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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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Harvard Medical School professor and New Yorker staff writer Dr. Jerome Groopman’s new book, The Anatomy of Hope, takes a scientific approach to a notion often overlooked by scientists: how does hope influence healing? Three themes braid together in this book: Groopman’s stories of real patients, his own experience with a debilitating back injury, and a review of what science is learning about the mind-body connections, especially the placebo effect. As a result, readers will conclude that realistic hope can heal. Here’s an excerpt from the concluding chapter, “Lessons Learned,” pp 208-212:


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


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: Anatomy of Hope.htm


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