To share vulnerability is to show strength: A discursive study of self-disclosure by Chinese cancer patients on short-form video platforms

Abstract

The widely-used social media have offered Chinese cancer patients online sites for self-disclosure. Collecting self-disclosing discourses from 200 Chinese cancer patients on TikTok and SnackVideo, this study systematically analyzes the discursive strategies employed by Chinese cancer patients and their emotions expressed during self-disclosure, with the help of NVivo 12 and LIWC 2015. As a result, it is found that: (1) Chinese cancer patients display self-disclosure oriented toward facts, relationships, desires, and experiences discursively; (2) Chinese cancer patients showed a higher proportion of positive emotions than negative emotions, with female patients being more conservative and stable than their male counterparts when disclosing positive emotions. To some extent, the findings above would shed insights into the provision of psychologically inclusive support for the cancer patients in Chinese culture and beyond.

Keywords

Cancer patients Chinese emotions discursive strategies self-disclosure

Introduction

Coping with cancer is a constant challenge for a patient in terms of his or her physical condition as well as psychological well-being, where self-disclosure serves as an outlet for such a challenge (Cohen and Wills, 1985; Pawelczyk and Erskine, 2008). As self-disclosure is defined as the sharing of one’s inner feelings, a huge body of research in the field of psychology and discourse analysis has witnessed consistent and positive correlations between self-disclosure and the outcomes of stress relief and emotional improvement (Jaworska and Ryan, 2018; Malloch and Taylor, 2018; Masur, 2019). However, unlike patients in other cultures, most Chinese patients who suffer from severe emotional distress during cancer treatment are reluctant to disclose their feelings offline for the sake of face or privacy (Zhang et al., 2018; Zhang and Hou, 2022). Thanks to the anonymity, convenience, and popularity of social media, there is a silver lining for cancer patients as social media allow them to demonstrate self-disclosure with strangers, that is, sharing their feelings and experiences to gain comfort and support by releasing posts or videos (Wright, 2016). While the existing literature on the posts focused mainly on discursive features and emotional veins of the patients’ self-disclosure in the written form (Jaworska and Ryan, 2018; Malloch and Taylor, 2018), some studies on videos aim to detect more subtle psychosocial states of patients through the cultural cues in their oral discourse (Benfilali et al., 2021; Zhang and Hou, 2022). One finding that is of special relevance to the present study is Zhang and Hou’s (2022) discovery of the emotional and cultural cues in the discourse of self-disclosure in online videos delivered by Chinese cancer patients. However, there is still a huge space for research on short videos for discourse analysis directed toward more disadvantaged groups, that is, Chinese patients of two genders. Considering this, the present study examines the discursive strategies and the emotional dispositions underlying self-disclosure in online videos by Chinese cancer patients of two genders. In this sense, the paper is intended to map out the self-disclosing strategies employed by Chinese cancer patients while providing some insights into the emotional support to cancer patients in health communication.

Literature review

Self-disclosure

Self-disclosure is a speech act of sharing one’s feelings with others sincerely (Jourard, 1971). Derlega and Grzelak (1979) argued that self-disclosure was strategic because of its goal-orientedness, and they teased out five functions of self-disclosure: self-expression, social confirmation, identity clarification, relationship development, and social control. Focusing on its emotional and social functions, cancer patients rely on self-disclosure, that is, the narratives of sincerely sharing one’s feelings about the disease, to relieve their stress and gain social support in cyberspace (Masur, 2019), which has served as the departure point for many ensuing studies.

For instance, an important line of research on patients’ online self-disclosure is the analysis of language and discourse in the posts and videos. Malloch and Taylor (2018) rendered a computerized linguistic analysis of the discursive features and the emotional veins of self-disclosure in online support groups regarding different stages of breast cancer, using Linguistic Inquiry and Word Count (LIWC) 2015 (Pennebaker et al., 2015). Based on the finding that emotional self-disclosure was ‘constant across cancer stages’, Malloch and Taylor (2018: 768–769) concluded that self-disclosure by patients was theme-oriented, echoing the ‘goal-orientedness’ in the findings of Derlega and Grzelak (1979). The emotional self-disclosure of patients was related to various thematic words, including cognitive words, biological words, affect words, death words, and social words, in which ‘social connections were one of the most common issues that breast cancer patients express their feelings about in online support groups’ (Malloch and Taylor, 2018: 770).

Similarly, Jaworska and Ryan (2018) provided a corpus-based discourse analysis of the patients’ narratives, focusing particularly on the difference in frequency and collocation of pain-related words used by the two genders. Along this vein, the gender difference in patients’ self-disclosure can be seen from lots of themes including ‘physical actions’, ‘mental actions’, ‘affective qualities’, ‘people’, and so on (Jaworska and Ryan, 2018: 111–113). Most importantly, it is found that there are significant quantitative and qualitative differences between women and men in terms of their disclosing ways: women disclose pain ‘more frequently’ with ‘a wider lexical repertoire’ including ‘more specific and factual references as well as cognitive and psychological words’, while men disclose ‘fewer descriptors’, most of which are ‘highly emotive’ (Jaworska and Ryan, 2018: 107). These findings seem to be contrary to the findings that females tended to be more emotive than males in general (Kring and Gordon, 1998), which indicates that gender differences in patients’ self-disclosure may challenge our knowledge (Jaworska and Ryan, 2018).

In the Chinese context, Zhang and Hou (2022) studied the discourse analysis of Chinese patients’ self-disclosure in online videos. Based on narrative therapy theory, Zhang and Hou (2022) investigated the themes and emotional changes in cancer disclosure by Chinese patients online. To figure out the thematic concentration, based on Corbin and Strauss’s (2015) ‘three major types of coding’ of grounded theory, they pointed out that the theme of Chinese patient disclosure could be summarized into five categories: ‘emotional attitude’, ‘daily life’, ‘disease status’, ‘treatment experience’, and ‘knowledge sharing’ (Zhang and Hou, 2022: 108). Later, they also did an emotional analysis of patients’ disclosure by Gooseeker, finding that patients’ positive emotions in the disclosure are greater than the negative emotions in the middle and later stages of cancer (Zhang and Hou, 2022). This pioneering study helps to enlighten the present study about how the emotional state of patients would be discursively constructed in the early stage of cancer.

From the review above, it is clear that the existing research has done a lot on theme-orientedness and emotional veins in online self-disclosure by patients, but Zhang and Hou (2022) appears to have been the only study touching on both the emotional and cultural cues of Chinese patients’ self-disclosure, leaving space for the further exploration based on gender factors. Besides, it is evidenced that ‘gender-based differences permeate the conversational styles of both men and women across cultures and with divergent degrees of strength and expression’ (Benfilali et al., 2021: 13; Jaworska and Ryan, 2018). Therefore, drawing on the gender differences on this issue, discursive and emotional analysis on self-disclosure in online videos is pinpointed as an issue that is worth further investigation, especially those that take the perspective of cultural discourse studies.

Cultural discourse studies

Cultural discourse studies (CDS) is the study of speech acts from a cultural perspective, which requires ‘a culturally conscious and critical mode of doing discourse research’ (Shi, 2012: 492). Based on the vision of local (‘culture-specific needs and perspectives’) and global awareness (‘culturally diverse perspectives and human concerns’), CDS also values exchanges with ‘relevant international scholarly traditions in terms of concepts, theories, methods, terms, etc.’ (Shi, 2012: 493). For instance, regarding discourse as the product of interaction against the social and cultural context, Brown and Yule (1983: 1) believe that discourse has twofold functions: ‘that function which language serves in the expression of “content” we will describe as transactional, and that function involved in expressing social relations and personal attitudes we will describe as interactional’. Along the same vein, van Dijk (1988: 31–32) advocates paying attention to the macro-propositions and macro-structures in discourse, holding that ‘propositions are the smallest, independent meaning constructs of language and thought’ and ‘macro-structures are organized sets of propositions’. The propositions in the macro-structures are called ‘macro-propositions’ (van Dijk, 1988: 32), which are not the result of simple addition of propositions, but recursion of propositions according to the hierarchical sequence. This means that macro-propositions at the highest level obtained by recursion are themes – the most important, central, and dominant concept of discourse (van Dijk, 1988: 32–33). As such, CDS sheds light on both the ‘theme-orientedness’ and sociocultural cues in relevant medical discourse studies (Jaworska and Ryan, 2018; Malloch and Taylor, 2018; Zhang and Hou, 2022).

Also, as indicated by relevant discourse studies, cultural psychology, designed ‘ultimately to help understand and guide cultural practice’ (Shi et al., 2016: 33), has become a very critical branch of CDS (Shi and Feng, 2013). As Gallois et al. (2021: 44–46) commented, there has been ‘a stronger emphasis on emotional language and words, as well as the inter-group focus (especially on gender)’. As a result, a bunch of methods of studying emotion emerged from the perspectives of physiology, behaviors, content, and concept analysis as well as experience sampling (Gallois et al., 2021). Compared with the effectiveness of the other three methods in detecting emotions of non-verbal studies, content and concept analysis methods have made ‘great strides’ in ‘the automated analysis of the text’ (Gallois et al., 2021: 47). Besides the analysis-nuanced but labor-intensive software like NVivo, there are two main approaches for emotional analysis of this method: ‘machine learning’ and ‘lexicon-based’ analysis (Liu and Lei, 2018: 145). Admittedly, ‘cultural psychological and discursive properties are dialectical’ (Shi et al., 2016: 33). Machine learning approaches can more accurately serve the emotional analysis ‘for specific purposes and contexts’ (Liu and Lei, 2018: 3), but in the absence of readily available labeled data, lexicon-based approaches like Wordsmith, word cloud, Leximancer, and LIWC can better highlight the psychological and social variables of multi-thematic discourse as a whole (Gallois et al., 2021). As such, lexicon-based analysis is frequently used for detecting emotional dispositions in CDS of patients’ self-disclosure.

Methodology

Research questions

Drawing both thematically and methodologically on the implications of discursive and psychological properties of patients’ self-disclosure in previous research, the present study chooses to explore this issue further by focusing on the discursive strategies and emotional dispositions of self-disclosure by Chinese cancer patients of two genders. Thus, the following research questions will be explored:

1) What discursive strategies are employed by the Chinese cancer patients of two genders during self-disclosure?

2) How do emotions perform discursively by the Chinese cancer patients of two genders through self-disclosure?

Data collection

The data used in this study were retrieved from the Chinese version of TikTok and SnackVideo, which are two of the most popular Chinese short video platforms (Zhang, 2020). To collect the data, we first searched for the keywords ‘癌症 (ai zheng, cancer)’ and ‘抗癌 (kang ai, anti-cancer)’ in the searching interface of both TikTok and SnackVideo, and then pinpointed 200 Chinese cancer patients (100 women and 100 men) as targets according to three criteria: (1) nationality, that is, pinpointing Chinese users according to their video locations and ethnic characteristics; (2) authenticity, that is, ensuring that the video published by the targeted user is about his or her own personal cancer experiences; (3) continuity, that is, ensuring that the videos in each patient’s home page have a continuous release of the personal cancer experiences.

Besides, patients may experience a collapse during the diagnosis period, which indicates greater fluctuations in their discourse and emotions (Zhang and Hou, 2022). Therefore, the present study chose to collect one self-disclosure video which was closest to the time of cancer diagnosis from each patient’s home page, with an attempt to complement the study of Zhang and Hou (2022). In this way, 200 self-disclosure videos about 13 kinds of cancer were collected as the corpus of this study, including breast cancer, liver cancer, nasopharyngeal carcinoma, gastric cancer, lung cancer, ovarian cancer, cervical cancer, colon cancer, lymph node cancer, gallbladder cancer, eye cancer, rectal cancer, and pancreatic cancer.

Finally, it is worth mentioning that our decision to use a total of 200 patients each with one video (n = 200 video clips about 150 minutes overall) rather than more and fewer videos was admittedly random in a sense, but we believe that 200 is the appropriate number as it is an even number that allows better comparison of gender differences. Moreover, it is not too small to leave out some truly important cues but not too large to increase the labor burden of the research meaninglessly according to the prior studies (Jaworska and Ryan, 2018; Malloch and Taylor, 2018; Zhang and Hou, 2022). Therefore, based on these 200 videos, we transcribed the patient’s self-disclosing discourse, with the language kept colloquial in Chinese for subsequent analysis. The corpus size is shown in Table 1.

Table 1.

Corpus size.

Corpus name	Corpus size	Chinese characters
MCor	100	7818
FCor	100	7505
Total	200	15323

Mcor: male corpus; Fcor: female corpus.

Data analysis

The data collected in this study were subsequently explored in terms of discursive strategies and emotional dispositions under the guidance of CDS. To figure out discursive strategies as much detailed as possible, the present study used the software NVivo 12 within the framework of Corbin and Strauss’s (2015) ‘three major types of coding’ of grounded theory: ‘open coding’, ‘axial coding’, and ‘selective coding’.

We began by thoroughly reviewing the entire corpus and coding the strategies without making any assumptions. First, in the open coding process, we leveraged the patients’ original language to cluster discursive strategies with similar functions. Subsequently, we abstracted and summarized these strategies to enhance logical coherence during the axial coding process. During this process, it was found that a blend of discursive strategies stemming from the diversity and complexity of themes in each corpus. To further systematize the discursive strategies in the selective coding process, we opted to code the strategies according to theme-orientedness aligned with van Dijk’s (1988) macro-propositions and prior studies (Jaworska and Ryan, 2018; Malloch and Taylor, 2018; Zhang and Hou, 2022). The first author individually incorporated strategies within the identified themes, a step validated by the second and third authors. The results of the strategies emerged after extensive deliberation and multiple rounds of modifications to better align with the collected data. Finally, the 200-video corpus was divided into 330 extracts, each focused on a single theme and assigned a distinct code in respective strategies in line with similar themes named after in previous studies of patients’ self-disclosure (Jaworska and Ryan, 2018; Malloch and Taylor, 2018; Zhang and Hou, 2022).

To explore the emotional dispositions in self-disclosure by the patients of two genders more precisely, the patients’ corpus was submitted to the lexicon-based program LIWC 2015 for its adding ‘an extensive and researcher-controlled dictionary and thesaurus to content analysis’ which ‘allows for combining word types into a wide variety of psychological and social variables’ (Gallois et al., 2021: 47–48; Pennebaker et al., 2015). In this sense, we first read and segmented the whole corpus. Then, on the basis of lexical classification, syntactic analysis, and the Chinese Emotion Word Ontology (Chen, 2009), we manually tagged 314 emotional words that were missed in the original SC-LIWC dictionary, making a specific dictionary suited for the context of patients’ self-disclosure. Next, the segmented texts of two genders were keyed into the LIWC 2015, with the quantitative data pertaining to emotions automatically output and collected.

Finally, it is worth mentioning that all the extracts below follow the same format for the sake of reader-friendliness: (1) all extracts presented were translated into English from Chinese; (2) with respect to ethical concerns regarding data taken from social media platforms, any sensitive and identifiable information, such as names and IDs, was omitted in the following parts.

Results

This section quantitatively and qualitatively analyzes the discursive strategies employed by Chinese cancer patients and the emotions expressed in their self-disclosure with illustrative extracts.

Discursive strategies

To begin with, we were interested in identifying discursive strategies and frequency, percentage, and gender differences for each of them in the 200 videos of our dataset. The findings are presented in Table 2, with the results of a Chi-square test to determine whether there was a significant difference between the patients of two genders on discursive strategies.

Table 2.

Discursive strategies employed by Chinese cancer patients.

Strategy	Freq.	P (%)	M	MP (%)	F	FP (%)	Sig.
Fact-oriented self-disclosure	212	64.24	111	65.29	101	63.13	0.68
Disclosure of personal information	20	6.06	8	4.71	12	7.5	0.29
Disclosure of cancer condition	29	8.79	17	10	12	7.5	0.42
Disclosure of feelings	159	48.18	83	48.82	76	47.5	0.81
Disclosure of the opinions of others	4	1.21	3	1.76	1	0.63	0.34
Relationship-oriented self-disclosure	50	15.15	24	14.12	26	16.25	0.59
Focus on the offline relationships	36	10.91	15	8.82	21	13.13	0.21
Focus on the online relationships	14	4.24	9	5.29	5	3.13	0.33
Desire-oriented self-disclosure	51	15.46	22	12.94	29	18.12	0.19
Expression of inward desires	20	6.06	6	3.53	14	8.75	0.05*
Expression of outward desires	31	9.39	16	9.41	15	9.38	0.99
Experience-oriented self-disclosure	17	5.15	13	7.65	4	2.5	0.04*
Sharing of informational experiences	8	2.42	6	3.53	2	1.25	0.18
Sharing of emotional experiences	9	2.73	7	4.12	2	1.25	0.11
Total	330	100	170	100	160	100	N/A

Some of the figures above have been approximated for presentation purposes, which may cause errors in calculation.

Freq.: frequency; P: percentage; M: male; MP: male percentage; F: female; FP: female percentage.

The difference is significant at the 0.05 level (p ⩽ 0.05).

As Table 2 suggests, self-disclosure in our dataset is predominantly employed toward fact-orientedness (64.24% of all discursive strategies), with experience-oriented strategies accounting for only 5.15%. The percentage of relationship-orientedness and desire-orientedness are comparable at 15.15% and 15.46%. Moreover, Table 2 also illustrates that there is no significant difference between men and women in their discursive strategies of self-disclosure, with the exception of the strategy ‘inward desire expression’ (n = 20, p = 0.05) and experience-oriented self-disclosure (n = 17, p = 0.04).

Fact-oriented self-disclosure

Fact-oriented self-disclosure refers to the direct statement of illness information about the disclosers, serving as a ‘transactional’ tool for expressing content (Brown and Yule, 1983: 1), in which feelings (see Extract 3) are most frequently disclosed than personal information (see Extract 1), cancer condition (see Extract 2), and the opinions of others (see Extract 4).

4.1.1. Extracts 1–4

Hello everyone, I am Li Yiru (pseudonym), a bone cancer patient, and you can call me Ru Ru. I hope you can pay me more attention in the future.

The pathological report has just come out, and it’s basically what was expected. It’s confirmed to be an invasive ductal carcinoma, and it is consistent with breast cancer metastasis. This is basically the hospital consultant’s opinion, so I’m going to the doctor tomorrow to decide what the follow-up treatment will be.

I woke up just now. Abdominal lymph cyst makes me a little painful.

Today, my friend said that I was not like any cancer patient she had ever met before. I told her that if she had had more experience, she would be able to look away from everything ~ living hard is the most important thing ~

In our dataset, fact-orientedness is employed in self-disclosure by almost all patients. As Shi (2012: 489) mentioned, ‘in the Chinese/Asian cultural context, there are specific norms not only for the speaker but also for the hearer, without knowledge of which proper interpretation will be impossible’. In this sense, the use of the four strategies of fact-oriented self-disclosure allows patients to set the ‘norms’ with personal information, cancer condition, feelings, and the opinions of others from a superficial remark to an in-depth discussion (Attrill and Jalil, 2011). This not only helps to highlight the authenticity and reliability of their disclosures but also makes it easier for the recipients to formulate more specific responses with these premises (Collins and Miller, 1994; Derlega et al., 1973; Han, 2016; Wingate et al., 2020).

Relationship-oriented self-disclosure

Relationship-oriented self-disclosure is used by cancer patients to spread their disclosure to the extent of social relationships. According to Self-Determination Theory (SDT) proposed by Deci and Ryan (2000), relatedness is an innate psychological nutrient for all human beings. Confronted with a life-threatening situation, cancer patients have a stronger need for such relatedness manifested in self-disclosure as relationship-orientedness, in which offline relationships (see Extract 5) are still focused more than online relationships (see Extract 6), even in cyberspace.

4.1.2. Extracts 5–6

5. I must be strong for my family.

6. I, a patient with advanced bone cancer, am very grateful to my old friends (netizens) for being with me when I was in the most pain. Whenever I was in pain, it was you who encouraged me and gave me the strength to get to where I am today.

Being influenced by Confucianism, Chinese people attach extra importance to their collective relationships (Ren and Guo, 2020). Therefore, when suffering from cancer, particularly in the early stages, Chinese patients are more inclined to think and act in a collective way to facilitate themselves into a group where they can share care and concerns. In this sense, the offline relationship enables the patient to affirm his/her social identity like the identity of ‘family member’ in Extract 5, and then overcome anxieties (Derlega et al., 1993; Yang and Chen, 2023), while the online relationship helps the patient establish a closer communicative relationship with an unknown netizen as shown in Extract 6, thereby evoking the netizen’s concern and empathy for the patient (Collins and Miller, 1994; Worthy et al., 1969).

Desire-oriented self-disclosure

Desire-oriented self-disclosure refers to the expression of the disclosers’ inner thoughts and wishes, serving as an ‘interactional’ tool for expressing personal attitudes toward self and others (Brown and Yule, 1983: 1). Based on the consciousness of self and others, the desire-oriented self-disclosure can be divided into two types: the expression of inward desires, that is, the desire about self (see Extract 7) and the expression of outward desires, that is, the desire about others (see Extract 8).

4.1.3. Extracts 7–8

7. I want to live well, I still have many dreams to come true, I haven’t filial piety to my parents, I wish this cancer away from me, and I want to live.

8. Sometimes, men also need a shoulder, a warm embrace to rely on. Friends, give me some advice.

The Chinese resort to expressing desires of objective situations (including that of self and others) to express personal attitude and emotion when facing illness (Tang and Liu, 2022). In this sense, the expression of inward desires allows patients to express desires about themselves and construct their psychological expectations for a better life (Shen, 2001). And also, the expression of outward desires, more frequently used as shown in our dataset, allows patients to express their needs and desires about others so as to gain the opportunities of receiving appropriate external help (Derlega et al., 1993).

Experience-oriented self-disclosure

Experience-oriented self-disclosure, similar to ‘knowledge sharing’ mentioned by Zhang and Hou (2022: 108), refers to the fact that patients often disclose their experiences of cancer treatment and emotion management on social platforms. According to Social Exchange Theory (SET) (Derlega and Grzelak 1979), informational and emotional experiences exchange among people, indicating two strategies in experience-oriented self-disclosure: the sharing of informational experiences (see Extract 9) and the sharing of emotional experiences (see Extract 10).

4.1.4. Extracts 9–10

9. I believe that many people have never heard of this disease, which is a very rare type of cancer! Attention must be paid to this disease!

10. Cancer is not so terrible, never treat yourself as an alien, come on, we can make it.

‘Helping each other’ (shou wang xiang zhu/守望相助) is the core of ‘harmony’ (he/和) which is ‘the most basic and central social value in the Chinese cultural mind’ (Shi et al., 2016: 37). There is always a ‘balanced social relationship’ motivating the Chinese to share information with others after experiencing devastating changes or dangers in their lives not for self-affirmation but others-warning (Shi et al., 2016: 37). In this sense, the sharing of informational experiences allows patients to affirm his/her own social values, gaining a sense of belonging or satisfaction (Derlega and Grzelak, 1979). While the sharing of emotional experiences creates a channel, mutual emotional assistance can be established between the patients and others (Collins and Miller, 1994).

Emotional dispositions

Language and emotions are interrelated and interactive (Gallois et al., 2021). To the Chinese, however, there is just a ‘oneness, of many parts interacting, interpenetrating and interchanging with one another’ (Shi, 2012: 488). Consequently, language and emotion are parts amongst many themes, which shed light on the fact that ‘research is about looking at the totality and all parts of that totality. . .’ (Shi, 2012: 488). Therefore, to clarify the emotion in the self-disclosure of Chinese cancer patients, the following sections elaborate on the positive and negative emotional expressions in the patients’ self-disclosure as a whole. For a comprehensive and detailed description of the present dataset, the emotional dispositions of Chinese cancer patients in this study were analyzed from two levels. On the macro level, as indicated in Table 3, in the cases of self-disclosure by cancer patients, the highest positive emotion score was 53.85 and the lowest was 0.00, while the highest negative emotion score was 57.14 and the lowest was 0.00. On average, the aggregation and fluctuation of positive emotions (M = 12.11, SD = 10.35) were greater than that of negative emotions (M = 8.11, SD = 8.77) (See Table 3).

Table 3.

Emotions of Chinese cancer patients.

Affect	N	Max	Min	M	SD
Positive	200	53.85	0.00	12.11	10.35
Negative	200	57.14	0.00	8.11	8.77

On the micro level, in terms of gender differences, the data with the results of an independent t-test conducted are shown in Table 4, which indicates that there is no significant difference between men and women in their expression of positive emotions (p = 0.18) and negative emotions (p = 0.73). However, as the dataset indicated, unlike traditional gendered perceptions of self-disclosure that men always disclose less than women (Hill and Stull, 1987), women (M = 11.13, SD = 9.26) tend to be more conservative and stable than men (M = 13.09, SD = 11.29) when disclosing positive emotions, while men (M = 7.89, SD = 8.42) tend to be more conservative and stable than women (M = 8.32, SD = 9.15) when disclosing negative emotions.

Table 4.

Emotions of Chinese cancer patients of two genders.

Gender	Affect	N	Max	M (SD)	Sig.
Male	Positive	100	53.85	13.09 (11.29)	0.18
Female		100	41.67	11.13 (9.26)
Male	Negative	100	37.50	7.89 (8.42)	0.73
Female		100	57.14	8.32 (9.15)

The difference is significant at the 0.05 level (p ≤ 0.05).

Overall, both men and women disclosed more positive emotions than negative emotions, a finding which is consistent with previous studies on the emotional self-disclosure of patients (Malloch and Taylor, 2018; Zhang and Hou, 2022). For a more specific exploration of this result on a lexicon-based level, the five highest-scored cases for positive and negative emotions respectively are analyzed below.

Positive emotions

The disclosure of positive emotions by cancer patients is a common form of emotional expression (Zhang and Hou, 2022). All forms of support and help are conducive to the disclosure of positive emotions. In return, such disclosure tends to encourage patients to strengthen their own commitment to cancer treatment, enabling them to be psychologically stronger, and thus reducing the physical pain and anxiety caused by external stresses during treatments (Derlega et al., 1993).

Table 5 shows the five examples of self-disclosure with the highest positive emotion scores in the dataset, ranked in a descending order. As indicated in Table 5, the negative emotion scores of these five examples are all 0.00, indicating that these five examples did not contain any negative words. This suggests that under a highly positive state of emotion, Chinese cancer patients are, to some extent, able to completely ignore their negative emotions, which is particularly conducive to the maintenance of positive emotions as it aids the formation of a closed positive loop, thereby reducing the psychological pressures and anxieties experienced by the cancer patients.

Table 5.

Examples of positive emotions.

Rank	Code (positive/negative)	Content
1	098M (53.85/0.00)	Thank you for your concern, I will cooperate with the treatment well. I will face it strongly!
2	182M (50.00/0.00)	Cherish the present happiness!
3	059F (41.67/0.00)	Learn to be strong and believe that everything will be better. Don’t cry.
4	134M (38.46/0.00)	Keep going on the road of anti-cancer, the bright ahead is waiting for me! Persistence is the greatest courage!
5	114M (38.46/0.00)	It’s no big deal to survive with a tumor. Fighting! Fighting! On the 582nd day of anti-tumor therapy, although renal metastasis affected the feet, I limped to the hospital for treatment in order to firmly believe in my destiny. Netizens who are willing to support, please give me a thumbs-up! I believe that cancer cannot make me die. Come on!

Positive emotion words in examples are italicized.

M: male; F: female.

Negative emotions

Coping with cancer is, undeniably, a negative experience, and therefore the self-disclosure of negative emotions by cancer patients is unavoidable. Physical pain, mental fear, economic pressures, and lack of support all contribute to the negative emotions of disclosure by the patients. Self-disclosure accompanied by negative emotions not only helps cancer patients to relieve the stress associated with their suffering (Derlega and Grzelak, 1979) but also allows their relatives or other interventionists to obtain a precise picture of their needs.

Table 6 presents the five examples of self-disclosure with the highest negative emotion scores in the dataset, ranked in a descending order. It is worth noting that, unlike positive emotion of disclosure (where all the opposite emotion (i.e. negative) scores were 0.00), the opposite emotion (i.e. positive) scores of these five examples are not all 0.00. For example, the second highest negative emotion score (091F) of female disclosure has a positive emotion score of 14.29 due to the positive word ‘living’, which partially evidences that female patients’ disclosure was stable in positive emotion. This further enlightens the practitioners to notice the possible positive disclosure in patients’ negative disclosure and take this as an entry point for their supportive communication with patients (Zhang and Hou, 2022).

Table 6.

Examples of negative emotions.

Rank	Code (negative/positive)	Content
1	108F (57.14/0.00)	I can’t afford it. Give up! No more treatment!
2	091F (42.86/14.29)	Compared with death, I am more afraid that I am living the wrong way and life is not worth living.
3	155M (37.50/0.00)	It’s so hard, my white blood cells have dropped again! For more than four months I’m so tired, so tired, damn lymphoma, how long will it torment me?
4	096F (33.33/0.00)	Desperately trying to earn money, and then it takes my hard-earned money to buy health, life is so cruel.
5	044M (28.57/0.00)	Interesting! Living has become a luxury. Every day I face all kinds of drugs, Chinese medicine, Western medicine, and all kinds of capsules, do nothing, just to live!! Interesting! Life is ridiculous.

Negative emotion words in examples are italicized; Positive emotion words in examples are underlined.

M: male; F: female.

Discussion

Our study investigated the discursive strategies and emotional dispositions in online video discourse of self-disclosure by Chinese cancer patients both quantitatively and qualitatively. The results indicate that there are four categories of self-disclosure, oriented respectively toward facts, relationships, desires, and experiences, with the overall trend of positive emotions greater than negative emotions. Furthermore, the results also indicate differences between both genders in their use of the strategy ‘expression of inward desires’ and experience-oriented self-disclosure, as well as their performance of processing positive/negative emotions.

As for the strategies, fact-oriented self-disclosure (64.24%) is predominantly employed, whose frequency seems to contradict the priority of ‘social relationships’ in patients’ self-disclosure mentioned by Malloch and Taylor (2018: 6). However, it is worth mentioning that Chinese patients are anonymous in online videos. To prevent misunderstanding due to anonymity in the high context of Chinese, it is necessary for Chinese patients to eliminate an informational context or ‘norm’ for their online recipients (Shi, 2012: 489). In the present dataset, compared with the other three fact-oriented strategies, the strategy of ‘self-disclosure of feelings’ ranks highest in frequency, which is quite in line with the emotion-sharing feature of self-disclosure reported by Jourard (1971).

In addition, relationship-oriented self-disclosure (15.15%) was also one of the most predominant types in the present dataset. Along with many prior studies, ‘people’ and ‘social relationships’ were always the concern of cancer patients when self-disclosing (Jaworska and Ryan, 2018: 113; Malloch and Taylor, 2018: 6). However, except for offline relationships, the study witnessed a more collective concern on online relationships among Chinese patients, a phenomenon also observed in self-praising by Chinese bloggers (Ren and Guo, 2020). The patients disclosed themselves in a collective way online to facilitate themselves in an online group where they can share care and concerns to gain more responses and support, which can also be viewed as evidence for the relationship-centeredness of interpersonal communication in Chinese (Haugh et al., 2013).

In the present study, we find desire-oriented self-disclosure (15.46%), which has not been reported in the prior research. It is closer to the ‘interactional’ nature of the language by expressing personal attitudes toward self and others (Brown and Yule, 1983: 1). This can be partially explained by the fact that the Chinese value the expression of desires in a more subjective approach than people in English Communities (Tang and Liu, 2022). In desire-oriented self-disclosure, Chinese cancer patients often conduct psychological scanning, that is, the expression of desire, of objective situations (including that of self and others), and then the expression of the meaning, attitude, and emotion they have not output in the form of language through the recipients’ pragmatic inference (Shen, 2001).

Although Social Exchange Theory (SET) attached great importance to experience exchanges among people in the field of interpersonal communication (Derlega and Grzelak, 1979), this study observed only a limited number of extracts of experience-oriented self-disclosure (5.15%). The structural trend of self-disclosure by Chinese cancer patients mentioned by Zhang and Hou (2022) may account for its low frequency. As Zhang and Hou (2022) indicated, collapse, confrontation, and communication appear repeatedly in the patients’ discourse, but finally present a structural trend from the early collapse to the latter confrontation or communication which includes the theme of ‘knowledge sharing’ or experience-oriented self-disclosure (Zhang and Hou, 2022). Therefore, the dataset regarding the early stage of cancer may witness limited extracts of experience-oriented self-disclosure.

The findings that highlight the underlying emotions of cancer patients resonate with those of Zhang and Hou (2022) on the fact that the positive emotions of the patients’ disclosure are greater than the negative emotions. However, the lexicon-based emotion analysis suggests gender differences in the processing of positive/negative emotions. Specifically, male patients render negative disclosure less frequently but more durable than females, while the latter render positive disclosure less frequently but more durable than the former. The difference seems to challenge the findings of Kring and Gordon (1998) and Hill and Stull (1987), who reported that female patients tended to be more emotive than males in general, and the latter tended to have lower levels of self-disclosure compared to the former.

However, this is quite in line with Chinese social norms of gender, which can be partially explained by the Chinese saying ‘men do not easily shed tears’ (nan er you lei bu qing tan/男儿有泪不轻弹). Due to the socially perpetuated notion of hegemonic masculinity on men rather than women, male patients tend to constrain the negative emotions in their discourse resulting in their less frequent but more durable negative disclosure (Jaworska and Ryan, 2018). This may further explain that when it must follow negative statements about illness, male patients less frequently express their inward desires than women. Instead, female patients can hold a greater ability to process negative emotions outwardly and contain positive emotions inwardly (Jaworska and Ryan, 2018; Shi et al., 2011), resulting in their less frequent but more durable positive disclosure when facing negative cancer. In this sense, it further explains why women less frequently employ experience-oriented self-disclosure than men, when it requires more positive modification to attract unknown netizens (Jaworska and Ryan, 2018).

Although the self-disclosure of Chinese patients regarding strategies and positive/negative emotions is motivated by Chinese culture, it also echoes the prior findings on four types of self-disclosure and emotions to varying degrees. Since Chinese cancer patients discuss facts, relationships, desires, and experiences more frequently in online videos, these videos can help social workers fuse information obtained from this online context with social support theories. Moreover, this facilitates the enrichment of these theories with a more accommodating dataset which can help make up for the lack of applicable offline research. In this sense, the above findings can be used as supplementary for offline intervention or other previous findings regarding patients’ self-disclosure. In addition, they can also serve as supportive references for further research on self-disclosure by cancer patients regarding their emotional reactions to facts, relationships, desires, and experiences, especially from the perspective of Chinese culture.

Conclusion

The present study has explored the self-disclosure strategies used by Chinese cancer patients and the emotions they express in their discourse, and it was found that these discursive strategies can be categorized into four main categories, oriented toward facts, relationships, desires, and experiences. When self-disclosing, Chinese cancer patients yielded more positive emotions than negative emotions. In terms of positive emotion disclosure, women tended to be more conservative and stable than men; in terms of negative emotion disclosure, men tended to be more conservative and stable than women. These findings not only help to broaden the study of online self-disclosure and enrich the theoretical basis for further research on self-disclosure by cancer patients in general, but also provide social workers with empirical support and concrete evidence to enable suitable psychological help to cancer patients. Follow-up studies could explore other dimensions of self-disclosure by cancer patients on different platforms as corpus sources and in-depth interviews or focus groups to analyze self-disclosure by cancer patients. These joint endeavors would furnish practitioners with a wealth of valuable information at hand to provide supportive channels of communication to cancer patients.

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study is funded by “An interpersonal pragmatic study of doctor-patient interaction discourse in a rural medical context” supported by The National Social Science Fund of China (Grant No. 23CYY061).

ORCID iDs

Yue Zhao

Yansheng Mao

Shuang Wei

Author biographies

Yue Zhao is currently graduate student in School of Foreign Studies of Harbin Engineering University. Her research interests include health discourse and pragmatics.

Yansheng Mao received his PhD in Pragmatics from Nanjing University and is currently a professor in School of Foreign Studies of Harbin Engineering University and China Research Center for Language Strategies. His research interests include health communication and cultural pragmatics. School of Foreign Studies, Harbin Engineering University, Nantong Street 145, Nangang District, Harbin 150001, HLJ, P. R. China. E-mail: wiltonmao@163.com

Shuang Wei received her PhD in Linguistics from National University of Singapore, and currently serves as an assistant professor at School of Foreign Studies, Central University of Finance and Economics. Her research interests include critical discourse analysis, pragmatics, health communication, gender, and media.

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