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

Jerome 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. 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 survived.

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.

Groopman thinks 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.”

Groopman believes 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.

Pick up a copy of this book and join Dr. Groopman as he takes you on a journey through his final years of medical training and practice experiences. He will introduce you to patients that showed him how true hope differs from false hope leading you through a labyrinth of pain to undying hope, the biology of hope and deconstructing hope. This journey can benefit both physician and patient. It will not only be the most inexpensive trip you could take, but also the most valuable and rewarding one you might experience.