The Anatomy of Hope: How People Prevail in the Face of Illness

Hope is one of our central emotions, but we are often at a loss when asked to define it. Many of us confuse hope with optimism, a prevailing attitude that "things turn out for the best." But hope differs from optimism. Hope does not arise from being told to "Think Positively," or from hearing an overly rosy forecast. Hope, unlike optimism, is rooted in unalloyed reality. Although there is no uniform definition of hope, I found on that seemed to capture what my patients had taught me. Hope is the elevating feeling we experience when we see - in the mind's eye- a path to a better future. Hope acknowledges the significant obstacles and deep pitfalls along that path. True hope has no room for delusion.

The cerebral processing of that visceral input as a signal of death was accurate. Without the kinds of therapy that had been developed over the decades, this cancer would have been fatal. Hope, then, is constructed not just from rational deliberation, from the conscious weighing of information; it arises as an amalgam of thought and feeling, the feelings created in part by neural input from the organs and tissues.

... omniscience about life and death is not within a physician's purview. A doctor should never write off a person a priori.

True hope has no room for delusion.

One of the difficulties I experienced in trying to learn about the biology of emotions was the definition of terms...How would [Prof. Richard Davidson], as an experimental psychologist, deconstruct [hope]? "I understand hope as an emotion made up of two parts: a cognitive part and an affective part. When we hope for something, we employ, to some degree, our cognition, marshalling information and data relevant to a desired future event. If...you are suffering with a serious illness and you hope for improvement, even for a cure, you have to generate a different vision of your condition in your mind. That picture is painted in part by assimilating information about the disease and its potential treatments. "But hope also involves what I would call affective forecasting--that is, the comforting, energizing, elevating feeling that you experience when you project in your mind a positive future. This requires the brain to generate a different affective, or feeling, state than the one you are currently in.

This is the vicious cycle. When we feel pain from our physical debility, that pain amplifies our sense of hopelessness; the less hopeful we feel, the fewer endorphins and enkephalins and the more CCK we release. The more pain we experience due to these neurochemicals, the less able we are to feel hope.

Despite education and knowledge and experience, when you are the patient--suffering, confused, and despairing--it is very, very hard to take matters into your own hands. I was not a George Griffin, able to stand alone and challenge the prevailing assumptions. I needed an external voice, strong and determined, to guide me.

Researchers are learning that a change in mind-set has the power to alter neurochemistry. Belief and expectation—the key elements of hope—can block pain by releasing the brain’s endorphins and enkephalins, mimicking the effects of morphine.

While it is a convenient construct to divide hope into a cognitive and an affective component, the two are tightly coupled. Feelings and emotions mold logical thinking and eliberate decision making...True hope, then, is not initiated and sustained by completely erasing the emotions, like fear and anxiety, that are often its greatest obstacles. An equilibrium needs to be established, integrating the genuine threats and dangers that exist into the proposed strategies to subsume them. So when a person tells me that he doesn't want to know about the problems and risks, that he believes ignorance is necessary for bliss, I acknowledge that yes, yunbridled fear can shatter a fragile sense of hope. But I assert that he still needs to know a minimum amount of information about his diagnosis and the course of his problem; otherwise his hope is false, and false hope is an insubstantial foundation upon which to stand and weather the vicissitudes of difficult circumstances. It is only true hope that carries its companions, courage and resilience, through. False hope causes them to ultimately fall by the wayside as reality intervenes and overpowers illusion.