Hope is not optimism

True hope takes a hard look at reality, then makes a plan | Aeon Essays
Photo by Bastien Doudaine/Hans Lucas/Headpress A general practitioner speaks to his patient’s palliative care nurses in Saint-Chamond, Loire, France, March 2021.

Even when you know that prospects are grim, hope can help. It’s not just a feeling, but a way to step into the future

David B Feldman is the J Thomas and Kathleen L McCarthy Professor in the Department of Counseling Psychology at Santa Clara University in California. He hosts the KPFA Radio programme About Health and the podcast Psychology in 10 Minutes, and has co-authored books including The End-of-Life Handbook (2007) and Supersurvivors: The Surprising Link Between Suffering and Success (2014).

Benjamin W Corn is professor of oncology at the Hebrew University of Jerusalem, deputy director of the Cancer Center and head of the Radiotherapy Unit at Shaare Zedek Medical Center, and co-founder of the NGO Life’s Door.

Melanie, a 47-year-old partner at a top civil engineering firm in Boston, could not accept the fact that she was staring at tacky art in a physician’s waiting room. Sitting there, her thoughts drifted back to her advisor in college, who cautioned her that it would not be easy to succeed in a male-dominated field. But she was a fighter and would not be deterred. Her drive had been easily identified by her supervisors, and she was continually rewarded with broader responsibilities. Indeed, her personal and professional lives were textbook descriptions of how to use ingenuity and grit to overcome grim obstacles. But this was different. This was her body betraying her. She could deal with the unexplained weight loss and the yellow tint that had altered the colour of her eyes. But then came the pain. Deep, boring, twisting pain. The agony catapulted her to seek medical attention and, within a week, the work-up was complete. Pancreatic cancer.

Inside her office, Dr Tamika was reviewing the PET scans and mulling over what to say to Melanie. After 20 years in practice, it seemed like having these conversations had gotten only harder. Surely someone as bright as Melanie had Googled pancreatic cancer and seen the adjectives (deadly, devastating) and the clichés (‘the tumour that gives oncology its reputation’) that go along with this particular malignancy. She had undoubtedly already uncovered the fact that long-term survival was achievable only in a relatively small percentage of cases. Dr Tamika wanted to provide hope. But, under these circumstances, wouldn’t it be less than totally truthful to talk about hope? Perhaps, Dr Tamika pondered, she should instead speak with Melanie about her goals for the time she had left, preparing her for the likely scenario that it would be only a matter of months. That felt more honest, but wouldn’t Melanie’s hope be crushed?

Dr Tamika’s thoughts capture what we call ‘the double-bind of hope’. Oncologists and other physicians who care for seriously ill patients such as Melanie often find themselves entangled by such a predicament. On the one hand, they worry that sharing the whole truth about a medical situation might destroy their patients’ hopes, leading to despair. But they also worry about the opposite strategy: that not accurately providing all relevant medical information or putting too rosy a spin on that information could lead patients down a path of false hope, denying them the time and space to emotionally prepare themselves and their families for whatever awaits.

Caught in this bind, physicians are tempted to throw up their hands and conclude that addressing hope isn’t their job. But this isn’t a tenable conclusion either. Ignoring people’s need for hope won’t make it go away.

This dilemma results from an overly narrow view – one commonly held in the medical world – that equates ‘hope’ with ‘cure’. If we buy into this equation, it means accepting that hope simply isn’t accessible for patients for whom cure isn’t possible, unless, of course, they deny the medical truth.

But these treacherous waters are navigable for physicians willing to follow a new body of research in psychology and accept a broader understanding of hope, one that allows the inclusion of difficult truths. And because unpleasant realities permeate our lives beyond the realm of illness, this new understanding may also pay dividends no matter what difficulties we’re facing.

Hope is not wishful thinking, optimism, or ‘the power of positive thinking’. There’s nothing wrong with being optimistic, of course. Research shows that optimism is associated with many beneficial outcomes. But that doesn’t mean it’s the same as hope. The Cambridge Dictionary defines optimism as ‘the feeling that in the future good things are more likely to happen than bad things’…



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