Look on the bright side: The interactional construction of a survivor identity in the breast cancer clinic.

Objectives: People with breast cancer are widely encouraged to “look on the bright side” and “think positive” in the face of adversity, and research suggests a positive correlation between patient optimism and health outcomes. However, the promotion of a bright-side disposition has also been criticised because it can be perceived as a moral obligation that implies poor outcomes are a result of individual failure to adopt the correct attitude. In this paper, instead of treating bright-side talk as empirical evidence for a person's mental state, or reporting evidence for or against bright-side thinking, we systematically examine what bright-side talk is doing interactionally, and how it functions in real-time clinical consultations.<br/><br/>Design and Methods: Thirty-three instances of bright sides were identified from a corpus of 73 transcribed video-recordings of clinician–patient consultations (totalling over 30 hours) in a National Health Service breast unit, and analysed using conversation analysis.<br/><br/>Results: Bright sides function as practical, in-the-moment tools to do identity work. Consistently positioned following expressions of dissatisfaction with, or bad news about, treatment outcomes, bright sides manage and deflect potential inferences that patients may be overly upset by, or complaining about the trivialities of what has been life-saving treatment. Instead, bright sides offer a comparatively upbeat counter-balance to the prior negative stance that focuses attention on the bigger picture of the patient’s survival and its appreciation.<br/><br/>Conclusions: Clinicians and psycho-oncology interventions can usefully deconstruct cultural mandates to “look on the bright side” by encouraging discussion of legitimate patient concerns that may otherwise remain hidden.