Patients with terminal illness often experience accelerated personal growth in their final days and begin to meet life with more gratitude, determination, and positivity, according to a new paper published in the journal International Psychogeriatrics. The researchers found that this growth was linked directly to an increase in wisdom.
Scientists define wisdom as a complex trait with several interrelated components, such as compassion, emotional regulation, spirituality, and tolerance.
Researchers at the University of California (UC) San Diego School of Medicine asked 21 hospice patients, ages 58 to 97 and in the last six months of their lives, to describe what they believe to be the core characteristics of wisdom. They also wanted to know whether the experience of a terminal illness would have an impact on the patients’ understanding of wisdom.
“The end of life presents a unique perspective,” said senior author Dilip V. Jeste, M.D., senior associate dean for the Center of Healthy Aging and Distinguished Professor of Psychiatry and Neurosciences at UC San Diego School of Medicine.
“This is an extremely challenging time, a confluence of learning to accept what’s happening while still striving to grow and change and live one’s remaining life as best one can. It’s this paradox that, if embraced, can lead to even greater wisdom while confronting one’s own mortality.”
Jeste and colleagues have spent years studying the nature of wisdom, from its definition and assessment to its neurobiology. In the current study, mental health professionals interviewed male and female residents of San Diego County (primarily Caucasian) who were staying in their homes or in healthcare facilities. Nearly half of the patients were dying from cancer.
All of the participants were asked the same set of questions, such as “How do you define wisdom?” and “What experiences have influenced your level of wisdom?”
The interviews were open-ended to allow the patients to introduce or expand upon topics of importance to them. The interviews were audiotaped, transcribed, analyzed, and interpreted using several different evaluative methods.
In order of importance, participants ranked the defined components of wisdom to be prosocial behaviors, social decision making, emotional regulation, openness to new experience, acknowledgement of uncertainty, spirituality, self-reflection, sense of humor, and tolerance.
Serious illness, a diagnosis of terminal disease or the beginning of hospice care significantly altered the patients’ ideas of wisdom. “My perspective, my outlook on life, my outlook on everything has changed,” said one study participant. “It’s grown tremendously.”
One recurring theme among interviewed hospice patients was the search for acceptance or peace related to their illness, particularly in terms of physical changes and loss of functioning.
“It wasn’t passive ‘giving up,’ but rather an active coping process,” said first author Lori P. Montross-Thomas, Ph.D., assistant adjunct professor in the Department of Family Medicine and Public Health.
“They emphasized how much they appreciated life, taking time to reflect. There was a keen sense of fully enjoying the time they had left and in doing so, finding the beauty in everyday life.”
Patients also spoke of “galvanized growth,” said Jeste, adaptive characteristics “stimulated and forged by the difficulty of living with a terminal illness, such as greater determination, gratitude, and positivity. The growth was linked directly to an increase in wisdom.”
Overall, the hospice patients described wisdom as a continuous recalibration between actively accepting their illness and still wanting to grow and change as individuals. The process see-sawed, they said. There was no static solution, but rather a constant effort to find balance, peace, and joy at the end of life.
“Now, wisdom is being aware of my surroundings, trying to read the people that I meet, and trying to appreciate my day and look for the gifts. Look for the positive instead of the negative, I would say,” said one patient.
Another patient said, “I want them to remember me with a smile, laughing and giggling and doing some of the silly things we do. You know, it is fun. Why do you want to leave on a sad note? I do not want to be remembered being sad.”
Source: UC San Diego