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ANNIKA LILLRANK

THE TENSION BETWEEN OVERT TALK AND COVERT EMOTIONS IN ILLNESS NARRATIVES: TRANSITION FROM CLINICIAN TO RESEARCHER

ABSTRACT. In this article I discuss my interview experiences as joint constructions with Finnish parents whose children had been diagnosed with cancer. In doing so both the interviewer and interviewees became engaged as anxious “defended subjects” in an intersubjectivity of acknowledging but unable to talk of “how it really is” to have a child diagnosed with cancer. This appeared as tensions between overt talk and covert emotions. In the overt talk the parents underlined the manageable aspects of the illness. The speechless and painful part of the illness experience appeared as covert emotions that the interviewer was able to recognise and contain. Only when both the overt talk and the covert emotions were taken into account did it open up a more comprehensive way to understand the depth of the illness suffering. This is illustrated with one interview as an example. KEY WORDS: defended subjects, interview as joint construction, overt talk and covert emotion

INTRODUCTION When I interviewed parents of children with cancer for my doctoral dissertation (Lillrank 1998), the interviews were much more difficult to conduct than I expected. The dilemma I faced as an interviewer was twofold. Firstly, as an experienced clinical social worker for families with disabled children I had learned to be skeptical about parents’ smoothing over problems of what it means to be parents of a disabled child. It often took several appointments to develop mutual trust so that parents were able and willing to talk about personally vulnerable questions. In counseling I could interpret our discussions for parents to ease and help them better cope with distressing things. Hence, I began the interviews with a general hypothesis, that parents of children with cancer probably lived under considerable physical, mental, and social stress (Lillrank 1999: 95). However, as a research interviewer I was assigned an entirely different role. As a novice social scientist interviewer, I had been taught according to the common assumption in traditional qualitative research that the respondents are ‘telling it like it is’ and are able and willing to ‘tell’ Culture, Medicine and Psychiatry 26: 111–127, 2002. © 2002 Kluwer Academic Publishers. Printed in the Netherlands.

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this to an interviewer who is a stranger (Hollway and Jefferson 2000: 2–3; Gubrium and Hollstein 1997; Mishler 1986), and further, that the researcher was not supposed to come up with any of his/her own interpretations during the interview, or to doubt suppressed contradictions of a respondent’s story. According to modernist social science, interviews were framed as unproblematic verbal behaviour. As long as the interviewer kept to scientific standard and ethics of research, the data would be generalizable and unbiased (Bell 2000: 185; Mishler 1986). Last but not least, the interviewer was supposed to be emotionally neutral, at least regarding his/her own emotional reactions. As a research interviewer I had no knowledge of how to handle upcoming emotions in a research interview, in a way as Ann Oakley (1990: 216) has pointed out: “[b]ecause mainstream knowledge considers them [emotions and feelings] unimportant [it] has consequently developed no methodology for studying them.” The emotional interaction as part of a research relationship was no matter of concern. Thus my interviews became a tentative mixture of these two different interview traditions when I tried to balance between a therapeutic interview (Kvale 1999) and a research interview. By using one interview as an example, I discuss in this article how my interviews became joint constructions (Mishler 1986) between the interviewer and interviewees that went beyond the qualitative interview interaction as speech event. Our main efforts were in managing tension between what I call overt talks (social) and the covert emotion (psyche) observed. I suggest that the tensions between these two interplayed realities make explicit what is often overlooked in research on illness experiences because it might be too painful. However, by respectfully observing the tension between overt talk and covert emotion in a joint interview interaction, it might give voice to an otherwise neglected depth of illness suffering. THE DATA My interviews were scheduled in conjunction with the child’s appointment at the University of Helsinki Paediatric Clinic, treated between April 1 and July 1 1990. Forty-five families of children with cancer were invited to participate in the study. Participation requests were limited to children under 12 years of age who had been diagnosed with cancer between January 1986 and January 1990. Families of currently hospitalised children were excluded. In addition the child had to be undergoing routine treatment on an ambulatory basis at the time of the study and have been diagnosed with cancer for at least six months and not less than four years prior to the

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study. Thirty-two one- or two-parent families agreed to participate in an individual interview. In all, 49 parents were interviewed. All seven singleparent families were excluded because I wanted to keep the individual mothers and fathers of two-parent families as the basic unit of analysis. In this study I have used 42 individual interviews of parents from 25 families. It included 23 mothers and 19 fathers representing two-parent families. Mothers and fathers were interviewed separately and it was not always possible to interview both parents from the same family. Thus I am aware that the mothers are slightly over-represented in the data, which has perhaps biased the results. The study was designed to focus on the illness trajectory; the pre-diagnosis, diagnosis and post-diagnosis social situations in addition to social support received through the Finnish welfare state (Lillrank 1998: 58–66). Overall the interviewed parents were quite motivated to participate in the study and they mentioned how relieving it was when someone was interested in how the parents were doing. The interviews were tape-recorded and transcribed and the transcripts were read several times. They were coded according to themes of the crisis experience. Each major theme emerged after reading and sorting out, counting and comparing, as suggested by Glaser and Strauss (1967: 23): “one generates conceptual categories, then the evidence from which the category emerged is used to illustrate the concept.” Further, I compared the mothers’ and fathers’ statements to determine similarities and/or contradictions. Other methodological issues included the systematic search for deviant cases and to make analytical distinctions between parental statements or behaviour and their supposed meanings, which are discussed in detail elsewhere (Lillrank 1998: 75–77). In the next sections I discuss the interviews as joint constructions. The Interviews as Joint Construction Without planning to do so, my interviews became joint constructions (Mishler 1986) of managing tension between overt talk and covert emotions. I began each interview by emphasizing that I was interested in learning about the interviewees’ own family experiences with childhood cancer and that they should feel free to say whatever they think because the purpose of the study is to hear the parents’ point of view (Lillrank 1998: 65). Each interviewee understood my suggestion and questions according to their biography and illness related circumstances. In addition, this was embedded in a unique joint construction of each interview interaction. Hence, efforts to understand and meaning-make were part of the complex interview interaction. Despite differences in the 25 families interviewed, there were fundamental similarities in the way they talked

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about their illness experience. Their overt talk and behavior is interpreted as having two purposes: to manage the existential dilemma and related covert emotions, and to engage in goal-oriented behavior. That is, the desirable illness outcome (Lillrank 1998: 77). By overt talk I refer to parents’ and my way of verbally talking about their illness experiences. The interview interaction consisted of me asking questions; the interviewees answered by longer or shorter narratives, depending on how talkative they were and how willing they were to remember their illness experiences in our interaction. The parents’ overt talk was an effort to meaning-make the illness experience, acknowledge the illness as a crisis and to present themselves as responsible parents in keeping with the way the Finnish culture and society has made rules and norms for good parenthood (Lillrank 1998: 65, 68). These were attempts to maintain as normal an existence as possible (Bury 1991; Strauss and Glaser 1975), to take good care of their children, protect them from harm and injury, and emphasise their identity as normal and morally responsible parents (Gustavsson 1989; Silverman 1985; Baruch 1981). In addition, they were attempts to keep up a social discourse of childhood cancer as a manageable and legitimate illness experience. I began the interviews having confidence in my own professional ability to communicate trust and understanding, which is usually expected in good medical and similarly related encounters (Lupton 1996: 168). On a practical basis this meant that I tried to become personally involved in a reciprocal relationship by being both emotionally and intellectually sensitive in order to understand the parents from their point of view. I wanted to give the impression that the interviewees were to decide how much and to what extent they wanted to share their experiences with me (Lillrank 1998: 55–66). I realised that in well organised talk the parents tended to avoid talking about their feelings and fears of the illness’s life-threatening character, the long-lasting uncertainty of illness prognosis, its unknown aetiology, and how much it had changed their life. Nevertheless, it appeared as what I call covert emotions, non-verbally communicated emotional pain, which I observed in almost all interviews. However, I did not want to challenge their unwillingness to talk about it. Instead I intuitively accepted it, because I experienced the interviewees as emotionally extremely vulnerable. Despite my professional experience I was emotionally unprepared for the interviewees’ depth and immersion of non-verbally communicated extreme emotional pain. It made me feel that the parents had gone through something so extraordinarily painful that I found it difficult to face so much human suffering (Lillrank 1998: 66). In

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other words, both the interviewer and the interviewees became engaged as anxious “defended subjects” in an unconscious intersubjectivity of acknowledging but unable to talk of “how it really is” to have a child diagnosed with cancer or to merely talk about selected aspects of what the extraordinary caring responsibility demands. The Defended Subject To emphasize the interviews as joint constructions I borrowed the concept “defended subject” from Wendy Hollway and Tony Jefferson (2000: 19). They underline how suffering, conflict and threats to self operate on the psyche in ways that people choose certain forms of talking rather than others. The concept “defended subject” shows how people talk in certain ways “when these offer positions which provide protection against anxiety and therefore supports to identity.” It offers theoretical explanations of defences against anxiety “by which both rationality and irrationality can be explained” (Hollway and Jefferson 2000: 23). The concept “defended subject” departs from a fundamental proposition in the psychoanalytic theory, where anxiety is seen as inherited in the human condition; particularly threats to the self create anxiety, and these operate basically at an unconscious level (Hollway and Jefferson 2000: 19). In the work of Melanie Klein (1988a, b, quoted in Hollway and Jefferson 2000), self is engaged in unconscious defences against anxiety. According to Klein, early experience in life is dominated by anxiety in the face of the infant’s state of total dependency. The infant experiences polarised emotions of ‘good’ (when fed) and ’bad’ (when hungry) because of its inability to anticipate satisfaction or frustration. According to Klein, the need to keep good and bad separated becomes a defensive purpose and the important feature of mental development. The concept of splitting originated in Freud’s description of a division of mind, as conflicted with the ability to produce inconsistent thoughts and beliefs. Freud (1938) described late in his career the ways in which the mind could adopt two separate points of view. Klein’s work on splitting the ego emphasised how parts of the self experienced as bad are split off through projection and usually identified as belonging to an outside person or object (Hinshelwood 1991: 433–434, quoted in Hollway and Jefferson 2000). In her concept of unconscious defences against anxiety, Klein did not agree with the assumption of the self as a single unit or that the self has unproblematic boundaries that separate it from the external world of people or things. Instead Klein proposed that defences against anxiety are intersubjective, that is, they come into play in individual interactions. The splitting of good and bad is achieved through unconscious projection and

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introjection in interpersonal relationships (Hollway and Jefferson 2000: 20). This means that both interviewer and interviewees are seen as anxious, defended subjects, “whose mental boundaries are porous where unconscious material is concerned” (Hollway and Jefferson 2000: 45). Thus both interviewer and interviewees will be subject to projections and introjections of feelings and thoughts appearing in the interview interaction. “It also means that the impressions we have about each other are not only based on the ‘real’ relationship, but that what we say in the interaction will be mediated by fantasies which date back from our histories of significant relationship. Such histories are often accessible only through our feelings and not through our conscious awareness” (Hollway and Jefferson 2000: 45; Good et al. 1985). This study raised an emotional perspective of illness experience that appeared as tensions between overt talk and covert emotions as a joint construction. In the empirical part of the article, I discuss this in my interview with Maire.

MY INTERVIEW WITH MAIRE Maire was a married secretary in her early 40s and mother of two children. My interview with Maire lasted for about an hour and a half. It could be characterised as a typical one in that she was motivated to participate in the research and treated the interview situation as significant. Maire was quite talkative; she seemed to enjoy my attention and the questions easily triggered associated narratives about her illness experience and its management. However, I experienced her as both confident and reserved, which made me uncertain how to be respectful without causing her any harm. When the interview moved to emotionally difficult illness experiences her overt talk became defensive and emotionally reserved, without much verbal expression of her feelings and related thoughts. During the interview Maire’s overt talk and covert emotions, these separate although interplayed realities took place simultaneously with such intensity that it became impossible for me to comment on her emotionally painful story and pursue related questions. Instead I followed the interview guide quite strictly, partly as a strategy to ensure comparative data and reasonable reliability, but more importantly it was my way, as defended subject, to deal with the non-verbally communicated emotional pain (Lillrank 1998: 70). My clumsy interview strategy led Maire, among a few, to critique my questions as inappropriate according to her family situation. I explained that I did not expect any certain kinds of answers

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and that her answers were good and appropriate, which she seemed to understand and accept. The Overt Talk The interview usually began with general questions concerning the family life about one year prior to the diagnosis of cancer. In this way most interviews began on a relaxed level with nonsensitive, non-threatening subject matter and moved gradually toward more painful and individual areas of the illness experience. Usually the parents’ story began with the minimally threatening initial symptoms and how the process toward the diagnosis proceeded. In this study the child received either an immediate diagnosis after a couple of days or two weeks, or had a delayed response of several weeks to six months before the cancer diagnosis was confirmed (Lillrank 1998: 83–100). Maire’s 5-year-old son, Ari, received an immediate diagnosis. He was diagnosed within a couple of days after the first symptoms appeared. At the same time, Maire was returning to work after being a housewife for more than five years. Similarly important life-events were taking place in many families. By asking Maire to describe the first symptoms and how the cancer was discovered, the interview moved to her emotionally vulnerable illness experience: Maire: Everything happened very quickly. It was the first of June, a Monday.1 Annika: Excuse me, which year? Maire: 1987, or about three years ago. On Monday my work was scheduled to begin. What actually happened was that on Sunday Ari fell off the swing and hurt his teeth, so that he was bleeding from the mouth. On Monday I went to work as planned, but I had organised Ari’s day so he was taken care of. In the morning I did not look very carefully, but he had been bleeding during the night. I worked the whole day and when I came home in the evening Ari was very tired and had a fever. When he lay down beside me, his gums started to bleed again. I suspected that he had an infection in his teeth, which caused the fever and bleeding. That is how I explained it to myself. Next morning we went to the dentist, but they didn’t discover anything. It was strange, but when he was standing he wasn’t bleeding at all; it was maybe because his heart didn’t beat so strongly. So, after the visit to the dentist, Ari was taken to the Health Care Center where they noticed some changes. From HCC we were sent to the University clinic, and that is how everything started . . . so actually this was the story. The illness was discovered because of a lucky accident. Annika: Was it within a week or was it . . .? Maire: Within a day, a day, that on Tuesday we were already in the hospital when he fell off the swing on Sunday. I did not see any symptoms. Ari had bruises, but it was May and he had started to ride his bike and all kinds of things happened so I did not pay any particular attention. And he was pale after the winter, that you don’t see such things in your own child, maybe someone else could . . . Annika: Well, how much were you then able to be in the hospital with Ari?

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The Covert Emotions The shocking part of Maire’s story was how leukemia strikes suddenly without any time to suspect and prepare for its dangerous character. The usual expectation of trust in continuity of a predictable life broke down abruptly, so her story felt like a chaos story (Frank 1995). How the cancer diagnosis turned Maire’s and her family’s life upside down was the hornet’s nest of the covert emotions I as the interviewer stumbled upon. In other words, Maire was suddenly threatened with the loss of her healthy son, her sense of herself as ordinary mother, and her belief in a controllable and predictable world. She had to suddenly face cancer – its unknown aetiology and possible death threat, its long lasting and unpredictable medical prognosis – with no time to prepare. This shook Maire’s (and all parents’) existential security – that is, their sense of who they are and what the motivations for their lives are. Hence, the existential being and doing became an unresolved conflict she had no words for (Lillrank 1998: 101–103; Charmaz 1991; Giddens 1991; Davis 1963). The diagnosis forced Maire (and the other parents) into a variety of contradicting, threatening and extremely painful emotions, and splitting them off was the only way they were able to deal with them. The Emotional Chaos Story When Maire told me her story I became overwhelmed with unarticulated feelings of exhaustive emotional pain. Her non-verbally communicated emotional pain took me by surprise because of such an overwhelming sense of anxiety, despair and helplessness (Lillrank 1998: 66). It unconsciously triggered my memory of a personal crisis in another social context. This enabled me to recognize the depth of her emotional pain and to contain it. Nevertheless, it overwhelmed me in such a way that I became speechless, unable to comment or ask related questions. Other possible reactions could have been to split it off immediately, or for example, deny its painfulness by reassurance (see Hollway and Jefferson 2000: 50). In a similar way Arthur Frank (1995: 101) has characterised the chaos story as incommunicable. It is told in silence because the storyteller has no words for it. In other words, “the chaos narrative is always beyond speech, and thus it is what is always lacking in speech.” Frank (Ibid.: 104) explains how in chaos stories an individual has lost control of his/her own experience because nothing redeems suffering as ordinary; instead it feels arbitrary and meaningless. The sense of immediacy and timeless presence of lived emotional chaos was present in Maire’s story. Frank (1995: 98) relates to this when he emphasises how the “wounded storytellers” are continuously living the chaos, which makes reflection and storytelling

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impossible. Thus, according to Rosalind Minsky (1998: 12), attempts to find words for such frightening experiences are split off, since we usually do not need to face questions of unorganised parts of our selves. I assume my sense of chaotic emotions was split off parts of Maire’s personal experience she projected into me because they were too frightening. Hence she was unable to reflect or talk about them. Maire’s shocking story set the tone of the entire interview(s). It became a challenge to hear the rest of her story because I felt it emotionally too threatening, as Arthur Frank (1995: 97–98) also has characterised the chaos story. So I myself became a defended subject and the only thing I was able to come up with was to ask her how fast it actually happened. My question then gave Maire the opportunity to relate to the practical social situation shortly before hand and how she did not suspect anything serious. The Unconscious Intersubjectivity Within the object-relation psychoanalytic theory, Wilfred Bion (1962) has conceptualised unconscious intersubjectivity as container and contained. Bion departs from Klein’s ideas of projection, projective identification and introjecton to describe how a baby projects parts of its self into its mother and takes parts of the mother into its internal world. Bion sees a mother’s relation to her baby as a container of the baby’s frightening and chaotic internal experiences that she returns to the baby in a digested form. The mother makes them bearable for the baby, who is not yet able to do it for him/herself (Minsky 1998: 165). In a similar way, Donald Winnicott (1967, 1990) describes intersubjectivity between mother and baby in terms of “the holding environment,” where a sensitive and “good enough mother” functions as coordinator of the baby’s chaotic emotions. Even when Maire’s story and overt talk were very well organised I felt that there was just a very thin curtain between the well organised talking and the emotional feelings of chaos. It was also apparent according to my intuition that Maire, as well as the other parents, were so extremely afraid of the variety of their own complex feelings that they were not consciously aware of them and consequently unable to talk about them (Lillrank 1998: 67). Thus I assume that my ability to recognise and function as a container for these unbearable emotions helped to develop enough trust to keep the interviews going. Maire may also have felt some relief that I did not react with any verbal embarrassment or demand her to speak about her related feelings and thoughts; rather, she may have unconsciously experienced being understood. Since I was able to contain (Bion 1962) her emotional pain, it probably marked our joint understanding of acknowledging but

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not talking about her covert emotions and related vulnerable aspects of the illness experience. Because I was unable to verbally comfort her or comment on her story, I just went on asking “how much were you able to be with Ari in the hospital?” And Maire began talking about the practical arrangements of the hospital care. Maire’s and My Joint Interview Interaction We continued discussing the delivery of the diagnosis as leukemia and how Maire had discussed it with Ari and his sister. She mentioned how Ari once asked if he was going to die if he didn’t want the treatment, to which Maire replied that “at that moment I just said, yes, you can die. After that we did not discuss it. Ari has never asked if he is going to die.” And a little later Maire mentioned how Ari probably does not understand the meaning of death. So to continue the interview on less vulnerable issues I asked how she and her family acknowledged the illness to other people: Annika: So who told this to your relatives, friends and neighbours and how did they respond to you? Maire: I probably told them, I cannot really remember. Yes, besides when somebody was told it spread very quickly to others. So I did not need to tell everybody. But there was a lady; she and I had taken our children to a music school, which ended in the beginning of May. One month had passed and then Ari was already hospitalised. She [the lady] was not a close friend of mine; we just knew each other because of our children. Once I met her in the shop and she greeted me very happily and asked how we were doing. At that moment I of course said that we are not doing well and told her about Ari. So the situation became upside down because she started to cry and I had to comfort her “. . . please don’t, . . . we are doing fine,” and I told her in greater detail about it. So that it is how sensitive people react. I did not think that I should need to take care of her feelings. If I can endure it, others have to endure it too. Annika: [2] In telling others were these kinds of situations, in your opinion, the most difficult ones? Maire: No, I do not know. I am not unemotional, but in my opinion, this needs to be managed with pure reason. [3] I do not know where I have my emotions and perhaps they ooze up somehow in form of rash and that sort of thing. I have had this before [she showed me her arms] but now it is quite bad. Maybe this is possibly psychological. Annika: Well, when you had such a special situation, you had recently begun working and then Ari was seriously ill, so who took care of the practical management of everyday life?

In her narrative about a friend’s reactions it repeated my experience of “the challenge to hear” her story. This occasion became an embarrassing social interaction because Maire was unable to predict or control her friend’s emotional reaction while she revealed her own altered identity as mother of the seriously ill child. However, her friend’s inability to deal with Maire’s story might have been experienced by Maire as a humiliating form of social rejection, or as impossible to be understood by others (see Lillrank 1998: 114–118).

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When I in my second [2] question attempted to interpret and acknowledge this particular situation and the illness experience as emotionally extremely demanding, Maire became defensive and emphasised her rational way of dealing with the illness. She wanted to characterise it as contained, excluded from its emotional significance, because she probably did not want to take any risks of having uncontrollable emotional reactions. Rather, as Kathy Charmaz (1991: 66) noticed: “to present the self so that illness remains controlled and delimited.” However, the interview interaction was probably safe enough because Maire continued talking about her rash as a sign of suppressed emotions. When she gave me a clue [3] for a possible discussion of her suppressed emotions I was not ready to take it. Instead I changed subject matter by asking about the practical illness management at home. Maire responded to my emotional indifference by giving very short answers to my following questions. And the tone of her voice revealed that she felt offended. Shortly afterwards we returned to her situation at work. Maire’s and My Continued Co-Production of Data In our continued interview interaction we moved to discuss external social circumstances that I thought were less emotionally vulnerable: Annika: Well, then your work situation was such that you needed to take sick leave almost the next day. How was this managed at work according to your situation? Maire: Well, when I had started as a temporary worker it created a situation where they needed to replace a temporary worker with another one. But I did not need to be that much absent. The acute hospital treatment passed very quickly and the month I took care of him at home. And then I got a homemaker for another month. After all I was at work a lot. Because we have not had any greater difficulties during his treatment schedule, only once a chicken pox that needed in-hospital care and then the very normal out-of-hospital treatment. So I would say that parents with small children are absent from work now and then, that in my opinion, I did not deviate from my workmates.

Maire’s overt talk focused on Ari’s illness as easily manageable and gives an impression of an ordinary childhood illness rather than childhood cancer. By focusing on the smooth illness trajectory she downplayed the life-threatening character of chicken pox for children with cancer. Rather than focusing on the child’s needs or her relationship to him, Maire frankly compares herself to her workmates, which enables Maire to conclude her ordinary status. When Maire emphasised the illness as a minor interruption in her work life, she probably made an effort to minimise the illness’s impact on her identity as a working mom. In other words, Maire wanted to emphasise her ordinary identity and ordinary status in the labour force. I experienced her narrative as a rational description of the ordinariness of her life. I felt it was not possible to doubt, question or discuss it further.

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So Maire’s explanation kept me going in the same overt talk interaction of illness-related social facts. My only comment was a ’fact’ related question. This triggered her associated narrative that now seemed to follow an emotional rather than rational reasoning: Annika: For how long a time was Ari then hospitalised? Maire: Well, I think it was not for more than three weeks. Then we visited [the hospital] daily and were able to stay at home. As matter of fact we put up a very strict limit for visitors at home. I have heard that, in my opinion in an irresponsible way, many parents take their children with very low blood counts to various [public] places. Luckily it was summer, that we did not invite any friends and we could not either visit anyone. But if people occasionally stopped by we did not let them inside. Instead we sat outside in the garden chairs. If the weather was cold we just put on more clothes. We were maximally cautious, but we thought that at least Ari couldn’t get any infections.

Maire suddenly wanted to emphasise how she and her husband took extended caring responsibility of Ari’s illness related needs. Maire may have became uncertain of how to balance between her emphasised identity as ordinary working mom and how to ensure parental self-respect by living up to social and cultural expectations of providing extended care to the seriously ill child and reducing the time and energy normally devoted to other life projects (Lillrank 1998: 191). The existential dilemma may have been especially demanding for her as a mother since, according to the gendered division of labour, mothers are supposed to have the primary care-providing responsibility and ensure well-being of the child (Chodorow 1989). Maire may have wanted to redirect any doubts of irresponsible behaviour by picturing other fellow parents as less responsible, compared to herself and her husband. This freely associated answer revealed some of her complex role as Ari’s mother. It also made clear how she was able to control only a few illness-related issues. In the final section of our joint interview interaction I discuss Maire’s awareness of her postponed self-reflexivity. Maire’s Postponed Self-Reflexivity At the time of our interview, about three years had passed since Ari was diagnosed with leukemia. He had already begun school and Maire mentioned how Ari soon may not need medication anymore. The increasing sense of continuity did not require extended parental attention anymore. Hence, it became possible to let things ooze into her mind as part of self-reflective emotional work. Thus, now in the middle of our interview it seemed possible to ask Maire about some of her major concerns: Annika: Well, as a mother, what were your major concerns at this time?

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Maire: Yes, it was the threat of death and when [the treatment] was now and then painful. As mother I would have wanted to take away the pain. But no, if I lose [him] was the only thing in my mind. Annika: Were you able to think about anything else concerning Ari? Maire: Well yes, I did not let the fears ooze into my mind, . . . we tried to live as normal a life as possible. . . . It was June and we had been to a sauna where I had washed Ari’s hair. I realised he was losing his hair, which made me cry. I started to cry about unimportant things. But after the diagnosis I was kind of deep frozen, so that I absolutely did not let the things come into my mind, and even now I have not let them come into my mind.

In my containment of Maire’s fear of death, it seemed safe enough to acknowledge, and she may have experienced being emotionally understood. This enabled her to face more about herself when she continued talking about how she has not “let the things come into my mind.” In other words, Maire was aware of her postponed self-reflexivity and she had not yet found a personal solution to her existential dilemma. This is connected to the major finding in my research; in a similar way the majority of parents seemed to avoid self-reflexivity (Giddens 1991) about the overall illness experience. Namely, it remained an open question whether, when, and how the majority of parents in the future will increase their self-reflexivity in order to more closely process and overcome the “socially forbidden mourning” (Fyhr 1990) they have been engaged in while managing the practical caring responsibilities. Since surviving together was the overall parental goal, their ability and willingness to self-reflexively process their emotional thoughts were postponed for an unknown period of time (Lillrank 1998: 279). This has probably been an essential cornerstone of the tension between overt talk and covert emotions.

SUMMARY AND CONCLUSION In this article I have discussed how my interview with Maire became a joint construction of managing the tensions between overt talk and covert emotions. The joint interview interaction went beyond the verbal dimension to gain research data. Consequently, this is what I now perceive to be the heart of the matter: how Maire (and other parents) simultaneously communicated two different versions, a verbal and a non-verbal, of their illness experience. Hence, if I had based my understanding only on Maire’s overt talk, I could have repeated her talk on a rather ordinary illness experience, and the emotional logic of our overt talk would have remained silent. Thus this study clearly shows the need to incorporate in future research an understanding of the emotional state of the interviewees and interviewer as well as emotional content of the gathered data. Only when the

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emotional dimensions of research interview interaction are acknowledged and discussed can the true meaning of the obtained data be understood and appreciated. This study opens up emotional dimensions of interactive talking, not simply the context to which language refers (Riessman, in press). In doing so, my interpretations are tentative without creating any “truths” about Maire (or other parents), but what is methodologically, theoretically, and empirically convincing (Hollway and Jefferson 2000: 97). The interview interaction became a mixture of a therapeutic interview (Kvale 1999) and a research interview. The therapeutic dimension of the interview was my professional ability to recognise and contain Maire’s split off covert emotions, which may have served as therapeutic for her (see Lillrank 1998: 59), and created enough trust to keep the interview going. In addition, maybe my ability to keep this contradictory emotional data in my mind and contain it (Bion 1962) helped in analysing and making sense of the covert emotions, why they were postponed, and how the parents’ main efforts were to manage the desirable illness outcome (Lillrank 1998: 69–77). In a similar way, anthropologist Ria Reis (1998; see Wikan 1992; Good et al. 1985; see also Boyer 1999) emphasised how the interviewer’s experienced emotional reactions, or resonans, during fieldwork “may alert to socio-cultural issues in a similar way to [how] a psychotherapist’s countertransference may alert to core issues” (Reis 1998: 295). In ‘my story’ of the interview, I have discussed its subjective and joint construction where both the interviewer and interviewee behaved as defended subjects. This opens up new possibilities for social scientists researching on emotionally sensitive topics. In agreement with Hollway and Jefferson (2000: 155), the concept of defended subjects is very useful and applicable to social research, particularly to qualitative research and interview methods. This resonates with the following current trends in social research on illness experience. Firstly, social scientists have already recognised that the researcher’s personality has a significant impact on the data collection and on the production of knowledge (Riessman 1993). Secondly, in order to understand illness experience, it includes more than only the experiences of others. In addition, it needs an insider’s perspective of the researcher’s attempts to understand the respondents’ experiences (Conrad 1990). Thirdly, social scientists, such as Arthur Frank (1991) and Irving Zola (1982), have reflected about their individual experiences of having an illness. This mirrors the general tendencies in social sciences to bring the “self” of the interviewer back in to the center of data collection and analysis (Bell 2000: 186). Finally, the concept of defended subjects could help open up social scientists’ uneasiness to include emotions in

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research on social behaviour. The tendency to ignore emotions, as Andrew Finlay (1996: 92) has pointed out: “cannot be explained in terms of a failure to grasp their relevance to social life and behaviour; more likely it is rooted in the difficulties involved in researching them.” This study is an attempt to open up new possibilities to research on emotional dimensions of illness experience.

ACKNOWLEDGMENTS I wish to thank Kathy Charmaz, Peter Conrad, Marja-Liisa Honkasalo, Lauren E. Storck, and two anonymous reviewers for their helpful comments on earlier versions of this paper. An earlier version of this paper was presented at the Annual Meetings of the American Sociological Association, Washington, D.C., in August, 2000. This paper is based upon work supported by ASLA-Fulbright scholarship and the Academy of Finland.

NOTE 1. The interview has been translated from Finnish into English by the author. The interview is referred with pseudonyms only. The quotations have been further edited to make them easily accessible to the reader. Authorial deletions and insertions have been indicated with ellipsis and brackets, respectively, in the usual fashion.

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Department of Sociology Brandeis University Waltham, MA 02454-9110 USA