Coragem

Senhor, dai-me coragem para mudar o que deve ser mudado;
Sabedoria para aceitar as coisas que não posso mudar e
Discernimento para perceber a diferença entre as duas situações (Oração da Serenidade).
 

Mesmo sendo a felicidade um estado subjetivo, vários estudos sobre o tema consideraram escalas e inventários envolvendo quatro fatores convergentes ao bem-estar: (1) presença de emoções positivas e ausência de emoções negativas; (2) traços maduros de personalidade, incluindo a cooperação, autonomia emocional e auto-transcendência (espiritualidade); (3) qualidade de vida e satisfação pessoal; (4) outros traços de personalidade como a esperança, compaixão e coragem. 

Ser feliz

“Posso ter defeitos, viver ansioso e ficar irritado algumas vezes, mas não esqueço que minha vida é a maior empresa do mundo. E que posso evitar que ela vá à falência.

Ser feliz é reconhecer que vale a pena viver, apesar de todos os desafios, incompreensões e períodos de crise.

Ser feliz é deixar de ser vítima dos problemas e tornar-me um autor da minha própria história.

É atravessar desertos fora de si, mas ser capaz de encontrar um oásis no recôndito da sua alma.

É agradecer a Deus a cada manhã pelo milagre da vida.

Ser feliz é não ter medo dos próprios sentimentos. É saber falar de si mesmo. É ter coragem para ouvir um “não”. É ter segurança para receber uma crítica, mesmo que injusta.

Pedras no caminho? Guardo-as todas, um dia vou construir um castelo…” (Fernando Pessoa).

Costumo dizer aos meus pacientes que “visualizar o caminho antecipadamente é um passo fundamental para percorrê-lo”. 

Façamos da interrupção um caminho novo…

Da queda, um passo de dança…

Do medo, uma escada…

Do sonho, uma ponte…

Da procura, um encontro!

(Fernando Sabino) 

Onde existe o perigo, cresce também o que dele nos salva. Heidegger 1953 

A resiliência também é abordada enquanto conceito que pode ser aprendido e operacionalizado como estratégias saudáveis para gerir os extremos de violência e abusos que a civilização, infelizmente, inflige em nas sociedades.

Trarei exemplos práticos de alguns pacientes que cresceram e se desenvolveram psicologicamente com base nos aprendizados adquiridos em suas experiências dolorosas.

Elie Wiesel, sobrevivente do Holocausto, escritor e vencedor do Prêmio Nobel da Paz em 1986, escreveu e reescreveu suas experiências e certamente pode significar e ressignificar seus traumas através de sua obra. Esse exemplo de superação nos deixa uma importante lição: “…nós devemos falar. Ainda que não consigamos expressar nossos sentimentos e memórias da maneira mais adequada, devemos tentar. Precisamos contar nossa história tão bem quanto pudermos. Eu aprendi que o silêncio nunca ajuda a vítima, apenas o vitimizador… Se eu ficar em silêncio, enveneno minha alma.”

O terapeuta pode facilitar o acesso a outras redes de padrões associativos com base nas memórias já existentes desses indivíduos, para que então possam significar suas experiências e aprender com elas.

1: Recenti Prog Med. 2008 Sep;99(9):440-2.

Related Articles, Links

[The courage and the fear: an incessant dialogue]

[Article in Italian]

Callieri B.

The wide range of modulations of the experience of fear and of courage is here explained with its resonances. From the sensorial to the spirituals feelings, the author recalls the dialectics between passion and reason and underlines the unavoidable existential reference to the “timor et tremor” by Kierkegaard and to the “courage to be” by Tillich. At the outcome of this dialectics between fear and courage, the author places the fortitudo, both Stoic and Christian.

O diálogo entre o medo e a coragem está presente em muitas expressões artísticas.


2: J Anxiety Disord. 2009 Mar;23(2):212-7. Epub 2008 Jul 12.

The role of courage on behavioral approach in a fear-eliciting situation: a proof-of-concept pilot study.

Norton PJ, Weiss BJ.

Department of Psychology, University of Houston, University of Houston, Houston, TX 77204-5022, United States. pnorton@uh.edu
Coragem pode ser definida como um comportamento de aproximação a despeito da vivência do temor. Tal aproximação pode ser objetiva e/ou subjetiva. Por exemplo, vinte e dois voluntários com medo de aranha foram estudados quanto à coragem de enfrentamento de suas fobias. Para isso, foram submetidos a instrumentos psicológicos que avaliam diretamente e indiretamente a coragem, assim como a exposição real a quatro tarântulas taxidermes com o objetivo de aproximar a mão o máximo possível. O estudo realizado em 2009 pelo Departamento de Psicologia da Universidade de Houston mostrou que os escores de coragem subjetiva estiveram significativamente correlacionados as distâncias de aproximação das aranhas, isto é: os participantes com maior pontuação de coragem chegaram mais próximos às aranhas. A coragem é um importante fator para o enfrentamento dos temores e adversidades. A chegada ao consultório psicoterápico revela esse passo de coragem e motivação para vencer a dificuldade. Considerando que a expressão do medo se relaciona diretamente a vulnerabilidades específicas, ao que o indivíduo não controla e/ou não conhece, a coragem fortalecerá durante a psicoterapia com o conhecimento e controle adquiridos.

As pessoas se sentem às vezes desmoralizadas por não terem ainda a coragem suficiente ao enfrentamento. A cultura pode exercer uma crítica influência nesse sentido, ampliando  no auto-julgamento pejorativo da covardia, icapacidade,

“O medo enfraquece a Fé, a Fé mata o medo”.

The current study was conducted to assess courage, defined as behavioral approach despite the experience of fear, in an effort to better understand its relationship with anxiety, fear, and behavioral approach. Thirty-two participants who completed a measure of courage and reported elevated spider fears during an earlier screening participated in a Behavioral Approach Test where they were shown a display of four taxidermied tarantulas and asked to move their hand as close to the spiders as they felt comfortable doing. After controlling for scores on measures of spider fears, courage scores were significantly associated with approach distance to the spiders, such that participants with greater courage moved closer to the spiders. This study advances knowledge about the relationship between courage and fear. Based on our findings, future studies can explore the extent to which (a) courage mediates willingness to engage in therapeutic exposure in treatment, and (b) whether courage can be augmented in treatment prior to implementing exposure therapy.


 


5: J Palliat Care. 2007 Spring;23(1):40-3.

Is courage the counterpoint of demoralization?

Wein S.

Department of Pain and Palliative Care, Peter MacCallum Cancer Centre, East Melbourne, Australia, Victoria, Australia.

OBJECTIVE: To consider the role courage plays in our ability to cope with threat and adversity, especially the role of courage in understanding demoralization and dignity. METHOD: By exploring standard psychiatric texts and Aristotle’s concept of courage and virtue. A review of Medline and PsycINFO provided few relevant documents, reflecting the paucity of research on the concept of courage in psychiatry, palliative care, and psycho-oncology. RESULTS AND CONCLUSIONS: Courage is an important precursor to maintaining morale and therefore may play a critical causative role in demoralization. Courage is also intimately related to the concepts of self-esteem, free will, and personal values in life. The utility of the concept of courage is that it enables a response to a difficult circumstance. The main drawback of courage in a therapeutic sense is that it is often linked with cowardice, which has a pejorative connotation and is notoriously difficult to diagnose.

PMID: 17444461 [PubMed – indexed for MEDLINE]


Liquid courage: alcohol fosters risky sexual decision-making in individuals with sexual fears.

Stoner SA, George WH, Peters LM, Norris J.

Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195-1525, USA. sastoner@u.washington.edu

The interaction of sexual fear and acute alcohol intoxication on the likelihood of risky sexual behavior was explored. Participants (Ps; N = 115) completed a measure of sexual fears and were randomly assigned to no-, low-, or high-dose alcohol conditions. Ps then read an eroticized vignette, where they were the protagonist, and rated their likelihood of sex with a new partner when no condom was available. Controlling for gender and social desirability, compared to sober Ps, highly intoxicated Ps indicated that they were more likely to engage in risky sexual behaviors. Sexual fear was modestly negatively related to risky sex likelihood among sober or mildly intoxicated Ps but strongly positively related to risky sex likelihood among highly intoxicated Ps. Findings underscore the notion that alcohol affects different types of individuals differently and indicate that alcohol may foster sexual risk-taking, in part, by attenuating or counteracting fear or anxiety.


9: Integration. 1998 Fall;(57):34-5.

Matching their courage. Care.

El-sadr W.

PIP: In this article, a physician working at Harlem Hospital in New York City describes how she awaited her Friday clinic with trepidation 10 years ago but now awaits it with eagerness inspired by her patients. To illustrate this phenomenon, she introduces several of her patients. First is Mary Ann who has multiple health problems compounded by AIDS and never misses a single dose of her medications, although the list of drugs she takes extends to two single-spaced pages. Next is Rochelle, a 36-year-old grandmother who transformed herself from a homeless drug addict when she learned she had AIDS. Then there is Jackie, whose fear sparked such irrational behavior that she caused commotions when she was in the waiting room. Jackie had to put AIDS treatment on hold to combat multiple drug-resistant tuberculosis yet she never missed a dose of medication. Another patient is Gardenia, who blames her young son’s death not on AIDS but on his medication and who always has an excuse for not taking her medication. Lester has been drug-free for 102 days and asks tough, intelligent questions about the efficacy of his proposed treatment. Hermine arrives with a notebook stuffed with clippings and information she has gathered from a variety of sources because she is afraid of missing out on the newest magic drug. These patients are similar to other HIV/AIDS patients in that they encounter the same pain, frailties, and doubts, but they are individually distinct in the way that HIV/AIDS has transformed their lives and given them the courage to face daunting odds. This courage should be matched by a commitment on the part of physicians to understand current treatments and address key questions about treatment effectiveness.

10: Pediatr Nurs. 1999 Sep-Oct;25(5):558-9.

Related Articles, Links

On leadership. The culture of courage.

Kerfoot K.

Hermann Hospital, Houston, TX, USA.

We all want health care to be delivered in an atmosphere of utmost integrity. However, integrity only occurs where there is courage to do the right thing in very difficult situations. Leaders must be very courageous to be successful. They must foster and build courage among their staff to create cultures in which the staff feel safe and supported to always act with integrity. We are not born with courage. We learn courage by eventually mastering situations in which we can act with less and less fear. The leader’s obligation is to assess the environment and build opportunities for staff to work courageously with less and less fear as they master more difficult situations in their everyday lives.

PMID: 12024406 [PubMed – indexed for MEDLINE]


11: Nurs Econ. 1999 Jul-Aug;17(4):238-9.

Related Articles, Links

The culture of courage.

Kerfoot K.

We all want health care to be delivered in an atmosphere of utmost integrity. However, integrity only occurs where there is courage to do the right thing in very difficult situations. Leaders must be very courageous to be successful. They must foster and build courage among their staff to create cultures in which the staff feel safe and supported to always act with integrity. We are not born with courage. We learn courage by eventually mastering situations in which we can act with less and less fear. The leader’s obligation is to assess the environment and build opportunities for staff to work courageously with less and less fear as they master more difficult situations in their everyday lives.

12: Can J Nurs Res. 1998 Spring;30(1):153-69.

Courage in middle-aged adults with long-term health concerns.

Finfgeld DL.

Sinclair School of Nursing, University of Missouri-Columbia, USA.

The purpose of this study was to develop a substantive grounded theory of courage among middle-aged adults with long-term health concerns. Twenty-five persons from rural and non-metropolitan areas of Central Illinois were selected to participate in this study based on theoretical sampling procedures. Interviews of 1 to 2 hours using openended questions were audiotaped and transcribed verbatim. The data were analysed using grounded theory methods. Courage among middle-aged adults with long-term health concerns was determined to consist of an ongoing progressive-regressive process of becoming and being courageous. Being courageous involves being fully aware of and accepting the threat of a long-term health concern, solving problems using discernment, and developing enhanced sensitivities to personal needs and the world in general. Courageous behaviour consists of taking responsibility and being productive. Courage is not limitless, and the process of becoming and being courageous is dependent on intrapersonal and interpersonal factors. Health-care providers facilitate this process by demonstrating competence and communicating effectively. Outcomes of being courageous include personal integrity and thriving in the midst of normality.

: Nurs Manage. 1997 Jul;28(7):38-40.

Never fear, never quit.

Tye J.

Courage and perseverance are the primary determinants of professional success and personal happiness. This article describes 10 core principles that show how to make the Never Fear, Never Quit philosophy part of your life and work.

 Behav Res Ther. 1994 Sep;32(7):683-90.

The overprediction of fear: a review.

Rachman S.

Department of Psychology, University of British Columbia, Vancouver, Canada.

There is converging evidence that many people overestimate how frightened they will be when faced by a fear-provoking situation (Arntz & van den Hout, 1988, Behaviour Research and Therapy, 26, 207-223; Rachman & Bichard, 1988, Clinical Psychology Review, 8, 303-313; Rachman, 1990, Fear and courage (2nd edn). New York: W. H. Freeman). This overprediction of fear is commonly seen in people who are troubled by excessive fear (e.g. claustrophobics, panic patients), but is not confined to them. Anecdotal, clinical, and research evidence suggests that the tendency to overestimate the subjective impact of an aversive event is a common psychological phenomenon. This review will present examples of overpredictions, put forward some explanations of why people might overpredict, consider the function that overpredicting might serve, and the possible consequences of overpredicting. The process by which overpredictions are reduced is also considered and an attempt will be made to relate this strong tendency to overpredict fear to other types of psychological overestimation.

: Behav Res Ther. 1992 Sep;30(5):463-70.

Cognitions and courage in the avoidance behavior of acrophobics.

Marshall WL, Bristol D, Barbaree HE.

Department of Psychology, Queen’s University, Kingston, Ontario, Canada.

Fifty subjects (29 fearless and 21 fearful) were tested in a potentially acrophobia-inducing situation, and their avoidance behavior and self-reported fear were noted. Subjects also completed various scales intended to measure their fearfulness and thoughts in hypothetical height-phobic, social-phobic and nonphobic situations. Interviews conducted immediately after the behavioral test, evaluated their thinking, fearfulness and tactics designed to deal with any fear they experienced. Analyses indicated that catastrophic thinking is more evident than irrational thinking in height situations and that such thinking was the best predictor of behavior among the measures used. The results are discussed in terms of their relevance for cognitive views of acrophobia and in terms of their relevance for treatment.
: Soc Sci Med. 1984;18(4):351-60.

Courage: a neglected virtue in the patient-physician relationship.

Shelp EE.

The contribution that the virtues can make to the moral life in general and to the moral community constituted in the patient-physician relationship more specifically is gaining increased scholarly attention. This paper explores the meaning and relevance of the virtue of courage for patients and physicians. Courage is presented as a virtue for physicians in addition to the excellences of competence and compassion and a virtue for patients in addition to the excellences of compliance and gratitude. In agreement with Alasdair MacIntyre, courage is held to be necessary, at times, to our expression of care and concern for one another. The patient-physician relationship is shown to be a context in which care and concern is expressed, a context in which courage can be a relevant virtue. Certain conditions are listed as necessary to courage: freedom, fear, risk, uncertainty, an endangered good and a morally worthy end. Equivalents to these necessary conditions are discussed and held to be potentially present in patient-physician encounters. Physicians are pictured as a ‘sustaining presence’ who have duties toward patients of ‘encouragement’ that can be fulfilled in ways relative to the requirements of each circumstance. Patients are held to have a duty to learn about the nature of human existence and to develop the character necessary to its negotiation. Patients and physicians can be agents of courage who come together in a context of care and concern where certain goods are preserved even, at times, in the midst of loss. Thus, courage is presented as a relevant and important moral virtue for the patient-physician relationship in which those qualities that define who we are as a moral community are expressed and sustained.

KIE: Shelp discusses the virtue of courage as manifested in the physician patient relationship. He comments briefly on other virtues associated with physicians and patients, defines courage, and outlines the prerequisites for courageous conduct. He then explores the traditional nature of the therapeutic relationship, in which the physician symbolizes relief and protection from mortality to the ill, vulnerable patient. Shelp concludes that when clinical skills prove useless, physicians may be called upon courageously to admit their limitations and to function as a “sustaining presence” to patients in helping them find the courage to negotiate the realities of illness and death.

 Br J Psychol. 1983 Feb;74 (Pt 1):107-17.

An experimental analysis of fearlessness and courage.

Cox D, Hallam R, O’Connor K, Rachman S.

In an attempt to assess the performance under stress of people who had received awards for gallantry, the subjective, behavioural and psychophysiological reactions of a group of seven decorated bomb-disposal operators were measured during a conflict test. Compared to a group of seven equally experienced and successful, but non-decorated, bomb-disposal operators, the decorated subjects maintained a lower cardiac rate when making difficult discriminations under threat of shock. There were no differences between the groups on subjective reactivity or on their performance under stress. Both groups of bomb-disposal operators reported having experienced fewer fearful reactions than did a small number of comparison subjects. The implications of the results for theories of fear and of courage are considered.

J Am Acad Psychoanal Dyn Psychiatry. 2009 Spring;37(1):137-52.

Psychoanalysis and spirituality-catastrophic change and becoming “o”.

Nachmani G.

William Alanson White Institute, New York, NY, USA. Gilead18@aol.com

This article considers the relationship between post-Kleinian psychoanalysis and spiritual experience in the healing process of a physically ill man undergoing medical care for an unknown disorder. He entered psychoanalytic psychotherapy after two years of being ill and after numerous medical interventions had failed. The psychotherapy involved certain religious experiences in the patient and the analyst that attuned them to one another. It also involved his fighting with doctors, family, and analyst. The fights were considered a transcendence of his troubling life, a mustering of courage and strength to live with illness and loss, and his use of a godlike fantasy figure, which could also be considered as a vivid good internal object. The therapeutic work was punctuated by numerous instances of catastrophic change, hope, and disappointment and by his not knowing about why his body acted as it has and why important people treated him as they had. He learned to know, in the sense that Bion used the term, to live with adversity, and return to as normal a life as is possible. The psychotherapy is a work in progress.

Chronic Illn. 2008 Sep;4(3):219-30.

Adaptive coping with rheumatoid arthritis: the transforming nature of response shift.

Sinclair VG, Blackburn DS.

Vanderbilt University School of Nursing, Nashville, TN 37240, USA. vaughn.sinclair@vanderbilt.edu

OBJECTIVE: Qualitative investigations of patients’ perspectives of coping can offer insights into a wide array of adaptive coping patterns selectively used to deal with illness-related challenges. The purpose of this qualitative study was to examine adaptive coping patterns reported by a sample of women with rheumatoid arthritis (RA). METHODS: Using thematic analysis, interviews from 19 participants were analysed until theoretical saturation was achieved. The interviews were coded, with narrative excerpts collated within each code, sorted by codes into potential themes, and then collated within identified themes. These themes were then further defined, providing specific adaptive coping strategies for each major theme. RESULTS: Major themes included accepting role limitations, reclaiming control, reframing their situation, and bolstering courage. Women described accepting more realistic performance standards, accepting their limitations and dependence on others, and altering their basis of self-worth. They reclaimed control of their lives by changing priorities, pacing themselves, being flexible, delegating to others, and setting appropriate boundaries. Reframing their situation enabled them to change their perspective, minimize threats from RA, re-prioritize their values, and find meaning and positive changes associated with their suffering. To bolster courage, they turned to a variety of sources for encouragement, including confidence from past successes, inspiring role models, and social support. CONCLUSIONS: The data reflect adaptive strategies similar to response shift processes. A link between response shift processes and higher levels of perceived control is discussed.

 Int J Group Psychother. 2008 Jul;58(3):345-61.

The courage of the group therapist.

Shapiro EL, Gans JS.

Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, MA, USA.

This report strives to legitimize for the field of psychodynamic group therapy the reflection on and study of courage. The authors surveyed group therapy leaders, asking them to describe courageous moments in their own group practice, and then explored the common themes arising in these examples, including openly confronting their mistakes, facing their own and group members’ anger, and dealing with unexpected moments in group sessions. Attending to courageous leader moments-and the feelings of hope and pride that they engender-help to neutralize the negative emotions that group leaders are constantly invited to contain. Paradoxically, accessing courageous moments can also evoke feelings of shame in the leader. If we are to require ourselves to embrace the sometimes terrifying challenge of journeying into the unknown with our patients, we must learn to be honest not just about our mistakes and our weaknesses, but also about our successes and our strengths.

Psychoanal Q. 2006 Apr;75(2):533-56.

Catching the wrong leopard: courage and masochism in the psychoanalytic situation.

Levine SS.

CathexisSL@msn.com

This paper introduces the subject of courage into the psychoanalytic discourse about masochism and also demonstrates that ordinary ethical and axiological concerns can and should be included in our psychoanalytic language and practice. At each stage of a psychoanalysis, it may be helpful to consider whether the patient’s experience might be that taking a step deeper into the psychoanalytic relationship is both courageous and masochistic. This consideration can open the door to exploration of conscious beliefs and how they are related to unconscious fantasies and assumptions. Considering the possibility that even a sadomasochistic enactment may simultaneously represent a courageous attempt to rework conflict or trauma can enrich the way analysts listen to both manifest and latent material.

Behav Res Ther. 1999 Jul;37 Suppl 1:S163-73.

Footsteps on the road to a positive psychology.

Gillham JE, Seligman ME.

Psychology Department, University of Pennsylvania, Philadelphia 19104-6196, USA. jgillham@psych.upenn.edu

We have argued that psychology as a field has been preoccupied with the negative side of life and has left us with a view of human qualities that is warped and one-sided. Psychology is literally ‘half-baked’. We need to bake the other half now. It is time for us to become equally concerned with the qualities and experiences that make life most worthwhile. A balance is needed between work that strives to relieve damage and work that endeavors to build strength. This balance is beautifully exemplified by Jack Rachman’s work over the past 40 years. As an astute and compassionate clinician and researcher, Jack developed and evaluated effective treatments for some of the most debilitating anxiety disorders. At the same time, he was impressed by the resiliency of his clients and the courage they exhibited daily. His observations and studies of courage have helped to launch a systematic science of human strengths. They are giant footsteps on the road to a positive psychology.

 Entrevista com o Dr. Julio Peres para Revista Vida Simples – Coragem