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The
Anatomy of Hope: How Patients Prevail in the Face of Illness by Jerome Groopman Rating: ••• (Recommended) |
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Scientific It has been nearly thirty years since I
walked into Esther Weinberg’s room. Now, when I meet a new patient, listen
to his history, perform a physical examination, review his laboratory tests,
and study his X rays, I am doing more than gathering and analyzing clinical
data. I am searching for hope. Hope, I have come to believe, is as vital to
our lives as the very oxygen that we breathe. My focus beyond the strictly clinical science
was widened by the many patients whom I cared for (luring those three
decades--patients like Frances Walker and Dan Conrad and Barbara Wilson. I
am sure there will be others who will teach me more about hope. While my own
research continues to concentrate on understanding why cancer cells grow and
spread in an unchecked way, how viruses like HIV and hepatitis C invade and destroy
healthy cells, and what guides the genesis of blood in the hone marrow, today
I follow with intense interest experiments on emotions and how the brain and
the body biologically talk to each other. The question ---- why some people find
and hold on to hope while others do not ---- was what moved me to write this
book. There is no one simple answer. But insights can be drawn from the
experiences recounted here. For many who cannot see hope, their vision is
blurred because they believe they are unable to exert any level of control
over their circumstances. When I encounter such patients, like Esther
Weinberg, I try to discover why they feel so completely at the mercy of the
forces around them. Helping them find hope harks hack to the two elements of
the emotion that Richard Davidson discussed: a cognitive,
or “informational” one, and an affective, or “feeling” one. I learned that it takes much more than
mere words to communicate information and to alter affect. Dan Conrad
forcefully showed me how often I fall short of the mark on both counts. I try
hard to let patients read in my eyes that there is true hope for them. The
distillation of Sharon Walker’s words comes to mind: that for a physician to
effectively impart real hope, he has to believe in it himself. Even then, the
stated facts and the chance of prevailing are often best articulated in more
than one voice. Doctors are fallible, not only in how they wield a scalpel
or prescribe a drug but in the language they use. Family and friends, clergy
and social workers, psychologists and counselors, and, often most compellingly,
other patients like Dotty Hirschberg and George Griffin can better speak from
personal experience and reach the roots of despair and distrust. 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 deliberate decision
making, as Damasio’s studies of patients like S.M.
show. True hope, then, is not initiated an(l
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, unbridled 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, an(l 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. Each disease is uncertain in its
outcome, anti within that uncertainty, we find real hope, because a tumor has
not always read the textbook, and a treatment can have an unexpectedly
dramatic impact. This is the great paradox of true hope: Because nothing is
absolutely determined, there is not only reason to fear but also reason to
hope. And so we must find ways to bridle fear and give greater rein to hope.
George Griffin knew this long before I did. And, as Dan Conrad and many
others since have seen, the uncertainty of science also brings hope. Science
may progress in time to produce new therapies that can make the incurable
curable. Many people searching for hope look to
their faith. When confronting suffering and loss in my own life, I have found
strength and solace in both the insights of tradition and the structure of
ritual. Still, as the great Protestant theologian Paul Tillich
noted, true faith does not discount doubt. There are times when I doubt and
do not see how faith can holster hope. At such moments I think hack to George
Griffin, and especially the psalm that he recited during his struggle. There
is deep comfort in the sense that we are not alone when we try to move out of
the shadow of death. I also think of Barbara Wilson, whose faith enabled her
to sustain the calm and balance to address the yearnings of her soul. There
are also instances when patients and their families look directly to God for
assistance in a cure. I once asked one of these patients, a middle-aged
Italian-American woman with breast cancer who attended mass regularly, what
words she addressed to God: “I pray that he helps my doctors, that he gives
them wisdom.“ That
has become my prayer. Patients are awash in a sea of
statements about the link between their emotions and their maladies. For
years I diverted or dismissed their inquiries because I did not know how to
answer. Now my response is formed by the lessons taught to me by my patients and the stirrings of serious
science. I recount some of the narratives detailed here, and say we arc just
beginning to appreciate hope’s reach and have not defined its limits. I see
hope as the very heart of healing. For those who have hope, it may help some
to live longer, and it will
help all to live better. The stories and Groopman’s
personal experiences related in The
Anatomy of Hope combine to make this a book well worth reading. Steve
Hopkins, May 25, 2004 |
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ã 2004 Hopkins and Company, LLC The recommendation rating for
this book appeared in the June 2004
issue of Executive Times URL for this review: http://www.hopkinsandcompany.com/Books/The
Anatomy of Hope.htm For Reprint Permission,
Contact: Hopkins & Company, LLC • E-mail: books@hopkinsandcompany.com |
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