1. Carroll, V. Susan Editor

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It has happened again. Early in the summer of this year, Disney's Pixar Studio released another children's film, Inside Out, that challenges viewers of all ages to think differently and creatively about life. This film looks at emotions and the impact these have on us every day. Riley Andersen, a hockey-loving tween girl from Minnesota, moves to California with her family when her father accepts a new job. As Riley adjusts to the myriad changes in her life after the move, her inner, emotional life begins to emerge in new ways; within her mind, five of her emotions-Joy, Sadness, Fear, Disgust, and Anger-come to life. The emotions live in Headquarters, a part of Riley's conscious self, where they influence Riley's actions and memories via a control console. Her new memories are housed in colored spheres, which are sent into storage at the end of every waking period. The most important or core memories are housed in a central hub in Headquarters and provide power for each of the five "islands" that reflects a different aspect of Riley's personality. Joy is the leader of the emotions, attempting to keep Riley in a happy state despite the changes in her life.

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A series of events cause Joy and Sadness to be moved out of Headquarters and into her long-term memory; Riley's happy core memories are lost. Now, without Joy to lead them, Fear, Disgust, and Anger try take over the controls in Headquarters with potentially disastrous results. When an "idea" to run away and return to Minnesota is planted in Riley's mind, Joy and Sadness realize they need to work together to create a new, amalgamated core memory that creates a new personality island that will promote positive coping and adaptation to a new life and allow Riley to lead a more emotionally complex life that weaves emotions together.


As neurosciences nurses, we understand the cerebral connections forged among a host of neurotransmitters; the effects on cognition that result from shifts in electrolytes, antioxidants, and drugs and the individual "wiring" of each individual; and the ways all of these elements work in concert, or discordantly, to frame our emotional lives. Inside Out provides us with a visual framework in which to better articulate these connections and perhaps help our patients better understand how emotions can play an integral part of health, wellness, and illness. For example, watching Anger shift the background to a deep red or Sadness change the landscape to blue, we can appreciate the parallels we see in a positron emission testing scan. When neural control mechanisms change after a brain injury, a stroke, or a seizure, we can think about these in ways the film illustrates and counsels our patients to shift or adapt so that core memories and personality elements can change.


As nurses, we can help our patients tap into their emotional intelligence (EQ) as a way to adapt to illness. The phrase "emotional intelligence" (EQ) is ubiquitous today. Used in a variety of ways that may or may not fit all contexts, it is a part of our social landscape. One EQ "subset"-social and emotional learning-embraces the themes of Inside Out. In curricula implemented to help children grow emotionally in positive ways, in early elementary school, students learn to recognize and accurately label their emotions and how they lead them to act. By the late elementary years, lessons in empathy should make children able to identify the nonverbal clues to how someone else feels; in junior high, they should be able to analyze what creates stress for them or what motivates their best performance. Finally, in high school, the social and emotional learning skills include listening and talking in ways that resolve conflicts instead of escalating them and negotiating for win-win solutions. These are the skills Riley's emotions and their work in Headquarters teach all of us. These are skills nurses can build on and use as we care for patients. We can support them as they build on their individual skills to better manage their long-term illnesses and healthcare needs.


Riley's inner emotional life gives us a map for managing our own and underscores the need for balance. Inside Out tells us we can be happy, sad, and fearful simultaneously, and in true Pixar form, the film is all of these. It shows how to look inside ourselves at the positives and negatives we face daily. So, take a long hard look.

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