Emotional Implications Research Articles

The impact of surgical cancellations on children, families, and the health system in an Australian paediatric tertiary referral hospital.

Reasons for elective surgery cancelations and their impact vary from one institution to another. Cancelations have emotional and financial implications for patients and their families. Our service has a particularly broad and geographically diverse patient population; hence, we sought to examine these impacts in our service. We identified families with procedural cancelations and administered a telephone questionnaire. Survey items included the reason for and timing of cancelation, how the family was informed, the mode of transport and distance traveled to the hospital, associated leave from work, expenses, whether the child was required to fast, missed school, as well as the child's and parent's emotional responses to the cancelation, along with overall parental satisfaction with how the cancelation was handled. During our study period, a total of 7870 procedures were booked. 6734 (86%) of these were completed and 1136 (14%) were canceled, with 6% canceled on the day of surgery. In 750 (66%) of these cancelations, families were successfully contacted by telephone and agreed to participate. Of these 305 (41%) cancelations were family-initiated and 444 (59%) were hospital-initiated, with these hospital-initiated cancelations occurring closer to scheduled surgery. The most common cause of cancelation was that the child could not undergo the procedure due to illness (22%) or being unable attend the hospital (14%). The greatest disruption to families and children occurred when procedures were canceled late, particularly when the cancelation occurred on the day of the planned procedure.

Implications for Emotion: Using Anatomically Based Facial Coding to Compare Emoji Faces Across Platforms.

Emoji faces, which are ubiquitous in our everyday communication, are thought to resemble human faces and aid emotional communication. Yet, few studies examine whether emojis are perceived as a particular emotion and whether that perception changes based on rendering differences across electronic platforms. The current paper draws upon emotion theory to evaluate whether emoji faces depict anatomical differences that are proposed to differentiate human depictions of emotion (hereafter, “facial expressions”). We modified the existing Facial Action Coding System (FACS) (Ekman and Rosenberg, 1997) to apply to emoji faces. An equivalent “emoji FACS” rubric allowed us to evaluate two important questions: First, Anatomically, does the same emoji face “look” the same across platforms and versions? Second, Do emoji faces perceived as a particular emotion category resemble the proposed human facial expression for that emotion? To answer these questions, we compared the anatomically based codes for 31 emoji faces across three platforms and two version updates. We then compared those codes to the proposed human facial expression prototype for the emotion perceived within the emoji face. Overall, emoji faces across platforms and versions were not anatomically equivalent. Moreover, the majority of emoji faces did not conform to human facial expressions for an emotion, although the basic anatomical codes were shared among human and emoji faces. Some emotion categories were better predicted by the assortment of anatomical codes than others, with some individual differences among platforms. We discuss theories of emotion that help explain how emoji faces are perceived as an emotion, even when anatomical differences are not always consistent or specific to an emotion.

Screening all incoming travellers for COVID-19, What the world could learn from Qatar?

Background: There is a global spread of Corona Virus Disease (COVID-19) with Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) being identified as the causative organism. This pandemic has infected over 53 million people globally causing over 1.3 million deaths resulting in lockdowns being implemented across many countries in the world. Global travel has been severely restricted especially in the early phase with far reaching social, economic and emotional implications. In addition to local measures undertaken by each country to curtail the spread of the disease, many countries implemented entry restriction on flights to reduce the risk of importing the disease by potentially infected incoming travellers. The State of Qatar eased travel restrictions from 1st of September 2020 (Phase IV of reopening of pandemic restrictions) [1]. Incoming travellers from high risk countries had to have a mandatory COVID-19 Naso-Oropharyngeal swab negative result before boarding their flight to Qatar. Then they had to commit to two weeks of compulsory quarantine. Travellers from low risk countries had to be swabbed at Hamad international airport on arrival, followed by a week’s mandatory home quarantine. All travellers had to have COVID-19 RT-PCR nasooropharyngeal swab on day 6 after arrival in Qatar. Method: We looked at the data provided by Ministry of Public Health (MOPH), Qatar from 1st of September to 30th of November. This was retrospective observational study looking at the prevalence of COVID positivity of return travellers as compared to the total positive cases in the country [1]. Results: In our review, out of a total of 19,909 COVID-19 positive cases, 2692 were incoming travellers which amounts to about 14 % of total COVID positive cases in Qatar. It was also noted that with each passing day, the ratio of incoming traveller’s in comparison to the total cases have been increasing, with figures of 9% in September 2020 as compared to 21% in November 2020. Conclusion: This figure clearly shows how important it is to screen all return travellers for COVID-19 as travellers are generally asymptomatic and could potentially spread the disease in the local community. All countries should consider implementing similar policies to reduce the risks of importing COVID-19.

Emotional discourses in the courtroom: women’s empowerment work in honour-related trials

The article investigates emotional exchanges as manifestations of power through emotional body language. Subtle as well as obvious displays of emotion are related to the macro political renegotiation of power relations taking place out of court in light of the court case. The testimonies of women in trials investigating honour-related crimes include emotional displays of contempt, friendly intimacy, anger and resignation, each connecting to the sociology of emotions theories primarily of Clark, Katriel and Hochschild. These theories are in turn connected to the critical discourse analysis of Fairclough. When emotions are analysed through the lens of critical discourse analysis as social practices manifested through (body) language, it highlights the significance and implications of emotions as signifiers of change. The empirical study suggests that critical discourse analysis and emotions theories analysing (body) language are both theoretically and empirically interconnected. This lays theoretical as well as methodological foundations for future studies, addressing the connection between emotions, discourse and power.

Recomendaciones para la atención odontológica de niños con discapacidad y riesgo médico durante la pandemia COVID-19

En el marco de la actual situación mundial provocada por la pandemia de COVID-19 resulta imprescindible dedicar de forma prioritaria la atención a niños y adolescentes con discapacidad quienes se encuentran en una situación de vulnerabilidad al incluirse dentro de los grupos con mayor riesgo de complicaciones1,2. Las medidas de protección frente a la pandemia que se adopten en este grupo no sólo estarán destinadas a los niños sino a sus familias y cuidadores. El objetivo de este artículo es proporcionar recomendaciones y consideraciones para la atención odontológica de niños con discapacidad y con condiciones médicas de riesgo evaluando el impacto en la salud general y las implicancias emocionales y psicológicas que la pandemia tiene sobre ellos y sus familias y/o cuidadores.

Luz de apoyo

This essay explores the nature of light in terms of personal experience, but also its emotional, poetic, and philosophical implications. Even when Plato is not quoted, the myth of the cave is implicitly discussed, in terms of the meaning of light as that which literally illuminates and creates belonging and, at the same time, also produces shadows, which are not —in this essay— the pale reflection of reality, but rather the unique and ephemeral traces of a true exercise of memory.

Reading Hoda Hadadi in Tehran: The Implicit Articulation of Lesbian Identity in Iranian Children’s Literature

Reading Hoda Hadadi in Tehran: The Implicit Articulation of Lesbian Identity in Iranian Children’s Literature Massih Zekavat (bio) Sexuality in its full diversity has been expressed in Iranian lore and literature both explicitly and implicitly (Alfiyah and Shalfiyah, Astarābādī, Floor, Khānsārī, Najmabadi, Nakhshabī, Shamisa). Yet, as the modern notion of childhood and children’s literature emerged at roughly the same time as the heterosexual/homosexual divide consolidated, sexuality also receded from Iranian children’s literature.1 Besides religious considerations, censorship is another important reason. Publications are subject to censorship both before and after their release in Iran. For a book to be published, the manuscript must be licensed by the Ministry of Culture and Islamic Guidance, which often involves demands for modifications to ensure compliance with the law and sharia, yet this does not immunize the author and publisher against further liability in case authorities later find traces of transgression even in a licensed publication that might lead to a ban on the book and potential punishment for the parties involved. While unashamedly and avowedly heteronormative, Iranian children’s literature frequently attempts to eschew sexuality. Nonetheless, we seem to have both a pattern of slow emergence in the face of hostility and heteronormativity (as in the West in the 1960s) and a particularly pronounced version of those things due to religious beliefs and the political situation in Iran. Examples of this slow emergence include Azadeh Mohseni’s title story in Born in the Owl Month, Nooshin Zargari in Woody, and, in particular, Hoda Hadadi in children’s and young adult literature. Hadadi, writer, poet, and illustrator, was born in 1977 in Tehran. She has so far created almost sixty titles as author, illustrator, and author/illustrator and has won several distinctions and awards. Her books My Day with the Clouds, Deep in the Sahara (written by Kelly Cunnane and illustrated by Hadadi), Drummer Girl (with Hiba Masood), and Rainbow in My Pocket (written by Ali Seidabadi and illustrated by Hadadi) are available in English.2 [End Page 283] Responding to Caitlin L. Ryan and Jill M. Hermann-Wilmarth’s call for queer readings of the works that are already on the shelf in hopes of advocating diversity and inclusiveness, I argue that Hadadi repudiates heteropatriarchy and subtly depicts an alternative paradigm of lesbian rapport in three of her books. Specifically, in her picturebook Goli and Zebra (2007) Hadadi censures the institution of heterosexual marriage, and in her young adult novel The Clown (2012/2013) she explores the joys of a homosocial bonding of characters in an unsympathetic and repressive context. Hadadi further depicts the jouissance of a lesbian rapport in her picturebook Two Friends through drawing on nature, investigating the philosophical, emotional, and ethical implications of lesbian sexual performance and creating a dialogic, rather than imitative, relationship between the text and illustrations. Taken together, these moves demonstrate a daring transgression that is even more impressive in an Islamic context where male homosexual practices are still subject to corporal punishment or even execution, and lesbianism is almost inconceivable. These three books fit different categories and genres and use different modes of expression. Their intended readers and arguably their social functions are also different. Hadadi starts with criticizing heteropatriarchy and exposing the devastating effects of a heterosexual marriage for women in her animal fable Goli and Zebra, where marriage does not lead to the realization of the protagonist’s self and her dreams. Her realist novel The Clown uses meticulous characterization and a socially located setting to offer a more pragmatic attitude to exploring resistance at a social level. Meanwhile, the picturebook Two Friends features unnamed protagonists in a natural setting not bound by time or place; it adopts an open-ended, psychological and individual perspective in order to address fundamental and philosophical questions. Reading these works together, I argue, sheds light on Hadadi’s revisionary project through which she attempts to break with the tradition, open a space for and give voice to the peripheries, and destabilize the ideology propagated by the repressive regime. The supposed asexual nature of children and the necessity of guarding their innocence postponed homosexual representations in children’s literature. At...

Emotional and Physical Health Impact in Children and Adolescents and Their Caregivers Using Open-Source Automated Insulin Delivery: Qualitative Analysis of Lived Experiences

Background: Given the limitations in access and license status of commercially developed automated insulin delivery (AID) systems, open-source AID systems are becoming increasingly popular amongst people with diabetes, including children and adolescents. This study focused on lived experiences, physical and emotional health implications of children and their caregivers following the initiation of open-source AID, their perceived challenges, and sources of support, which have not been explored by the existing literature. Methods: Qualitative data were collected through two sets of open-ended questions of a web-based multinational study survey from 60 caregivers of children with diabetes from 16 countries. The narratives were thematically analysed and a coding framework was identified through an iterative process after the alignment discussions among three coders. Results: A range of emotions, improvements of quality of life and physical health were reported as open-source AID enabled the families to shift their focus away from diabetes therapy. Caregivers were less worried about hypoglycaemia at night-time and outside of their family home, leading to increased autonomy for the child. Simultaneously, glycaemic outcomes and sleep quality of both child and caregiver improved. Nonetheless, the acquisition of suitable hardware and technical set-up could be challenging. The #WeAreNotWaiting community was the primary source of practical but also emotional support. Conclusion: Our findings show the benefits and transformative impact open-source AID and peer-support have on children with diabetes, their caregivers, and families, where commercial AID systems are not available or suitable. Further efforts are required to improve effectiveness, usability, and facilitate access for children with diabetes worldwide to benefit from this innovative treatment. Funding: European Commission (H2020-MSCA-RISE-2018), Berlin Institute of Health Digital Clinician Scientist and SPOKES Wellcome Trust Translational Partnership Program. Declaration of Interest: KB received fees for medical consulting and public speaking from Roche Diabetes Care, Dexcom, Medtronic Diabetes, Diabeloop, Novo Nordisk, Sanofi Diabetes and BCG Digital Ventures; outside the submitted work. KR received fees for medical consulting and public speaking from Dexcom, Abbott, Lilly Diabetes Care, Novo Nordisk (Germany) and Springer Healthcare UK; outside the submitted work. All other authors have nothing to disclose. Ethical Approval: Ethical approval was provided by Charite – Universitatsmedizin Berlin (EA2/140/18).

COVID-19 and neurologic Complications in Elderly patients

The COVID-19 pandemic continues to prevail as a catastrophic wave infecting over 111 million people globally, claiming 2. 4 million lives to date. Aged individuals are particularly vulnerable to this disease due to their fraility, immune dysfunction, and higher rates of medical comorbidities, among other causes. Apart from the primary respiratory illness, this virus is known to cause multi-organ dysfunction including renal, cardiac, and neurologic injuries, particularly in the criticallyill cohorts. Elderly patients 65 years of age or older are known to have more severe systemic disease and higher rates of neurologic complications. Treatment of neurologic dysfunction of COVID-19 is based on existing practice standards of specific neurologic condition in conjunction with systemic treatment of the viral illness. The physical, emotional, psychological, and financial implications of the COVID-19 pandemic have been severe. Long-term data are still needed to understand the lasting effects of this devastating pandemic.

Implications of False Positive SARS-CoV-2 by PCR Test in the Health Care Work Force

The novel nature of the SARS-CoV-2 virus inherently creates a paucity of reliable and validated data. Implementing evidence-based and data-driven protocols have been exceedingly difficult. As new information is released and integrated into the complex system, the health care delivery workflow must adapt. Incorporating changes on a frequent, if not daily basis, has led to confusion, frustration and loss of confidence among clinicians across the nation. This report illustrates the negative impact that false-positive COVID-19 results can have on the health delivery workforce and the emotional implications that false-positive results cast on health care providers.

Adult Hearing Loss: Applying the Five Models of Osteopathic Medicine to Diagnose and Treat

Hearing loss is a common complaint with extensive cognitive, physical, emotional, social and financial implications. Many adults are expected to present with varying degrees of hearing loss by the age of 60 to 69 years old that can be classified according to the cause into conductive, sensorineural and mixed. There can be associated symptoms, like tinnitus, vertigo and otalgia and/or abnormal behaviors such as social withdrawal and difficulty with interpersonal communication. Somatic dysfunctions can accompany hearing troubles and range from fluid problems such as fluids accumulation in the middle ear, lymphatic congestion of the head and neck, and structural dysfunctions in the eustachian tube, neck musculature, thoracic spine, ribs and the cranial rhythmic impulse in addition to other neurologic dysfunctions such as sympathetic hyperactivity and viscerosomatic changes. In this review, we provide several suggestions that may assist the osteopathic family physician in identifying the various causes behind the hearing loss, especially life-threatening or quality-of-life limiting causes. We will also provide an effective treatment addressing the cause of the hearing loss presentation and associated somatic dysfunctions, alone or in conjunction with other appropriately trained health care providers, based on the understanding of the five models of osteopathic medicine and how they can apply toward the anatomical and physiological components of adult hearing loss.

Clinical presentations and patterns of neuro-developmental disorders in a health facility in Ghana: implications for the health and educational sectors

Background: Neurodevelopmental disorders (NDD) are a heterogeneous group of disorders with life-long implications for cognition, behaviour, emotions, academic performance, social well-being, and future career. Early identification and interventions yield a better outcome. Yet, there is a gap in knowledge about the range of NDD that exists in Ghana among laypersons, health, and education professionals. Objective: This study examined the clinical presentations and patterns of NDD in a clinical psychological clinic of a quasi-governmental hospital in Ghana. Methods: Using a retrospective chart review design, secondary data were extracted from eligible psychological reports of children managed at the clinic from January 2012 to December 2018. Results: Most children(62.96%, n = 85/135)were aged 6-13 yr. at the time of establishing a diagnosis. They had been referred from private schools (49.62%, n = 67/135) because they were doing poorly academically (38.51%, n = 52/135) or exhibited some behavioural problems (22.22%, n = 30/135). Most of them had been born at term by spontaneous delivery (58.51%, n= 79/135) but went through traumatic delivery and suffered perinatal complications (32.6%). There was a significant association between birth asphyxia and labour complications (p <0.0001), gestational age (p< 0.008), mode of delivery (p < 0.016), and cerebral palsy (p< 0.018). Almost forty percent had comorbid neurodevelopmental disorders. Conclusion: Findings from this study have implications in the prevention and early identification of NDDs. Parental education must be intensified during antenatal care and childhood educators must be trained to identify NDDs to enable early referral for diagnosis and intervention.

Os modos tradicionais de dizer dos séculos XIX e XX: uma análise de cartas pessoais de pernambucanos

Ao investigarmos os diferentes modos tradicionais de dizer presentes em 80 cartas pessoais (subgêneros cartas de amigo e cartas de família) de pernambucanos do século XIX e XX, objetivamos verificar quais marcas composicionais estão presentes nas missivas e como as formas recorrentes de dizer contribuem para uma maior ou menor implicação emocional das expressões e, também, o que isso, consequentemente, nos traz de evidência acerca do grau de proximidade/distância comunicativa a partir da observação das relações de poder (hierárquicas) ou igualitárias presentes (BROWN; GILMAN, 1960). Para isso, adotamos o modelo de abordagem das Tradições Discursivas (TD) (KOCH; OESTERREICHER; 2006; KABATEK, 2006), a fim de percebermos quais marcas pragmático-discursivas são evocadas no gênero carta pessoal. Os resultados nos mostram que o uso de expressões recorrentes da carta pessoal se apresentou nos dois subgêneros da missiva e nos dois séculos e que esse uso oscila e é atualizado de missivista para missivista, dependendo de com quem se fala, do objetivo da carta e da assimetria ou simetria no relacionamento construído entre os correspondentes.

Untangling insurance, rebuilding, and wellbeing in bushfire recovery

AbstractHome and contents insurance is framed as key to Australia's national strategy for disaster resilience. Despite the perceived importance of financial indemnity, ambiguity characterises the ways in which it facilitates both short‐ and long‐term everyday household recovery when disaster strikes. Addressing such ambiguity, this article explores how insurance impacts upon households' capacities to rebuild and recover after disastrous bushfire. In‐depth interviews conducted with residents in the Blue Mountains of New South Wales four years after they were affected by the October 2013 bushfires show that insurance was fundamental to recovery. Swift claims handling and payouts allowed participants to access rental accommodation, material necessities, and sufficient finances to repair, rebuild, and refurnish their houses—essentials in restoring everyday routines and a sense of normalcy. Yet, many people were underinsured and used alternative strategies to stretch “adequate” insurance coverage, which had practical and emotional implications. Importantly, while insurance reduced post‐disaster stress and trauma, the length and depth of recovery were more closely determined by the impacts of personal and situational circumstances than by insurance. On that basis, analysis points to the conclusion that while insurance is a crucial tool for disaster resilience, greater levels of psychosocial support are needed to improve households' short‐ and longer‐term recovery.

Overview on current approach on recurrent miscarriage and threatened miscarriage

Miscarriage is a frequent outcome of pregnancy, with major emotional implications to the couple experiencing such an event. Threatened miscarriage is the commonest complication of early pregnancy and affects about 20% of pregnancies. It presents with vaginal bleeding with or without abdominal cramps. On the other hand recurrent miscarriages are post implantation failures in natural conception. Increasing age of women, smoking, obesity or polycystic ovary syndrome (PCOS) and a previous history of miscarriage are risk factors for threatened miscarriage. The pathophysiology has been associated with changes in levels of cytokines or maternal immune dysfunction. Clinical history and examination, maternal serum biochemistry and ultrasound findings are important to determine the treatment options and provide valuable information for the prognosis. Many surgical and non-surgical interventions are used in the management of threatened and recurrent miscarriages. In this review, we present available evidence-based guidance on the incidence, pathophysiology, investigation and clinical management of recurrent miscarriage and threatened miscarriage, focusing mainly on the first trimester of pregnancy and primary healthcare settings. The review is structured to be clinically relevant. We have critically appraised the evidence to produce a concise answer for clinical practice.

Both sides of the story: Narratives of romantic infidelity

AbstractWe applied a narrative identity approach to the study of romantic infidelity. In Study 1, participants provided narratives of the moment they discovered their partners' infidelity. In Study 2, participants were prompted for narratives of their unfaithful actions. In both studies, measures of personality traits, forgiveness, empathy, and self‐esteem were administered. Narratives were coded for themes of redemption (bad beginnings, positive endings) and exploration (engaging with the experience's emotional implications). After controlling for relevant covariates (e.g., story length), participants who formed redemptive stories of their partner's infidelity evinced higher levels of forgiveness and lower levels of empathy (Study 1), whereas participants who disclosed redemptive stories about their own infidelity demonstrated decreased forgiveness (Study 2). Across studies, exploratory narratives corresponded positively with conscientiousness.

"Compassion Fatigue" is a Misnomer: How Compassion Can Increase Quality of Life.

Health-care workers are at risk of experiencing negative consequences for their own health and job performance due to a wide variety of stressors. Care providers suffer from varying expressions of a generalized symptom set that has been termed "burnout" or "compassion fatigue." These terms can help us understand the phenomenon that is happening in our health system, but a strong understanding of the physical, mental, emotional, and psychological implications will increase the efficacy of treatment and benefit of preventive care. This article asserts that the term "compassion fatigue" is a misnomer, resulting in a misunderstanding of the causes and effects of compassion on the individual. This article challenges the term, positing that it has become outdated based on what we now know about the neuroscience of compassion, empathy, and mindfulness. Instead, this discussion offers the relevance of the term "empathic distress leading to empathic distress fatigue," suggesting that contemplative practice, mindfulness, and compassion training can protect and empower health-care providers.

Trying to motivate employees through intimidation? Think again

PurposeThis study advances our knowledge about counternormative emotion management processes utilized in organizations. We investigate a research model in which managerial intimidation, and more specifically subordinates' perceptions about it, evokes fear, which reduces their job satisfaction and increases their turnover intentions.Design/methodology/approachThe model was tested using two samples, one from the public sector and the other from the private sector. The data were collected in three waves using questionnaires.FindingsOur findings validated the research model in the public sector alone, revealing sectorial differences regarding the destructive emotional and attitudinal implications of perceived managerial intimidation.Originality/valueThe current study sheds light on counternormative emotion management processes utilized in organizations, a topic we know little about. Furthermore, it advances our knowledge regarding the responses of the targets of impression management attempts, revealing sectorial differences about them. Finally, this study broadens our understanding about intimidation, an under-investigated impression management strategy.

"It Got Likes, But I Don't Think People Understood": A Qualitative Study of Adolescent Experiences Discussing Type 1 Diabetes on Social Media.

The majority of adolescents with type 1 diabetes (T1D) integrate social media engagement into their daily lives. The aim of this study was to explore adolescents' experiences and perspectives discussing their T1D on social media. Semi-structured interviews with adolescents with T1D were conducted in person and via telephone. Questions focused on the participant's experiences utilizing social media to discuss T1D and factors that informed the nature of T1D-related social media engagement. Open coding and thematic content analysis were used to identify emergent themes that aligned with accepted domains of social media affordances. Participants included 35 adolescents with T1D. Adolescents' experiences related to discussing T1D on social media aligned with four affordances of social media: identity, cognitive, emotional, and social. The identity affordances of social media platforms allowed adolescents to curate online personas that selectively included their diagnosis of T1D, while managing the potential negative emotional and social implications linked to the stigma of T1D. Adolescents who decided to discuss T1D on social media leveraged cognitive affordances by providing and receiving diabetes management advice, emotional affordances by obtaining affirmation from peers, and social affordances by extending their network to include other individuals with T1D. Adolescents with T1D flexibly leverage the affordances offered by social media to access emotional support, information, and identity affirmation resources while navigating stigma-based social consequences. Our findings highlight the value of developing tools to support adolescents with T1D in comfortably discussing and receiving appropriate support about T1D on social media.

A British South Asian Muslim relational negotiation of divorce: uncoupling beyond the couple

Through analysis of the narratives of one British South Asian Muslim woman contemplating divorce, this article explores how the termination of marriage is negotiated within families. The article charts the involvement and emotional implication of multiple family members in the decision at multiple levels: the interpersonal, via their involvement as sounding boards, advisers and mediators, and the intersubjective, as people’s sense of their own internal will or resolve to divorce is dialogical and unstably tied to others’ expressed views. The negotiation of divorce is an agentic intervention in the reordering of relationships and sheds light on wider processes linking agency, culture and belief. While these multiple levels of the relational negotiation of divorce may be particularly piqued in South Asian contexts, there are wider implications for sociology as, in contrast with individualisation theory, uncoupling is shown to involve more than the feelings and choices of just the husband and wife.