Is Active Listening a Cure-All? The Difficulty of Empathy in a Psychiatric Ward
Hello. I am Midori Maruoka, a medical writer.
In a previous article, I introduced an episode where I would arrive at work more than an hour and a half early for night shifts to mentally warm up. (If you are interested, please take a look here👇)
However, no matter how much time I spent, there were times when I could not be fully prepared, depending on who I was working the night shift with.
During my time working on the ward, there was a colleague (let's call her Ms. A) who repeatedly criticized a specific nurse with unusual intensity. I had to psych myself up more than usual before going to work to avoid getting caught up in that aggression.
Can active listening backfire?
As a psychiatric nurse, I made it a rule to listen to Ms. A by first accepting her feelings.
While empathizing, I never agreed with her, chose objective words, and tried to listen as calmly as possible... but deep down, I felt uneasy.
Listening to patients is my job. But why do I have to be so careful with Ms. A, who is a nurse, and provide her with something like counseling?
And what was strange was that the targets of her attacks were always nurses who were evaluated by those around them as being "good at their jobs."
Lying in bed in the nap room, I vaguely formed the following hypotheses.
1. Is she trying to elevate herself by belittling others?
2. Is she getting a dopamine rush from bad-mouthing others?
The true nature of "aggression" revealed by research
My hypothesis at the time seems not to have been entirely wrong.
First, regarding the relationship between self-esteem and aggression. One study reports that people with lower self-esteem tend to show greater reactive aggression based on anger and hostility (Amad et al., 2020).
This is just my own imagination, but I speculated that Ms. A might have been harboring intense frustration that she was "not being properly evaluated." Perhaps a mechanism was at work where she tried to maintain herself in a distorted way by attacking ace-level nurses?
Next, why does the criticism escalate? According to one study, it has been shown that engaging in aggressive behavior toward others activates areas of the brain known as the reward system. It is reported that the aggression itself becomes pleasurable for the brain, driving further aggressive behavior (Chester et al., 2018).
It was also mentioned that there is a possibility that the behavior is unconsciously reinforced and habitualized, becoming established as a pattern.
A prescription for "not listening too much"
Continuing to listen carefully for the sake of the other person also carries risks. I feel from my own experience that it may further stimulate the reward system in the brain and accelerate the cycle of aggression.
Active listening skills cultivated as a psychiatric nurse. However, I have reaffirmed that after discerning the intent of the conversation, it is sometimes necessary to maintain an appropriate distance.
If there is someone highly aggressive in your workplace, it might be worth considering that "perhaps their brain is receiving a reward for this..."
As a nurse, I usually write medical articles that emphasize evidence.
Looking up questions that suddenly come to mind in research papers is a valuable time to calmly confirm, "I thought so."
A series verifying small daily questions through English research papers.
I look forward to delving into another familiar theme next time.
[References]
Amad, S., Gray, N., & Snowden, R. (2020). Self-Esteem, Narcissism, and Aggression: Different Types of Self-Esteem Predict Different Types of Aggression. Journal of Interpersonal Violence, 36, NP13296–NP13313.
https://pubmed.ncbi.nlm.nih.gov/32065011/
Chester, D. S., Lynam, D. R., Milich, R., & DeWall, C. N. (2018).
Neural mechanisms of the rejection–aggression link. Social Cognitive and Affective Neuroscience, 13, 501–512.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6007431/
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