, we could still even let. [00:10:30] Speaker A: Them know why they're coming, what we're doing, right? This is part of that empowerment, part of educating them on why they're coming to speech and kind of treating them as sort of your partner, essentially, to some extent, right now we get to dissimilarity. So they say this occurs in three ways. So there's like three subsets of this. This is similar to impaired Patient Agency but essentially dissimilarity in illness. Meaning by the very nature of someone being ill or severely injured, they already are a little bit separated from our idea of like a fully formed person, particularly when thinking of adults. And I think this is another thing that can happen with even people who work in schools or work with pediatrics. When you're dealing with developmental disorders or something, it's all too easy to not think of them as fully human. Even if they're kids. Just because they're developing differently doesn't necessarily mean they're not fully formed humans, right? [00:11:33] Speaker B: But it's so easy to fall victim to that. [00:11:36] Speaker A: Also considering the fact that most of the time when adults look at kids, we just see like, not fully formed humans anyway, right? Because prefrontal cortex is not working so great. Forethought, maybe don't try to balance on the highest little rail of the playground, things like that. [00:11:54] Speaker B: It's like adults are like, you might. [00:11:56] Speaker A: Fall and break your leg and the kid is just like, whatever, I'm going. [00:11:59] Speaker B: To do it anyway. [00:12:00] Speaker A: Right? [00:12:00] Speaker B: So there's a little balance there with. [00:12:02] Speaker A: Little ones because you definitely have to keep them alive and uninjured. You have to tend to their physical safety a fair amount because they are not always aware enough to tend to it. But that goes for all kids, right? That goes for kids without any developmental disorder. That goes for kids not in special education. So, honestly, if you work with pediatrics and this might be harder to do with clinical with private clinics, but I always loved taking some time out of my day when I worked at a preschool to watch the non special education. [00:12:35] Speaker B: Kids, you know what I mean? [00:12:37] Speaker A: Like watch just kid interaction period, right? Get a better touchstone into not just like, the list of norms, not the stuff we learned in grad school, but watch how they interact, watch how they play. Because the older you get, the more separated you get from the type of play that kids do and from what natural interactions look like with little kids. [00:12:58] Speaker B: You know what I mean? [00:12:59] Speaker A: Which is really informing and then also seeing, like, okay, I see a difference in how, say, these kids are interacting versus my autistic kids, so maybe I can help bridge that, you know what I mean? That's what I'm thinking in terms of that. Instead of seeing it as like, well, they're the ones who are dissimilar. The autistic kids are dissimilar, therefore we need to make them not so dissimilar. That's not the way to go. That's not neurodiversity affirming. So instead of thinking that way, thinking. [00:13:25] Speaker B: More in terms of, like, maybe we. [00:13:27] Speaker A: Can bridge some of these differences and still learn to either parallel play or at least share the same play space. [00:13:34] Speaker B: Together in a more safe and peaceful. [00:13:37] Speaker A: And getting along sharing kind of a way, right? Totally. Okay, so that's dissimilarity and illness. The labeling of the patient as an illness is another occurrence of dissimilarity, which is sort of similar. I don't think we do it as much in our field. I feel like I heard this a. [00:13:56] Speaker B: Lot more often in skilled nursing facilities. [00:13:59] Speaker A: When I used to work in them. [00:14:00] Speaker B: Especially at one where the nursing staff. [00:14:03] Speaker A: Was not necessarily ethically the greatest, but they would just be like, oh, yeah, dementia room, blah, blah, blah. They literally just call out the illness. It was basically instead of their name, they would just call out the diagnosis in the room. [00:14:21] Speaker B: And you're like, okay, that's not great. [00:14:23] Speaker A: To just call those people the disease. Right? So, like, calling somebody like the cancer patient versus a patient with cancer, or a lot of times people use the room number in the bed, right? It'll be like two B or something. That was Hamlet. Two B. Or not to be no, but yeah, like, oh, yeah, the patient in two. [00:14:44] Speaker B: A or something, right? But this also brings up, just as. [00:14:48] Speaker A: A side note, the thought of person first language versus identity first. And to help address this, I actually want to go ahead and read off a little bit of the Autistic Self Advocacy Network's statement they have on their website about this, which I will also, of course, link. [00:15:08] Speaker B: But this is written by one of. [00:15:11] Speaker A: Their interns, Lydia Brown. At least that's the header. I don't know if she's still an intern. Not sure if she still works there or not. But she originally published it on her blog and then Asan put it on their webpage and I think it's a really great statement about identity first versus persons first for autistics since I know this is still something that is still discussed, right? And people still have a little feeling of pushback against it. So I wanted to go ahead and pull some of her words from it so that I'm using the words from an autistic person because I think she makes a really good point when it comes to labeling somebody as an illness versus what autistics are wanting when they say identity first versus person first. [00:15:52] Speaker B: Okay, so this is just a quote from the middle. So it says one argument I encountered. [00:15:59] Speaker A: In one of the more cogently written papers in favor of person First Language exposulates that because cancer patients are referred to as people with cancer or people who have cancer as opposed to cancerous people, the same principle should be used with autism. There are some fundamental flaws with this analogy, however. Cancer is a disease that ultimately kills if not treated or put into long term remission. There is absolutely nothing positive, edifying or meaningful about cancer. Cancer is not a part of a person's identity or the way in which an individual experiences and understands the world around him or her. [00:16:36] Speaker B: It is not all pervasive. [00:16:39] Speaker A: Autism, however, is not a disease. It is a neurological developmental condition. It is considered a disorder and it is disabling in many and varied ways. It is lifelong. It does not harm or kill of its own accord. It is an edifying and meaningful component of a person's identity and it defines the ways in which an individual experiences and understands the world around him or her. It is all pervasive. [00:17:05] Speaker B: End quote. [00:17:07] Speaker A: So I really like how Lydia Brown made that comparison. Know, when a person has the flu or a person has a cold versus a neurological developmental condition in the sense of the brain is literally wired differently. They perceive the world differently. They experience the world differently, right? So their entire identity as themselves and who they are in the world, it is very much saturated with the fact that they're autistic. [00:17:34] Speaker B: It's all filtered through an autistic brain, right? [00:17:38] Speaker A: If there is a group of advocates out there, like adult autistic advocates who. [00:17:41] Speaker B: Say we prefer identity first, use that. [00:17:45] Speaker A: Because that is not the same thing as labeling somebody as their illness. Meaning like the stroke patient or the heart attack patient or the cancer patient, right? [00:17:56] Speaker B: It's not labeling that way. [00:17:58] Speaker A: Those are things that happen to people that are unfortunate, that do change their life and really do have very wide reaching impacts on that person. [00:18:07] Speaker B: But it's not quite the same as. [00:18:10] Speaker A: Like they were born with a completely differently wired brain. The third way that dissimilarity occurs is the natural power imbalance the asymmetry that's common to the physician patient Dyad. This is the point that I'm going to expand upon. So I'm going to now switch over to Kalina Kristoff's 2014 paper because I think this power asymmetry is another place for us to really be very aware of unintentionally using microaggressions or some type. [00:18:44] Speaker B: Of utterance that really distinguishes us from. [00:18:48] Speaker A: The people we're in front of. Or maybe it could even be like economically we have more means than the family we're serving, possibly. And so if we talk about our vacations and stuff, maybe it makes them feel not so great because they don't get vacation and they're working three jobs, you know what I mean? [00:19:06] Speaker B: So it's that kind of stuff of. [00:19:08] Speaker A: Being more aware that there are things we might say accidentally that we feel we're just bonding. [00:19:14] Speaker B: This is how people in my culture. [00:19:17] Speaker A: Bond, but maybe it's not the way they bond and maybe it's actually more. [00:19:21] Speaker B: Off putting than bonding, you know what I mean? Because as Kalina Kristoff says, she actually mentions this whole evidence for relatively mild. [00:19:33] Speaker A: Dehumanizing attitudes and behaviors, which previous literature has called microaggressions and things like that. Mild dehumanizing, which, I mean, okay, you're not throwing people in concentration camps, so sure, not quite as severe as that, but mild also makes it seem like it doesn't have an impact, which is not true. Research has shown that microaggressions and things like this have long term negative consequences on mental health. They create a chronic traumatic environment, a sustained traumatic environment where the person can never get away from verbal aggression and verbal bullying, maybe harassment, social rejection, and that stuff really impacts people's mental health. And then she also mentions this is a very good thing, I think, for clinicians to be aware of. She mentions that people who inadvertently use these types of maltreatments, maybe they're not really aware, they don't really mean to be doing it, but they do it if they happen to get called out. This is kind of part of the white supremacy culture, right? So if you're starting to call that person out and say, like, hey, that makes me really uncomfortable when you say XYZ, a lot of times the perpetrator the one who's being told that they said something harmful because their initial emotional reaction is shame, feeling ashamed of themselves and maybe feeling some guilt in order to protect themselves. This is the thing about uncomfortable emotions, right? Most of us don't want to have uncomfortable emotions, so we want to protect ourselves from it. So it's a psychological protection thing where. [00:21:12] Speaker B: They start to downplay the severity of that, right? [00:21:16] Speaker A: They start to downplay the actual suffering and then they use it to kind. [00:21:19] Speaker B: Of justify their statements. [00:21:22] Speaker A: Like they kind of self justify why they did it and like, they kind of make up this narrative, like their intention is the more important thing and. [00:21:30] Speaker B: That creates this cycle. [00:21:33] Speaker A: So as Christophe says, and I'm quoting, a vicious cycle may emerge whereby dehumanization promotes maltreatment and aggression, which further promotes dehumanization. [00:21:44] Speaker B: Does that make sense? [00:21:45] Speaker A: So you have this constant cycle of it feeding off of each other. This is where you get into those everyday little microaggressiony type things that certain groups experience. [00:21:55] Speaker B: And this says, and I quote, everyday. [00:21:58] Speaker A: Interpersonal maltreatments can leave its victims feeling degraded, invalidated or demoralized. And the reason this came to mind when I was reading about the whole power imbalance dissimilarity is the fact that because of that imbalance, our clients are very unlikely to tell us if we're saying or doing something that is potentially. [00:22:23] Speaker B: Harmful to them, like being someone in. [00:22:27] Speaker A: A female presenting body. I have definitely gone to physicians before who have said some things that were not exactly pleasant to hear, some kind of mansplainy attitude a little bit. I kind of got babied, right? We've all had those sort of things happen to some extent where someone has taken on a tone or used a phrase or something that is really rooted in this casual, everyday dehumanization, in these microaggressions, right? And I talked about this a little bit in my Systemic versus Individual adversity. I believe I believe it was that episode. I'll have to double check and make sure, but I know I talked about this in one of the other episodes in terms of microaggressions. But I think that's the main thing is to know that to be trauma. [00:23:14] Speaker B: Informed means you really do have to. [00:23:19] Speaker A: Develop this habit of increasing your awareness, continually building your awareness, trying to keep in touch with the changes that are happening in society. Because especially nowadays with the Internet, so many groups are able to speak out against things that are harmful to them. And it happens really fast, right? And it can make people feel kind of threatened when it's like, well, I'm using this term or this phrase, and I didn't even know the origin anymore of it and it shouldn't be a big deal. I should still be able to just be able to say that because I'm not even aware when I'm doing it, right? And so that's part of that, like I don't want to have to actually feel any guilt or any concern around possibly hurting somebody. I just want to sort of defend it as like, well, it doesn't make me a bad person just because I'm using this informal casual language that I grew up around. And that's just kind of an intrinsic part of how I talk, right? And the reality is, in order to be trauma informed, we have to be vigilant against that type of defensiveness, really, because what that defensiveness is really saying is you're probably feeling some level of guilt, possibly some shame. And that needs to be processed, it needs to be felt, it needs to be dealt with so that you can access those higher cognitive functions where you. [00:24:46] Speaker B: Can change your habits, where you can. [00:24:48] Speaker A: Say, oh, okay, I'm going to try. [00:24:50] Speaker B: To do better with that then. Right. [00:24:52] Speaker A: And maybe in certain contexts, we can allow some space for students, clients, patients to let us know if we happen to say something that seems to be. [00:25:02] Speaker B: Maybe a little alienating to them. [00:25:04] Speaker A: But I think the main thing is as long as the intention is continue to learn and to change and to grow, I think that's far more important than making sure you have the laundry list of things to say versus things not to say. It's not so much that it's more like the intention is I don't want to alienate. I don't want you to feel othered. [00:25:26] Speaker B: Right? [00:25:26] Speaker A: I don't want to casually mention something. [00:25:29] Speaker B: That makes you feel uncomfortable or that. [00:25:32] Speaker A: Makes me seem so much different from you. So maybe things just stay more general for a while until you really get to know each other a little better. You know what I mean? Who knows? But I don't really have an answer to that. But I think it's just something to. [00:25:44] Speaker B: Be aware of that we all will. [00:25:48] Speaker A: Use and probably still use despite even our best efforts. We might still use some phrases and some terms and some things that are. [00:25:56] Speaker B: Potentially, at least mentally and emotionally harmful. [00:26:01] Speaker A: Toward people of certain marginalized groups. And we have to just try to be aware and to work against that and to be okay with feeling the guilt when we find out something, being okay with being corrected. [00:26:16] Speaker B: Right. [00:26:17] Speaker A: Not having that knee jerk response of I should be able to say whatever I want because I'm clearly not a bad person, right. Instead of that sort of defensiveness. So I just think that's something to be aware of with this power differential, this dissimilarity, because, yeah, we're the authority figure in the room, so if we accidentally insult somebody, they're unlikely to tell us, right? Some people might, but my guess is they would be more like the statistical outliers compared to most people. Most people smile and nod, right? Like when I was at the physician and they were like kind of baby talking me, I smiled and nodded even though I did not like what they were doing. I did not find it enjoyable. I did not ever want to go back to that person ever again. I think it was like an urgent care thing, the one I'm thinking of. [00:27:03] Speaker B: But anyway, there's been more than just. [00:27:05] Speaker A: That one time, but that was a particularly bad one. But yeah, it's unlikely that you'll speak up in that context because they come to us for a service, right? They don't come to us well, first off, they definitely don't come to us to be psychologically harmed, but they come. [00:27:18] Speaker B: To us to receive services right, that we provide. And for some people, needing to say. [00:27:25] Speaker A: Something about things you say that might be hurtful to them isn't worth the fight. [00:27:31] Speaker B: Right. [00:27:31] Speaker A: They have to kind of divvy out their energy toward that kind of fight, and it just might not be the place to do that kind of fight, right? So that's why it's more on us as the person in the position of. [00:27:42] Speaker B: Authority to do our best, to be. [00:27:45] Speaker A: As aware as we possibly can, and to be as sensitive and culturally humble as we possibly can when it comes. [00:27:50] Speaker B: Toward things like microaggressions. [00:27:55] Speaker A: So up next, let's go through the functional causes, or what Hook and Wyatt's call the functional causes of dehumanization. And then we'll do the Kalina Kristoff's 2014 paper as the counterpoints to that. And then we'll finish it up with the emotional labor section. [00:28:13] Speaker B: So let's get going on those what they call functional. [00:28:18] Speaker A: And we're going to really we're going to question that. [00:28:22] Speaker B: That's right. [00:28:24] Speaker A: Once again, they broke this down into three different types or to three different causes, I guess one is mechanization. So that is thinking of patients as mechanical systems made up of interacting parts for the purpose of diagnosis and treatment planning. [00:28:39] Speaker B: So essentially this is kind of diagnostic. [00:28:42] Speaker A: Thinking as we're trained as well, right? Kind of like whenever you do your Criterion list, you ever do your little checklist of like, they show this, they don't show that. I mean, that's similar to what physicians will do in terms of diagnoses and planning. And when you're breaking a human, an. [00:29:00] Speaker B: Individual down into those individual little components. [00:29:05] Speaker A: You'Re mechanizing them, right? You're kind of making them into an object of study, basically, in terms of mechanical dehumanization. In this article, they were saying to counteract that they suggest humanizing procedures and personification. [00:29:22] Speaker B: So, like making sure you review patients. [00:29:27] Speaker A: History and things like that, making sure you're reading through things in their chart to make them this is for physicians, of course, to have them seem more like a human rather than just the mechanical parts. Once again, I think we do have a little leg up in the sense that we sit and we talk and even our assessments are so communication based. [00:29:44] Speaker B: That when we do have to do. [00:29:46] Speaker A: That breakdown, it's still within the context of the communication we already had with that client or student or patient. So I do think that helps us sort of it's a little extra protectiveness. [00:29:57] Speaker B: Against that, even though we do have. [00:30:00] Speaker A: To break things down in order to do the assessments we need to do. But I think we're at less of a risk of only seeing those component parts and not seeing the individual because we're spending so much time, even in an assessment, interacting with them. [00:30:15] Speaker B: You know what I mean? [00:30:16] Speaker A: But I guess that's one thing to say. Make sure you are interacting, especially if you're doing assessments. Like make sure there's still that human component of communication either with the patient, the client, the student, or with their family. I know sometimes in schools you can. [00:30:31] Speaker B: Feel so rushed and feel like, we got to. [00:30:34] Speaker A: Get through this. We got to get through this. Let's drill, drill, drill. [00:30:36] Speaker B: Let's get going. And you really want to try to. [00:30:39] Speaker A: Get the kid to sit still. Sit still, right? And that can definitely affect you feeling like I actually got to know this kid a little bit in their assessment. So take a little breath and make sure you're not getting too mechanistic and. [00:30:53] Speaker B: That you're still looking at that whole. [00:30:55] Speaker A: Person, the whole individual in front of you, be it a child or not. The second functional cause they talk about is empathy reduction and it actually spills over into the third one, which is moral disengagement. So empathy reduction as they define it is based off of brain function studies that showed physicians, and I think also some nurses tend to have less activation in the brain areas that are correlated with empathy when they're watching things like sticking somebody with the needle, right. Or some kind of surgery type thing or something. So something that would cause a patient pain. They seem to be reducing their empathy for that. So there's some kind of dehumanization happening. [00:31:44] Speaker B: In the sense of for nurses and. [00:31:47] Speaker A: Physicians, there's probably less for us, we don't do as much discomfort things, things that cause pain other than, I don't know, maybe diet textures that are not the best. That's a little painful, I suppose, when. [00:31:59] Speaker B: You'Re staring at a plate of puree. [00:32:01] Speaker A: And especially if you're still on the thick and liquids life. Nobody likes those. But they say that's functional in the sense that people do that so that they can cause pain essentially, so they don't feel bad about causing the pain because the pain is in service of the treatment, essentially. Like if you have to be injected with the drug or something like that. Or they have to draw blood, right? [00:32:26] Speaker B: These things are painful when they prick. [00:32:28] Speaker A: You, but they're important. So Hook and Wyatts were talking about. [00:32:31] Speaker B: This as like they suggest teaching physicians. [00:32:34] Speaker A: To shift between objectivity and empathy. Like to make sure they turn back on their empathy, basically to make sure. [00:32:43] Speaker B: That you can shift between the two. [00:32:45] Speaker A: Really honestly making a conscious choice to switch. That's what they suggest. We have a little bit of a counterpoint on that as well, which we'll get to in a second because I want to just go ahead and finish. [00:32:56] Speaker B: Up the huck and Wyatt's here. So moral disengagement, that's the third functional cause. [00:33:01] Speaker A: And this is like I said, it relates to empathy reduction. But basically they are saying that physicians and also nurses have to suspend themselves from their role in committing harm in. [00:33:15] Speaker B: The sense of potentially painful treatments, right? [00:33:19] Speaker A: It could be medicine that tastes really bad. It could be they list proctology exams as an option, right? So it's essentially sort of disconnecting from your emotional states, the moral disengagement kind of disconnecting from any judgment of you. [00:33:37] Speaker B: Causing someone else harm or discomfort in. [00:33:40] Speaker A: Service of the treatment, and it relates to empathy reduction. [00:33:43] Speaker B: Right. [00:33:43] Speaker A: That's what they're saying. So they suggest things like decreasing the psychological distancing between patients and doctors. Make sure patients have their own personal clothes. Like in a hospital, of course. Put the patient's face. Put the face with the medical records, which I think a lot of hospitals are now doing. And it might have come from something more like this, really, where it's like this will keep the human in your mind if you see their face, rather than just looking at numbers and data sheets and reports. [00:34:14] Speaker B: Right. [00:34:14] Speaker A: But what I do think is interesting is Huck and White's do go on to talk about how you really do have to have an ability to cognitively. [00:34:23] Speaker B: Shift, like consciously shift between those states. [00:34:26] Speaker A: Because they cite all this. Literature that says that in order for there to be effective problem solving, you need to reduce your empathy. Which is something I haven't directly heard, but I feel like I indirectly understood. [00:34:41] Speaker B: It based off of professional expectations and. [00:34:45] Speaker A: Clinical expectations and analyses and thinking critically and problem solving and stuff that it's like you don't want to bring empathy or emotion into that decision making process. I think that that was a somewhat understood aspect. However, here are the counterpoints. So, Kalina Christos 2014 paper, she mentions. [00:35:06] Speaker B: How human thinking and problem solving actually. [00:35:08] Speaker A: Occur in two distinct domains. So they could happen in a physical domain, which is like visiospatial mechanical properties of some kind of object, right? Like you're doing a Rubik's Cube, essentially. That would be like a physical domain, problem solving, and then also the social domain. So if you're doing problem solving that involves social life of other people, other. [00:35:33] Speaker B: Humans, the social domain is different from. [00:35:37] Speaker A: That physical domain, and it involves thinking. [00:35:39] Speaker B: About the mental states of other people. [00:35:42] Speaker A: It involves that empathy. Right? [00:35:44] Speaker B: It involves considering that other person's life. [00:35:47] Speaker A: And all these other factors. It's very salutogenic. It's very trauma informed. Right. That idea of making sure you consider culture and their desires and quality of life and all of that stuff, that social domain problem solving. [00:36:01] Speaker B: And the research that they did on problem solving in the physical domain, some. [00:36:07] Speaker A: Of that research has shown that maybe. [00:36:11] Speaker B: Reducing empathy helps, basically. [00:36:14] Speaker A: So there might be some evidence it's not concrete, but there might be some evidence from brain scans and things that if you're doing problem solving in a physical domain and that mechanistic. I'm kind of thinking more like surgical kind of level. If it were thinking medicine, then, yeah, the empathy and the moral engagement, the emotional involvement, might interfere a little more with their problem solving in that domain. [00:36:38] Speaker B: But in the social domain, what they have found is empathy is not only. [00:36:45] Speaker A: Compatible with the problem solving, it's actually a crucial component. So when you're doing problem solving about a human so in that social domain problem solving, it requires empathy to actually really be effective, to effectively problem solve for that person to consider their quality of life, to consider all these things. You have to use empathetic responses and emotion and moral engagement and really thinking about that other person and thinking about. [00:37:14] Speaker B: Their place in their life and how. [00:37:16] Speaker A: They'Re treated and how others treat them and think of their needs and things like that. Right? Which is very salutogenic, very trauma informed. But it's so interesting to me that if you are doing problem solving in. [00:37:29] Speaker B: That kind of domain, you need to access empathy. It actually creates better problem solving, is what research has shown, which is pretty cool, right? Yeah. [00:37:45] Speaker A: So basically, if you're out there thinking about your clients or your students or your patients, and you're really trying to put yourself in their shoes as much as you can to problem solve and. [00:37:56] Speaker B: Think through what they might need, that. [00:37:59] Speaker A: Actually is probably a more effective way of clinically problem solving, at least for. [00:38:03] Speaker B: What we do for most of the time. And yes, we still have to do. [00:38:07] Speaker A: Some objectivity, we have to do some mechanistic dehumanization just because of our assessment tools and we got to check those boxes, we got to score, got to get the data, that sort of thing. Sure. [00:38:18] Speaker B: But we also need to consider the. [00:38:23] Speaker A: Whole person and the whole picture. And I think in our practice, in most of the areas of our scope of practice, social domain problem solving is. [00:38:32] Speaker B: What we're doing because we are so communication based, right? So it is actually crucial for us. [00:38:39] Speaker A: To be able to access our own empathy to some extent and to think through what this person might need, which in my mind is how we probably. [00:38:47] Speaker B: Arrive at, in trauma informed sense, what. [00:38:51] Speaker A: Promotes this person's safety and what can actually empower them. So they can advocate for safety for themselves and their needs, right. They can advocate to get their needs met. I just found that so interesting because I've always read about I've heard about the empathy reducing problem solving before, but. [00:39:08] Speaker B: I've never heard it broken down into. [00:39:11] Speaker A: These two domains and the fact that there's research for social domain requiring the empathy versus like spatial. And so Christophe, when she talks about inflicting pain on know, dehumanizing is a way to cope with that. [00:39:29] Speaker B: Inflicting pain. [00:39:31] Speaker A: She was arguing that physicians could actually focus on just the overall improvement. They just focus on the big picture. [00:39:38] Speaker B: Right. [00:39:39] Speaker A: Instead of dehumanizing, you can literally just focus on the big picture and think, this thing is necessary. It's like a means to an end, right? [00:39:45] Speaker B: This is necessary to help them heal or to help repair the damage from. [00:39:50] Speaker A: An injury or an illness. Right. You don't have to actually dehumanize or turn off empathy in order to do. [00:39:58] Speaker B: Those particular types of treatments, which I. [00:40:00] Speaker A: Think is very true. [00:40:01] Speaker B: Honestly, when I used to do skilled. [00:40:03] Speaker A: Nursing work and some hospital work, like. [00:40:06] Speaker B: Mentally working at skilled nursing, for example. [00:40:09] Speaker A: It can get kind of tough. [00:40:10] Speaker B: Like, you do lose patients, somebody's going to pass away. [00:40:15] Speaker A: It can be really hard. It can be hard to deal with some of that stuff. [00:40:18] Speaker B: And so I remember coming home and. [00:40:21] Speaker A: My spouse being like, how do you cope with that? [00:40:23] Speaker B: And I was like, Well, I tend. [00:40:25] Speaker A: To look at the big picture here, and I look at it as like, if that's me, if I'm in this bed at my end of life, if I'm looking at my future self, how. [00:40:33] Speaker B: Would I want to be treated? And I like being part of if. [00:40:38] Speaker A: I'm part of a really good treatment team that I really like. And I liked my rehab team on all those. The rehab teams were amazing for all the sniffs I worked at. But I like being part of the people who are really trying to make this end of life care as comfortable. [00:40:52] Speaker B: As it can be, right? To give them dignity near the end. [00:40:57] Speaker A: Of their life, to give them enjoyment. [00:40:59] Speaker B: Of foods they like, for example, with. [00:41:02] Speaker A: Giving lots of education on why and what the risks are. [00:41:05] Speaker B: But there's something really important about being. [00:41:09] Speaker A: Able to eat what you love, and. [00:41:10] Speaker B: There'S something important about being able to. [00:41:13] Speaker A: Communicate with loved ones before you pass. And I think it's a beautiful thing, really, to be part of that. [00:41:19] Speaker B: And I take that really empathetic look. [00:41:22] Speaker A: Of the big picture of, like, if. [00:41:23] Speaker B: This was me, what kind of dignity. [00:41:26] Speaker A: Would I like to have? What kind of respect would I like to be shown? [00:41:29] Speaker B: Right? [00:41:31] Speaker A: There was also another thing that came up when I was thinking of this. [00:41:33] Speaker B: Like, inflicting pain or discomfort when it. [00:41:36] Speaker A: Comes to dehumanizing or not looking at the overall picture. [00:41:39] Speaker B: So this is an example from at. [00:41:42] Speaker A: My high school where I worked for a couple of years. There was a student with really significant medical needs who was fed through a feeding tube. [00:41:51] Speaker B: And it was very clear, just based. [00:41:55] Speaker A: Off of non speaking communication, that this student really hated the feeling of that feeding tube. Like, when it came time to change it or put it in or take. [00:42:05] Speaker B: It out, he hated that, right? But he needs the feeding tube to survive, right? [00:42:12] Speaker A: So you're causing him some distress, you're causing him some discomfort. [00:42:16] Speaker B: But the big picture here is he. [00:42:18] Speaker A: Needs that to survive. And I felt that my big role as a communication person, as the communication. [00:42:24] Speaker B: Disorder specialist, was to try to make. [00:42:27] Speaker A: Sure he understood as much as he. [00:42:28] Speaker B: Could as to why he has to. [00:42:31] Speaker A: Go through this discomfort all the time. Because I don't think anyone had ever taken the time to explain that to him because he's non speaking. Quite frankly, people infantilize this particular student an awful lot. So I made sure to explain and to say how long it was, okay. [00:42:46] Speaker B: Give her ten more seconds to get. [00:42:49] Speaker A: That finished and count to ten and. [00:42:50] Speaker B: That sort of stuff, just to let. [00:42:52] Speaker A: Him know what's going on. [00:42:53] Speaker B: Because it's his body, he has a right to know. [00:42:56] Speaker A: But that's one of those things where. [00:42:58] Speaker B: It'S like there is a compliance need there because you need physical safety. You need basic physical needs for survival, like food. Right? So that's one way to look at. [00:43:12] Speaker A: It, is that big picture of, like, your body needs nutrition in order to survive. [00:43:16] Speaker B: So as uncomfortable it as it is. [00:43:18] Speaker A: This is the way we currently have with medical technology to give you nutrition. [00:43:23] Speaker B: You know what I mean? [00:43:23] Speaker A: Total side note, I guess, on Star Trek, technically, they could, like, beam food into someone's stomach. [00:43:28] Speaker B: Do you think that's a thing on Star Trek? [00:43:31] Speaker A: Yeah, I don't remember them ever having peg tombs or anything. So maybe like, maybe they could just beam their food into their stomach. [00:43:36] Speaker B: That'd be kind of dope. You could bypass all that discomfort. But that's science fiction, and that's just an ADHD brain aside. [00:43:50] Speaker A: The other thing that I thought was interesting and this brings us to this. [00:43:53] Speaker B: Emotional labor idea is one of the. [00:43:57] Speaker A: Arguments in favor of dehumanization in medicine. [00:43:59] Speaker B: Is that feeling all these feelings and. [00:44:03] Speaker A: Experiencing all the empathy can actually possibly lead to healthcare worker burnout. So there's a lot of thoughts on this, and there's a lot of older. [00:44:13] Speaker B: Literature that just kind of assumed that. [00:44:15] Speaker A: Basically that maybe it's the high emotional load at the job that creates this burnout. [00:44:20] Speaker B: So if we reduce this emotional load by essentially disengaging our emotional systems, then we might help ourselves with burnout. But actually, you guys, this is very. [00:44:35] Speaker A: Interesting to me, and it's honestly really in line with divided attention, how your cognitive resources reduce. If you have the radio playing while you're looking for a place and you're a little bit lost, you want to turn off the sound because you don't. [00:44:48] Speaker B: Want to divide your attention. You need all your attentional resources on. [00:44:52] Speaker A: Finding where you are. [00:44:54] Speaker B: So it's very interesting to me that. [00:44:58] Speaker A: In the Christophe paper, she mentions that. [00:45:01] Speaker B: There'S evidence for if you have to. [00:45:05] Speaker A: Suppress a naturally occurring empathetic response, if you're trying cognitively to suppress your emotions, it's actually a source of additional psychological stress. [00:45:16] Speaker B: Basically, it's an additional cognitive load, and. [00:45:20] Speaker A: It causes some level of stress, and it's actually been shown to have a really negative impact on mental health. Fascinating. So that reading about that is what kind of led me into this emotional labor concept. So let me go ahead and introduce that to you guys, and then we'll go into it in a little more detail in some later episodes, okay? When we're thinking about this relationship between burnout and empathy, right? Like the older adage is if you feel empathy, you're going to get too burnt out because you got too much emotional load, so you got to shut it down, right? You got to turn that stuff off. You got to compartmentalize and ignore your emotions, you know what I mean? And how many of us have been taught that it's a very socialized, normal thing to do in the United States, especially professionally, to just be expected not to have feelings or really display feelings. [00:46:09] Speaker B: It's white supremacy culture, you guys. [00:46:11] Speaker A: It comes from there. People in positions of power really want to feel comfortable. They don't want to deal with other people's challenging emotions. [00:46:17] Speaker B: Essentially. [00:46:18] Speaker A: What I found, though, this was pretty cool, I ended up finding a lit review where they looked at the relationship between burnout and empathy and healthcare professionals. And this was like Wilkinson et al. In 2017. And this lit review found that there is a negative association, a really strong negative association between burnout and empathy. Which means for people who scored really. [00:46:43] Speaker B: High on empathy type of questionnaires and measures, now they scored really low on burnout and vice versa. Now, these authors do caution people not. [00:46:54] Speaker A: To extract some sort of causation here, right? [00:46:57] Speaker B: Not to think of it as like. [00:46:59] Speaker A: High burnout is the cause of low empathy. I can see where people get that idea because psychologically that makes sense. If you're in high burnout and maybe getting into survival modes, you might not be able to access empathy as easily. [00:47:12] Speaker B: Due to the information not getting up. [00:47:14] Speaker A: To your frontal cortex, essentially your emotional states. But they are basically saying it doesn't mean it's causal. This is just finding a really strong negative correlation, basically between burnout and empathy. And I found that so fascinating. So that started getting me to think about what role that takes with professionalism, right? Because we know detachment is supposed to be a good thing, basically, right? And then it got me to the. [00:47:44] Speaker B: Concept of emotional labor, which you might. [00:47:46] Speaker A: Not know exactly what emotional labor is. I knew about this term. [00:47:50] Speaker B: I started Googling it in relation to. [00:47:52] Speaker A: This because I knew about it from articles that I feel like I saw. [00:47:58] Speaker B: Them around like kind of early to mid 20 teens. [00:48:01] Speaker A: They might have been written before that. That's when I started seeing them pop up in suggestions and feeds and stuff. [00:48:09] Speaker B: But per the Oxford Dictionary, when I. [00:48:12] Speaker A: Googled emotional labor definitions, the definition I was familiar with was this first one, which was mental activity required to manage or perform the routine tasks necessary for maintaining relationships and ensuring smooth running of household or process. [00:48:27] Speaker B: Typically regarded as an unappreciated or unacknowledged. [00:48:31] Speaker A: Burden borne disproportionately by CIS, hetero women, heterosexual women. [00:48:36] Speaker B: So that's the way I was introduced to this concept. [00:48:40] Speaker A: But it turns out academically emotional labor. [00:48:43] Speaker B: Actually began to be studied due to. [00:48:47] Speaker A: The second definition actually in the Oxford. [00:48:50] Speaker B: Dictionary, which is the management of one's. [00:48:53] Speaker A: Emotions in order to present oneself and interact with other people in a certain. [00:48:57] Speaker B: Way while doing a job. [00:48:59] Speaker A: So essentially customer service type stuff, right? They're looking to kind of customer facing positions and you have to kind of hide certain emotions in order to seem. [00:49:10] Speaker B: To align yourself with what your job wants you to be, right? [00:49:15] Speaker A: So I was a server at a restaurant for several years, and it's the. [00:49:19] Speaker B: Feeling of like you're just about to. [00:49:21] Speaker A: Close and you're just about to go home and it's like you're so close. And then a big party walks through the door like 1 minute before close, and you're just like, I just want to go home. But of course, outwardly you're like, oh yeah, no problem at all. Yeah, come on in and blah, blah, blah, right? And you just kind of suck it up and do it right? [00:49:41] Speaker B: That's emotional labor having to suppress your. [00:49:44] Speaker A: Real feelings and display a different feeling, that is some level of labor, right? [00:49:51] Speaker B: It takes cognitive effort to do that, right? [00:49:54] Speaker A: It's divided attention. It's working memory. All this stuff has to work a little harder time because you're having to. [00:50:00] Speaker B: Monitor yourself more while you do it, right? And so it's very possible that that. [00:50:06] Speaker A: Kind of emotional labor might actually lead. [00:50:08] Speaker B: To more exhaustion mentally, which might correlate. [00:50:13] Speaker A: More with Burnout, which we'll get into actually, I think I'm going to save for a different episode. But we'll get into Burnout. We'll get into what I kind of think is going on, perhaps even more. [00:50:23] Speaker B: So than what we call Burnout. [00:50:25] Speaker A: Those who went to Asha to my talks, you already know what I'm going to talk about. [00:50:29] Speaker B: You already have a leg up, but. [00:50:30] Speaker A: I'm going to put it on here. [00:50:32] Speaker B: Too, so you can share it with. [00:50:33] Speaker A: Your friends if they weren't at, right? [00:50:37] Speaker B: So oh, and a total side note here. [00:50:41] Speaker A: When I talk about emotional labor and when I talk about this customer service voice, this is not the same thing as masking. [00:50:47] Speaker B: Just to make this clear. When neurodivergence say we mask or we're. [00:50:53] Speaker A: Trying not to mask, like in my case, it's not quite the same as customer service. I really truly feel, based off of my own experiences with masking, that masking. [00:51:04] Speaker B: Is a form of fawning. [00:51:06] Speaker A: It comes from social rejection. It comes from feeling very unsafe around. [00:51:11] Speaker B: Other people socially due to some level. [00:51:15] Speaker A: Of either verbal bullying or microaggressions or constant corrections, some kind of rejection, something like that. [00:51:23] Speaker B: That's where a lot of the masking comes from. [00:51:25] Speaker A: It's not quite the same thing as. [00:51:27] Speaker B: Customer service voice, because look, people in. [00:51:31] Speaker A: Customer service understand that if you're there for eight plus hours trying to be super happy, friendly, you're going to let the facade drop a little at some point. It's not going to be as strong as it was. And as long as you make an attempt, they're usually fairly happy with you. You know what I mean? [00:51:46] Speaker B: Happy enough, right? [00:51:47] Speaker A: But masking is different because if you. [00:51:49] Speaker B: Fail at Masking, it's not going to be enough. [00:51:53] Speaker A: You're not going to be safe anymore. You're not going to have emotional safety or physical safety or psychological safety around people. [00:51:59] Speaker B: So that was a little side note. [00:52:01] Speaker A: I just want to make that really. [00:52:02] Speaker B: Clear because I think that's one of. [00:52:05] Speaker A: The biggest differences between customer service voice and masking is that the consequences are. [00:52:09] Speaker B: Much bigger if you fail to mask compared to occasional dips in customer Service Voice. [00:52:16] Speaker A: So let's go ahead and end this here just for the sake of time. We're going to get into this emotional. [00:52:21] Speaker B: Labor thing more on the next episode. [00:52:24] Speaker A: I think, and maybe we'll get into. [00:52:26] Speaker B: Some definitions of burnout and traumatic stress. [00:52:31] Speaker A: Because this is some important stuff to talk about. I'm just so excited that I ended up dovetailing where I wanted to go. That's kind of nice. It just kind of like showed up there. [00:52:40] Speaker B: So nice. [00:52:44] Speaker A: Main key takeaways from today is that we might have these internalized ideas that we need to reduce empathy and not access certain challenging emotions when we're at work or when we're in our professional life or we're clinically problem solving, but in actuality for the type of work. [00:53:01] Speaker B: We do, we're always problem solving in that social domain. [00:53:05] Speaker A: So having access to empathy is actually a good thing. It's actually a good thing to have access to your own empathy, to try. [00:53:14] Speaker B: To kind of think from that other. [00:53:15] Speaker A: Person'S perspective and try to plan in terms of quality of life and wants and needs and all of that stuff, like taking that all into consideration, which. [00:53:25] Speaker B: Is very much the salutogenic trauma informed approach. [00:53:28] Speaker A: You're looking at a whole person and. [00:53:30] Speaker B: Their holistic well being, right? [00:53:33] Speaker A: We're trying to get the big picture, keep the big picture in mind. It's very much that same thing but this actually is evidence that it's positive to do that. [00:53:42] Speaker B: Yay. So don't be afraid. [00:53:45] Speaker A: Don't be afraid to tap into your empathy. Don't be afraid to really try to put yourself a little bit in their. [00:53:50] Speaker B: Shoes and think what would I really. [00:53:53] Speaker A: Really need in this situation? And also there's additional research for being aware of these systemic challenges that marginalized. [00:54:03] Speaker B: Groups face and really trying to make. [00:54:06] Speaker A: Sure you're not inadvertently, perhaps accidentally or. [00:54:10] Speaker B: Just unawareedly saying or doing something that. [00:54:14] Speaker A: Might be off putting to someone of. [00:54:16] Speaker B: A different group than yours, right? And that could include economic status as. [00:54:22] Speaker A: Well as BIPOC as well as queer LGBTQIA communities. I feel like I need to throw a P in there for polyamory because polyamory is a thing that exists, y'all? But yeah, and also neurodivergence, you know what I mean? So when you're dealing with these sort. [00:54:37] Speaker B: Of groups that are always encountering some. [00:54:40] Speaker A: Level of discrimination, oppression, marginalization, really taking an active, ongoing, continued practice to deprogram. [00:54:52] Speaker B: Things, which means sitting with the discomfort and sitting with any shame or guilt that happens to kick up when you. [00:55:01] Speaker A: Become aware that you were possibly doing or saying something that was perceived as harmful. [00:55:06] Speaker B: I have been there. [00:55:07] Speaker A: I'm sure going to be there in the future. I'm sure I'll be corrected on something and I'll be like, oh my gosh, right? [00:55:14] Speaker B: But we have to know how to deal with that so we don't feed. [00:55:19] Speaker A: Into that cycle where our discomfort is something we want to hide or not feel. So we push it away and we psychologically defend ourselves. And then we just kind of double. [00:55:29] Speaker B: Down on doing and saying things that. [00:55:33] Speaker A: Are potentially harmful to someone else just. [00:55:34] Speaker B: Because our intention isn't to harm, right? [00:55:37] Speaker A: The intention not to harm is great. [00:55:40] Speaker B: But if it doesn't stop you from harming, it's not very useful, right? [00:55:45] Speaker A: So you got to take that intention. [00:55:46] Speaker B: Not to harm and maybe hear about. [00:55:49] Speaker A: Something where you might have accidentally harmed someone by saying something or whatever, and. [00:55:54] Speaker B: Then sit with that a little bit, right? [00:55:57] Speaker A: Process those emotions, feel it and then. [00:56:01] Speaker B: Deprogram it, you know what I mean? Which I think we'll also talk about. [00:56:04] Speaker A: In a future episode as well because I think that's a really important thing to do. I actually might that more make little. [00:56:10] Speaker B: I actually might that make I might. [00:56:12] Speaker A: That make that's what I said. That's what I meant to say. I actually might make it more of like a discussion with some of my friends because I know this is something that I've discussed with other friends of mine, too, with other SLP colleagues and such. So that might be a nice thing for a future episode. [00:56:28] Speaker B: But anyway, that's the big takeaway. Feel your feelings, basically, feel your feelings, feel your empathy. [00:56:36] Speaker A: Try to take perspective of people so that you can take a more salutogenic holistic approach. And there is evidence for that because. [00:56:42] Speaker B: There isn't actually a whole lot of. [00:56:45] Speaker A: Use of dehumanization, at least in our area of medicine, in the way we're trained and what we do and what's in our scope of practice. There's not a whole lot of purpose. [00:56:54] Speaker B: In it outside of making sure we. [00:56:58] Speaker A: Get our diagnostics checked off for insurance and assessments for qualifying on IEPs and. [00:57:06] Speaker B: Things like that, right? [00:57:08] Speaker A: And maybe getting objective data and stuff. There's not a whole lot of purpose outside of that. But then also making sure that stuff. [00:57:15] Speaker B: Isn'T the big picture for you, right? The data that you take on your. [00:57:20] Speaker A: Goals is not the big picture. It's the status of that person and. [00:57:23] Speaker B: Their holistic well being. That's actually your big picture. And what is your role in helping. [00:57:29] Speaker A: Improve their well being, if you can, hopefully. Right? [00:57:33] Speaker B: So with all of that said, I. [00:57:35] Speaker A: Hope you guys all have a really great week or two. Take care of yourselves, and I hope you all join me again as we all discover what it means to be trauma, informed, SLPs.