Bodily contrast experiences in cultivating character for care

Abstract

Since 2008, in Flanders, we organize immersion sessions in a simulated context with the aim of stimulating student nurses and health professionals to learn virtuous caring. In this contribution, we first outline the purpose of this experiential learning: the cultivation of moral character. We come to the core of what we mean by moral character for care. We refer to Joan Tronto and Stan van Hooft to claim that caring is central to all aspects of nursing practice and is the basis of its moral quality. We also stipulate that caring involves the integration of action with emotions, motivations, and knowledge. Second, we briefly explain how the immersion sessions in the care ethics lab take place and, in particular, reflect on what it yields in terms of experiences for the participants who take on the role of simulant patients in this experiential learning process. We focus on the significant role contrast experiences play in these experiences. Especially the negative contrast experiences do not wear off easily; care professionals remember even long after the immersion session and continue to carry them with them as a “corporeal built-in alarm.” Third, we discuss the role of contrast experiences in cultivating moral character for care. In particular, we explore the role of the body in the kind of knowing it cultivates and, by extension, its role in cultivating virtuous caring. By referring to specific philosophical ideas of Gabriël Marcel, Hans Jonas and Emmanuel Levinas, we try to understand how contrast experiences bring about an integration of virtuous action into knowledge, motivation, and emotion. We conclude that we need more space for contrast experiences in cultivating moral character. More attention should be paid to the role of the body in this learning process.

Introduction

In his posthumously published autobiography “When Breath Becomes Air,” Paul Kalanithi describes his experiences as a beginning physician but also those as a cancer patient. In a passage, he recounts a painful clash with a colleague who unilaterally decides to refuse him, as a patient, specific pain medication. He feels belittled and humiliated. From a respected physician, he has suddenly become a disempowered and powerless patient. At that moment, he remembers a patient who had told him that she wore her most expensive socks to the doctor’s office, so that when she was in a patient’s gown and shoeless, the doctor would see the socks and know she was a person of substance, to be treated with respect. He ironically concludes: “Ah, there’s the problem – I was wearing hospital-issue socks, which I had been stealing for years!” (p. 187). ¹

This passage is revealing and it teaches us something about how healthcare professionals grow in care ethics and how they cultivate their moral character. The experience of Kalanithi can be seen as a negative contrast experience. The patient’s words did stick with Kalanithi, but they remained abstract. Through this painfully humiliating bodily experience, they suddenly gain performative power. They activate an insight that will probably make this doctor relate differently to his patients. Just because he wants to spare his patients this experience of which he himself has found out: this is not good!

In this contribution, we first outline how care ethics frames the cultivation of moral character. We come to the core of what we mean by moral character for care. Second, we briefly explain how the immersion sessions in a care ethics lab take place and, in particular, reflect on what it yields in terms of experiences for the participants who take on the role of simulant patients in this experiential learning process. We focus on the significant role contrast experiences play in these experiences. Third, we discuss the role of contrast experiences in cultivating moral character for care. In particular, we explore the role of the body in the kind of knowing it cultivates and, by extension, its role in cultivating virtuous caring.

Background

The theologian Edward Schillebeeckx defines contrast experiences as negative experiences that one undergoes or witnesses that make the person who is befallen by them shout out “this cannot be allowed to continue!” (p. 6). ² It is a “basic experience” of our life in this world and “the veto to life as it is” (p. 81). ³ Typical for contrasting experiences is that people, as a result of what they see or experience, notice an extreme contrast “in the body” between the unacceptable nature of what has befallen them and what would be acceptable under the circumstances. This means that people undergoing a negative experience not only detect a lack of what should be there, but, consequently, also feel what would be right in that situation. This is not a cognitive knowing of good or bad, but a “bodily experienced knowing,” gained at an affective level, as we will further explain. Contrast experiences in itself are a starting point for ethics as the ethical reflection is provoked by the actual threat and attack on the humanum: it is an ethical challenge and an ethical imperative. ² So, precisely in the bodily experience of human misfortune and unhappiness here and now, one’s eyes are opened anew to the extent of human suffering that exist (and the choices you have to make to do things differently). ³

Since 2008, in Flanders (Belgium), we organize immersion sessions in a simulated context with the aim of stimulating student nurses and health professionals to learn care ethics through experience-based learning. In these sessions, student nurses and/or (experienced) healthcare professionals are immersed in the simulated world of the (geriatric) care receiver and they are challenged to reflect on this experience to what this means for caring (as virtue). Taking on the role of a patient and undergoing many things that patients in reality undergo, generated haunting experiences in the participants. This is, among other things, manifest in the way they talk about what happened: as something very real that they lived through. Explorative research to the experience of healthcare professionals who participate to immersion sessions as simulated-patient show that contrast experiences do play an important role. ⁴ Participants who claim “to know things differently now”—and “to do things differently now”—are making this claim on the basis of contrast experiences they have had during the immersion session.

Character for care: The perspective from care ethics

For us, care ethics provides the basic framework for the ethical education of healthcare professionals and of nursing students. Joan Tronto, in her foundational work Moral Boundaries, argues that caring is a practice, a complex combination of certain actions, and a habit of mind, rather than a set of rules and principles. ⁵ Caring as a practice involves: “caring about,” noticing the need of care of the other in the first place; “taking care of,” assuming responsibility for care; “care-giving” the actual work of care that needs to be done; and “care-receiving,” the response of that which (or the one that) is cared for to the care. At each of these phases of caring, Tronto argues a moral quality is required. “Caring about” requires attentiveness as recognizing the needs of those around us. “Taking care of” requires responsibility as recognizing a need for caring. “Care-giving” requires competence as performing the caring work in an adequate way. “Care-receiving” requires responsiveness as being concerned with conditions of vulnerability and inequality. In Tronto’s view, caring is all about the integration of these four elements or moral qualities into a whole. She emphasizes that care, as a practice, involves more than simply good intentions, emotions, or motivations. ⁵ It involves also knowledge and making judgments. These moral qualities arise out of caring itself.

Precisely because of this integration of action with emotions, motivations, and knowledge, Stan van Hooft speaks of caring as a virtue. In his view, caring is central to all aspects of nursing practice and is the basis of its moral quality. ⁶ Asking for example a patient to describe a nurse as caring, this patient will praise that nurse in a way that refers to what he or she characteristically does and to the way that it is done, and also in a way that attributes admirable traits of character or typical motivations to that nurse. ⁶ In this sense, the nurse must care about the right things and in the right way. “This is precisely what Aristotle takes to be definitive of virtue,” van Hooft states (p. 190). ⁶

Knowledge

Certainly, caring as a virtue involves having the right scientifical knowledge and know-how as a nurse or healthcare professional. Van Hooft also points to knowledge of common ethical codes and moral standards specific to the profession. Yet it is about more than that. Van Hooft refers to knowledge that comes from a sensitive awareness of what is important in clinical and health-related situations and of the values that are morally salient in such situations. “I suggest that virtuous health care workers are those who have a more or less articulate grasp of the value and significance of life, of health, of what it is to be a person who is suffering malady or mental distress, of pain and suffering,” van Hooft writes (p. 10). ⁷ This entails knowledge about the human condition and about what pain and suffering are. “Such knowledge will ground the feeling of caring and of responsibility that health workers feel towards their patients and will motivate their helping actions,” van Hooft says (p. 196). ⁶

Tronto also stresses the importance of knowledge in terms of awareness of what the human condition entails. For her, this means above all: understanding what vulnerability means. Seeing only independence and autonomy as the nature of human life leaves out much of the human experience. ⁵ This is why it is so important to remain alert to the possibilities of abuse that come with vulnerability. With responsiveness as a moral quality of caring, Tronto suggests that it is necessary that we consider other’s position as that other expresses it. It presupposes a change of perspective: we have to take the other person’s perspective. “One is engaged from the standpoint of the other, but not simply by presuming that the other is exactly like the self,” Tronto states (p. 136). ⁵ Persons are not interchangeable. Developing a capacity for responsiveness entails knowledge of the other as other. It makes responsiveness an important moral quality in caring.

Motivations

This kind of knowledge is not theoretical knowledge, it is knowledge that “shapes attitudes and structures motivation” (p. 10). ⁷ The “caring knowledge,” as van Hooft calls it, is in itself motivating as it leads the person to apply it. Once you know what is really at a stake for a person, because you are aware of it, also in the sense that you feel it, you will be moved to act. In the same sense, Tronto sees the moral quality of responsibility. Responsibility is the result of recognizing a need for caring: there is no other way that the need will be met except by our meeting it. ⁵

Van Hooft uses the notion of commitment as the basis for the motivation of caring in the health care professions. The motivation of caring is clearly other-directed: a caring healthcare professional is committed to the well-being of the other and to his needs. Caring involves “a sense of concern for the needs of others” (p. 198). ⁶

Emotions

Such commitment involves emotions in the sense that it starts from a concern for the other person: as a healthcare professional, you want the other person to do well. You are emotionally involved in the well-being of the other. That is, you are feeling well when that patient is doing well and you feel bad when that other person is not doing well at all. Or you become angry when colleagues or the system of the organization compromise the caring outcomes for the patient. For van Hooft, virtuous healthcare professionals “do not need to be too gushing in their emotional responses,” but at least there is sufficient emotional involvement, whereby the patient experiences that these professionals are “not merely doing their job” (p. 199). ⁶ Caring thus involves affective engagement and emotional sensitivity. ⁸

But the virtue of caring is clearly not just emotional or motivational, nor it is only a form of thinking and knowing. It is an orientation towards others that leads to action that these others will describe as good or right. It is a moral character trait that is necessary for right action and correct thinking. ⁹

Contrast experiences of simulant patients during immersion sessions

Acquiring the virtue of caring, like any virtuous learning, is not a matter of acquiring theoretical knowledge alone, it is also—and more important—about learning in and through experience and reflecting on experience. ¹⁰ Moreover, caring as virtue is never fully or definitively acquired. Healthcare professionals—like Kalanithi, with whom we have started this contribution—who themselves become ill or temporarily dependent on care, can also learn from that experience. By literally standing in the shoes of the care receiver, a care professional gains experience that allows to practice or exercise Tronto’s moral quality of responsiveness. This refers to knowledge of the fragility of human existence and to the awareness of how it can be to be sick, lonely, care dependent, physically limited, suffering of dementia… ¹¹ This knowledge also stems from changing of perspective, namely, not looking from me (as health care professional) to you (as patient or care receiver) but from you to me.

Mainly because nursing students often do not have this kind of experience and because the ordinary internship does not provide enough reflective space—and sufficient incentives—to come to that changing of perspective, we have started in 2008 with the organization of immersion sessions in a simulated context that we have called “a care ethics lab.”

The immersion sessions in the care ethics lab

During immersion sessions, a small group of student nurses and/or experienced healthcare professionals are immersed in a simulated care environment as patients during at least 1 day: they are washed in a high/low bathtub, they are put on the toilet with a hoist after a call has been made for this purpose, they receive assistance with meals, they eat adapted meals (e.g., thickened food given in case of swallowing problems), they wear incontinence pads and they may just already try to do their needs in it, they sleep in a hospital bed with raised bed rails, and if they are a patient with dementia with problematic wandering behavior, they experience other restraints… As best they could, during the time of the immersion session, they adopt the perspective of a concrete patient they met in their care practice and try to identify with the patient’s world as best they can. They adopt the perspective of a resident with dementia, that of a Korsakov patient, that of a silent patient with mobility problems, that of a resident with swallowing problems, that of a palliative patient who is anxious, that of a resident who is still mobile but in deep mourning after the death of the spouse… These “profiles” adopted by these simulant patients are discussed, elaborated, and fine-tuned well in advance with the other group of student nurses or healthcare professionals who act as simulant caregivers during the immersion session. ¹²

It is also well discussed beforehand what tools can help them do this. For instance, a so-called old age simulator can be used, a suit that makes you walk and stand like an older person with joint problems. Or the room is decorated, for example, with pictures and objects, so that it is helpful to identify with that patient’s world. All kinds of wheelchairs and hoists can be used for those simulant-patients who simulate mobility problems. Or earplugs are provided to help simulate hard of hearing easily. Also present in the care ethics lab are all kinds of glasses that simulate all kinds of vision problems. Sometimes, a session is offered beforehand with a VR-program, in which the simulant-patient experiences, by using Virtual Reality, what it is like to have dementia, so that the simulant can better empathize during the session itself.

Every immersion session ends with a reflection moment that takes at least 2 hours. Simulant-patients and simulant-nurses reflect together on their experiences. This reflection starts with ventilating their emotions. This is a must, as the experience has been intense and for many participants often completely different from what they imagined beforehand. Precisely by going deeper into these emotions, further attempts are made to understand the experience of exposure. In doing so, the guiding question is this: what did I learn about caring and about caring relationships? This reflection is essential to explore personal experiences—“I liked that” or “I found that repugnant”—for what they have to say (e.g. about vulnerability, about relational caring, about responsibility…). ¹³ The dialogue between the different simulant patients who often have very different experiences is also fruitful for this reflection. As is the exchange of experiences with the team of simulant-nurses. For the latter, the open feedback they experience is unique: in concrete care practices, care patients are most often vulnerable and in a powerless position to (be able to) give that feedback openly. ¹⁴

Experiencing contrast experiences

In the explorative study already mentioned, the experiences were mapped of healthcare professionals who participated as simulant-patients in an immersion session of a day and a half (with the night included). ⁴ The qualitative study used interviews with participants about their experience. More details, including the ethical aspects, are reported elsewhere. ⁴ Research ethics approval was granted for this previous explorative study and is applicable to discussion of findings in this work.

The explorative study revealed the crucial role of contrast experiences in the learning process. In the role of patient, it becomes almost inescapable how corporeal experiences impose themselves. Some participants testify how “agreeable” some experiences were (e.g., having a warm relaxation bath and enjoying personal attention). But most participants talk about how long it takes when you don’t know what is going to happen, how tired you get from sitting in a wheelchair, how painful it can be—you become stiff and rigid, how distasteful food is when it is put not in your mouth and you don’t taste what you are eating because the food is all mixed, how humiliating it can be when others move you or do something to you that they didn’t consult with you or warn you about, how humiliating it feels to lose your autonomy and especially your privacy…

Hygienic care is experienced by many as invasive, and suffering cold during washing in particular was named by some participants in the explorative study as a profound experience. Experiences associated with daily nursing tasks such as bathing, going to the toilet, and drinking left a great impression. When bathed, one simulated patient recounted that the caregiver’s small talk did not go beyond the standard chat: “I felt let down as a person,” this woman testifies, “as though I wasn’t a person but an object to be washed” (p. 74). ⁴

Almost all participants thought much about how desolate you can feel as a patient if the caregiver does not pay attention to you. A number of participants also mention the gnawing insecurity you slowly feel growing inside yourself due to dependency. “Should I call or not?” This was, for example, a dilemma of a simulant-patient who was thirsty in the middle of the night, but could not reach her glass of water and was waiting for the caregiver who had said he would come by shortly but wasn’t “soon” back. Or someone recounting how she hung in a hoist for 20 min because she was forgotten.

Others tell of experiencing dependency that made them feel small, but not able to indicate this at the time. One participant was overwhelmed when she was put to bed without consultation while watching news at television. Various participants mentioned that it was painful to be unable to go to the toilet by yourself when you feel the need.

For just about every participant, the immersion session brings corporeal contrast experiences. They describe feelings of shame, humiliation, and fear that accompany the very physical experiences that are inescapable during the immersion event. These often intense emotions qualify the perceived contrast between the unacceptability of what happens to them and what would be acceptable under those circumstances. Being hurt by what does not feel right and is not good forces reflection. One participant is asking himself “do we treat our people like this as well? It should be different!” “It is all done with the best of intentions, but it is a confronting experience. It has to change!” so this person says (p. 75). ⁴

All participants who were interviewed a second time 3 to 6 months after the immersion session remember their experiences very vividly. Especially the negative contrast experiences do not wear off easily, care professionals remember even long after the immersion session and continue to carry them with them as a corporeal “built-in alarm.” Even among healthcare professionals who have experienced the immersion session as “I already knew all this”or who invoke numerous reasons that prevent them from doing something with their experience in practice indicate how their experiences make them more likely to “put on the brakes” in situations where they sense that “it’s not right here”.

Contrast experiences and moral character

What exactly do contrast experiences contribute to cultivating the moral character of healthcare professionals? How do these experiences bring about caring as an integration of virtuous action into knowledge, motivation, and emotion? By going back to what makes caring a virtue, namely, the integration of action into emotions, motivations, and knowledge, and by looking philosophically and ethically to what contrast experiences bring about in terms of emotions, motivations, and knowledge, we seek to better understand the impact of experiential learning on the acquisition of caring as a virtue.

Knowledge

Many participants in the 2-day immersion session say they left differently than they arrived. Just as Kalanithi’s experience brings something he did know to a knowing differently, so too do the contrast experiences for most participants bring about a knowing differently, namely, a experiential knowing—or using a term from the French philosopher Gabriël Marcel: “participative knowing”: a knowing not from outside but from inside.

For a proper understanding, the distinction made by the same philosopher between “problem” and “mystery” is helpful. ¹⁵ A “problem” is something that we “put in front of us,” something that we keep outside of ourselves and investigate with all kinds of scientifical methods and measuring instruments, with the intention of not only better understanding it in its composition and function, but also to be able to work with it, literally to be able to manipulate it. We ourselves are not taken into account: we are not part of the problem. We keep ourselves out of it, even if it concerns us. In dealing with a problem, we become to ourselves an object, a matter to analyze and study. This way of knowing is useful and efficient. Yet it creates distance, a distance that can prevent involvement. The question is whether it is even possible to talk about good and evil without mentioning the way in which humans are involved. When we are overwhelmed by an experience, things are completely different. At that moment we experience reality as “mystery.” As “mystery,” there is no distinction between outside and inside, because we—as bodily living subjects—are part of the so-called problem, with our lived experience of the problem. This involvement of the person in his entire existence also leads to a very specific form of knowledge, namely knowledge-through-participation.

In the same vein, we can see bodily contrast experiences as knowledge-through-participation. They participate by their physical experiences of vulnerability—even of hurt or injury—into the vulnerability of their patients. What might before have been a problem they could approach remotely and deal with rationally now becomes “mystery.” This “mystery” is not source of inaccessibility, darkness, and unknowability, but it is a “knowledge of the heart.” Knowledge and emotion are intertwined intimately. We can think of Blaise Pascal’s idea that we know the truth not only by the reason, but by the heart.

This knowledge-through-participation is only possible, thanks to our bodies. Corresponding to the distinction between “problem” and “mystery,” Marcel ¹⁵ also makes the distinction between “corps-objet” (as having a body) and “corps-subject” (as being a body). It is precisely through our bodies that we are subjects. Our body is the possibility condition of our personhood. Of course, we can approach our body as an object that we place before us as a problem. At the same time, our body is a way in which we are and experience or perceive ourselves. In a clinical approach, healthcare professionals can look at people’s suffering from the outside. As (simulant-) patients, however, they experience a failing body themselves as their own failing self. Precisely this latter experience installs a different relationship to the world and to the other, and so to themselves.

Motivations

The immersion sessions in the care ethics lab give impetus to knowledge-through-participation, a knowing grounded in first-hand experiences of (participating in) vulnerability. Participants know differently than before because they have felt it into their own bodies. Reflection plays an important role in bringing about this knowing differently. ¹³ Reflecting on experiences of one’s own vulnerability leads to an awareness of vulnerability in general, a vulnerability that all humans share, and an understanding of how important it is to take protection for it: something to avoid or a practice to just perpetuate. Reflecting on contrast experiences—as corporeal experiences of where caring fell short, no matter how well intentioned it was—leads to people actually being motivated to never do this to their patients themselves. Now that they know how miserable it feels, they indicate what they want to change in their practice to spare patients that experience. They feel a responsibility, even a duty from within to do something about the other person’s misery.

It is the Jewish German-American philosopher Hans Jonas ¹⁶ who already made extensive reference to the importance of this kind of negative experiences in awakening people to responsibility. According to Jonas, persons only know what is at stake when they know it is at stake. In what he calls “a heuristic of fear,” he indicates that feeling precedes knowledge of how to act. This feeling is an experience of contrast, specifically the experience that something is not right. We simply do not know what the right thing is—the right thing is an abstraction and subject to many opinions. Much more concrete, immediate, compelling, inescapable is the experience of what is not good. “It is doubtful whether anybody would ever have praised health without at least the sight of sickness, praised sincerity without the experience of trickery, praised peace without knowing of war’s misery,” Jonas says (p. 126).

Moreover, negative experiences—or contrast experiences in our terminology—are not only source of knowledge, they are the ultimate motivation: they make the person who is befallen by them shout out that this “has to stop,” because it cannot and must not go on like this. ¹⁷ In a sense, then, this motivation is also negative, not only because it is prompted by a negative feeling (from which there is an immediacy), but also because it motivates one not to do something, to stop action, and to withdraw oneself. Thus, again in all immediacy, it points to a boundary that must be respected. Jonas makes clear that this certainly does not say everything about ethics, but in any case, ethical reflection starts here.

Emotions

The contrast experiences in the lab make it tangibly clear to participants that, as caregivers, they are in the position where they can do violence to care receivers in their vulnerability. By being exposed (literally) naked themselves to the scrutinizing and unashamed gaze of others, they experience first-hand the power position of healthcare professionals and their “vulnerance” (as the possibility to do violence to the vulnerable patient). ¹⁸ Some even experience that this violence takes many forms: indifference, being approached paternalistically, and being waved away (“I hear you, but…”). The contrast experiences make them realize that this vulnerability (as temptation to direct or subtle violence) is a risk in every relation of care (because of the disengaged “problem” approach that is in the clinical observation as Marcel makes clear). It makes them realize that true caring for the other is not self-evident, does not bubble up from romantic sentiment. They experience at first hand that caring begins as restraint: holding back in the movement approaching the other.

We also find in Emmanuel Levinas' philosophy how withdrawal, not doing something, hesitation, “shuddering”, already involves a first form of responsibility. ¹⁹ He calls this withdrawal “the beginning of goodness” as it allows persons to be close to others even in their utmost vulnerability, to assist and carry them, and to strengthen them in their dignity and responsibility. ²⁰ That “goodness” (as proximity) must be brought to caring in a second movement and it takes reflection and practical wisdom to arrive at that caring. ¹⁹ But the lived experiences of vulnerability, even being hurt (which is what the contrast experience concretely is), help in that basic and first movement of retreat.

For Levinas, it is precisely the confrontation with the extreme vulnerability of the other that touches and appeals. ²¹ Responsibility originates in the felt discomfort with which the other—for Levinas specifically, the face of the other—confronts me. The fact that a number of participants in the immersion session in the care ethics lab experienced discomfort more quickly precisely from their contrast experiences—we spoke earlier of a kind of built-in alarm that went off faster due to the experience in the lab and was more sharply tuned, as it were—does say something. This possibly indicates that contrast experiences in particular act on sensibility, as a passive possibility, or as a condition (preceding every possibility or potentiality that we possess) of being appealed to by the vulnerability or injury or trauma of others. With Levinas, we can call this sensibility passive, a passivity as human condition or createdness preceding receptivity, because it precedes any intention to want to be appealed, or the desire, present or not, to take responsibility, or the ability, present or not, to do so. There is no caring possible without this passive sensibility or touchability-and-affectability-by-and-for-the-other. So to safeguard this sensibility as a source of caring, contrast experiences may well play an important role.

In this touchability as a condition for caring, the body is fundamental. Ethical engagement with the other finds its first, existential starting point in our bodies, which, because of their vulnerability, are sensitive to what another human being has to endure. So the body is not only a condition for standing in and acting from ourselves (as Marcel says), our bodies also connect us to other selves. Through our bodies, we are exposed to the other. This is the visceral dynamic of contrast experiences: they make us partakers of the other’s vulnerability. Contrast experiences reveal sensibility as a human condition and, at the same time, they make us more aware of this sensibility (and of the responsibility it brings with it).

Conclusion

In this contribution, we approached caring as virtue, the integration of action with knowledge, motivation, and emotion. In particular, we outlined the possibilities of experiential learning in education to encourage this virtuous caring. We explored the immersion session in the care ethics lab as a form of experiential learning and the prominent role contrast experiences play here. By looking at those contrast experiences from the perspective of specific elements from the philosophy of Marcel, Jonas, and Levinas, we tried to understand how this form of experience impacts on virtuous caring.

The conclusion of this contribution is not necessarily that we need more of this kind of experiential learning in healthcare education. Although, deliberate and supervised immersion in the other person’s environment is definitely fruitful. Rather, the conclusion should be that more attention should be paid in concrete care practices to contrast experiences. The Covid pandemic has provided healthcare professionals with numerous and painful contrast experiences. But even apart from this crisis, healthcare practices bring about numerous contrast experiences. Being able to give space to these experiences is crucial. By giving space, we mean: opportunities to ventilate about contrast experiences, to express them in words, and then to reflect on them. A context that provides space for this helps ensure that healthcare professionals do not have to look for escape routes to get rid of the discomfort or to stop feeling its pain. This space is also essential to remain sensitive. It further yields that precisely those negative experiences lead to caring.

Last but not least, another conclusion of this contribution is this: discomfort is a message from the body. It wants to tell that something is wrong, that something needs to be done. It is therefore a signal. “It is an alarm clock, a signpost, a wound that under plaster and the gentle healer only gets worse,” the Dutch philosopher Laura van Dolron aptly says. ²² Trying to brush away this discomfort deprives healthcare professionals of the opportunity to grow in a caring and careful practice.