Hope, Happiness and Science
"Hope is patience with the lamp lit."Tertullian
"Positive Psychology shifts the focus from a decrease in pathology to an increase in pre-existing strengths and a discovery of hidden talents. Thus, this is a mission that could unite the science and practice communities."
Linley, PA, Joseph, Stephen, Harrington, Susan and Wood, Alex M. Positive psychology: Past, present and (possible) future. The Journal of Positive Psychology, January 2006. 1 (1):3-16.
In the spring of 2006, the Center’s speech therapist, Merritt Tucker returned from a statewide conference brimming with excitement. “There’s a recent development in psychology called Positive Psychology. Researchers from all over are excited about what we have been doing for years!” It is exciting and refreshing to know that research will be increasingly available to steer our work by refining our knowledge of what works and discovering new ways of helping our students optimize their rehabilitation.
What is this new field of research? Positive Psychology looks at what works and seeks to find ways to making it work better, rather than focusing on what has gone wrong and finding ways to fix it. At the individual level this means studying traits and processes such as self-efficacy, optimism, happiness, resiliency, hope, and a host of other factors.
Positive Psychology re-frames
the questions usually asked by diagnosticians. A diagnostician or therapist can view a person undergoing rehabilitation through a lens of defining and overcoming illness and weakness, or a lens of defining and enhancing wellness and strength. If one is seeking deficits, that’s what is seen and assets tend to be overlooked.
The staff at the Center were all trained in “illness-treatment” settings. The emphasis in our training was on discovering what is wrong with someone and then finding and implementing therapeutic strategies to eliminate or minimize the deficit. Minimizing deficits is seen as the measurement of success. The framework of Positive Psychology accepts minimizing deficits as valuable, but stresses that strengthening assets. Stengthening assets as a focus of treatment tends to be undervalued in traditional treatment settings. At the Center, we have learned it is the key to healing!
Over the years, the Center has been gradually evolving from its original illness-centered roots. There is now a fundamental but palpable difference between what students and staff experience at the Center and what is found in illness-based clinical settings.
During the Center’s history, there have been too many people whose stroke recovery or whose Parkinson’s or multiple scleroses progression didn’t “read the textbook!” Students who entered with global aphasia, speak. They speak haltingly, but meaningfully and spontaneously. Students with severe paralysis, begin to walk. Those are the dramatic changes. Just as illuminating is the fact that most students arrive frightened, defeated, sullen, depressed and/or angry. Within a remarkably short period of time they visibly change to being smiling, laughing, and determined. They often comment that they now feel valued and accepted. They become part of the Center’s community, embracing the group norm of realistic optimism and authentic hope.
We have sought a way of explaining what is happening and have found that our illness-based training has not been sufficient to guide us toward satisfactory understanding. We hope that the new trend in scientific research will help us to better understand what we are doing as we focus on the traits and strategies that work at the Center, and to help us understand where we can do better.
Hope is a tricky concept and one that has caused confusion and controversy at the Center. It is difficult to walk the line between offering what has been called “false hope,” and denying someone the right to hope. This is especially true when one personally knows many “hopeless cases” who have defied their prognosis.
At gathering several years ago of cancer patients and survivors, a motivating and dynamic speaker concluded her talk by proclaiming that “false hope was an oxymoron!” This remark was met with thunderous applause from a group of people who had believed that various medical professionals had done their best to deprive them of the right to hope.
In defense of the medical professionals, we are taught that to offer hope when a prognosis is bleak is cruel and results in an increase and prolonging of pain and suffering. Because of the strength of this belief, until very recently in the world of modern medicine, hope has remained the sole province of the individual patient, their family and/or their faith.
In the mid 70s when the Center was founded, despite the emergence of humanism in the 60s, this attitude was still prevalent in medicine and the allied health therapies. The relationship of hope and other positive factors like happiness, resilience, and optimism had not yet been scientifically associated with healing or studied empirically.
Over the years, the Center’s therapists intuitively incorporated “what worked” into the educational philosophy and practices of their classes. And, what worked was often not just the therapeutic protocol, but things like laughter, love, forgiveness, and students modeling for each positive traits like resilience and courage. And what happens in classes appears to inspire hope.
In The Anatomy of Hope, Harvard Medical School Professor, Jerome Groopman, reviews and summarizes an extensive body of literature that is being built toward an understanding of hope. He stresses that true hope resides in identifying for each individual that middle ground where both truth and hope have room to reside. He discusses the importance of providing adequate information so that a patient can choose how to deal with worst and best case scenarios plus that which lies between. To mislead someone who is on a healing journey by omitting bad news or providing an overly positive prognosis is false hope at its worst. However, by using one’s professional authority to preclude hope, is to deny someone the right to hope. This prevents what is known as authentic hope. With clear and scientifically valid information a person can live life on their own terms. They can prepare for the worst and still hope for a miracle. It is, after all, part of the human spirit to endure.
Studies of the importance of hope in illness are only one part of a larger movement that is researching positive traits. Researchers at major universities are now seriously studying a variety of other positive factors that are now believed to influence healing, if not curing. At the level of the individual, traits and processes such as self-efficacy, optimism, happiness, prayer, resiliency and forgiveness, among others, are being scrutinized.
This is not the popular mind-body trap that fosters the belief of the mind’s absolute primacy. That belief dangerously leads people to believe that if their illness or symptoms are not overcome, it is their fault for not believing hard enough or being good enough. Researchers today are seeking to understand the complexity of the connections between the body and the mind. The former has received the attention of medical science, and now the significance of the latter is being recognized. Strength promotion is now being integrated into settings where it has been traditionally undervalued. And, at the Center, where hope, resilience, optimism, self-efficacy, and self-determination are recognized as vital components of healing, we welcome the opportunity to better understand how to integrate strength promotion into everything we offer to students.
Some particularly striking research is already helping us to understand what happens at the Center. Although there are more than 25 different traits and strengths receiving serious attention from researchers, a few are worth noting here because of their particular relevance to the Center’s work.
Resilience is characterized by the ability to function effectively following a trauma and despite prolonged exposure to stressful circumstances. It has been shown that there are definitely psychobiological mechanisms of resilience and vulnerability that can be seen through chemical and brain studies. Some people are more likely to be naturally resilient than others. However, it is also known that resilience can be learned.
Post-traumatic stress syndrome (PTSD) is widely studied and publicly discussed. It is expected that some symptoms of PTSD will be encountered by people after a traumatic event such as a stroke. What is less known is that there is post-traumatic growth. Some people naturally show positive changes as a result of trauma. Research shows that these people demonstrate:
- Increased perception of competence and self-reliance;
- Enhanced acceptance of one's vulnerability and negative emotional experiences;
- Improved relationships with significant others;
- Increased compassion and empathy for others;
- Greater efforts directed at improving relationships;
- Increased appreciation of own existence; and
- Greater appreciation for life.
By investigating the characteristics of individuals who show psychological growth rather than impairment, scientists are finding ways to teach post-traumatic growth. Steps to acquiring the resilience and strength required for post-traumatic growth appear to be:
- Acceptanceof limitations and misfortunes;
- Affirmationof life and deciding it’s worth fighting for;
- Determinationgaining persistence and courage;
- Developing Confidencethrough succeeding at reasonable and attainable goals;
- Relationships--discovering that in helping others, you find healing for yourself.
Self-efficacy is already widely accepted as a valid health related process. It is a person’s perceived confidence to perform a specific task related to attaining a performance goal. If a person has high self-efficacy relative to a certain task, they are more likely to exert more energy, persist longer at the task and acquire more knowledge and skills related to the task. The importance of self-efficacy in psychological and health-related processes has been demonstrated in literally hundreds of empirical studies. There are known to be changes in biochemical effects, autonomic activity, pain regulation, and immune functioning as well as behavioral effects such as quitting smoking, improving diet and exercise, and adhering to medical regimens. Substantial evidence exists that directly increasing confidence to perform a valued task greatly increases the likelihood it will be performed.
At the Center, self-efficacy is fostered in many ways in the classroom, as students accomplish tasks leading to their overall goals. Students are directly involved in setting their own rehabilitation goals. This involvement in the decision-making process, while receiving constant guidance and encouragement to accomplish tasks leading to their goals, enhances self-efficacy.
Optimism is one of the positive emotions that has been widely studied and has been found to significantly impact health. The results of numerous studies with patients undergoing life-threatening diseases suggest that those who remain optimistic show symptoms later and survive longer than patients who confront reality more objectively. According to researchers, an optimistic patient is more likely to practice habits that enhance health and to enlist social support. Optimists resist depression when bad events occur. Optimism may also possibly retard the course of illness. Interestingly it has been found that persons high in optimism and hope are actually more likely to provide themselves with unfavorable information about their disease, thereby being better prepared to face up to realities even though their positive outcome estimates may be inflated.
Most important, though, are the findings that indicate that optimism can be taught and learned. Martin Seligman, one of the founders of Positive Psychology has conducted many empirical studies on building optimism and has written a popular book for the general public called Learned Optimism.
His methods of building optimism by recognizing and disputing negative and pessimistic thoughts and beliefs are intuitively practiced by Center therapists. Studies of changes in student’s levels of optimism could be quite revealing in improving our teaching/learning processes.
One of the most commonly heard remarks from people visiting the Center is: “There is so much joy and happiness here!” Science can help to understand how this happens and what it means. From recent research we know that happy people endure pain better, try harder to succeed at tasks and generally take better care of themselves than those who are unhappy.
It is also known that objective good health is only slightly related to happiness. When severe and disabling illness occurs, happiness does decline, although only somewhat, and not nearly what one would expect. Another research finding is that when people accept a disability or that an illness occurred, that acceptance becomes a new baseline for them and they will seek alternative approaches to regain happiness.
These new studies are bringing new happiness and hope to medical professionals also. The new studies open new pathways to explore in helping individuals toward healing. They are not a new way of looking at disease and disability meant to replace the traditional illness-based approach, but they offer whole new areas to develop in our quest to optimize the rehabilitation experience.
Bandura, A (1997) Self-efficacy: The exercise of control. New York: W. H. Freeman.
Bandura, A. (1986). Social foundations of thoughts and action. Englewood Cliffs, New Jersey: Prentice-Hall, 1986.
Csikszentmihalyi, M. (1993). The evolving self. New York: HarperCollins.
Gillham, J.E. (Ed). (2000). The Science of Optimism and Hope: Research Essays in Honor of Martin E. P. Seligman. Radnor, PA: Templeton Foundation Press.
Groopman, Jerome. The Anatomy of Hope, How People Prevail in the Face of Illness. Random House, New York. 2004.
Harris, Alex H. & Thoresen, Carl E. Extending the influence of positive psychology interventions into health care setting: Lessons from self-efficacy and forgiveness. The Journal of Positive Psychology, January 2006; 1(1) 27-36.
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Seligman, M.E.P., & Csikszentmihalyi, M. (2000). Positive psychology: An introduction. American Psychologist, 55, 5-14.
ContextAging Population and Health Care Crisis