The mysteries of hope and healing
Jerome Groopman had endured a trying week. The Harvard Medical School professor had been taking care of patients with cancer, blood diseases, and AIDS, all of them reeling from the emotional shock of their diagnoses. Mulling over his conversations with these patients on a solitary walk home, he realized that they were all looking for a sense of genuine hope--and indeed that hope was as important to them as anything he might prescribe as a physician. His musings and subsequent research led to his new book, The Anatomy of Hope (Random House, $24.95).
How do you define hope?
It's ironic. The word is so commonly used and it's something that we all have experienced, yet it's very, very difficult to define. I searched and searched. Basically, I think hope is the ability to see a path to the future, and it has two components to it. It has a cognitive part, and it has a feeling part. You are facing dire circumstances, and you need to know everything that's blocking or threatening you. And then you see a path, or a potential path, to get to where you want to be. Once you see that, there's a tremendous emotional uplift that occurs, and with it actual neurochemical and biological changes.
Is there such a thing as false hope?
Yes, and unfortunately I've given false hope. I had good intentions, but good intentions can be catastrophic. During my training as a cancer specialist, it was common to either use jargon with patients or flat-out omit information about the severity of their circumstances. There is one woman I recall vividly. She was a very well-grounded, religious woman, an African-American. I basically led her to believe that the chemotherapy we were giving her would cure her. We used the term "remission"--and she of course, like most people, thought that remission meant cure. But remission in her situation meant only a temporary respite. So I gave her false hope, and once you deceive a patient they can never trust you again. It ruptures the relationship.
On the other hand, you don't bludgeon someone like a presiding judge handing down a death sentence. That's false as well. Biology is variable, and outcomes are uncertain, and medicine is an inexact science.
You write about one breast cancer patient who had exhausted all of her treatment options, yet remained hopeful. How is that possible?
I learned so much from her. Although she no longer had choices or options about her body--she knew that she was going to die--she still had choices and options about her soul. She could act in a way to reconcile important relationships in her life that had frayed and that were troubled. And she could seek hope, seek a better future, seek a path to a place where--since she was a religious woman--her soul was at peace. So I think that one of the remarkable things about hope is that, even when there isn't hope for the body, there's always hope for the spirit.
What can doctors do to bolster the spirit?
A doctor's words are like a scalpel. If they are applied precisely at the right time and in the right place, they can be amazingly beneficial. But if they are misdirected and misapplied, they can be terribly harmful. I've learned this the hard way because I've said things to patients that were not said right or shouldn't have been said at all. So I think it's very important for physicians to understand the power of their words and how to communicate in a way that most helps their patients.
You yourself despaired after a failed back surgery, and a doctor helped you find hope. How?
At that point, I couldn't walk more than four or five blocks. But he said no, it didn't have to be that way. He shook me up. He was brash and forceful, but he was smart. He realized that I had bought into others' incorrect assumptions. He told me that the narrative I had been living for nearly two decades--that there was no hope for me and that I would be constrained to live in a very debilitated state--was wrong. It was tough love.
Is hope more or less important than it was a hundred years ago?
I think hope has been, is, and always will be the heart of medicine and healing. The ancient Greeks realized that human beings could not live without hope. It's central to the Pandora myth. It's the one gift from the gods that's not lost, because without hope mortals could not endure. I think it's easy to lose sight of that in a time when there's so much technology--the genome, the MRI scan, the PET scan, and all of the euphoria of science. But we still come back to this profound human need to believe that there is a possibility to reach a future that is better than the one in the present.
This story appears in the January 26, 2004 print edition of U.S. News & World Report.