“I’m not sure how much my pain has changed but you’ve given me hope” he said as we discussed his discharge and future.
He thought he’d end up in a wheelchair. Doing less and less over time. He’d had multiple back surgeries. The first over 30yrs ago! He’d worked his whole life in the ergonomic seating business. But couldn’t find a seat to help his back pain.
This made me think about hope. What is it? What did he mean? Why had this made such a difference for him. Now he was walking further and further. Not dragging his leg as much. His hope seemed not to be tied to his pain outcome. Which on intial assessment was his main complaint although function was also a problem. Hope doesn’t rely on perfection (see La Méprise). Maybe not even a good outcome.
This jolted my thinking. I had always tied hope to a future event. But actually hope is something distinct from its object. I can hope my football team wins. I don’t get stuck in traffic. My kids sleep through the night. Some of these I have more expectation than others. More possible. But my hope is for the now. The event or object of my hope is in the future. We can live in hope. We can’t live in the future. Sometimes we mistake hope for blind optimism.
People can get into cyclical decay. Perpetual setbacks rob their hope. Blind them. From possibility. Opportunity. Life. I sometimes wonder whether the opposite of hope is depression. Or the loss of hope is part of this. What is it like to live without hope? Trapped in the now. With a seemingly monotonous future. Bleak. No expectancy. Nothing to look forward to. Just cycle after cycle.
This is not a polemic for offering any treatment as it will give the person some hope. In fact this may keep them trapped in the cyclical nature of suffering. It encourages an escapism mentality. Detached from reality. Craving future escape. It distracts our sight from the now to the future. This can cloud thinking, judgement, attitude. It becomes blind ‘hope’. Learning to live in hope is different to having hope in something. It is grounded. Real. Current.
When people have had a setback this is not easy. This is not the only part of someone’s rehabilitation. But it is the one that takes the most time and effort in my clinic. Not to say pain is a social construct. But that there are social constructs around pain. Attitudes. Beliefs. Behaviours. This can be a learning experience for people living in pain (and hope). Or it can be a devastating time in which they cling steadfastly to old beliefs. When hope is lost we need new eyes to see the world differently. Not to ignore pain. Nor to put into perspective that others are worse off. But to see what IS possible. Now.
You might argue eyes that view only the now are part of the problem. They only view the pain now. The suffering now. I don’t think this is the problem. The problem is when the eyes start to view the future as the present. The present is duplicated into the future.
Alva Noë describes how our bodies and senses are required to ‘see’. To perceive. To touch, smell, investigate. Do we allow people to do this? Or do we pull them out? This is where new eyes are needed. I overheard (on twitter) of someone describing their physiotherapist as their hope dealer (I think @SandyHiltonPT). That is one hell of a compliment. How often are we hope dealers?
There are 2 basic approaches to rehabilitation. The ‘lifter out-er’ and the ‘sitter in-er’. The lifter out-er approaches the person as some one who needs to be pulled out. Saved. Acted upon. The sitter in-er approaches the person as someone to be supported. Assisted. Engaged with. The lifter out-er needs to be either highly effective or extremely strong. The sitter in-er needs time and understanding. The lifter out-er is fully relied upon for the work to get the outcome. The sitter in-er is less pivotal (although important) compared to the person being sat in with. The classic example of this is depression. A lifter out-er approach looks to pull the person out of depression. This may be done in a variety of manners. A sitter in-er approach would look to sit in with them and help them find their own way.
I had a similar experience of gaining new eyes. In a slightly different context. To give you some background I am and have always been a ‘jock’. Sports lover. Weight lifter. Gym go-er. I despised art and all associated with it. Galleries. Theatre. Ballet. Culture. It was all a bit fancy. Flouncy. Extravagant. Unnecessary. I was a realist. Only interested in real stuff. Science. Sports. Exercise. Health. Stuff you can touch. Then I met my wife! Not only beautiful and intelligent but much to my disgust an artist, illustrator, designer. Over time through a sneaky graded exposure approach I have come to appreciate art, culture, quality over quantity in a way I would never have imagined before. The reality I now realise is that my confirmation bias rejected it. I was terrible at art in school. I got straight A’s at GCSE except for Design + Technology (D). My Renaissance experience gave me new eyes to see things before they had not. Although I jest my wife covertly pulled the strings At no point did I ‘hope’ to like art in the future. Now I can’t imagine humanity without it. My eyes changed a little at a time. Always in the now. In response to exposure of things previously not seen. I wonder if there are any parallels for healthcare here?
So what kind of healthcare practitioner are you? A lifter out-er? A sitter in-er? Both?
How can we be hope dealers to those with no hope? Should we concentrate on the past, present or future? How can we help people to see with new eyes?
Be more human. Be less robot.
Thanks for reading this far
Alva Noë (2004). Action in Perception. MIT Press.