Study Offers Insight into Patients’ Healing Journeys

September 29, 2017

Model illustrates how people transcend suffering to find healing

Substantial research has established the importance of doctor-patient relationships in facilitating the healing process. But few studies have explored patients’ broader experience of healing and how it can be fostered outside the medical system. Now, a new study supported by the Institute for Integrative Health, sheds light on the complex progression from illness to healing, which the authors call the “healing journey.”

Published online this month in BMJ Open, the study is one of few to examine healing from the patient perspective.

“The findings are helpful because they show, from the lived experience of people who are suffering, how the winding path of healing happens,” said Institute for Integrative Health Scholar, Kurt C. Stange, MD, PhD, Distinguished University Professor at Case Western Reserve University.

The authors performed thematic analyses of in-depth interviews with 23 patients who had a variety of medical, psychological, and social issues. All had experienced healing, defined as “recovering a sense of integrity and wholeness after experiencing illness and suffering.” Interviews were conducted by the first author, John G. Scott, MD, PhD, for an earlier study of healing relationships between doctors and patients.

Using a combination of qualitative methods to analyze the transcripts, the authors identified emerging themes and developed a model illustrating the healing journey. The process it depicts begins with a wounding event, causing suffering, defined as “the experience of distress when the intactness or integrity of the person is threatened.” Its degree and quality are related to the individual’s characteristics, relationships, and stage of life.

Through persistence, the suffering person forms safe, trusting relationships with helpers, who in turn, enable the person to gain resources, such as positivity. The cycle of acquiring relationships and resources repeats indefinitely, fostering beneficial attributes, such as self-acceptance. These contribute to a restored sense of wholeness and integrity, which constitutes healing.

Transcript analyses revealed that healing was an erratic, long-term process, experienced uniquely by each person with their individual circumstances. The authors wrote: “People in the sample experienced healing journeys that spanned a spectrum from overcoming unspeakable trauma and then becoming healers themselves, to everyday heroes functioning well despite ongoing serious health challenges.”

The study found that people on healing journeys created connections with a wide range of helpers, including not only family, friends, and health professionals, but also non-human sources of support, such as pets, spirituality, and personal interests. Crucial to forming connections were a feeling of safety and a sense of trust that connections would be conducive to healing. These relationships proved instrumental in helping participants develop skills and resources through observation and practice, including the ability to reframe suffering in a positive light, the choice to adopt an optimistic attitude, and the capacity to take responsibility for one’s recovery from illness.

The authors note that the healing journey was recursive in nature, not step-wise. Mustering persistence and battling despair, people continually formed connections and gained new resources. As a result, they gradually found relief from suffering and began to exhibit emergent characteristics: a sense of hope, self-acceptance, and a desire to help others—the immediate precursors to healing.

Importantly, the authors go on to say that restoring a sense of integrity and wholeness doesn’t require the absence of illness. None of the study participants was cured, yet as the authors point out, “they were all able transcend their suffering and in some sense to flourish.”

The authors are hopeful the study will influence a shift in the way patients and health care practitioners think about and approach healing. “By filling a gap in understanding the healing process, the study’s findings may offer hope to those who are suffering and guide how they respond to their state of illness,” said Dr. Stange. “Likewise, greater understanding of patients’ journeys may positively inform the way health professionals, caregivers, and communities support those who are ill.”

Other authors include three Institute for Integrative Health Scholars, Paul Dieppe, MD, FRCP, FFPH (University of Exeter Medical School), David Jones, MD (The Institute for Functional Medicine), and Sara L. Warber, MD (University of Michigan Medical School) as well as John G. Scott, MD, PhD (Northeastern Vermont Regional Hospital).

In addition to funding from The Institute for Integrative Health, Dr. Jones received some support from The Institute for Functional Medicine, and Dr. Warber received some support from a Clinical Research Professorship from the American Cancer Society.

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. 

When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) 

“When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” 

Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. “…they gradually found relief from suffering and began to exhibit emergent characteristics: a sense of hope, self-acceptance, and a desire to help others—the immediate precursors to healing.”

 In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” 

  • Helping Others: We find meaning in helping others. “Understanding that suffering gives the strength and experience to help others in similar situations.”
  • Hope: We begin to have hope that we will not always feel this bad. A Crohn’s patient said, “I think gradually I realized that I was going to feel better. I did have days when I actually didn’t vomit, when I did feel better. And I think gradually I came to believe that maybe I could have a normal life again.”
  • Self-Acceptance: We see our inherent value and understand that we are not to blame for our suffering. A participant living with HIV said, “I’m really proud of myself. I think that now I still want to live. I don’t want to die, and I really love myself a lot. I have a lot of comfort in myself.”

Suffering is the ongoing pain from wounding. 

There is some debate about whether people always experience suffering on the path to healing.

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. 

“The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”

Characteristics: How predisposed someone may be to wounding/how many tools and resources someone may have to deal with trauma/illness.

Lifestages: Developmental timing plays an important role in the impact of trauma — young children often do not have the same resources as older adults.

Relationships: Relationships can provide solace and support for those suffering, while lack of healthy relationships can prolong suffering.