THE ANATOMY OF HOPE- How People Prevail in the Face of Illness by Jerome Groopman, MD, Random House, Inc, New York, © 2004, ISBN-0-375-75775-0, 248 pp, PB $14.95 (US) $21 (Can).
Review by Del Meyer, MD
Groopman in his first book in 1997, THE MEASURE OF OUR DAYS - New
Beginnings at Life’s End,
focused on “End of Life” issues after losing his father to what he considered
incompetent medical care. http://healthcarecom.net/bkrev_MeasureOfOurDays.htm In this, his third book, he tries to understand
why some people find hope despite facing severe illness, while others do not. And can
hope actually change the course of a malady, helping patients prevail?
He looked for the
answers in the lives of several extraordinary patients that he cared for over thirty
years. They led him “on a journey of discovery from a point where hope was absent
to a place where it could not be lost.” In the process, he learned the difference
between true hope and false hope and describes times when he foolishly thought the
later was justified. He also describes instances where patients asserted their right
to hope and he wrongly believed that they had no reason to do so. He felt that
because they held on to hope, even when he felt that there was none, the patients
In a number of
examples, he explores his patients' religious beliefs. He describes one woman of deep
faith who showed him that even when there is no longer hope for the body, there is
always hope for the soul. He credits his patients for helping him see another
dimension in the anatomy of hope.
that many of us confuse hope with optimism, a prevailing attitude that “things turn
out for the best.” But he thinks that hope differs from optimism. Hope does not
arise from being told to “think positively” or from hearing an overly rosy
forecast. Hope, unlike optimism, is rooted in unalloyed reality. Without a uniform
definition of hope, his patients taught him that “hope is the elevating feeling we
experience when we see—in the mind’s eye—a path to a better future. Hope
acknowledges the significant obstacles and deep pitfalls along that path. True hope
has no room for delusion.”
that hope gives us the courage to confront our circumstances and the capacity to
surmount them. He was well into his career when he came to realize this. He states
that for all his patients, hope, true hope, has proved as important as any medication
he might prescribe or any procedure he might perform. Making a diagnosis and finding
the optimal therapy were essentially detective work. Solving a complex case and
identifying the best treatment is indeed an exhilarating intellectual exercise. But
the background and stories of patients’ lives give doctors the opportunity to probe
another mystery: How do hope and despair factor into the equation of healing?
After three decades
in the practice of hematology and oncology, Groopman only gave a passing nod to hope
as he labored from the bedside to the laboratory bench. As a rational scientist,
trained to decode the sequence of DNA and decipher the function of proteins, he fled
the fairy-tale claims of hope, slamming the door, closing off his mind to seriously
considering it as a catalyst in the crucible of cure. What he eventually found
missing had to be learned from experience, both as a physician and as a patient.
As a patient for
some nineteen years after failed spine surgery, Groopman lived in a labyrinth of
relapsing pain and debility. It was rekindled hope that gave him the courage to
embark on an arduous and contrarian treatment program and the resilience to endure
it. “Without hope, I would have been locked forever in that prison of pain. . . It seems to exert potent and palpable effects
not only on my psychology but on my physiology.”
As a scientist,
Groopman began to distrust his own experience as he set out on a personal journey to
discover whether the energizing feeling of hope can in fact contribute to recovery.
He found that there is an authentic biology of hope. Researches are learning that a
change in mind-set has the power to alter neurochemistry. Belief and expectations can
block pain by releasing the brain’s endorphins and enkephalins that mimic the
effects of morphine. In some cases, hope can also have important effects on
fundamental physiological processes like respiration, circulation and motor function.
Thus, hope can have a domino effect making each step of improvement more likely. It
changes us profoundly in spirit and in body.