“Gratitude researcher” Mathieu Bernard enjoys challenging mountain climbs as much as behavioural science. On the positive slope.
After completing my degree in psychology, I had the opportunity to work for the Department of Psychiatry at Lausanne University Hospital (CHUV). I was assigned to a research project aimed at better understanding risk behaviour in adolescence, especially involving the consumption of psychoactive substances. As I myself enjoy certain mountain activities that are considered risky, I had trouble understanding the “pathologising” discourse sometimes found in medical literature. I wanted to dig deeper, but I needed an angle. That’s when I discovered, somewhat by accident, the flow theory developed by Hungarian-American psychologist Mihály Csíkszentmihályi in the study of positive psychology. It is the idea of “optimal experience” felt by a dancer, surgeon or climber when they are completely absorbed in what they’re doing, making one movement after another as if nothing else existed around them. Csíkszentmihályi believes that achieving this very particular mental state – the perfect balance between challenge and skill – can enhance the feeling of personal accomplishment and well-being.
To build on that model, I decided to focus my dissertation on flow in mountain climbing. Meanwhile, I was hired as an assistant on a research project relating to communication in oncology led by the Department of Psychiatry, then to develop a project on support care and quality of life for oncology patients. These two environments didn’t seem related at first, but they ended up overlapping. Now, I think it’s really interesting to try to apply certain positive psychology principles and concepts, such as gratitude, to palliative care and the study of end of life, also in continuity with research focusing on patient needs and resources.
Quality of life is the key indicator in palliative care. We more often consider the ideas of quantity and quality of life as diametrically opposed. A patient who has just been told he or she has an advanced stage of cancer might say, “Give me everything. Let’s try anything to help me live as long as possible.” The approach then is to cure, sometimes taking extreme measures. In that case, it’s about quantity of life. That reaction is easy to understand, and we have to respect that. If I was diagnosed with a fatal disease, my first reflex, and perhaps my last, would probably be to say, “I want to live!” But as the disease develops and treatments are taken, the question of quality of life may be, or go back to being, essential.
After attempting three chemotherapy treatments, the patient’s priorities may change and a different therapeutic direction will be taken to enhance quality of life.
That doesn’t mean we stop the treatments and forget about the patient. Instead we shift from a curative perspective to a palliative one. But we also have to determine what quality of life means for the patient, and what can contribute to it. It’s not necessarily just about his or her state of health. It’s deeply subjective. Quality of life means something different to every individual.
Post-traumatic growth refers to the positive psychological changes that can occur as a result of traumatic life events, such as being told you have a potentially deadly disease. In the case of positive life events, for example winning the lottery, some studies show that you’ll probably experience a peak of well-being, then your curve will quite rapidly return to its original level. The opposite can also be seen. When a person is told they have a fatal disease, a psychological process, either conscious or unconscious, may be triggered, in which some people manage to bounce back, adapt, and find deeper reason to go on living based on new values or new goals. It may result in developing a form of spirituality or in deciding to focus on and enjoy those close to them to the fullest.
These changes can help create a sense of personal accomplishment, or at least acceptance of the disease as it progresses and some degree of solace.
That doesn’t happen with everyone, of course, but we’ve observed the process in many palliative care patients. Understanding the mechanisms that contribute to it is key to offering the best possible support for future palliative care patients.
Mathieu Bernard is Head of research of the Palliative Care and Support Service at Lausanne University Hospital and lecturer at the Institute of the humanities in medicine.