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New Book Discusses Link Between Hope and Cure in Recovering from Serious Illness - 2004-04-22

Self-help writers have long claimed there's a link between hope and recovery from serious illness. Now, a prominent American cancer specialist suggests there is a medical basis for that link, in a best-selling new book called The Anatomy of Hope: How People Prevail in the Face of Illness. The author is Jerome Groopman, a professor at the Harvard University Medical School, and a staff writer on medicine and biology for The New Yorker magazine.

Jerome Groopman drew on his own medical cases and recent scientific discoveries to write The Anatomy of Hope. He believes it's important to understand first of all what hope is, and how it differs from optimism.

"An optimist says everything is going to turn out fine," he explained. "But in fact, we know in life that's often not the case. True hope sees all the problems and all the difficulties we face, but through that we see a potential path to a better future. And what's new about the book is this understanding of hope and the changes that occur in our brain and our body when we see that path to the future."

"There are chemicals released in the brain that markedly reduce the amount of pain we feel," contnued Mr. Groopman, explainingg some of those changes. "And pain is often the greatest obstacle for patients, to begin [that keeps them from beginning] a treatment or to have the strength to endure a treatment. There are also important changes in muscle function. Hope in Parkinson's Disease can release chemicals in the brain that allow the muscles to be much more flexible, so that people with Parkinson's are more functional. Arthritis - it can reduce the pain of arthritis and increase circulation to the joints so people can undergo an effective rehabilitation program. Heart attacks - there are good studies that show that hope can speed the recovery from heart attack and give more permanent recovery."

Jerome Groopman thinks differently about cancer.

"Cancer is not clear yet. It's certainly not a case of 'think positively or be hopeful and the cancer will just melt away.' But what it [hope] does in cancer is it gives you a clear-eyed vision," he said. "You can make the best choices for yourself, and it gives you the strength to enjoy a treatment that hopefully can cure you."

Jerome Groopman believes the doctor's role is to be honest with patients, but also encourage them to maintain hope and pursue treatment, even in the face of a grim prognosis.

"No doctor is God. So to hand down a death sentence and say, 'You have three months to live or six months to live.' I can't tell you how many people I've seen for second opinions have been told that, and it's now been a year or two years," he said. "But what you can say is, 'We know this is a serious problem. We know that many people don't survive. But we also know that nothing is written in stone. And we may be able to keep you alive for a much longer period, and also a new treatment, a new drug, may arrive in time to radically change the course of your disease.' And I've seen that many times over the last 30 years."

Sometimes this means searching for the reasons behind a patient's inability to hope. Dr. Groopman tells the story of a Vietnam War veteran he treated named Dan Conrad.

"He had a lymphoma that could be cured, and yet he couldn't take the first step, " said Dr. Groopman. "He saw no hope. And it turned that an Army buddy of his had had cancer, a different kind of cancer, a lung cancer, had been treated with drugs that didn't work out, and had died a horrible death. So his whole reference point was this friend who had died. And a nurse did something very brilliant in the chemotherapy clinic. She sat Dan next to a woman with a lymphoma who was well on her way to a cure. And he saw that there was really hope, and with that he could envision a future for himself."

Dr. Groopman, at the other extreme, wrote about his colleague George Griffin, who had hope when nobody else did, including his doctors.

"George Griffin was the chairman of the pathology department and a world expert on stomach cancer," he said. "And in his late 50s he developed stomach cancer. He knew how long the odds were, how unexpected it would be that he would survive. In fact he planted bulbs so they would flower in the spring and grace his coffin.

"And yet he insisted upon being treated," continued Dr. Groopman. "I was a young cancer specialist on the staff, and with my colleagues, I said, he's out of his mind. And then 18 years later when I started to write the book, I interviewed George. And I said, 'George, if I had been your doctor, you'd be dead.' And he said, 'I know that, and I know most of the other staff felt the same way. But I had the right to hope. I had to try.' Nothing is completely certain. There's always a chance."

Dr. Groopman has this advice for a patient, who has reached the point where there is no more hope.

"I talk about a woman named Barbara Wilson who taught me a very important lesson in this regard," he said. "She had breast cancer. She did very well for a long period of time. And then I came to her bedside, and I said, 'Barbara, I have no more medicines to give you.' And she said, 'No, Jerry you're wrong. You have the medicine of friendship.' And I think what you do is you work with a patient to shift from hope for the body to hope for the spirit."

Jerome Groopman says when he attended medical some 30 years go, he learned nothing about the value of hope.

"In fact it was looked at in a belittling way because it wasn't hard science like genes or MRI scans," he said. "I think we're just beginning now to appreciate how critical the mindset of the patient is and how vital hope is in the equation of healing."

Dr. Groopman believes people come to a doctor in search of hope. Part of the doctor's job is to get to know those patients, to understand what shapes their outlook and what inner resources they can draw on to make hope flourish.