Lately, colleagues and I have been debating the issue of “prognosis”. More specifically, when it comes to people with severe illnesses or injuries, in a physical rehabilitation setting: how, when and if we should communicate “prognosis” to them? There seem to be two camps of thinking when it comes to this. On the one hand, there are those who feel the professional obligation to introduce patients to the “truth” about their circumstances. Alternatively, there are some of us who feel that “hope”, even if completely unrealistic, should be kept alive. Although I, without a doubt, camp steadfast on the pro-hope side, I have nevertheless become interested in the counter argument. For example, just the other day I was surprised to read in Jamie Fox’s Always Looking Up; “We do so much to protect ourselves from the truth, but what I have learned and drawn strength and comfort from, especially over the last seventeen years or so, is that the truth protects us from ourselves. That is, of course, if we can recognize it and trust it.” He goes on to quote Henry Davis Thoreau, in saying “in dealing with the truth we are immortal, and need fear no change nor accident”. As a long time sufferer of Parkinson’s Disease, I take Jamie Fox’s sentiments seriously and it reinforces the nagging, more traditional psychological voice, in the back of my head, that sometimes encourages me to “stick to the facts”. You see, I have come to follow a school of thought in psychology that has become increasingly reluctant to see us as therapists as Gate Keepers to peoples’ experiences. Therefore, I am reluctant to see it as my job to introduce patients to the, so called, “truth” about their situation. Is it my job to try and convince someone with a spinal cord injury that they are likely to never walk again? What if HOPE is sometimes the only thing that is getting you through the unimaginable difficulty and change that illness or injury introduces into your life? And I ask myself, do I have any business crushing such hopes (no matter how delusional)?
South African Artist, Duncan Stewart, writes: “How would you define Hope? To my mind it is like fuel that propels our bodies to pursue certain actions, the consequences of which we believe, correctly or not, will bring us a form of reward akin to pleasure, fulfilment, satisfaction and significance. Hope is very close to belief and belief, in turn, is close to faith. Faith is the substance of things hoped for, the evidence of things unseen. Faith also requires action or propulsion in a certain direction…an activity inspired by what one believes.” What this quote may argue, on my behalf, is that if you take away hope, belief or faith, you risk robbing someone of their “propulsion”. In a rehabilitation setting, the will to act, to move and to propel yourself is, surely, paramount? Why then, as therapists, do we see it as our “job” to stick to the supposed “truth”? Why are we so obsessed with thinking about the trauma of the past rather than the promise of an imagined future?
And then, just to burst my bubble, a previous patient who had suffered an horrific gunshot wound to the back and who has been so courageous in her battle with being in a wheelchair (at least for now), came back to see me, very agitated, saying – “No one prepared me for this…No one let me know it was going to be this mentally tiring to be out there.” I could not help but translate her “No one” into a “you”. Was she suggesting that it was my job to be more truthful with her and hence, prepare her better for life post-injury? Are clients sometimes calling for the “truth”, a responsibility that I am shying away from out of blind dedication to a more “postmodern psychology” or in order to order to avoid upsetting anyone?
Patients continue to defy their prognosis and I choose to continue to camp on the side of HOPE. But, there are perhaps times when you need to lend a few truths here and there to help equip you for the grueling journey of recovery. I think, if you listen close enough, clients usually ask for this when they feel they need it.