Journal of Occupational Rehabilitation

, Volume 13, Issue 3, pp 183–195 | Cite as

Shame-Inducing Encounters. Negative Emotional Aspects of Sickness-Absentees' Interactions with Rehabilitation Professionals

  • Tommy Svensson
  • Agneta Karlsson
  • Kristina Alexanderson
  • Cecilia Nordqvist


There is little knowledge on how sickness absentees experience encounters with rehabilitation professionals. This paper explores and describes negative emotions (“shame” in a broad sense) experienced by individuals on sick leave in their interactions with rehabilitation professionals. We performed a qualitative analysis of data from five focus-group interviews. The participants had experience of sickness absence with back diagnoses and discussed factors that facilitate or impede return to work. Reports of demeaning experiences in encounters with rehabilitation workers were frequent and could be divided into two major categories: 1) subjects perceived the behavior of rehabilitation professionals as distanced in a negative way, and felt that they were treated in an indifferent and nonchalant manner or fairly routinely; 2) subjects felt that they were disqualified, which included being discredited or belittled. This explorative study indicates the need for further, more directed investigations of emotional aspects of interactions between sickness absentees and rehabilitation professionals.

Sickness absence lay perspective encounter rehabilitation shame focus-group interviews 


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  1. 1.
    Marmot M, Feeney A, Shipley M, North F, Syme S. Sickness absence as a measure of health status and functioning: from the UK Whitehall II study. J Epidemiol Commun Health 1995;49:124-130.Google Scholar
  2. 2.
    Bloch FS, Prins R, eds. Who returns to work and why? A six-country study on work incapacity and reintegration. London: Transaction Publishers, 2001.Google Scholar
  3. 3.
    Alexanderson K. Measuring health. Indicators for working women. In: Kilbom å, Messing K, Bildt Thorbjörnsson C, eds. Women's health at work. Stockholm: National Institute for Working Life, 1998, pp. 121-161.Google Scholar
  4. 4.
    Alexanderson K. Sickness absence; a review of performed studies with focus on levels of exposures and theories utilized. Scand J Soc Med 1998; 26(4): 241-249.Google Scholar
  5. 5.
    Popay J, Williams G. Public health research and lay knowledge. Soc Sci Med 1996; 42(5): 759-768.Google Scholar
  6. 6.
    Mishler E, Norwood N. The discourse of medicine: Dialectics of medical interviews. Norwood, NJ: Ablex, 1984.Google Scholar
  7. 7.
    Fisher S. Institutional authority and structure of discourse. Discourse Processes 1984;7:201-224.Google Scholar
  8. 8.
    Agar M. Institutional discourse. Text 1985;5:147-168.Google Scholar
  9. 9.
    Silverman D. Communication and medical practice. Social relations in the clinic. London: Sage, 1987.Google Scholar
  10. 10.
    Waitzkin H, Britt T. A critical theory of medical discourse: How patients and health professionals deal with social problems. Int J Health Serv 1989; 19(4): 577-597.Google Scholar
  11. 11.
    Östlund G, Alexanderson K, Cedersund E, Hensing G. “It was really nice to have someone”: Lay people with musculoskeletal disorders request supportive relationships in rehabilitation. Scand J Public Health 2001; 29(4): 285-291.Google Scholar
  12. 12.
    Lewis H. Shame and guilt in neurosis. New York: International University Press, 1971.Google Scholar
  13. 13.
    Hochschild A. Emotion work, feeling rules and social structure. Am J Soc 1979;85:551-575.Google Scholar
  14. 14.
    Hochschild AR. The managed heart. Berkeley: University of California Press, 1983.Google Scholar
  15. 15.
    Heiss J. The social psychology of interaction. Englewood Cliffs, NJ: Prentice-Hall, 1981.Google Scholar
  16. 16.
    Scheff T. Microsociology. Discourse, emotion and social structure. Chicago: University of Chicago Press, 1990.Google Scholar
  17. 17.
    Shott S. Emotion and social life: A symbolic interactionist analyzis. Am J Soc 1979; 84(6): 1317-1334.Google Scholar
  18. 18.
    Scheff T. Emotions, the human bond and social reality. Cambridge, UK: Cambridge University Press, 1997.Google Scholar
  19. 19.
    Nathansson D. Shame and pride. Affect, sex and the birth of the self. New York: W.W. Norton, 1994.Google Scholar
  20. 20.
    Taylor G. Pride, shame and guilt: Emotions of self-assessment. Oxford: Clarendon Press, 1985.Google Scholar
  21. 21.
    Davitz J. The language of emotion. New York: Academy Press, 1969.Google Scholar
  22. 22.
    Nathansson D. The shame/pride axis. In: Lewis H, ed. The role of shame in symptom formation. Hillsdale, NJ: Erlbaum, 1987.Google Scholar
  23. 23.
    Goffman E. Interaction ritual. New York: Anchor Books, 1967.Google Scholar
  24. 24.
    Scheff T. Shame and conformity: The deference-emotion system. Am Sociol Rev 1988;53:395-406.Google Scholar
  25. 25.
    Borg K, Hensing G, Alexanderson K. Predicitive factors for disability pension. An 11-year follow-up of young persons on sick leave due to neck, shoulder, or back diagnoses. Scand J Public Health 2001; 29(2): 104-112.Google Scholar
  26. 26.
    Östlund G, Alexanderson K, Cedersund E, Hensing G. Developing a typology of the “duty to work” as experienced by lay persons with muscelosceletal disorders. Int J Soc Welfare 2002;11:150-158.Google Scholar
  27. 27.
    Kjellman G, Alexanderson A, Hensing G, Öberg B. The course of neck, shoulder, or low back pain. A retrospective 12 year follow up. Physiother Res Int 2001; 6: 61-73.Google Scholar
  28. 28.
    Ringsberg K, Alexanderson K, Hensing G. The health line–-A method for collecting data on self-rated health over time–-Pilot study. Scand J Public Health 2000; 29(3): 233-239.Google Scholar
  29. 29.
    Alexanderson K, Hensing G, Borg K. Sickness absence with low-back, shoulder, or neck diagnoses-a 12 year follow-up regarding sickness absence and disability pension. Manuscript Submitted for publication.Google Scholar
  30. 30.
    Nordqvist C, Holmqvist C, Alexanderson K. Views of laypersons on the role employers play in return to work when sick-listed. J Occup Rehabil 2002; 13(1): 11-20.Google Scholar
  31. 31.
    Krueger R. Focus groups. A practical guide for applied research. London: Sage, 1994.Google Scholar
  32. 32.
    Nordqvist C, Holmqvist C, Cedersund E, Alexanderson K. Att komma igen [To return to work]. Socialmedicinsk tidskrift 1999;76(4):347-356. (in Swedish).Google Scholar
  33. 33.
    Patton M. Qualitative evaluation and research methods. Newbury Park, CA: Sage, 2002.Google Scholar
  34. 34.
    Scheff T. The shame-rage spiral: A case study of an interminable quarell. In: Lewis H, ed. The role of shame in symptom formation. Hillsdale, NJ: Erlbaum, 1987.Google Scholar
  35. 35.
    Stevens P. Focus groups: Collecting aggregate-level data to understand community health phenomena. Public Health Nurs 1996; 13(3): 170-176.Google Scholar
  36. 36.
    Kitzinger J. Introducing focus groups. B M J 1995;311:299-302.Google Scholar
  37. 37.
    Wilkinson S. Focus groups in health research exploring the meanings of health and illness. J Health Psychol 1998; 3(3): 329-348.Google Scholar
  38. 38.
    Morgan D. The focus group guidebook. London: Sage, 1998.Google Scholar
  39. 39.
    Wilhelmsson S. Psychosocial working conditions among general practitioners and district nurses. Linköping, Sweden: Linköping University, 2001.Google Scholar
  40. 40.
    Kemper T. A social interaction theory of emotions. New York: Wiley, 1978.Google Scholar
  41. 41.
    Lincoln Y, Guba E. Naturalistic inquiry. Newbury Park, CA: Sage, 1985.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Tommy Svensson
    • 1
  • Agneta Karlsson
    • 1
  • Kristina Alexanderson
    • 1
    • 2
  • Cecilia Nordqvist
    • 1
  1. 1.Division of Social Medicine and Public Health Science, Department of Health and EnvironmentFaculty of Health SciencesLinköpingSweden
  2. 2.Personal Injury Prevention, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden

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