Emotional Labour in Work With Older Adults and Palliative Care

By Adam J. Pearson

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In “Can Emotional Labour Be Fun?” Arlie Russel Hochschild poses a question as incisive as it is relevant to our own discipline of social work. Hochschild defines emotional labour as “the work of trying to feel the appropriate feeling for a job either by evoking or suppressing feelings — a task we accomplish through bodily of mental acts.”

This concept resonates very personally with the work I’ve been doing for the past year with older adults in residential care settings. Working with older adults and people in end-of-life and palliative care can be tremendously fulfilling and rewarding. When we work with clients in this demographic, we get to spend time with them at a time that is a very important phase in their lives. It is a time in which people take stock of the lives they have lived, of their proudest achievements and most painful disappointments, of the beautiful memories they’ve shared with the people they cared for and the more traumatic events that continue to haunt them. It’s also a sacred time in which people have a very heightened sense of their own mortality as they prepare for the Great Mystery of death that awaits them.

Doing this work is often beautiful, sometimes hilarious, often heartwarming, occasionally frustrating, and very often heartbreaking. In all cases, it involves emotional labour.  I remember one day in particular last semester when I came into my stage only to discover that not one, not two, but three of my clients had died over the weekend while I was away. One of the clients was in good health the last time I saw her and was not expected to die. Just a few weeks ago, another one of my clients, who was lucid, happy, and conversational one day, fell ill and lost the ability to speak and was suddenly dead a few days later. Coming into work and hearing news like this can be very challenging. I can feel heartbroken and shocked at once, yearning to grieve, and yet knowing that I need to manage my emotions and put on a happy face for the other clients with whom I have appointments in the afternoon. So, I suppress emotion. And I display positive emotion when I’m grieving internally. I can only release my true feelings when I return home and am drained after a long day of managing other people’s feelings along with my own. Emotional labour if a balancing act. As Hochschild points out, “a meaningful job is one thing; an easy job is another.”

Hochschild quotes a worker who reported that when she works with clients with dementia, she has to learn to “enjoy” them in a “just-now way.” That has very much been my experience in the two CHSLDs at which I’ve worked. Many of my clients are in such a medically precarious state of health that they can die at any time and often do. Many of them are in a palliative condition. Often, they are in tremendous pain that keeps them bedridden. Sometimes, they have multiple comorbid conditions that interact to make their lives even more challenging — cancer, heart disease, various forms of dementia, depression, and anxiety are all common. When clients are in such an extreme state of pain or such an advanced stage of dementia that they can barely speak, working with them can become even more difficult. But it is still work that needs to be done. Important work, meaningful work. Even if often agonizing.

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Social work for me is inextricable from emotional work, even when I attempt to put my own emotions aside to tune in to and support my clients. Putting my own emotions aside is itself emotional work, emotional labour. As Hochschild points out, this work becomes even more difficult when it unfolds within a very constrained and limiting system; she notes that “emotional laborers face a great paradox. Though they may come to work hoping to take pride in a job well done, low pay, understaffing, rigid rules, and devaluation can set up circumstances which prevent that. Sadly, their main job becomes protecting patients from the harm of life in a broken, globalized, and over-bureaucratized or profit-hungry system.”

This certainly seems to hold true in our Hospitals, CLSCs, and CHSLDs. And it’s not only true for social workers either. Doctors, nurses, and orderlies all feel the strain of the broken system. And no one feels it more than our clients. The broken system weighs heavy on workers and clients alike; it grates them down, stresses them out, and often burns them out as well. In the case of older clients, the very system they go to for help can end up killing them, such as when an otherwise healthy older adult goes to the hospital, contracts C Difficile or CRO in the hospital, and dies shortly thereafter.

These realities are not pretty. They are a far cry from the sunny ideals that most social workers hold when they enter the profession. Facing these realities, coping with them, and working to change them when possible is emotional labour unto itself. It frustrates workers and clients alike and that frustration spills into our work.

If we are to safely navigate the troubled waters of emotional labour, however, we must prioritize the self-care of our own sailing vessel or risk capsizing. Overstressing, burnout, and vicarious trauma remain ever-present threats. Only by opening up, sharing, offering and receiving support, and prioritizing our own self-care can we avoid them and achieve something that approximates a healthy work-life balance. And of course, doing this, is emotional labour in itself.

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