Hospice Women's Reflections on Wisdom: A Qualitative Case Series

Wisdom represents a concept recognized by the humanities for centuries. While psychologists and sociologists have more recently examined the definition of wisdom in academic discourse, biologists and psychiatrists are also realizing its clinical relevance. Wisdom has been noted to increase with age; however, this relationship has not been consistently defined. Furthermore, it is not clear how the diagnosis of a terminal illness and hospice experience impacts wisdom, and to date, the gender differences in wisdom are not yet understood. This study qualitatively examines wisdom among hospice patients with the aim to learn more about this complex topic from those facing the end of life, and it explores how this type of interview could be used as a therapeutic intervention or tool in medical education. While models such as Erik Erikson's stages help characterize wisdom and aging from a developmental standpoint, his model and subsequent theories have been criticized as gender biased with a limited view of interdependence and the progression of relationships. This study further explores how wisdom may be defined from a women's perspective in this specific patient population and how this may or may not align with traditional models.

In an ongoing study, twenty-five hospice patients are being recruited to complete individualized, semi-structured, qualitative interviews exploring wisdom with 7 questions such as: “How do you define wisdom?”; “Can you describe a time in your life when you believe you were wise?”; “How has your illness affected your level of wisdom?” Of 11 completed interviews, four are female, and they have been selected for this study to further refine how older women view, explore, and define wisdom. Semi-structured qualitative interviews were digitally recorded and transcribed followed by coding and analysis to illuminate common and emergent themes. The aggregate results will be reported elsewhere, and here we present our findings on this specific group of women.

In this case series we examine four women's revelations and insights on wisdom at the end of life. All four women are unique individuals with diverse backgrounds: a 97 yo former philanthropist and nutritionist, a 64 yo transgendered male to female catholic woman who suffered from symptoms of chronic mental illness and substance dependence, a 73 yo married woman and mother who worked as a secretary, and a 83 yo nurse with over 50 years of professional experience who grew up in poverty. In their interviews, common themes emerged such as wisdom as an internal construct, learning from mistakes, wisdom gained through life experience, willingness to take risks, and altruistic behavior and attitudes. Specifically in these women's interviews, there is a focus on learning from others and the importance of family and loved ones in this process. One woman shares, “I think I learned the most wisdom from my mother and father…the greatest value in life was how you behave and how you regard other people.” Additionally, the topic of gender does begin to emerge naturally: “I think that a lot depends on women. They have a lot of goodness. They may not realize that they do.”

The process of interviewing these women in this end of life setting has both clinical and educational implications. The qualitative interview offers an opportunity for women to process their circumstances through the positive frame of becoming more wise such that it could potentially be a clinical or therapeutic intervention. Women and their providers can explore wisdom, aging, and disease in a positive light. There are additional opportunities to help resolve core conflicts in the end of life setting by integrating concepts such as Maslow's self-actualization or Erikson's integrity vs despair as patients begin to explore these ideas in the interview. These interviews also present an opportunity to explore these developmental models and constructs of wisdom from women's perspectives. Wisdom interviews may also serve as a tool to explore themes in successful aging in the end of life setting such as self-acceptance, engagement with life, and self-growth. Further developing these themes and ideas creates possibilities for individual and group therapies framed around exploring wisdom, revealing life experiences and sharing insight. In a time where there is a growing need to recruit and mentor future geriatricians and geriatric mental health providers, this type of interview serves as a form of experiential learning for trainees that presents aging and terminal illnesses in a positive light. Future studies may further examine concepts such as gender and family roles, relationships, and socialization to illustrate how women and men may explore and share their ideas about wisdom in different or similar ways.