Trust the Larger Hope

Hope is an odd emotion. Almost no aspect of human activity, endeavor, or aspiration can exist for long without it. It possesses the strange alchemy of serving as the power that drives us toward the light as well as also being the light we seek. So it is both actor and agent. Even in our daily routines and schedules, hope fuels our ambitions in scores of minor episodes to take risks and prevail: I hope I can find a good parking spot; I hope I brought the file with me; I hope the pace lets up a little. We hope so much we hardly notice.

But it is in the darkest, desperate moments that hope demonstrates its critical, stubborn luminescence. Viktor Frankl wrote in Man’s Search for Meaning about his desperate struggle to survive in a Nazi concentration camp: “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.”

Hope lights that way. It gives us the resilience to endure. The U.S. Army Survival Manual: FM 21-76 describes hope as the desire to live despite seemingly insurmountable odds. Hope, it asserts, is the fundamental ingredient of resilience. The manual tells soldiers to think of hope as the ultimate weapon, and I think that’s right. Hope is the ultimate weapon—for good.

Hope unites communities and drives social change. It is the force of collective action and belief that makes a better world a possibility. Hope encourages empathy and compassion and helps us see potential in others. Hope may not be tangible, but it is always palpable. Hope is the essential ingredient that can spell the difference between giving up and giving in or pressing on and standing up. Hope is the agent that shapes our goals and aspirations while simultaneously shielding them from despair. Hope is the workhorse of the best of civilization.

Hope as a Medical Problem

One of the most potent forms of how one’s will can warp reality is the placebo effect, which I first studied with Francis Moore, M.D., a scion of Harvard’s surgical aristocracy and physician-in-chief at what is now Brigham and Women’s Hospital. A true giant in the field, Moore defined modern surgical burn management and helped pioneer the world’s first organ transplants. He was also an incredible, thoughtful, respectful innovator who shaped a generation of surgeons worldwide. And he warned me about the curse imposed by placebo.

Once when we were about to examine a patient in one of his research protocols, he stopped me and told me not to “oversell” the research protocol, pointing out that this was a “blinded” study and we had no way of knowing whether the patient had received the experimental medication or a placebo. Speaking on behalf of scientific medical progress, he said, “There is no more damnable, mysterious, or confounding factor in all of medicine than the patient’s own ardent desire to attend to a positive outcome. All who wish to contribute to medical research must contend with its undeniable power if they wish to have any chance of success.”

Moore explained that hope is a beautiful force for good for the individual patient. The problem, as he saw it, is that hope’s effect is so “operator dependent,” so unpredictable, and so variable that it was virtually impossible to quantify or calibrate—making hope a confounding and even vexing variable for researchers trying to discern whether or not a medical treatment works. Not coincidentally, the word placebo derives from the Latin verb placere, meaning “to please,” so the study of placebos started with this strange emphasis on a “fake” medicine provided to please rather than treat the patient. I sense that the denigration of placebos morphed into a more general worry about the potential for “false hope”—the notion that providing hope could somehow be wrong or unethical.

With today’s science, however, we better understand the power of hope. With brain imaging, for example, we can look at patients receiving placebo injections rather than real ones with opiates. If the patient believes they are receiving an opiate, their brain activity is very similar to someone who is receiving an actual injection. In other words, the patient is actually “treated” by the placebo in quantifiable ways. While placebos may be the bane of the pharmaceutical industry, they remind us how powerfully the mind can manifest what it yearns for. Hope is a unique kind of magic in medicine that we are only beginning to understand.

Models of Hope

Many complex models for looking at and defining hope now exist, but some of the earliest and simplest still serve us well. One is a definition proffered by Oxford’s John P. Day, Ph.D., D.D., in his seminal essay “Hope.” Day knew a thing or two about loss and hope. Despite being orphaned at 14, he attended Oxford and served in British intelligence throughout World War II. As the war was drawing to an end, Day was asked to document findings at an old munitions factory on the outskirts of Munich. He was one of the first soldiers to witness the horror that was the concentration camp at Dachau.

In his philosophical thesis on hope, Day commented that hope could be reduced to two simple ingredients: probability and desire. He stated his definition in the same stark and streamlined fashion: “Hope is a desire for an uncertain event.” Many philosophers and social scientists have pointed out that hope is made of binding two elements together: yearning and uncertainty. Need married to doubt. Day saw the stakes for hope could be high. Up to 50,000 lives perished at Dachau while praying to survive.

Hope as a Catalyst

Understanding that introducing hope as a catalyst for positive change in individuals and societies is critical. In the individual, research shows that introducing hope promotes the healing of conditions such as severe mental illness, depression, anxiety, and post-traumatic stress disorder (PTSD). Hope allows patients to maintain a positive outlook despite their health challenges and helps them improve their quality of life. Research studies have also demonstrated that therapeutic encounters built around hope can enhance empathic connections between clinicians and patients, making addressing patients’ goals and the barriers to achieving them more accessible. Hope-based interventions also benefit vulnerable, underserved populations where mental illness may receive less attention.

Such studies suggest that we must tread very carefully when we cross into territory governed by hope. Words, gestures, and body language are all part of how clinicians communicate with their patients. Study after study has shown that hope dramatically affects a patient’s optimism, quality of life, support systems, activity level, pain perception, and more.

A Pledge to Myself

When I was starting as a surgeon, I had a young patient with a malignant brain tumor who responded well to treatment. He had a tight-knit family, and I always knew when they showed up at the clinic because they would drive down from Flagstaff, Arizona, and I would see their RV in the parking lot the night before. We got to be very close over the years, and at one point, when his family was out of the exam room, he told me he would fight the tumor with every ounce of his strength. But, he said, if things ever really went south, he wanted me to be honest: to tell him it was “time to go fly-fishing.”

I saw no problem promising that and cared for him for several more years. But eventually, the tumor recurred, and I operated on it several times. Then, right before Thanksgiving, he came into the hospital in an emergency. The cancer was going to end his life in a matter of days if I didn’t fix it. So, I took him to the operating room and put in a shunt to relieve pressure on the brain, and he immediately brightened up. We were trying very hard to get him home for the holidays because I knew he didn’t have much time left. His parents were out at the front desk picking up his prescriptions. I was alone with him for a few moments, so I looked at him and said, “You remember when you asked me to tell you when it was time to go fishing?” He nodded his head. And I said, “Well, it’s time.” I saw him turn sheet white and deflate like I’d stuck him with a pin. In the morning, I received a call from his mom. He passed away during the night.

I had committed to telling him the truth. That was an honorable thing, and I kept my promise. But I also know he died because I inadvertently took away his hope. He saw me lose hope in him, and then he lost hope. He lost his life to my truth; what I learned from him is that no one has the right to take away another person’s hope. Everyone is permitted to hold onto hope. On a broader scale, hope is the force for good behind movements for change, inspiring collective courage and action. Hope encourages empathy and compassion, a fundamental aspect of the human experience we should be cultivating.

After losing that young man, I vowed I would never deny another human being’s right to hope. I saw that each of us has the right to unfettered hope. I’ve learned that I can wait for a patient to tell me they’ve decided it’s time to go fishing. I’ll be there for them in the end, wherever they find it.

This article appeared in the Nov/Dec 2024 issue of Spirituality & Health: A Unity Publication®. Subscribe now.