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Positive Surgery

written by Miriam Akhtar 28 March 2009

Miriam Akhtar, MAPP from the University of East London, runs Positive Psychology Training, which provides courses, coaching, and communication in the science. Miriam is the author of Positive Psychology for Overcoming Depression and the co-producer of The Happiness Training Plan. Twitter: @pospsychologist. Full bio.

Miriam's articles for PositivePsychologyNews.com are here.

“… but just to be on the safe side, we’ll need to operate.”

Those are words many of us will have to deal with at some point in our lives and which happened for me earlier this year when I found myself facing surgery for the first time. As I contemplated how the surgeon would extract a suspect part from my body, I wondered if there was anything positive to be extracted from the experience of undergoing surgery? Can we apply research findings from positive psychology to preparation for going under the surgeon’s knife?

pill positive surgeryAfter a year of being drip-fed positive psychology in MAPP, it turns out the answer was a resounding yes. I left hospital on a big high and not just from the cocktail of drug. My first experience of the operating table turned out to be surprisingly positive. So here I offer my tips for surgical well-being derived specifically from research.

#1) Apply Self-Determination Theory

Self-determination theory focuses on to what degree a person’s behavior is self-endorsed, or self-determined (Ryan & Deci, 2000). Self-determination theory comes out of the study of intrinsic motivations, and sets up three psychological needs for well-being: autonomy, competence, and relatedness.

doctor positive surgeryAs an example of the theory in action, my autonomy was significant as my procedure is usually carried out under general anaesthetic. Having  a history of allergic reactions (the nadir of which was going into anaphylactic shock just hours before an REM performance!), you can understand why I’d prefer to be conscious and able to communicate that fact while having an adverse reaction. It was a relief when the anaesthetist gave me autonomy in choosing a local over a general anaesthetic even though it was going against the norm. This acknowledged my competence in making the best decision for my body and helped to calm the nerves pre-op.

I found surgery to be a time of pre-determined vulnerability when relatedness really counts. This is the moment to lean on friends and family for their support as I negotiate your passage through a period of fragility. I found a good model for relatedness came in the nurses who soothed me on your way to the operating room. Though it did amuse me when, just as the surgeon wielded his scalpel, the anaesthetic nurse attempted to distract me with that old cliché of the hairdressing salon, “and where are you going on holiday this year?” Nice try. It didn’t work!

#2) Use Your Strengths

Finding new ways of using your strengths can lead to lasting increases in happiness (Seligman, Steen, Park & Peterson, 2005).  Surgery certainly ticks the “new” box and I found all of my top character strengths came into play naturally on the day. OK, here I have to confess that Curiosity (my top VIA strength) was also behind my desire to have the procedure done under local rather than general anaesthetic. I wasn’t going to miss out on the chance to nose around a real operating theater.

doctor2 positive surgeryAppreciation of Beauty (No. 2 strength) may have been facilitated by the anaesthetic – those bright white lights carry a hint of heavenly blue, accented by the sky blue of the surgeon’s scrubs and the turquoise of the sterile sheet which was placed in front of my eyes so I couldn’t watch what was going on (boo!). Love of Learning (No. 3) combined with Social & Emotional Intelligence (No. 4): as I set about bonding with the surgeon and allowing me the chance to gain an insight into the operation and one of the highest status jobs around. During the operation, I found Creativity (No. 5) kicking in as I mentally imagined writing this article about one of the more surreal experiences of my life. I came out of the operating theater to a chorus of praise for my strength in making it through the operation fully conscious, which put me on a high that is still lingering six weeks later.

#3) Practice Gratitude

healthy woman positive surverySonja Lyubomirsky in The How of Happiness recommends gratitude as a “kind of meta-strategy for achieving happiness.” Gratitude has tended to be something I’ve done dryly in my head in the past but having surgery unleashed a torrent of heart-felt appreciation with all the accompanying positive emotions. The gift in surgery is that it presents you with many natural opportunities for gratitude. Being confronted with the reality of your mortality renews your appreciation for life itself; there’s fresh gratitude for the love of those who support you during this vulnerable time and appreciation for the skill and care of the medics in helping you back to health.

#4) Choose Optimism

optimism positive surgeryAlthough much more of a defensive pessimist (Norem & Cantor, 1986) than a natural-born optimist, I actively used optimism as an aid to recovery. A wealth of research (see Carver & Scheier, 2005) suggests that optimistic patients experience less distress pre-surgery and post-surgery greater relief, resilience and long-lasting life satisfaction. From the moment I received the news about the operation, I chose to believe that my body was already healed and distracted myself by focusing instead on the self-determination theory of surgery. As a result my healing was rapid and I made a gentle return to work 48 hours later. When I went back for the biopsy results, I got the result I was hoping for, the all-clear. What’s more there was not a trace of the suspected growth.  I am in no doubt that it was my choice of an optimistic belief which helped to create this reality (as Doug Turner wrote here earlier).   Truly a case of surgical well-being.



Carver, C. & Scheier, M. (2004). Optimism. In C. R. Snyder & S. J. Lopez, S. J. (Eds.), Handbook of Positive Psychology, pp 231-243. New York: Oxford University Press.

Lyubomirsky, S. (2008). Sonja Lyubomirsky, Ph.D., author of The How of Happiness: A Scientific Approach to Getting the Life You Want. New York: Penguin Books.

Norem, J. K. & Cantor, N. (1986). Defensive pessimism: Harnessing anxiety as motivation. Journal of Personality and Social Psychology, 51(6),1208-1217.

Ryan, R.M. & Deci, E.L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development and well-being. American Psychologist, 55, 68-78

Seligman, M.E.P., Steen, T.A., Park, N. & Peterson, C. (2005). Positive Psychology Progress: Empirical validation of interventions. American Psychologist, 60, 410–421.

Optimism in the sun courtesy of preciouskhyatt
Yoga woman courtesy of adria.richards
Pill courtesy of Brooks Elliott
Doctor 1 courtesy of SarahMcD ?
Doctor2 courtesy of SarahMcD ?

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WJ 28 March 2009 - 3:38 pm

Miriam, glad it all went well. You touch on the most powerful form of medicine – the placebo. I suspect much of PP is about placebo.

Christine Duvivier 30 March 2009 - 1:30 pm

Miriam, Congratulations on your successful application of PP in surgery– and on your successful outcome! Interesting to see the connection you made between SDT and your surgery– thanks for the insight you gave all of us.
All the best,

Christine Duvivier

Dave Shearon 31 March 2009 - 7:01 am

Thanks, Miriam, for sharing this experience. If PP doesn’t matter in facing real challenges (and opportunities) in our lives, then why bother? You turned a challenge into an opportunity! I’m looking forward to more of your posts!


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