Who is willing to consider illness, even a serious one, as an opportunity? Of course, done like this, point blank, the question can provoke incredulous reactions and, let’s face it, a healthy desire to consider who is formulating it, a provocateur. understandable. But we must reflect: The disease finds us where we are. When it came to me, I realized that I could experience it as an adverse and up to a certain point irritating circumstance or, conversely, as an immense and undeserved opportunity to learn. I decided my perspective would be the second. These words were spoken by an African doctor who wanted to leave them as a testimony to a colleague and which have been collected in a small book (Sendino dies, Vita e Pensiero Ed.). What to think? Does the initial question about the disease begin to appear in a different light? Does it sound less hateful, offensive, offensive? an important first step to talk about a project born from the experience of three carers: Antonella Delle Fave, full professor of Psychology at the State University of Milan, Giuseppe Masera, doctor-pediatrician, former director of the Pediatric Clinic at the University of Milan-Bicocca, San Gerardo hospital in Monza, and Alberto Scanni, oncologist, former director of the National Cancer Institute of Milan. And, just to declare the conflict of interest, the writer is also part of it.
A concept of ancient China and a scientific perspective
Let’s move forward, taking a step back in time and to the other side of the globe. In China, millennia ago, they coined two ideograms that become the word in our writing: Weiji (危机). This word (albeit with the approximation allowed by Western thought) contains two concepts: crisis and crucial point (turning point or change). Today, a growing number of studies show that it is not necessary to be in good health to perceive well-being and a good quality of life. Not only. A problematic event such as illness can have different consequences on a person’s well-being and quality of life depending on whether it is viewed negatively, as a source of threat and danger, or positively as a challenge to grow, to develop new skills, to identify new goals. and meanings of life. And here is the project “Disease as Opportunity” which is not based on an abstract idea but rather has its roots in the knowledge derived from the research of Positive Psychology: the one that, as explained by Marcello Cesa Bianchi, dean of Clinical Psychology in Italy, seeks to set the intervention on the healthy and the sick taking into account the positive potentials, considering that enhancing them can help to put the person in a situation as a whole to better face even the difficulties and sufferings.
Illness can be a two-sided coin
For two or three decades, studies in the field of Positive Psychology have provided scientific proof of this concept: The disease, as well as other traumatic experiences – Antonella Delle Fave points out -, has the ability to bring out positive values and resources (resilience, post-traumatic growth) in a wide range of cases. Giuseppe Masera explains: The disease can be considered as a two-sided coin: one characterized by the painful experience during the initial phase of diagnosis and therapy, the other includes the positive aspects resulting from the initial crisis. The path of the person with pathologies such as cancer but not only, for example, can be imagined as the entrance into a dark tunnel, which evokes “despair”. Over the past 30-40 years, a light of hope and the beginning of a new path have begun to appear for most people at the end of the tunnel. More and more frequently, patients are aware of this new perspective. The proposal of the promoters of the project, simple and at the same time almost reckless: Let’s open a comparison with sick people and health professionals – says Delle Fave – and consider the downside of the disease, evaluated not only in its negative aspect but also as opportunity to stimulate positive aspects.
Dialogue with the readers of the Corriere
What does this mean in practice? Act on two fronts: that of sick people and that of people who care. As far as sick people are concerned, it means inviting them to answer the question we formulated at the beginning: can illness also be experienced as an opportunity? For this purpose the Health Courier opens a dialogue window with readers on the online site, through a dedicated multi-author blog (signed by the project promoters), which is called Malattia come Opportunit. What we ask readers to send the story of their experiences (also via e-mail), making an effort to think about the positive side and not just the dark part of the tunnel. The invitation to focus on the change that has taken place. Because on one point it is possible to agree: the disease changes who is affected and nothing in his life is more like before. Not an easy task for anyone, of course. But giving a voice to sick or formerly ill people, family members, friends could contribute to a change of attitude in the face of serious illness. This is why the project wants to give value to the readers’ words: so that they are the first to become witnesses of change.
Rediscover important values, regroup affections
Without forgetting that behind every sick person there is a family that suffers – adds Alberto Scanni -. Attention must also be paid to family members to console them and educate them to support their loved one also from a psychological point of view. Can we speak here of resilience for family members? Certainly yes, this aspect has also been the subject of scientific studies and has led to the development of intervention programs aimed at families. The illness of your loved one can represent an opportunity to rediscover important values, regroup affections, find new roles. It is also necessary to admit that this is not always the case. With doctors, on the other hand, the project intends to propose the construction of a new paradigm of Medicine based precisely on the enhancement of the positive aspects that the experience of the disease can determine in the sick person. In other words, it is a question of moving from the current biomedical model of health centered on disease, to the bio-psychosocial model, which places the patient at the center with his psychological, social needs, integrated by empathic communication. As many scholars have pointed out, in the last fifty years the doctor-patient relationship entered into serious crisis precisely in conjunction with the great advances in biomedical sciences. Giorgio Cosmacini, historian of medicine speaks of the progressive extinction of relational anthropology and of the doctor-patient relationship.
The relationship can become a fundamental resource
One of the main factors of this crisis is silent diagnostics, which is increasingly impersonal and technological; less attention to communication and listening to the patient; defensive medicine, which leads to seeing the patient as a possible adversary. With the “Disease as Opportunity” project we would like to guide the doctor towards a more effective intervention modality in the relationship with the sick person – underlines Antonella Delle Fave -. Diagnostic and therapeutic choices must be accompanied by attention to the patient’s subjective experience in its emotional, but also cognitive and motivational aspects. Thus also the relationship can become a fundamental resource to facilitate the healing process or constructive coexistence with the disease. The doctor must also become a promoter of hope – says Giuseppe Masera -, which can be considered a “catalyst for healing”. Hope is the belief that you can find a way to tackle a problem effectively, and that you have the motivation and skills to do it. It should not be confused with optimism, with generic positive thinking, that is, with the “undifferentiated tendency to think that in one way or another everything is fine”. Nor should it be confused with illusion. Supporting the development of “conscious hope” is a possible, rewarding, even if demanding process for those who practice it, and lays the foundations for a fruitful collaboration in the subsequent course of treatment, and beyond. In short, we would like to encourage the construction (or rather the re-construction) of the relationship between doctor and patient on a new ground.
The patient’s story broadens the doctor’s horizons
In this vision, the doctors who want to join will be invited to collect the testimonies (anonymously) of the sick people to make them the object of personal reflection and also of scientific study. Transferring this knowledge and empirical evidence into clinical practice – explains Delle Fave – means providing patients with important tools to become aware of the skills and resources they often already have, to enhance them and thus pursue complex growth objectives consistent with their aspirations and values. . Encouraging patients to tell about themselves and to reveal their vision of the disease and of life can broaden the horizons of the doctor, allowing him to grasp a personal experience that – where resilient – can help the professional to understand more clearly the human processes of adaptation and – where fragile – it can represent a starting point to address the issue with the patient and support him in building a more constructive vision of the disease. But it also means facilitating the doctor’s work, favoring the development of a relationship of trust and mutual openness with the patient, whose positive consequences in terms of therapeutic success are amply demonstrated by the literature. A utopia? Maybe. Unattainable, as Fernando Birri says, a character that came from the pen of the Uruguayan writer, Eduardo Galeano. Who wonders what utopia is for then. The enlightening answer: This is exactly what it is for: to walk.
Memberships in the Disease as Opportunity project
They agreed or expressed interest in the project (in alphabetical order): Gianni Bona, chief emeritus of paediatrics, Aou Novara; Mario clerk, president of the Italian College of Primary Medical Oncology in Hospital; Giorgio Cosmacini, historian of Medicine and Health; Nicola Dioguardi Humanitas, Milan; Nicola Montano, full professor of Internal Medicine, Univ. Studies, Fond. Ca ‘Granda-Policlinico (Mi); Silvio Garattini, director, IRCCS Ist. Mario Negri (Mi); Riccardo Haupt, head of UOSD Biostatistical Epidemiology and Committees, IRCCS Gaslini (Ge); Momcilo Jankovic formerly responsible for day hosp. Pediatric Hematology, MBBM Foundation – Asst San Gerardo Monza; Giorgio Lambertenghi Deliliers, head of General Medicine, Capitanio Ist. Auxologico (Mi); Nicla La Verde, Head of Clinical Research, Medical Oncology Division ASST Fatebenefratelli Sacco (Mi); Enrica Morra, scientific coordinator of the Lombard Hematological Network; Armido Ruby, Emeritus Professor of Pediatrics. A. Federico II (Na); Gianni Tognoni, researcher Institute Mario Negri (Mi); Luciano Vector, former full professor of Internal Medicine, University of Verona.
May 13, 2018 (change July 16, 2020 | 11:14 am)