The unsayable: a concept analysis

Abstract

Although literature on the unsayable has been developed primarily outside the discipline of nursing, exploration of the concept within nursing may assist nurses to consider situations and experiences that are challenging, elusive, and perhaps impossible for patients to language while living amid illness.

Uncertainty

“…Not all uncertainties were fully voiced by parents to HCPs. Schick Makaroff’s (2013) concept analysis of the unsayable has potential utility in understanding parents not saying the word ‘autism’, despite these fears being alluded to during interviews. The concept of the unsayable is well recognized in psychology and its antecedents may include factors that make something unsayable because it cannot be defined or articulated, or the topic may be too sensitive, undesirable or painful.…”

“…The concept of the unsayable is well recognized in psychology and its antecedents may include factors that make something unsayable because it cannot be defined or articulated, or the topic may be too sensitive, undesirable or painful. According to Schick Makaroff (2013: 488), whilst psychologists focus on analysis of the unsayable it is more appropriate for nurses to be present for patients during illness and suffering and bear witness to ‘support them during these times of uncertainty’. In the context of child growth and development, nurses need to ensure that they are not dismissive of parents’ fears and instead facilitate understanding and teasing out the uncertainty they may be experiencing.…”

Stories of chronic kidney disease: listening for the unsayable

“…Other embodied experiences that were difficult to language were linked to suffering, such as physical pain or near‐death experiences. In the literature on the unsayable, suffering can be seen as an antecedent to the phenomenon of the unsayable (Schick Makaroff ). Similarly, others have found the unsayable in illness, pain (Mitchell ), near‐death experiences (Rominger ) and even unsafe events in hospitals (Schwappach ).…”

“…It is easy to forget that not all experiences can be fully expressed in language. The unsayable was defined in a concept analysis as ‘that which is not expressed yet alluded to through language and may be conscious or unconscious’ (Schick Makaroff , p. 485). Although unsayable aspects of experience are universally intrinsic in life (such as birth, pain, or suffering), the unsayable has not yet been examined as a phenomenon in nursing research.…”

Might Informal Carers of Adults With Enduring Suicidality Experience Anticipatory Loss?

“…However, as the current lexicon in suicide prevention policy and practice pertains increasingly to the aspiration for zero suicide (Mokkenstorm et al, 2017), open contemplation of anticipatory loss by suicide may be misconstrued as contrary to this ambition and indicative of an unacceptable attitude of inevitability. Such a misinterpretation might stymie professional curiosity and carer disclosure, thus making the concept “unsayable.” Schick Makaroff (2012) suggests that an overemphasis on the sayable (e.g., zero suicide) can marginalize the unsayable (e.g., anticipatory loss) and leave it unexamined. To render anticipatory loss in the milieu of suicidality as unsayable would be at odds with the need to talk openly about suicide and associated thoughts and feelings.…”