Experiences of Emotion Management in Medical Care (Case Study: Toronto)

Document Type : Research Paper


Assistant Professor, Department of Social Sciences, University of Isfahan, Isfahan, Iran


 This study lies at the intersection of the sociology of emotions and medical sociology, investigating emotion management among a rather unknown category of medical personnel –Hospital Chaplains. Sociologists of emotions seek to understand how emotions can be socially influenced in terms of both experience and expression. They believe emotions can be influenced by such institutions as culture and religion.  As a result, not only do societies and subcultures have different patterns of expressing emotions according to their own norms and characteristics, but there are also different ways of managing emotions in social institutions. For example, in North American healthcare system, hospital chaplaincy is institutionalized, like other members of the medical team, to provide spiritual and religious care, which is often accompanied with emotional support, requiring therefore emotion management. In order to explore emotional experiences that chaplains undergo as a result of working in hospital and dealing with people who are emotionally overwhelmed, the author utilized insights from interactional and symbolic interactionist, phenomenological, and ethnomethodological approaches within the sociology of emotions and spoke with different chaplains from five faith traditions. The aim was to understand how chaplains perform interpersonal emotion management, what techniques, strategies and skills are involved in dealing with people’s emotions, and how performing emotion management in healthcare institutions brings religion and spirituality at the forefront of a secular society.

Material and Methods
This is a qualitative study based on in-depth interviewing with hospital chaplains working in different hospitals in the Toronto area. Toronto has a large number of hospitals and medical/healthcare institutions, most of which have a spiritual care department in which a number of full-time and part-time chaplains work to provide pastoral and spiritual care for patients, their relatives, and other medical personnel. Approximately 50 chaplains work in different Toronto hospitals, of whom 21 individuals were selected using purposeful sampling: a non-random method of sampling in which the researcher selects “information-rich” cases for in-depth interview. The author tried to collect data as records of action-in-process from a variety of people. Because the in-depth responses obtained by qualitative studies cannot be easily categorized, analysis must rely less on counting and correlating and more on interpretation, summary and integration. Therefore, more than anything else, the findings of this study are supported by quotations and case descriptions. The method of data analysis is qualitative description, with a phenomenological inclination: that is, the goal is to describe emotion management experiences as they are lived and felt by chaplains.
Discussion of Results & Conclusions
Chaplains who participated in this study are between the ages of 33 and 65. The average age is approximately 52. Also, 11 chaplains work part-time and 10 chaplains work full-time. 18 of the 21 chaplains in the sample are women. Recruiting more than 3 male chaplains was not possible due to the fact that hospital chaplaincy is a job predominantly occupied by women. In terms of ethnicity, the majority of the respondents are white, with European and Anglo-Saxon backgrounds. However, the sample also includes two Asian chaplains (with Chinese and Indian backgrounds) and one from the Caribbean Islands. Moreover, the sample includes chaplains from five different religions and faith traditions. The majority of the chaplains are Christian, including five chaplains belonging to the Anglican Church, three to the Roman Catholic Church, two to the United Church of Canada, and one to the Baptist Church. The remaining four Christian chaplains did not specify their Church. Several of the chaplains are church ministers. Also, two chaplains from Buddhism, one from Islam, and one from Judaism are interviewed. Finally, a pagan chaplain, who is a believer in the modern paganism movement and is apparently one of only two such chaplains in Canada, is interviewed.
Modern chaplaincy is not about performing religious ritual as much as it is about providing emotional support. The chaplains’ role is to be a compassionate care provider who listens patiently and tries to identify the matrix of emotions in which people are caught. As such, chaplains are supposed to be emotionally present, available and attend to people’s spiritual needs. Like sponges, chaplains soak up people’s emotions, name them and process them so that a healthy release of stress and tension can occur. Therefore, creating effective communication is vital in the work of hospital chaplains. By displaying role distance to their title as “chaplain” and defining themselves as “spiritual care providers,” some chaplains manage to provide a safe social space in which clients feel free to open up and talk. But more importantly, chaplains are equipped with interactional competence, that is, the ability to initiate interaction and direct conversation in ways that patients become motivated to cooperate and talk about their problems. By making a kind of interpersonal emotional bridge, chaplains try to cultivate contextual spirituality. Clues that people give are essential to help chaplains obtain an indexical and contextual understanding of the situation. In other words, the type of spirituality chaplains seek to promote is very much dependent on the context and situation of their clients. As soon as a safe social space is provided, where people feel comfortable to open up and talk, working on contextual spirituality starts, and chaplains begin to explore whatever spiritual, religious or other inner force that is available to patients and can give them power and strength to cope with the situation or come to terms with it. The most important component of this mechanism is identifying and releasing emotions, a process that includes multiple techniques of self, as well as interpersonal, emotion management.


Main Subjects


[1] برای معرفی اجمالی جامعه‌شناسی احساسات نک: ربانی خوراسگانی، علی و کیانپور، مسعود. (1388). «جامعه‌شناسی احساسات»، جامعه‌شناسی کاربردی، سال بیستم، شماره پیاپی(34)، ش 2، صص 35-64.

[2] تا جایی که نویسنده اطلاع دارد، اخیراً در برخی از مراکز درمانی شهرهای بزرگ کشور تلاش‌هایی برای نهادینه کردن جایگاه روحانیت و حضور آنها در بیمارستان صورت گرفته است. از قرار معلوم، این طرح نخستین بار در بیمارستان‌های اصفهان و در قالب دفاتر «نسیم مهر» عملیاتی شد.   

[3] ناهمخوانی احساسی با انحراف احساسی تفاوت دارد، در این معنا که اولی به اجرای استراتژی‌های مدیریت احساسات می‌انجامد تا احساس نمود یافته با قواعد احساسی موقعیت هماهنگ شود، اما دومی وقتی رخ می‌دهد که فرد داوطلبانه درگیر مدیریت احساسات نمی‌شود و احساساتی را تجربه می‌کند و نمایش می‌دهد که با قواعد احساسی موقعیت تطابق ندارند. همچنین، نوع دیگری از انحراف احساسی وقتی رخ می‌دهد که فرد مدیریت احساسات را با شکست انجام دهد. قصور در اجرای موفق مدیریت احساسات، انحراف احساسی شغلی نام دارد (کپ، 1998).

[4] اخیراً در بیمارستان سید الشهدای اصفهان که مختص پذیرش بیماران سرطانی است، درمانگاهی برای ارائه مراقبت‌های تسکینی فعال شده، اما در سطح جامعه و نظام پزشکی کشور، هنوز طب تسکینی و چگونگی ارائه مراقبت‌های انتهای زندگی[1] به خوبی معرفی نشده‌اند.

[5] به طور میانگین بخش مراقبت‌های معنوی در هر یک از بیمارستان‌های مورد مطالعه بین 2 تا 5 نفر روحانی شاغل داشت که برخی از آنها پاره وقت کار می‌کردند. محقق در مجموع به 18 بیمارستان مراجعه نمود.

[1] end-of-life care

Bolton, S. (2000) “Who Cares? Offering Emotion Work as a ‘Gift’ in the Nursing Labour Process.” Journal of Advanced Nursing, 32: 580-6.
Bolton, S.C., Boyd, C. (2003) “Trolley Dolly or Skilled Emotion Manager? Moving on from Hochschild’s Managed Heart.” Work, Employment and Society, 17(2): 289-308.
Cadge, W. (2009) “Religion, Spirituality, and Health: An Institutional Approach. In Clarke, P., B. (Ed.) (2009) The Oxford Handbook of the Sociology of Religion, Oxford: Oxford University Press: 836-856.
Cadge, W., et al. (2008) “Hospital Chaplaincy in the United States: A National Overview.” Southern Medical Journal, 101(6):626-630.
Cicourel, A. (1973) Cognitive Sociology: Language and Meaning in Social Interaction. Penguin Books Ltd. Middlesex: UK.
Collins, R. (1981), “On the Micro Foundations of Macrosociology.” American Journal of Sociology, 86 (5): 984-1014.
Copp, M. (1998), “When Emotion Work is Doomed to Fail: Ideological and Structural Constraints on Emotion Management.” Symbolic Interaction, 21 (3): 299-328.
DeCoster, V. A. (1997) “Physician Treatment of Patient Emotions: An Application of the Sociology of Emotion.” In Erickson R. J., andCuthbertson-Johnson, B. (Eds.) Social Perspectives on Emotion (Vol. 4), NY: JAI Press. 151–78.
Denzin, N. (1984) On Understanding Emotion, San Francisco: Jossey-Bass.
Denzin, N. (1985) “Emotion as Lived Experience,” Symbolic Interaction, 8 (2): 223–240.
 Denzin, N. and Lincoln Y. (Eds.) (2000) The Handbook of Qualitative Research. Second Edition. Newbury Park, CA, Sage.
 Dey, I. (1993) Qualitative Data Analysis: A User Friendly Guide for Social Scientists. NY: Routledge.
 DiLalla, L. F., et al. (2004) “Empathy, Acceptance of Spirituality, and Wellness in Medicine: A Cross-Sectional Study.” Teaching and Learning in Medicine, 16: 165–70.
 Douglas, J. D., (1985) Creative Interviewing, Beverly Hills, CA: Sage.
 Eder, D. and Parker, S. (1987) “The Cultural Production and Reproduction of Gender: The Effect of Extracurricular Activities on Peer Group Culture.” Sociology of Education, 60(3): 200-213.
 Erickson R. J. and Grove J. C. (2008) “Emotional Labor and Health Care.” Sociology Compass 2 (2): 704-733.
 Francis E., L. (2006) “Emotions and Health.” In Turner, J. and Stets, J. (Eds.) (2006) Handbook of the Sociology of Emotions. NY: Springer. 591-610.
 Francis, L, Kathleen M, and Berger, C., (1999). “A Laughing Matter? The Uses of Humor in Medical Interactions.” Motivation and Emotion, 23: 155-174.
 Glaser, B. and Strauss, A. (1967) The Discovery of Grounded Theory. Chicago: Aldine.
Goffman, E. (1959) The Presentation of Self in Everyday Life. NY: DoubledayAnchor.
 Goffman, E. (1961) Encounters: Two Studies in the Sociology of Interaction. Indianapolis: Bobbs-Merrill.
 Gordon, S., L. (1981) “The Sociology of Sentiments and Emotions.” In Rosenberg M. and Turner R., H (1981) (Eds.) Social Psychology: Sociological Perspectives. New York. Basic Books. 261-278.
 Halpern, J. (2001) From Detached Concern to Empathy: Humanizing Medical Practice. Oxford, NY: Oxford University Press
 Hochschild, A. (1979) “Emotion Work, Feeling Rules and Social Structure.” American Journal of Sociology, 85 (3): 551-75.
 Hochschild, A. (1983) The Managed Heart: Commercialization of Human Feelings. Berkeley: University of California Press.
 Homans, C, G. (1961) Social Behavior: Its Elementary Forms. NY: Harcourt, Brace and World.
 James, V. and Gabe, J. (2003) Health and the Sociology of Emotions, Oxford: Blackwell.
 Kenney, J. S. (2010) Canadian Victims of Crime: Critical Insights. Toronto. Canadian Scholars’ Press.
 Lincoln, Y. S. and Guba, E. G. (1985) Naturalistic Inquiry, Beverly Hills, CA: Sage Publications.
 Lively, K. J. (2006) “Emotions in the Workplace.” In Turner, J. and Stets, J. (Eds.) (2006) Handbook of the Sociology of Emotions. NY: Springer. 569-590.
Lively, K. J. (2000) “Reciprocal Emotion Management: Working together to Maintain Stratification in Private Law Firms.” Work and Occupations, 21: 32–63.
 Lofland, J. and Lofland, L. (1995) Analysing Social Settings: A Guide to Qualitative Observation and Analysis. Belmont, CA: Wadsworth.
 Maxwell, J. A. (1996) Qualitative Research Design: An Interactive Approach. Applied Social Research Methods Series, Vol. 41. Thousand Oaks, CA: Sage.
 Mears A., and Finlay, W. (2005) “Not Just a Paper Doll: How Models Manage Bodily Capital and Why They Perform Emotional Labor.” Journal of Contemporary Ethnography, 34(3): 317-343.
 Miles, M. B. and Huberman, M. A. (1994) Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks: Sage.
 Patton, M. (2001) Qualitative Research & Evaluation Methods. Thousand Oaks, CA: Sage.
 Peterson, G. (2006) “Cultural Theory and Emotions.” In Turner, J. and Stets, J. (Eds.) (2006) Handbook of the Sociology of Emotions. NY: Springer.114-134.
 Rafaeli, A. and. Sutton, R. (1987) “Expression of Emotion as Part of the Work Role.” Academy of Management Review, 12: 23–37.
 Rubin, H J. and RubinI., S. (2005) Qualitative Interviewing: The Art of Hearing Data. Thousand Oaks, CA: Sage.
 Sandelowski, M. (2000) “Focus on Research Methods: Whatever Happened toQualitative Description?” Research in Nursing & Health, 23:334-340.
 Schweingruber D., and Berns N. (2005) “Shaping the Selves of Young Salespeople through Emotion Management.” Journal of Contemporary Ethnography, 34 (6): 679-706.
 Seery, B. L. (1997) Four Types of Mothering Emotion Work: Distress Management, Ego Work, Relationship Management, and Pleasure/Enjoyment Work. Dissertation Abstracts International, The Humanities and Social Sciences, 57(8): 3699.
 Snyder, E. E. and Aamons (1993) “Baseball’s Emotion Work: Getting Psyched to Play.” Qualitative Sociology, 16(2): 111-132.
 Stokes, A. (1985) Ministry After Freud, NY: The Pilgrim Press.
 Strauss, A. and Corbin, J. (1990) Basics of Qualitative Research: Grounded Theory Procedures and Techniques, Newbury Park, CA: Sage.
 Thoits, A. P. (1990) “Emotional Deviance: Research Agendas,” In Kemper, T (Ed.) (1990) Research Agenda in the Sociology of Emotions. Albany, NY: SUNY Press. 180-206.
 Thoits, A. P. (1996) “Managing the Emotions of Others.” Symbolic Interaction. 19 (2): 85–109.
 Turner, J and Stets, J. (2006) Handbook of the Sociology of Emotions, NY: Springer.
 Weiss, R. S., (1994) Learning from Strangers: The Art and Method of Qualitative Interview Studies. NY: The Free Press.
 Wharton, A., S. (2009) “The Sociology of Emotional Labor.” Annual Review of Sociology, 35: 147-65.
 Wright, M. C. (2000) “Chaplaincy in Hospice and Hospital: Findings from a Survey in England and Wales.” Palliative Medicine, 15: 229-242.