Psychological ideas in palliative care: Changing behaviour

Dr Jenny Strachan is a clinical psychologist at Marie Curie Hospice, Edinburgh, United Kingdom. Throughout the past year, Jenny has contributed a special series of articles to the European Journal of Palliative Care that aims to summarise some of the ‘big ideas’ in psychology and translate them into practical advice for those providing palliative care, and has also contributed to this blog. Here, she explains the background to her latest article in the November/December issue of the journal.

Dr Jenny Strachan

Recently, while I was writing the article about behaviour and behaviour change, which is now published in the European Journal of Palliative Care, I talked it through with a non-psychologist friend. ‘Isn’t that a bit grim?’ they asked. Intrigued, I asked them to explain. I discovered that they found the ideas of behaviourism ‘soulless’, and felt it ‘reduced’ human beings to ‘lab rats pushing buttons’.

I was somewhat taken aback that ideas that are the basis of my work attempting to understand and support people might be seen as in some way diminishing them.  Since I suspect that many readers may share this initial response, I would like to use this platform to make a counter-argument. In doing so, I’m going to draw heavily on a thought experiment proposed by one of my undergraduate lecturers. I regret that I have long since forgotten his name, but his analogy has stayed with me.

Imagine a very simple stimulus-response device: a light sensor attached to a beeper. If there is enough light to activate the sensor, it beeps. If there is not enough light, it doesn’t. If you place the device in a dark room, and you control the only light source, it’s very easy for you to predict whether the device will beep or not (this is the lab rat paradigm).

But what if you place the device on a window sill? Now whether it beeps or not depends on what time of day it is, and what the weather is like: a little harder to predict. Now imagine that you place the device on a television set, which is showing a news channel. Whether it beeps or not depends on what is happening in current affairs. It’s even harder now to predict whether this ‘very simple’ device will beep or not. Now imagine that the device is capable of taking in not one ‘bit’ of information at a time, but thousands. That it can spot patterns in the information. That it has preferences and can choose to give differing weight to different bits of information …

To think of human behaviour in terms of learned responses to stimuli is to ‘limit people’ only in as much as their exposure to different stimuli is limited. And if thinking in this way helps us to recognise that some people and groups are unfairly limited, so much the better.

Loss and suffering are a part of every life, never more so than when we, or those we love, approach death. Suffering, and being cared for are immensely powerful stimuli. Though vastly more complex than the light sensor, ours is still a learned response which depends on our past encounters with suffering and care. If the people who ‘cared for’ us in the past were good to us, our response to being cared for now is likely to be one of appreciation and co-operation. If they were abusive, shaming or neglectful our response is likely to be quite different. When we meet someone who responds to our ‘care’ with aggression, ridicule, dismissal, we must ask – what happened to them that they learned to do this? We must also recall that in different circumstances, with different experiences, they may have made different choices. So might we.

In that capacity to recognise our shared humanity, and resist judgement, are the roots of compassion. And that is the very opposite of grim.

Read the full article in the European Journey of Palliative Care
This post relates to Psychology series: Changing behaviour’ that is published in the November/December 2017 edition of the European Journal of Palliative Care (EJPC) (vol. 24 (6). (If necessary, click the ‘Browse the archive’ and choose 2017/November/December to read this article).

If you have a web-based subscription to the journal you’ll be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.

Links

  • Read more posts relating to articles published in the European Journal of Palliative Care on the EAPC Blog.
This entry was posted in EAPC-LINKED JOURNALS, European Journal of Palliative Care, PSYCHO-SOCIAL ISSUES and tagged . Bookmark the permalink.

2 Responses to Psychological ideas in palliative care: Changing behaviour

  1. Susan Brown says:

    I am sometimes so frustrated when I can only get what we would call a “teaser” and want to go deeper with the writer. Small complaint: some of us can’t get institutional support for a subscription to a European journal, so the only full articles we can read are generally the ones you offer as a free article.
    Nonetheless, I appreciate your blog. I look forward to it.

  2. pallcare says:

    Hi Susan
    Many thanks for taking the time to comment – it’s important that we get feedback like this.

    I appreciate how frustrating it must be for you if you cannot get free access to the longer journal articles to which some blog posts relate. Our authors work very hard to make sure that their posts have value as a standalone post rather than simply as a teaser to the longer article but, at the same time, they have to adhere to a very modest word count so it’s quite a challenge. Although this suggestion will not help with the current post, certain other articles from the European Journal of Palliative Care (EJPC) that relate to blog posts are uploaded as PDFs to the EAPC website and you can download these free of charge from http://www.eapcnet.eu (choose Resources/Official EAPC Journals). Each time a new EJPC article is uploaded to the EAPC website we announce this via our Facebook page so do keep an eye on this.

    With regard to the ‘Editor’s Choice’ posts that relate to longer articles published in Palliative Medicine (the other EAPC official journal), PDFs of the longer article are all available free of charge from the EAPC website. To access PDFs on the EAPC website you will need to login as an EAPC member, but if you are not a member you can simply register free of charge to download publications (www.eapcnet.eu).

    So sorry that this does not solve your problem with the current post but I hope it helps to direct you other publications that are free on our main website.
    And meanwhile I hope you will continue enjoying the blog.
    All the best, Avril.

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