(1) PhD. Student, School of Advanced Studies of the Romanian Academy. Institute of Philosophy and Psychology “Constantin Rădulescu – Motru”, Romanian Academy, Romania, psychologist “I.C. Fundeni”
(2) UNATC “I.L.Caragiale” Bucharest, Theater Faculty, Romania, volunteer in the Pediatric Oncology Department, within the P.A.V.E.L. Association, e-mail: email@example.com
(3) Institute of Philosophy and Psychology “Constantin Rădulescu – Motru”, Romanian Academy, Romania, e-mail: firstname.lastname@example.org
Address correspondence to: Elisabeta Niță, School of Advanced Studies of the Romanian Academy, “Constantin Rădulescu-Motru” Institute of Philosophy and Psychology, Department of Psychology, Romanian Academy, 13 September Avenue, No.13, 5th District, Bucharest, 050711, Romania. Ph.: + 40-720-100- 692; Fax + 40-21-312-02-09; E-mail: email@example.com
Objectives. The objective of the study was to evaluate the psychomechanics of the words used by adolescents who were cancer patients, in the terminal stage of the disease, selected from their posts on social networks.
Material and methods. In the first part of 2021, the psychomechanics of the language of posts on social networks from 30 adolescents with terminal cancer was analyzed, using the method of phenomenology, which explores the nature or meaning of everyday experiences. It should be mention that, at the time of the research, all subjects were dead. The words in their last ten posts were classified according to their general lexical meaning and their morphological characteristics.
Results. The results of the study showed a 2:1 ratio in favour of the terms of positive emotion, compared to those of negative emotion. This shows that, with or without medical information about the severity of their illness, cancer teens focused on topics that helped them understand and value life, religion, and family, which consequently helped them reduce anxiety and depression regarding death or even the annulment of thoughts of extinction, even if their physical condition was in a visible and rapid degradation.
Conclusions. The evaluation of the psychomechanics of the language used in the supporting texts shows that the idea of death or its approach is not as traumatic as people generally expect, which has important implications for how adolescents and cancer patients are should be cared and approached when they are in the terminal stage of the disease.
Keywords: adolescents, cancer, language, semantic plethora, psychomechanics.
In the broad field of linguistic analysis, the psychomechanics of language is a research method, which identifies thinking operations, those stages that generate utterances, found in the speaker’s premental (Popescu, 2006, p.34) thus revealing the invisible part of language (Timoc-Bardy, 2021, p.2). The one who postulated this linguistic method is G. Guillaume (1969), who starts the analysis from the idea that, prior to the speech, a time is set aside for organizing the statement, in its elements related to operations where it is selected, depending on communication intention, verb tense, types of nouns (concrete, abstract), adjectives, grammatical categories of speech parts, etc.
The linguistic act is, in the theory of G. Guillaume’s psychomechanics, directed in 3 directions:
1.Basic vision (intention to communicate)
2.The mental decibel (through which intention becomes a concept)
3.The physical decibel (the concept is integrated, by logical reasoning, in concrete statements). (Popescu, 2006, p.132)
According to the developmental stage, adolescents gain independence, formulate their self-identity, strengthen their relationships, define their future role in life, school and social interactions that can cause physical and emotional changes. To cope with neoplastic disease, adolescents develop, over time, adaptive or maladaptive coping strategies, through which they manage their suffering and use resources to perform specific situational tasks (Bearison & Mulhern, 1994, p.42). The work with adolescents with cancer has stated that they face strong emotional stress, and the emotional coping skills they develop are based on the specific elements of the developmental stage, namely identity development, initiative in establishing relationships, independence in decision making (Coccia et al., 2018).
Terminal illness in adolescents is, for the specialists from the psychoeducational care team who work with them, an extremely difficult and contradictory challenge: they are dying, but by their nature and need for development they want to live. At the same time, they are worried about their lack of achievements, but they tell themselves that life goes on and they will have time to compensate for these momentary shortcomings. Although they think they should be immortal, they create extreme scenes, from which they generate tribulations and questions such as: how to say goodbye or how to communicate with the loved ones about their eventual disappearance, how to be remembered after death (or if they will be remembered after they die!), if they die in emotional isolation. These contradictions can become the sources of interventionist proposals from experts, including: communicating adolescents’ concerns and wishes, honest and open discussions about how they would like to be treated, cared for and supported during their illness and how they want to be remembered after death; through them some comfort can be brought in the stage of death (Wiener et al., 2012).
In recent years, the development of existence in the online environment has made social networks tools that most teens use to track the lives and interactions of celebrities, colleagues and strangers and to build an online identity and personal brand (Masanet, Márquez, Pires, & Lanzeni, 2020).
Material and methods
Through the method of phenomenology, which explores the nature or meaning of everyday experiences and through the psychomechanics of language, the last ten posts on social networks from 30 adolescents with terminal cancer (16 male and 14 female) were analyzed in 2021.
The common denominator identified in at least one text of each subject is the use of religious-themed terms, which can be explained by the fact that, in general, in the case of life-threatening diseases, patients build their own universe, where they bring all the sacred props it could be an adjunct to them. For example, most support themselves emotionally, gaining strength by listening to the sermons of well-known Romanian clergymen (Father Arsenie Boca, Father Calistrat), saying prayers or conveying nouns such as: church, icons, holiness of the saints, Happy Easter, Saint Nectarius, God by God, the interjection amen. The utterances have the structure of a dialogued monologue, organized, in the teenager’s premental, as messages full of sensitivity, through which he expresses his desires or gratitude to God:
“Lord, thank you for waking me up. Please bless this day” (M., girl, 17 years old)!
“God, I have so many Reasons to thank you”! (C., boy, 17 years old)
“Are you okay? Bless God, and good remains. Are you sick? Bless God, and evil goes. Christ said happy for the poor in spirit, moved me. God heals you” (M, girl, 18 years old).
They are recorded recurrently, especially in the girls’ texts and the religious proper nouns listed have an almost apotropaic force, being sine-qua-non for most adolescents during illness.
Also, although many of them were, at the dates when these messages are recorded on their pages on social networks, during very aggressive treatments, the morphological architecture of the texts proves the option for nouns with positive, relaxing semantics, such as: motorcycle, car, sports, football, gymnastics, pizza, walking, travel, barbecue, painting, music (music is the medicine of my soul– girl, 14 years old), film or for emotion-generating nouns, from the family or domestic spectrum, such as: mother, child, sister, (there is no better friend than sisters – girl, 10th grade), brother, nature, cat, health, natural remedies, heart, mother’s tears, advice or nouns from the semantic plethora of longing (moments, nostalgia, tear, memory, love, heart, boredom, suffering, picture). The tones of the last texts are moderately optimistic, camouflaging enough melancholic notes, a fact suggested by the recourse to existential nouns, such as life, purpose, travel, experience, life in words, to those that call natural elements, such as park, nature, rain, October. The lexical theme of the play is represented, according to the developmental stage of the adolescents, by the spectrum of terms: game, masks, park, joke. From a syntactic point of view, nouns appear in simple constructions, avoiding circumstantial complements and, implicitly, the combination of nouns with specialized prepositions. The intrinsic motivation of their choice for summary organizations derives from the purpose of the communication, mainly enunciative, ascertaining or assertive. To these it is added a series of qualifying adjectives, with neutral meanings, such as wonderful, obedient, special, the best, sincere, but also with emotional semantics, as humiliated, painful, ugly, cruel, the weakest, lost, healthy.
The pronominal clutches identified in the supporting texts are part of the class of personal pronouns (me, you), of possessive ones (mine: my new company / a hamster), which denotes a subjective perception on the disease, as an individual event. Although it is limitedly represented, the class of adverbs is realized by the units here- there, now- then, never, always, sometimes at once, which, as a status relations, subsumes the general opposite tendency, being consubstantial to the verb tenses (past-future), by which suggests the temporal delimitation, in the minds of the authors, of the moment of the disease from the previous one.
At a frustrating level, statements on existential themes, such as sentences, words of the spirit, contain approaches to generally valid truths or are ample or reduced findings of fact:
“How hard it should be, how painful it must be to fight for what it is important to you. In life, everything happens with a reason, the important thing is that you be strong and always keep your head up … up” (D., boy, 16 years old).
The same subject is marked by the message and his presence at chemotherapy sessions: again at treatment / ugly. However, an assessment, by quantitative reference to the general themes of the statements in the investigated posts, provides information that these contexts related to illness, hospital, failure, loneliness, suffering are however limited, with a tendency to avoid topics, and, therefore, their camouflage by word.
At the verbal level, intuitive morphogenesis cannot be far from the subsidiary theme of the moment in their lives, betraying the experience with maximum intensity of each stage of their patients’ lives. Thus, the verb to love is one of the most common, appearing either in declarative or descriptive contexts, related to family, especially mother or colleagues, such as:
“Happy birthday, my heart / I love you with all my soul! Happy birthday, my mom! I love you so much! I love you, mom, it will always be the best treatment! Every day I tell my mother “I love you” so that I will not regret that I did not succeed” (M., girl, 13 years old).
“I love my mother with her, I’m not afraid in the world” (N., boy, 15 years old).
“Today, please, Holy Mother, enter my house and leave your blessing on your loved ones. Amen!” (L., girl, 16 years old)
The verbal register is also marked by units with ascertaining meaning, such as: he helped me, he taught me, he doesn’t look, through verbs sentiendi, that I’m not afraid, to shout, to cry, I will regret, he moved, through modal operators and aspectual, as it should be, I began, with verbs of absolute gratitude, as thank you, I forgive you, with verbs with a medical theme, as treating, healing, verbs of involvement or attitude, as I did, I provoked. Exemplify, in this sign, with the following statements:
“God is the greatest listener / there is no need to shout or cry because He hears the weakest prayer of a sincere heart. One day I will return home and I will never leave again (last post, before his death- I., boy, 17 years old).
“I just saw you again and I already miss you. If only I could stop the time and those wonderful moments spent with you. But I’ve already been to the clinic for two days. But I feel I have to tell you that you are wonderful, to wish you health, many achievements and success in the new school year, as well as to thank the headmistress and the whole team of teachers and students. Good luck to everyone! With respect and nostalgia! I know I don’t thank you often but when I do I do it in style” (I., boy, 17 years old).
Having appeared used only once to express possession: “What a photogenic hamster I have”! (A, girl, 13 years old) and once again with ascertaining-declarative value: “I have an angel in this world: my mother”(N, boy, 16 years old). The verb to be copulative describes moods or appears in descriptive contexts: “Life is cruel, this is the childhood of a child with cancer”(A., girl, 17 years old). The initial aspect operator follows the architecture of a statement with deep meanings for the author, more precisely it refers to one of the individual preferences for end-of-life care, preferences that can be explored and accompanied by specific interventions: “Another obstacle follows … I hope to be the last this time” (I., girl, 16 years old). Where contexts are accompanied by suprasegmental elements, such as photographs, the authors use descriptive verbs, which have become centers of necessary sections: “I take a deep breath so as not to have a nervous breakdown and do something I will regret” (M., girl, 17 years old). Can be mentioned that the presence of negative verbal forms in the analyzed texts (does not exist, I did not leave you, there is no need, do not look, do not do, I will not receive, I was not, do not allow them, are not better, do not I succeeded, I don’t forget you) is an effective indicator targeting the personal psychological feelings of adolescents, converted under the plethora of units with neutral or optimistic meanings. In this hermeneutic and reading key, the psychoeducational care team think that the general optimistic or neutral language of the investigated statements is the effect of an intentional elaboration, highlighting the natural physical decibel; and this is because teenagers know that Facebook will certainly offer them readers, spectators, in front of whom they must seem preoccupied with something other than disease. Also, the lyrics of some songs reproduced in the teen posts are also relevant to the suspicion of double language: I was lost, fallen and humiliated / and I thought it was over for me / but a tender voice in my heart whispered / raised and walk / I’m with you / I didn’t leave you.
Given that that all the subjects whose last 10 posts were analyzed were known by the psychoeducational care team, being in the work teams in the hospital (in teaching-evaluation activities, artistic activities, recreational, etc., during the hospitalization having a manifestation positive towards their future), it can be considered that this is an almost general attitude towards disease and death, optimism being a present condition until the final moment, but also a coping strategy. It fully illustrates the meaning of the saying, hope dies last, coming from the myth of the Pandora’s box!
The contexts analyzed are short, they also contain playful and humorous elements, which, added to those that express anger, fear, body image, even the idea of death, demonstrate the hope and concern of adolescents with cancer to identify a meaning of their lives away from the hospital and disease.
In the recent literature (Pahl, Wieder, & Steinberg, 2021), it is pointed out that, in general, adolescent cancer patients report levels of social connection in accordance with the healthy norms of the adolescent population, and subgroups with tumors of the central nervous system, present a higher risk of social isolation; at the same time, a 2020 article (Bradford, Walker, Cashion, Henney, & Yates, 2020) reports unmet needs for information about the long-term effects of cancer and access to activities and environments that support patients’ well-being during treatment. In conclusion, future research needs to continue to focus on analyzing how the development, diversification of services and facilities can meet the needs of adolescents with cancer (Bradford et al., 2020). This is all the more necessary as, in adolescents with cancer, important issues in social interactions are issues related to personal privacy and controlled exchange of information, independence, identity formation, positivity.
Thus, a more comprehensive understanding of the psychosocial experiences of adolescents with cancer allows those who interact with them to provide more optimistic support (Nicole, Kirsty, Baken, & Bimler, 2021). The literature, scientific and unscientific, highlights that death is a possibility to open existence. And the thought of the moment of the end of life can be one of the efforts that allow existence to reach integrity. The fear of death is a fundamental part of the human experience, with adults fearing the inevitability of pain and suffering and worrying that they will face the end on their own. Even the fear of death suggests that existence escapes its individuality (Zohreh, 2015). In adolescents, although the thought of death can cause considerable anxiety, new research suggests that real emotional experiences of death are more positive and less negative than people expect (Goranson, Ritter, Waytz, Norton, & Gray, 2017), as evidenced by this analysis in the current study. The approach of cancer concepts by adolescents with cancer, focusing on immediate or prospective personal goals can, however, maximize the quality of time spent with family and friends (Ciobanu, Lisița, Bradu, Derevenco, & Gutium-Hîrcîială, 2017).
The statements investigated are the expression of a special elaboration, to be read by an audience, in front of which the adolescent remains the brand he built and it is believed that the approach of death does not annihilate in the mind of any subject, regardless of age, the hope of a miracle that would bring him back to his pre-illness existence.
The results of the study showed a 2:1 ratio in favour of the terms of positive emotion, compared to those of negative emotion. This shows that, with or without medical information about the severity of their illness, cancer teens focused on topics that helped them understand and value life, religion, and family, which helped reduce anxiety and depression regarding death or even the annulment of thoughts of extinction, even if their physical condition was in a visible and rapid degradation. From the evaluation of the psychomechanics of the language used in the supporting texts it results that the idea of death or its approach is not as traumatic as, in general, people expect.
The results of the study provide useful information for members of the care team in relation to the specific needs of the developmental stage of adolescents, namely the need for assertion, the need to belong, the desire for independence and individual manifestation, self-knowledge, development of emotional system. These findings can serve as elements with important implications for the way in which adolescents with cancer in the terminal stage of the disease are cared for and approached.
A summary of this paper was presented at the online international conference: Individual, family, society – contemporary challenges, fourth edition, 6 to 7 October 2021, Bucharest, Romania and published in the journal Studii şi Cercetări de Antropologie, No. 7/2021.
- Bearison, D. J., & Mulhern, R. K. (1994). Pediatric Psychooncology Psychological Perspectives on, Children with Cancer. New York: Oxford University Press, Inc.
- Bradford, N., Walker, R., Cashion, C., Henney, R., & Yates, P. (2020). Do specialist youth cancer services meet the physical, psychological and social needs of adolescents and young adults? A cross sectional study. European Journal of Oncology Nursing, 44 (101709). https://doi.org/10.1016/j.ejon.2019.101709.
- Ciobanu, O., Lisița, N., Bradu, A., Derevenco, C., & Gutium-Hîrcîială,D. (2017). Îngrijiri paliative la copil Protocol clinic național [Palliative care in children National clinical protocol]. Ministerul Sănătății al Republicii Moldova. [Ministry of Health of the Republic of Moldova]. Retrieved August 5, 2021 from http://188.8.131.52/_files/15437-PCN-279%2520IP%2520la%2520copil.pdf
- Coccia, P.F., Pappo, A. S., Beaupin, L., Borges, V.F., Borinstein, S.C., Chugh, R., … Shead, D.A. (2018). Adolescent and Young Adult Oncology, Version 2.2018, Clinical Practice Guidelines in Oncology, J Natl Compr Canc Netw, 16(1), 66–97. https://doi.org /10.6004/jnccn.2018.0001.
- Goranson, A., Ritter, R.S., Waytz, A., Norton, M.I., & Gray, K. (2017). Dying Is Unexpectedly Positive. Psychological Science, 28(7), 988-999. doi:1177/0956797617701186.
- Guillaume, G. (1969). Langage et science du langage. [Language and language science]. Paris: Nizet-Quebec. Presses de L Universite de Laval. ed. 2.
- Masanet, M. J., Márquez, I., Pires, F. & Lanzeni, D. (2020). Self-Exposure in Social Media: Teenagers’ Transmedia Practices and Skills for the Construction of a Personal Brand. In Innovation in Advertising and Branding Communication. London: Routledge.
- Nicole, C., Kirsty, R., Baken, D., & Bimler, D. (2021). The Psychosocial Interactions of Adolescent and Young Adult Cancer Survivors and the Possible Relationship With Their Development. Cancer Nursing 1/2, 44(1), E23-E33. doi: 10.1097/NCC.0000000000000732.
- Pahl, D. A., Wieder, M. S., & Steinberg, D. M. (2021). Social isolation and connection in adolescents with cancer and survivors of childhood cancer: A systematic review. Journal of Adolescence, 87, 15-27. https://doi.org/10.1016/j.adolescence.2020.12.010.
- Popescu, I. (2006). Timp și limbaj: introducere în lingvistica lui G. Guillaume [Time and language: introduction to the linguistics of G. Guillaume]. Iași: Institutul European.
- Timoc-Bardy, R. (2021). Gustave Guillaume in Romanian: Translation Problems. Studii de știință și cultură [Science and culture studies], 8(2).
- Wiener, L., Zadeh, S., Battles, H., Baird, K., Ballard, E., Osherow, J., & Pao, M. (2012). Allowing adolescents and young adults to plan their end-of-life care. Pediatrics, 130(5), 897–905. https://doi.org/10.1542/peds.2012-0663.
- Zohreh, S. (2015). Heidegger’s ideas about death, Pacific Science Review B, Humanities and Social Sciences. 1(2), 92-97. https://doi.org/10.1016/j.psrb.2016.06.001.