Dialogic interactions among multi-professionals in the context of online sessions: The use of Mederu to understand Moyatto experiences
Main Article Content
Abstract
This study discusses professional love in the context of online sessions where healthcare professionals employ a dialogic framework to reflect on or explore how discomfort arises in their interprofessional practices. The goal of this study is to provide frontline practitioners and educators with insights into what constitutes professional love in dialogue and to suggest avenues of support for the development of continuous health profession education through such dialogue. We took a reflective writing approach based on observations of dialogic practices. This essay represents a reflective writing conducted by the first author as he explored, in his own practice, love in dialogic interactions among professionals in online sessions. He established a Study Group in 2014, aiming to improve interprofessional collaboration through dialogue on Moyatto, which is defined as emotional, cognitive, and physical distress experienced when individuals face conflicting communication with people who have different viewpoints and interests. We describe actual events that occurred in sessions and interactions that continue even without direct conversations after the conclusion of the session.
The results indicate that the first step for professionals to experience love in their professional practice is to share the Moyatto experiences without any quid pro quo in response to the other’s narrative. Even after the session's conclusion, the participants continued to feel something that could not be verbalized because of the other’s alienness. Therefore, the interactions comprising the exchanging of Moyatto experiences can continue even without direct conversations, and such experiences can motivate participants to inquire about perspectives hitherto unknown to them. We postulate that this process can be regarded as Mederu, a Japanese sense of loving used by people to willingly observe and care for the diverse elements of others or materials. This transitional learning that transcends professional and disciplinary boundaries may need to recur at various points in a professional’s career, requiring more sustainable and stable educational resources.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site;
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Revised 7/16/2018. Revision Description: Removed outdated link.
References
Akita, K., & Dingemanse, M. (2019). Ideophones (mimetics, expressives). In A. Mark (Ed.), Oxford research encyclopedia of linguistics. Oxford University Press. https://doi.org/10.1093/acrefore/9780199384655.013.477
Adib-Hajbaghery, M., Bolandian-Bafghi, S., & Zandi, M. (2021). Nurses’ perceptions of the factors contributing to the development of the love of the profession: A qualitative content analysis. Nursing Reports (Pavia, Italy), 11(3), 702–713. https://doi.org/10.3390/nursrep11030066
Bakhtin, M. M. (1975/1981). Discourse in the novel (C. Emerson & M. Holquist, Trans.). In M. Holquist (Ed.), The dialogic imagination: Four essays (pp. 259–422). University of Texas Press.
Bakhtin, M. M. (1979/1984). Problems of Dostoevsky’s poetics (C. Emerson, Trans.). University of Minnesota Press. https://doi.org/10.5749/j.ctt22727z1
Bakhtin, M. (1986). Speech genres and other late essays (V. W. McGee, Trans.). University of Texas Press. https://doi.org/10.2307/3684926
Bakhtin, M.M. (1990). Art and answerability: Early philosophical essays (V. Liapunov, K. Brostrom, Trans.). University of Texas Press. https://doi-org/10.7560/704114
Bebeau, M., & Monson, V. (2011). Professional identity formation and transformation across the life span. In: A. McKee. & M. Eraut (Ed.), Learning trajectories, innovation and identity for professional development. (pp. 135-162). Springer. https://doi.org/10.1007/978-94-007-1724-4_7
Berscheid, E. (2010). Love in the fourth dimension. Annual Review of Psychology, 61, 1–25. https://doi.org/10.1146/annurev.psych.093008.100318
Bolandian-Bafghi, S., Adib-Hajbaghery, M., & Zandi, M. (2022). Nurses’ experiences of the role of organizational and environmental factors in the development of love of the profession: a qualitative study. BMC Nursing, 21(1), 334. https://doi.org/10.1186/s12912-022-01117-4
Boersma, P. (2020). Prevalence of multiple chronic conditions among US adults, 2018. Preventing Chronic Disease, 17, E106. https://doi.org/10.5888/pcd17.200130
Burgess, A., & Mellis, C. (2015). Feedback and assessment during clinical placements: achieving the right balance. Adv Med Educ Pract, 6, 373–381. https://doi.org/10.2147/AMEP.S77890
Card, K. G., & Hepburn, K. J. (2023). Is neoliberalism killing us? A cross sectional study of the impact of neoliberal beliefs on health and social wellbeing in the midst of the COVID-19 pandemic. International Journal of Social Determinants of Health and Health Services, 53(3), 363–373. https://doi.org/10.1177/00207314221134040
Chatterjee, R. (2022). Bearing the intolerable: Analytic love. Differences, 33(2–3), 262–279. https://doi.org/10.1215/10407391-10124802
Cohen, B. M. Z. (2016). Psychiatric hegemony. Palgrave Macmillan UK. https://doi.org/10.1057/978-1-137-46051-6
Collett, T., Neve, H., & Stephen, N. (2017). Using audio diaries to identify threshold concepts in ‘softer’ disciplines: a focus on medical education. Practice and Evidence of Scholarship of Teaching and Learning in Higher Education, 12(2), 99–117.
Dingemanse, M. (2013). Ideophones and gesture in everyday speech. GEST, 13(2), 143–165. https://doi.org/10.1075/gest.13.2.02din
Dingemanse, M., & Akita, K. (2017). An inverse relation between expressiveness and grammatical integration: On the morphosyntactic typology of ideophones, with special reference to Japanese. Journal of Linguistics, 53(3), 501–532. https://doi.org/10.1017/S002222671600030X
Douglah, J. (2021). “BOOM, so it will be like an attack” Demonstrating in a dance class through verbal, sound and body imagery. Learning, Culture and Social Interaction, 29. https://doi.org/10.1016/j.lcsi.2020.100488
Emakpor, C., & Nyback, M. (2010). Love; a relevant concept in nursing and caring science. Novia University of Applied Sciences, Tehtaankatu 1, Vaasa, Finland, 1–15.
Fletcher, J. K. (1998). Relational practice: A feminist reconstruction of work. Journal of Management Inquiry, 7(2), 163–186. https://doi.org/10.1177/105649269872012
Fook, J., & Askeland, G. A. (2007). Challenges of critical reflection: ‘Nothing ventured, nothing gained.’ Social Work Education, 26(5), 520–533. https://doi.org/10.1080/02615470601118662
Freud, S. (1961). Fragment of an analysis of a case of hysteria. In: J. Strachey (Ed.), The standard edition of the complete works of Sigmund Freud 7. (pp. 7–122). Hogarth (Original work published 1905)
Fumio, H. (2023). Flower and health. Journal Dent Health, 73(2), 90¬–96.
Geese, F., & Schmitt, K.-U. (2023). Interprofessional Collaboration in Complex Patient Care Transition: A Qualitative Multi-Perspective Analysis. Healthcare, 11, 359. https://doi.org/10.3390/healthcare11030359
Green, M.J. (2015). Comics and medicine: Peering into the process of professional identity formation. Academic Medicine, 90(6), 774–779. https://doi.org/10.1097/ACM.0000000000000703
Hall, P. (2005). Interprofessional teamwork: professional cultures as barriers. Journal of Interprofessional Care, 19(Suppl 1), 188–196. https://doi.org/10.1080/13561820500081745
Haruta, A., Sano, I., & Kato, H. (2023). How can interprofessional education be implemented seamlessly from pre-graduation to post-graduation? Paper presented at the 55th Annual Meeting of the Japan Society for Medical Education “A paradigm shift in health professions education: reflecting on the history and the bright future ahead”, Nagasaki, Japan.
Harvey, D. A. (2005). A brief history of neoliberalism. Oxford University Press. https://doi.org/10.1093/oso/9780199283262.001.0001
Hobson, R. P., & Kapur, R. (2005). Working in the transference: Clinical and research perspectives. Psychology and Psychotherapy: Theory, Research and Practice, 78(3), 275–295. https://doi.org/10.1348/147608305X25801
Hosoma, H. (2012). Onomatope no on-in koozoo to jesuchaa no taiming bunseki [Sequence analysis of phonetic structure of onomatopoeic expression and the phases of gesture]. IEICE Technical Report, 112, 79–82.
Humphris, D., & Hean, S. (2004). Educating the future workforce: Building the evidence about interprofessional learning. Journal of Health Services Research & Policy, 9(1_suppl), 24–27. https://doi.org/10.1258/135581904322724103
Ikegami, E. (2005). Bonds of civility: Aesthetic networks and the political origins of Japanese culture. Cambridge University Press.
Iida, J., & Nishigori, H. (2021). Managing uncertainty: Collaborative clinical case conferences for physicians and anthropologists in Japan. In: I. Martinez & D.W. Wiedman (Ed.), Anthropology in medical education: Sustaining engagement and impact (pp 69–90). Springer International Publishing. https://doi.org/10.1007/978-3-030-62277-0_4
Janis, I. (1991). Groupthink. In E. Griffin (Ed.), A first look at communication theory (pp 235–246). McGrawHill.
Jasper, M. A. (2005). Using reflective writing within research. Journal of Research in Nursing, 10(3), 247–260. https://doi.org/10.1177/174498710501000303
Kaba, A., Wishart, I., Fraser, K., Coderre, S., & McLaughlin, K. (2016). Are we at risk of groupthink in our approach to teamwork interventions in health care? Medical Education, 50(4), 400–408. https://doi.org/10.1111/medu.12943
Kajimaru, G., Coker, C., & Kazama, K. (2021). An anthropology of ba: Place and performance co-emerging. Kyoto University Press and Trans Pacific Press.
Kakin, O. (2019). Polishing and admiring “immaturity” ―Cultural aspect of idols development as observed in fans behavior. Journal of the Graduate School of Humanities and Sciences, 21, 223–230.
Keevallik, L. (2015). Coordinating the temporalities of talk and dance. In A. Deppermann, S. Günthner. (Ed.), Temporality in interaction. (pp 309–336). John Benjamins. https://doi.org/10.1075/slsi.27.10kee
Khatri, R., Knight, J., & Wilkinson, I. (2020). Threshold concepts: a portal into new ways of thinking and practising in psychiatry. Medical Teacher, 42(2), 178–186. https://doi.org/10.1080/0142159X.2019.1670338
Kita, S. (1997). Two-dimensional semantic analysis of Japanese mimetics. Ling, 35(2), 379–416. https://doi.org/10.1515/ling.1997.35.2.379
Kumagai, A. K., & Naidu, T. (2015). Reflection, dialogue, and the possibilities of space. Academic Medicine, 90(3), 283–288. https://doi.org/10.1097/ACM.0000000000000582
Kumano, M. (2018). On the concept of well-being in Japan: Feeling shiawase as hedonic well-being and feeling ikigai as eudaimonic well-being. Applied Research Quality Life, 13(2), 419–433. https://doi.org/10.1007/s11482-017-9532-9
LaGuardia, M., & Oelke, N.D. (2021). The impacts of organizational culture and neoliberal ideology on the continued existence of incivility and bullying in healthcare institutions: A discussion paper. International Journal of Nursing Science, 8(3), 361–366. https://doi.org/10.1016/j.ijnss.2021.06.002
Lalande, C., Gauthier, S., Damant, D., Lessard, G., & Dubé, M. (2023). Professional representations of collaboration in the response to intimate partner violence. Journal of Family Violence. https://doi.org/10.1007/s10896-023-00504-y
Laming, L. (2003). The Victoria Climbie inquiry: report of an inquiry. The Stationery Office. https://assets.publishing.service.gov.uk/media/5a7c5edeed915d696ccfc51b/5730.pdf
Levinas E. (1949/1998). Discovering Existence with Husserl (A. Richard, Cohen & Michael B. Smith, trans.). Northwestern University Press.
Levinas, E. (1974/1981). Otherwise than being or beyond essence (A. Lingis, Trans.). Duquesne University Press.
Levinas E. (1987). Phenomenon and enigma. In A. Lingis (Ed.), Collected philosophical papers. (pp. 61–73). Martinus Nijhoff. https://doi.org/10.1007/978-94-009-4364-3_5
Lothane, H. (2000). Tender love and transference: Unpublished letters of C.G. Jung and Sabina Spielrein. The International Journal of Psycho-Analysis, 80(6), 1189–1204. https://doi.org/10.1516/0020757991599368
MacLeod, A. (2011). Caring, competence and professional identities in medical education. Advances in Health Sciences Education, 16(3), 375–394. https://doi.org/10.1007/s10459-010-9269-9
McNaughton, N. (2013). Discourse(s) of emotion within medical education: the ever-present absence: Discourses of emotion in medical education. Medical Education. 47(1), 71–79. https://doi.org/10.1111/j.1365-2923.2012.04329.x
Mitsutake, S., Ishizaki, T., Teramoto, C., Shimizu, S., & Ito, H. (2019). Patterns of co-occurrence of chronic disease among older adults in Tokyo, Japan. Preventing Chronic Disease, 16, E11. https://doi.org/10.5888/pcd16.180170
Moth, R. (2020). ‘The business end’: Neoliberal policy reforms and biomedical residualism in frontline community mental health practice in England. Competition & Change, 24(2), 133–153. https://doi.org/10.1177/1024529418813833
Neve, H., Lloyd, H., & Collett, T. (2017). Understanding students’ experiences of professionalism learning: a ‘threshold’ approach. Teaching in Higher Education, 22(1), 92–108. https://doi.org/10.1080/13562517.2016.1221810
Nishigori, H. (2020). Why do doctors work for patients? Medical professionalism in the era of neoliberalism. [Doctoral Thesis, Maastricht University]. Retrieved from: https://doi.org/10.26481/dis.20201117hn
Novick, J., & Novick, K. K. (2000). Love in the therapeutic alliance. Journal of American Psychoanalic Association, 48(1), 189–218. https://doi.org/10.1177/00030651000480011201
Nygren, A. (1953). Agape and eros. The Westminster Press.
Prusinski, L. (2012). Wabi-sabi, mono no aware, and ma: Tracing traditional Japanese aesthetics through Japanese history. Studies on Asia, 4(2), 25–49.
Public Health Agency of Canada. (2020). Aging and chronic diseases: A profile of Canadian seniors. https://www.canada.ca/content/dam/hc-sc/documents/services/publications/diseases-and-conditions/aging-chronic-diseases/canadian-seniors-report_2021-eng.pdf
Rees, C.E., Kent, F., & Crampton, P. E. S. (2019). Student and clinician identities: how are identities constructed in interprofessional narratives? Medical Education, 53(8), 808–823. https://doi.org/10.1111/medu.13886
Reeves, S., & Lewin, S. (2004). Interprofessional collaboration in the hospital: strategies and meanings. Journal of Health Services Research & Policy, 9(4), 218–225. https://doi.org/10.1258/1355819042250140
Reeves, S., Rice, K., Conn, L. G., Miller, K. L., Kenaszchuk, C., & Zwarenstein, M. (2009). Interprofessional interaction, negotiation and non-negotiation on general internal medicine wards. Journal of Interprofessional Care, 23(6), 633–645. https://doi.org/10.3109/13561820902886295
Rykkje, L., Eriksson, K., & Råholm, M.-B. (2015). Love in connectedness: a theoretical study. SAGE Open, 5(1), 1–11. https://doi.org/10.1177/2158244015571186
Sano, I., Morishita, M., & Nishigori, H. (2023). Reflection on interprofessional collaboration based on uncomfortable experiences. Medical Education (Japan), 54(3), 281–287.
Sano, I., Uehara, Y., Oshita, J., Kita, E., & Hashimoto, M. (2021). Moyatto o jōzuni ikasu tashokushu renkei: iryō jirei kara himotoku reshipi syū [Multidisciplinary collaboration to make good use of Moyatto - Recipes from medical cases]. Seiwa Shoten.
Sassoli, M., & Day, G. (2020). Understanding pharmacist communication and medication errors: A systematic literature review. Asia Pacific Journal of Health Management, 12(1), 47–61. https://doi.org/10.3316/informit.832463700662537
Szasz, T. (1956). On the experiences of the analyst in the psychoanalytic situation: A contribution to the psychoanalytic theory of treatment. Journal of the American Psychoanalytic Association 4(2),197–223. https://doi.org/10.1177/000306515600400201
Scanlon, J. M., Care, W.D., Udod, S. (2002) Unravelling the unknowns of reflection in classroom teaching. Journal of Advanced Nursing, 38(2), 136–143. https://doi.org/10.1046/j.1365-2648.2002.02157.x
Shapiro, D. E., Duquette, C., Abbott, L. M., Babineau, T., Pearl, A., & Haidet, P. (2019). Beyond burnout: A physician wellness hierarchy designed to prioritize interventions at the systems level. The American Journal of Medicine, 132(5), 556–563. https://doi.org/10.1016/j.amjmed.2018.11.028
Shulman, M. (2016). “Unavoidable satisfactions”: The analyst’s pleasure. Journal of the American Psychoanalytic Association, 64, 697–727. https://doi.org/10.1177/0003065116664892
Smith, J. A., Blackburn, S., & Nestel, D. (2018). Challenges in the commencement of consultant surgical practice: a study of threshold concepts in junior cardiothoracic surgeons. International Journal of Practice-Based Learning in Health and Social Care, 6(1), 78–95. https://doi.org/10.18552/ijpblhsc.v6i1.435
Stravogiannis, A. L. da C., Kim, H. S., Sophia, E. C., Sanches, C., Zilberman, M. L., & Tavares, H. (2018). Pathological jealousy and pathological love: Apples to apples or apples to oranges? Psychiatry Research, 259, 562–570. https://doi.org/10.1016/j.psychres.2017.11.029
Tajima, A. (2017). A dialogic vaccine to bridge opposing cultural viewpoints based on Bakhtin’s views on dialogue and estrangement. Integrative Psychological and Behavioral Science, 51(3), 419–431. https://doi.org/10.1007/s12124-017-9394-6
Tajima, A. (2020). On the meaning of poetry and the novel as concepts in M. M. Bakhtin’s works: Perspectives on Socratic dialogues and carnivalesque laughter. Trans-Cultural Studies, 23, 102–124.
Tajima, A. (2021). A sustainable consciousness promoting dialogue with alien others: Bakhtin’s views on laughter and Euripides’ tragi-comedy. International Review of Theoretical Psychologies, 1(2), 225–242. https://doi.org/10.7146/irtp.v1i2.128022
Tajima, A. (2021). Bakhtin’s views of love towards alien others: Generating dialogue beyond critical evaluation from the outside world. Material of XVII International Bakhtin Conference. Published online, 261–265.
Tajima, A. (2023). “Dialogue” and “conversation” for interprofessional collaboration: The value of “moyatto” from Bakhtin’s dialogue theory. Paper presented at the 84th Seminars and Workshops in Medical Education. Gifu, Japan.
Shūji, T., (2018). Japanese sense of beauty (M. Treyvaud, Trans.). Japan Publishing Industry Foundation for Culture.
Tanaka, Y. (1986). Edo no sōzōryoku: 18 seiki no media to hyōchō. [Imaginative power of Edo period]. Chikuma Shobō.
Ten Have, P. (2002). Sequential structures and categorical implications in doctor-patient interaction: ethnomethodology and history. Revised version of a paper read at the conference ‘Structure and Emergence of professionalized “Praxis”’, J. W. Goethe-Universität, Frankfurt, Germany, September 26-28, 2001. http://www.paultenhave.nl/seqstruct.htm
Ten Have, P. (2004). Understanding Qualitative Research and Ethnomethodology. Sage Publications.
The Bristol Royal Infirmary Inquiry. (2001). Learning from Bristol: The report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984–1995. The Stationery Office. Retrieved from: www.bristol-inquiry.org.uk/final-report/ index.htm
Thistlethwaite, J., Jackson, A., & Moran, M. (2013). Interprofessional collaborative practice: A deconstruction. Journal of Interprofessional Care, 27(1), 50–56. https://doi.org/10.3109/13561820.2012.730075
Togashi, K. (2009). An effort to find self psychological concepts in an Asian culture. International Journal of Psychoanalytic Self Psychology, 5(1), 113–115. https://doi.org/10.1080/15551020903384385
Tong, R., Roberts, L. D., Brewer, M., & Flavell, H. (2020). Quality of contact counts: The development of interprofessional identity in first year students. Nurse Education Today, 86, 104328. https://doi.org/10.1016/j.nedt.2019.104328
Tollefsen, T. T. (2021). Eros and agape – a critique of Anders Nygren. In K. Grødum, H. F. Hägg, J. Kaufman & T. T. Tollefsen (Eds.), Love – ancient perspectives (pp. 17–29). Cappelen Damm Akademisk. https://doi.org/10.23865/noasp.133.ch01
Vovin, A. (2017). Man yoshu Book 1: A new English translation containing the original text, kana transliteration, Romanization, glossing and commentary. Bilingual ver. Brill Academic Pub. https://doi.org/10.1163/9789004346703
Watson, J. (2003). Love and caring. Ethics of face and hand—An invitation to return to the heart and soul of nursing and our deep humanity. Nursing Administration Quarterly, 27, 197–202.
Welten, R. (2020). In the beginning was violence: Emmanuel Levinas on religion and violence. Continental Philosophy Review, 53(3), 355–370. https://doi.org/10.1007/s11007-020-09491-z
Yamane, I. (2008). Phenomenological psychology of love. The Japanese Journal of Human Relations, 6, 67–79.
Yasui, E. (2023). Japanese onomatopoeia in bodily demonstrations in a traditional dance instruction: A resource for synchronizing body movements. Journal of Pragmatics, 207, 45–61. https://doi.org/10.1016/j.pragma.2023.02.002