Patients lack words to talk about their sexual organs. This is also a reason for shame before the interview
You deal with embarrassing topics of women.
I think it is better to talk about shame in general, not excluding women or men from this experience. Shame is a human experience, although probably due to socio-cultural factors, it is experienced more often by women. There are many topics that are difficult for us to talk about, regardless of gender. Sometimes we are ashamed of something that concerns us and therefore it is difficult for us to talk about it. Sometimes it is troublesome for us to talk about something that may be embarrassing for our interlocutor. Shame is more often experienced by women, due to, for instance, the way girls and boys are brought up. “You don't do that. It is not fitting. You should be ashamed” – such sentences were probably heard more than once in their childhood by a large proportion of adult women. The contexts of these reprimands vary. Sometimes it is about revealing the body, sometimes about talking aloud about matters related to human physiology, other times about specific behaviour that, in the opinion of others, is "not appropriate".
Does health care affect our shame? Contacts with doctors, nurses, midwives...
Health professionals are part of our society and are raised and grown up in the same culture as everyone else. At the same time, they have medical knowledge that enables them to help patients. It is worthwhile during their studies to have the opportunity to develop skills that, firstly, will allow them to identify areas of their own shame and recognize shame in patients, and secondly, to talk about topics that are commonly considered taboo or shameful. If the healthcare professional is not properly prepared in this regard, then when they feel shame, they may start to behave nervously or even aggressively towards the patient or, on the contrary, adopt a submissive attitude. It may also happen that they will talk about embarrassing topics with irony or mocking. Education should also include developing the ability to perceive shame in the patient and building an atmosphere in which the patient will feel safe enough to talk about even the most embarrassing topics.
Another point worth paying attention to is language. Patients often lack words to speak in a neutral way, e.g. about the genitals. The most common phrases to talk about the genitals are those that are vulgar or very infantile. This is also the reason for the resistance to talking. On the other hand, medical personnel use specialized terms, often incomprehensible to the average person. It is worth developing a vocabulary that is non-specialist, understandable to a person without medical education, and at the same time not vulgar or infantile.
Do the medics see our shame?
Yes… if they are open, sensitive, listening to what the patients say (verbally and non-verbally). It is certainly important to alert medical staff that very different issues can be taboo. Also, the non-obvious ones, the ones that we commonly associate as embarrassing. Therefore, it is extremely important to shape attitudes that will allow doctors to be open to patients and their perspective.
What do we need to be able to break the shame? What or who do we need to see on the other side?
An attitude of acceptance and non-judgment. It is also worth for the medical staff to have skills that will encourage the patient to talk, e.g. by referring to the patient's behaviour, which often signals that it is difficult for them to talk about something. This can be seen in gestures, lowered eyesight, clasped hands, hesitation. It would be worthwhile for the doctor, midwife or nurse to notice this non-verbal message, ask and encourage the patient to speak. This can be done, for example, like this: "I see that you wanted to say something" or "I have the impression that there is something else worth talking about, I wish I could help you as best as possible." In summary, appropriate posture and communication skills allow you to notice and help overcome the patient's resistance or shame.
Can shame translate into our health?
Yes. For example, when we come to the doctor too late. We delay signing up for advice, we decide to do it when the symptoms make us feel severe discomfort and hinder our daily functioning. This affects the effectiveness of the treatment. Then you may find that fewer treatments are available or that the treatments that can be used are less effective or already have serious side effects. This is the case, for example, with urinary incontinence. Women put off visiting a doctor for years because they are ashamed to talk about it.
Words are the limit of our cognition. Without words, we are like in a fog.
You can look at it that way. If we are not talking about something, it is a bit as if it does not exist. We often do not even talk to our loved ones about embarrassing topics. Therefore, we do not know that the problems we struggle with are often also experienced by others, that a friend has similar ailments, and that a friend has the same symptoms. Thus, we do not have a point of reference by which to know that we are not alone with the experience. This winds up a spiral of shame.
This is the case, for example, in the event of a miscarriage. About 40,000 women miscarry in Poland every year. It often turns out that a woman who has lost a child feels very lonely with this experience. She doesn't talk to anyone about it. And when a breakthrough occurs and someone talks about the loss, it turns out that among the women I know there are many who have miscarried. It is easier then to understand, but also to feel belonging.
Silence makes us lonely. It is then difficult to receive support, help or advice in overcoming difficulties.
You often hear that your period hurts or even has to hurt. As a result, we diagnose endometriosis too late.
This phrase is such a myth, like some common beliefs that were passed down from generation to generation. Such sentences depreciate and downplay the feelings of the person experiencing them. They suggest that if it hurts, there is nothing you can do about it and you should be brave and endure the pain. When someone says "it must hurt," it is referring to the symptoms as if they were not paying attention to the fact that the person is hurting, that the pain is affecting their life. Above all, talking about pain is the beginning of finding its cause and taking someone's suffering seriously. This is where diagnosis, treatment and recovery and normal functioning begin. Today's medicine offers a number of options for relieving pain, and above all, it has diagnostic methods that allow you to treat the causes of pain. I think that, culturally, we are also much more open to talking about the fact that it hurts, how pain limits our functioning, how it affects our well-being or relationships. And just as we are lonely silently, if we talk about something (of course to the right people who want to help us or are just kind to us) we make the problem common, we share it with someone.
There are no universal truths? What about hot flashes during menopause?
Medics often say that each patient is different, that everyone should be treated individually. Following this lead, let's ask what the pain is, when it occurs, whether something soothes it or, on the contrary, increases it, let's try to measure it. This is necessary both to make an appropriate diagnosis and treatment planning, but also to show interest in the patient's symptoms, not the symptoms themselves.
The important thing is to treat the patient, not the symptoms. Questions that allow you to get to know the patient's perspective are also a hint for the patients themselves, what they should pay attention to, they encourage them to observe their body and the signals it gives us.
How to deal with shame to help yourself?
At the beginning, we can ask ourselves where this shame comes from in us. What are we ashamed of? Why is this happening? Sometimes it's worth talking to someone about it. This can be a partner, friend, or specialist who can help us identify the causes of our shame and advise on how to deal with it. If we go to the doctor, nurse or midwife and we know that the conversation will concern issues that are embarrassing to us, let's get ready for this conversation.
Let us consider how we will ask a question about a difficult topic, how we will talk about embarrassing ailments. In our imagination, we can turn to a specialist with whom we are to meet. And let's say these words out loud. Then we will hear how it sounds, we will have time to choose the right words. We will say these sentences for the second time in a real office. It will be a little easier.
Ewa Kaleta talks to dr. Antonina Doroszewska from the Medical University of Warsaw
Interview published on wysokieobcasy.pl on 12 December 2020.
