We all know the saying, “That which does not kill us, makes us stronger,” but is that really true? After all, for some people, traumatic experiences ultimately lead to truly debilitating outcomes. For others though, adversity really does seem to lead to “post-traumatic growth” where individuals move through suffering and find their lives changed in positive ways as a result. Why does this growth happen for some people and not others? How exactly does it happen? Can the positive results be purposefully replicated?
These are the central questions of a new study conducted by a team of researchers at the University of Virginia. They share their findings, along with practical advice and inspiring stories, in their new book Choosing Wisdom and the companion PBS documentary of the same name. Based on interviews with two distinct populations—medical patients coping with chronic pain and physicians coping with having been involved in serious medical errors—Choosing Wisdom delves into how average people respond to adversity, how they change, and what factors help or hinder positive change. Through these interviews, the authors chart each person’s journey, and though the circumstances of each case may be unique, the commonalities are remarkable.
By paying careful attention to the journeys of these exemplars, this cutting-edge research will shed new light on how we can grow, change, and develop wisdom through adversity. It will be a welcome source of inspiration for anyone facing their own difficult journey and for those who seek to aid them along the way.
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About the Author
Dr. Margaret Plews-Ogan is currently associate professor of medicine at the University of Virginia and director of the UVA Institute for Quality and Patient (IQPS). She is also lead investigator and director of the UVA Center for Appreciative Practice, a positive culture transformation initiative across the Schools of Medicine and Nursing, the Medical Center, and the Health Services Foundation physician group practice.
Dr. Justine Owens is associate professor in the UVA Department of Medicine, and has served on the faculty there for the past twenty-two years. She served as research director for the Center for the Study of Complementary and Alternative Therapies at UVA from 1995 to 1999, and she is the author of numerous publications on alternative therapies for pain management.
Dr. Natalie May is a faculty member in the UVA Center for Appreciative Practices and also serves as the project director for Call to Health, a new initiative devoted to improving the health of African American women with diabetes.
Read an Excerpt
Strategies and Inspiration for Growing Through Life-Changing Difficulties
By Margaret Plews-Ogan, Justine E. Owens, Natalie May
Templeton PressCopyright © 2012 Margaret Plews-Ogan, MD, Justine E. Owens, PhD, and Natalie May, PhD
All rights reserved.
It All Began with a Question: "How Do They Do It?"
FACING ADVERSITY is a common human experience, and I suspect that each of you reading this has faced hardship in your own life—some extreme, some less severe. I also suspect that you may have noted how you have been changed in a positive way—become a better human being—through the response to a difficult circumstance. You may know particular people who have lived through very difficult circumstances and whose lives, rather than exemplifying anger, bitterness, or disillusionment, manifest compassion, optimism, and strength. They seem to see the deeper meaning of things, to understand the bigger picture, to be able to tolerate life's ambiguities. The word "wise" might come to mind when trying to describe those who have faced difficulty and come out the better for it.
Until recently, much of the psychological literature on how humans cope with adversity has focused on its negative impact (posttraumatic stress), and much of the philosophical and religious literature has tried unsuccessfully to shed light on why humans suffer. But what about those people we all know who have grown and changed for the better in the face of harsh circumstances? How do they do it? What, exactly, have they learned about themselves and the world that helps them to be better human beings? The German philosopher Friedrich Nietzsche, who himself suffered a lifetime of physical illness, said, "What doesn't kill me makes me stronger." What can we do when we face difficulties in our own lives to help us grow stronger and perhaps even wiser because of those difficulties?
As a practicing physician, I care for many patients whose illnesses I cannot cure and whose situations I cannot alleviate. Some patients move through those experiences and emerge with positive changes. They learn things, grow, and change in positive ways. If I could not ameliorate their circumstances, are there nonetheless ways, I wondered, that I could help my patients to address these challenges that increased the likelihood that they would be changed for the better?
I am also a patient safety expert. In that role I work with physicians who confront perhaps the most difficult experience imaginable in their professional lives: making a mistake that harms a patient. Physicians go into medicine to help people. When the opposite occurs, when something they do harms a patient, it cuts to the core of who they are as doctors and as people. Some physicians are able to move through this experience and emerge as better doctors, with increased humility and compassion, more mindful of their limitations and better able to see the bigger picture. How could we help physicians who face such circumstances to confront them in a positive way, one that increases their capacity for learning and that promotes humility, compassion, and the ability to see the bigger picture?
When I started down this road, I can honestly say that I had not spent much time thinking about the definition of "wisdom." But I have spent twenty-five years observing people who faced difficult circumstances and the positive changes that occurred as a result. When I began to investigate the various conceptualizations of wisdom, the parallels were striking: compassion, empathy, humility, understanding the deeper meaning of things, recognizing the limits of what we can know, a clear-eyed view of the world, seeing things from another perspective. I had witnessed people learning all these things from difficulties in their lives. The questions arose: Can adversity result in greater wisdom? If so, how can we foster growth and wisdom when people are coping with adversity? How did these exemplary people do it? What did they learn and how have they changed? If they can do it, can I? Can we help each other?
That is the subject of this book. It is a book about regular people who faced difficult circumstances in their lives. It is built on the narratives and the findings of the Wisdom in Medicine project, a three-year investigation that examines two very different circumstances of suffering and two very different populations trying to cope with that suffering. These different groups (patients coping with chronic pain and physicians coping with having been involved in a serious medical error) were chosen for two reasons. First, they represent highly challenging circumstances in and of themselves, and our ultimate goal is to identify ways to help people cope positively with these circumstances. Second, despite their differences in perspective, we wanted to identify the common thread of change, illuminate the positive response to adversity in general, and understand more about how to help all people who face adversity in their lives.
Through in-depth interviews, the study investigators delved into how people respond to adversity, how they change, and what helps or hinders positive change. We also explored whether the growth they describe correlates with the components of wisdom. Investigators interviewed over 130 physicians and patients, and a common pattern has emerged, a path that traces the journey of coping with adversity and the commonality of what people see as their growth.
When people describe how the process of coping with adversity has changed them, what they learned, and how they do things differently, they use the language of wisdom. They describe how they are now more empathetic or compassionate; they have a wider-ranging perspective on things; they understand the deeper meaning of circumstances and events in their lives; they grasp the complexity, ambiguity, and uncertainty in life. They reflect on how they have grown in ways that they could not have if they had not struggled with this difficult circumstance, because their usual way of functioning had to change in order to cope.
Participants also describe a process or a journey through this experience. Many refer to this journey in the language of story, with low points and turning points, themes, and morals. They talk about what they had to let go of (perfection, blame), what they had to accept or acknowledge (limitations, ambiguity, imperfection), and what they had to do to move forward (accept responsibility, take charge). They talk about what it took to get them there (the support of colleagues, friends, and family; trying things; being open; sharing their story; forgiveness), and they have sage advice for others facing similar circumstances.
This book tells the stories of how ordinary people move through those experiences and emerge as better people, better doctors, with more compassion and empathy, and with a greater capacity to see themselves and situations honestly, stronger and more empowered, and wiser.
Although the two populations that were studied in the Wisdom in Medicine project may at first glance seem like strange bedfellows, their superficial differences in circumstance in some ways make it easier to focus on the common human experience of coping with adversity. I also believe that their unique circumstances are oddly universal. Who among us has not made a mistake and had that awful moment of realization? Who has not struggled with the guilt and shame that accompany the mistakes we make—big or small—and the resultant challenge to our deepest feelings of being a failure, a fake, or a sinner? I suspect that we all have felt some physical or emotional pain in our lives, and we can imagine the suffering that those patients must feel whose pain cannot be resolved.
The ultimate goal of this book is to enhance our understanding of how to help people who are facing challenges in their lives and to stimulate thought and conversation about how wisdom can be developed through these life challenges. Our hope is that by paying careful attention to the journeys of these exemplars we might shed light on how people can grow and change through adversity and how that contributes to the development of wisdom.
The people in this book are models of coping positively. Most of them have faced extreme difficulty. Patients endured continuous pain so severe that they could not eat or sleep, and they could not care for themselves or their families; some even contemplated suicide. Physicians, in most cases, were dealing with situations that resulted in harm to a patient: mistakes including a delayed diagnosis of cancer, failure to recognize infection that eventually was fatal, misdirecting a needle that resulted in puncture of an artery or a vital organ—all with devastating consequences. In some cases the physicians themselves contemplated suicide, stopped practicing, or found themselves at least temporarily unable to function. In many cases the "mistakes" were actually known complications of a procedure, but the physicians involved experienced them as a mistake. For many, it didn't matter if there was no discernible way to have prevented the bad outcomes. They still felt responsible.
We do not dwell on or describe in great detail the circumstances that these people faced. If you think about it, as humans we tend to grab hold of the details of tragedy and use those details to protect ourselves in some way from the thought that something similar might happen to us. Blame and judgment are ways we protect ourselves from our common vulnerability. As an example, I recall hearing about a tragic traffic accident that killed a teenage girl in my community, a girl exactly the age of my daughter. I was horrified, frightened, and so very sad. But I found myself searching for the details of the tragedy. Predictably, when I discovered that the accident happened on a road that my own daughter never traveled, my first insuppressible thought was, Well, that won't happen to my daughter. She never drives that road. The next thought was, In fact, I would never let her drive that road. My judgment, so swift and sure, came out of my deep desire to separate myself from other vulnerable mothers who suffer loss and grief, other humans who suffer for no discernable reason. I looked for a reason, assigned judgment, and thus protected myself from the truth—that this could happen to anyone. But when we set aside the specifics, we are more likely to be able to see and acknowledge the common experience of suffering and vulnerability and relate it to our own lives.
We want you, the reader, to be free to connect with the very common experiences of pain, or making a mistake, or misjudging a situation, or having to accept limitations of the body, and focus on the ways in which these people were able to move through their experiences and learn, grow, and change for the better. We focus on people's responses, rather than their specific circumstances, because in the responses to difficulty we can find the keys to developing wisdom in our own lives.
This book is arranged in three parts. Part 1 provides the conceptual backdrop for our understanding of how people cope positively with difficult circumstances. The first concept we tackle is wisdom (chapter 2). If you are like me, you may not have given much thought to the concept of wisdom, and even if you have, it is not something whose definition comes easily to mind. Wisdom is, however, something worth thinking about. In fact, as Stephen Hall puts it in his wonderful book on wisdom and neuroscience, "Thinking about wisdom forces you to think about the way you lead your life" (2010, 10). I hope this chapter stimulates your curiosity about this elusive but inspiring concept, because thinking about wisdom, in and of itself, is a worthy and productive endeavor.
The second concept we discuss (chapter 3) is an exciting and fairly new paradigm—one that has emerged in the last ten years and has had a dramatic impact on how we think about the effects of trauma. That is called posttraumatic growth. Much of the psychological literature prior to this had focused on the negative effects of trauma. Researchers and practicing psychologists Lawrence Calhoun and Richard Tedeschi, editors of Handbook of Posttraumatic Growth, noticed that there were people who seemed to learn and grow in positive ways in response to trauma and began to study that process. They and others began to research this phenomenon, which was a powerful first step in understanding how and why people respond positively to hardship. Eventually we may understand how to help people who face adversity.
In the second part of this book, we become keen observers and listeners as we recount the stories of people who have struggled with hardship and come through the experience better for it. The stories people tell have common elements or themes that are part of this journey, and we describe these as acceptance, stepping in, integration, new narrative, and wisdom. Part 2 is arranged around these themes. Not everyone's story contains each of these elements, and different journeys are dominated by different elements. It would not be accurate to describe these as linear steps, since people move back and forth, skip over, and repeat these elements in their journey. So we use the terms "elements" or "themes" to avoid the implication that this process is somehow linear. In fact, for most people, this process is quite iterative or circular. Rachel Naomi Remen, physician and author of Kitchen Table Wisdom, makes the point that this process of discovering wisdom is a dynamic process of wrestling with the most challenging life events and parts of ourselves. "We will pass through them [these life issues] again and again, each time with a new story, each time with a greater understanding, until they become indistinguishable from our blessings and our wisdom. It's the way life teaches us how to live" (Remen 1996, xxvi).
In the third part of this book, we listen to sage advice from the field, learning about things that people find helpful to them in moving along this path. Chapter 9 describes the role of community in helping people move positively through hardships. Talking about their journey and the support of peers, family, and friends all played a role in people's positive growth. In chapter 10 we focus on the role that gratitude and compassion play in the positive transformation. Chapter 11 spotlights the impact of reflection, whether through time in nature, mindfulness, yoga, or meditation, on the positive growth that people experience. In chapter 12, we hear about the importance of doing something, whether helping others or making positive changes to a situation or system so that what happened to them won't happen to someone else. In chapter 13 we learn about the role of spirituality, forgiveness, and doing the right thing in how these people coped with difficulty.
The final chapter is about choice. One of the most inspiring aspects of these stories is the common element of choice. The people in these stories made choices each step of the way—choices that empowered them, choices that moved them along a positive path, wise choices that in the end made them better people and better doctors, and made the world a better place because they are a part of it. As one doctor put it, "I realized at some point that I had a choice. I could choose to stay in this dark place or I could choose to get out of it. And that made all the difference, knowing I had a choice." In the end, this book is about choosing wisdom.CHAPTER 2
I want to beg you, as much as I can, to be patient toward all that is unsolved in your heart and to try to love the questions themselves like locked rooms and like books that are written in a very foreign tongue. Do not seek the answers, which cannot be given you because you would not be able to live them. And the point is to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer. —Rainer Maria Rilke
Wisdom is a love affair with questions. Knowledge is a love affair with answers. —Julio Olalla
IF THE EXPERIENCE of centuries of seekers is indicative, then we must acknowledge up front that, in spite of this chapter's title, we will not find answers to the question, "What is wisdom?" Simply asking the question and struggling with the idea, however, have the potential to help us become better people, so we learn to love the question, in all its complexity and nuance. Asking the question at the outset, with our eyes open, helps us to be better observers of the people we hear from in this volume. So we ask the question, not really expecting to come up with an answer, but knowing that the ideas we explore may resonate in the stories we hear, and then we might find the real meaning of wisdom for our own lives.
Excerpted from Choosing Wisdom by Margaret Plews-Ogan, Justine E. Owens, Natalie May. Copyright © 2012 Margaret Plews-Ogan, MD, Justine E. Owens, PhD, and Natalie May, PhD. Excerpted by permission of Templeton Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Part 1 Background
Chapter 1 Introduction 3
Chapter 2 Defining Wisdom 11
Chapter 3 Posttraumatic Growth 27
Part 2 The Path through Adversity
Chapter 4 Acceptance 43
Chapter 5 Stepping In 59
Chapter 6 Integration 77
Chapter 7 New Narrative 97
Chapter 8 Wisdom 115
Part 3 What Helps: Sage Advice from the Field
Chapter 9 Finding Community 137
Chapter 10 Gratitude and Compassion 151
Chapter 11 Quiet Reflection, Meditation, and Mindfulness 165
Chapter 12 Doing Something 181
Chapter 13 Spirituality, Forgiveness, and Doing the Right Thing 197
Chapter 14 Choosing Wisdom 215
Questions for Reflection and Discussion 221