Passing through end-of-life suffering: Possible or not? Results from a qualitative inquiry.

The objective of this study was to understand the factors associated with "passing through suffering" in terminal illness. We interviewed 19 adults diagnosed with terminal disease in palliative stage. Interviews were analyzed using thematic analysis. Four axes of understanding were generated. In the first, participants discussed the will to "feel alive" despite the disease. The second, the process of acceptance, is based on lucidity and on letting go. The third highlights the importance of relationships with others. The fourth axis describes the consequences of this passage through suffering. This study highlights a phenomenon of adapting to suffering.

Embodying or resisting social normativity? A carnal inquiry into exercise addiction experiences.

Exercise addiction has sparked a growing interest in the scientific and clinical literature, yet this behavioral addiction has mainly been investigated quantitatively, from a positivistic perspective. This article explores the subjective and embodied dimensions of exercise addiction, broadening current conceptions of this emerging, still unofficial mental health category. Building on carnal sociology, and through a thematic analysis of mobile interviews conducted with 17 self-proclaimed "exercise addicts" from Canada, this article examines the interrelations between the embodiment of exercise addiction and the normative social elements at stake in the shaping of the category, providing insights on how exercise is experienced as an addiction. Results show that most participants describe this addiction as "soft" and "positive", highlighting the virtues of exercising. However, their bodily accounts also reveal a suffering body, bringing forth the vices related to excessive exercising. Participants also put in relation the quantifiable and the sensible body, revealing the porous boundaries of this construct: exercise addiction can sometimes be regulatory in certain contexts and counternormative in others. Thus, it appears that "exercise addicts" enact various contemporary normative requirements, which vary from asceticism and body-ideals but also to the phenomenon of social and temporal acceleration. We argue that exercise addiction questions how certain behaviors, deemed potentially problematic, illustrate the tensions and complex articulations between embodying and resisting social normativity.

Non-somatic Suffering in Palliative Care: A Qualitative Study on Patients' Perspectives.

Objectives: Suffering is intimately linked to the experience of illness, and its relief is a mandate of medicine. Advances in knowledge around terminal illness have enabled better management of the somatic dimension. Nevertheless, there is what can be called "non-somatic" suffering which in some cases may take precedence. Inspired by Paul Ricoeur's thinking on human suffering, our aim in this qualitative study was to better understand the experience of non-somatic suffering. Methods: Semi-structured interviews were conducted with 19 patients. The results were qualitatively analyzed following a continuous comparative analysis approach inspired by grounded theory. Results: Three key themes synthesize the phenomenon: "the being enduring the suffering", "the being whose agency is constrained", and "the being in relationship with others." The first describes what patients endure, the shock and fears associated with their own finitude, and the limits of what can be tolerated. The second refers to the experience of being restricted and of mourning the loss of their capacity to act. The last describes a residual suffering related to their interactions with others, that of loneliness and of abandoning their loved ones, two dimensions that persist even when they have accepted their own death. Conclusions: Non-somatic suffering can be multifarious, even when minimized by the patient. When evaluating suffering, we must keep in mind that patients can reach a "breaking point" that signals the state of unbearable suffering. In managing it, we probably need to make more room for family and friends, as well as a posture of caring based more on presence and listening.

Is there a role for clowns in paediatric intensive care units?

Hospital clowning is a programme in healthcare facilities involving visits from specially trained actors. In the paediatric intensive care unit (PICU), clowning may appear inappropriate and less intuitive. The patient could appear too ill and/or sedated, the environment too crowded or chaotic and the parents too stressed. Relying on our experience with professionally trained clowns both in France and Canada, the purpose of this article is to offer a model for hospital clowning and to suggest standards of practice for the implementation of clowning in PICUs. In this work, we provide a framework for the implementation of clown care in the PICU, to overcome the challenges related to the complex technical environment, the patient's critical illness and the high parental stress levels. Regardless of the specifics of the PICU, our experience suggests that professional clown activity is feasible, safe and can offer multiple benefits to the child, his/her parents and to hospital personnel. Due to the specific challenges in the PICU, clowns must be educated and prepared to work in this highly specialised environment. We stress that prior to clowning in a PICU, professional performers must be highly trained, experienced, abide by a code of ethics and be fully accepted by the treating healthcare team.