I look at a lot of numbers at work, searching for patterns that could represent some serious health condition. The other day, in the emergency department at Sutter Alta Bates Medical Center in Oakland, CA, I saw a high protein level and signs of kidney dysfunction in a patient with fatigue and back pain. Yikes, I thought with a start, I think this might be a serious blood disorder.
Looking for clues to worst-case scenarios is a key part of my job. Lately, with all the cultural, political, and environmental tumult, I’ve been overwhelmed by my worse-case scenario thinking: Will my patients lose vaccine insurance coverage? Will the CDC continue to function? How will my state rebuild after these fires? Exhausted by such thoughts, I found myself thinking: If hope springs eternal, where is it now when I need it?
On reflection, I realized I must know more about hope than I’m consciously aware. After all, isn’t hope a foundational element to healing? Medical training focuses on developing the skills to treat the problem at hand. That is an inherently hopeful activity, as we approach every problem with possible solutions, persevering through setbacks toward a positive resolution for the patient.
With change comes opportunities. In trying to cope with these crazy times, I have a new appreciation for the value and the complex nature of hope. So, I’ve done some reflection on my medical practice and formal studying of hope, what psychologist William Miller calls “a vital component of our psychological capital.” I’d like to share what I’ve learned about what stifles it, what helps it spring forth, what social settings and cognitive states nurture it, and what habits we should develop in order to live with a hopeful mindset.
How to define hope
As psychologist Everett Worthington defined it, hope is “motivation to persevere toward a goal or end state, even if we’re skeptical that a positive outcome is likely.”
Life is always full of challenges and we need hope to carry on in the face of inevitable setbacks. Decades of research suggest being hopeful leads to not only a higher quality of life, but also to more resilience, creativity, and problem solving. For those with serious illness, hopefulness correlates with increased life expectancy.
But what Worthington’s definition of hope seems to ignore is that life—just like our health—is not static. And so our notion of hope—our goals, our plans, and the emotions we need to muster—needs to be dynamic.
I was recently reminded of this in a conversation with a patient battling stage-four lung cancer. “Mr. R, as we talked about the other day, it appears your cancer has progressed,” I said. “I am so sorry. I am going to sit down so we can talk about what this means and what we can hope for from here.”
He replied: “For years, I have had this bulldog determination that I was going to beat this thing, but thinking about it the last few days, honestly, all I want is to make it to my daughter’s wedding next month. I’m not sure I will have the strength to do that. What do you think, doc?”
I replied, “It brings tears to my eyes imagining you there. Yes! Your awesome team here at the med center will do all we can to get you there! We have your back!”
“Now, I am the one who is going to cry,” he said, tearing up.
Sometimes, hope involves shooting for the right goal—and sometimes, that’s the most realistic one.
Hope in the face of big challenges
When times are really tough, solutions and the hope to address them can be hard to find. Fear is an intense, hardwired emotion to prepare for threats. In the moment, fear is hard to control in the face of a threat, real or perceived. What we do next requires more complex thinking. That’s when we might need hope—but while hope might spring eternal, it also requires intentional, conscious cultivation, so that it can be there when you need it.
And what qualities of mind are needed to foster a healthy response to fear? As fear pounces upon us from the amygdala, we must draw upon diverse cognitive skills to cultivate hope. Critically, we need a desire for change and then we must cultivate steadiness of mind or equanimity in the face of the challenge ahead. We need the ability to calmly focus to bring curiosity and critical thinking to our situation. That enables us to formulate our plan. Lastly, we need a sense of agency to give us the drive to work against adversity to give our plan the chance of success.
Psychologist Charles Snyder proposed a model for a hopeful mindset with two components. Pathway thinking involves planning a route to our desired outcome; agency thinking requires an enduring belief that our goals can be achieved despite potential barriers. In tough times, we can feel demoralized, and both kinds of thinking can be hard to come by.
Hope together
This is where another key modulator of hope comes in: relationships and community. As my conversation with Mr. R reminded me, sometimes we just need the human connection to bolster our sense of hope. Even when I have no curative treatments to offer, and death is inevitable, just holding a hand and committing to “facing this together” provides my patients some solace. Simply being with someone can provide hope against the fear of isolation.
Hope, like other emotions, can be contagious. Together, people can support, motivate, brainstorm, and strategize, which helps everyone to develop pathway thinking and foster agency thinking. In fact, there is a form of group psychotherapy that uses this idea to help people move through life’s challenges: In hope therapy, people come together to listen, plan, and create a support system. Ideally, individuals leave the session with a hopeful approach to their struggles, with others to call upon for support as they move forward.
Building hope a little at a time
Lately, I have been trying to counter my worse-case-scenario meltdowns by holding on to this idea that in tough times, modest hopes with small steps is the best way to gain the confidence we need to address bigger challenges. In its best form, hope motivates us into action even if we are skeptical about our success. When we are battling hopelessness, we might try starting with a few things we are fairly certain will work out.
For the last few weeks at work, I’ve been holding hope up in front of me in all the small, everyday things I do, and I’m striving to acknowledge my patients’ little successes—better lab tests, improved strength, a smile—as examples of hope actualized. As I have started to more intentionally recognize small victories and see them as something we build collectively, I feel that our doctor-patient team is better prepared for tackling the larger health questions.
To heal our world, we similarly need to start small: in our homes and with our friends. We can share our fears and aspirations, and we can collectively brainstorm solutions, even if we are just tackling a gardening project. We should similarly get together with neighbors or local organizations to talk, build some enthusiasm, and plan for a hopeful approach to address simple community issues. Not only is hope a way forward for individuals, but research at the community level suggests hope promotes tolerance and conflict resolution, which is crucial in times of wide social divisions.
Where do we go from here?
Cynicism is “having a moment,” and not without good reason. The problem is that cynicism brings us the opposite of what hope does. It can lead to depression, burnout, and poor health outcomes—and that is a trap we should at least aspire to avoid.
Choosing hope is a start. If you think about it, hope is almost always right in front of us. It’s a liminal space, a threshold we are approaching before much of what we actually do. At a minimum, hope points us toward community and solace. At its best, hope feels as if it is lifting our body toward our goals, buoying us up and pulling us forward. As one study published this year in Emotion found, hope imbues life with meaning—and a sense that our actions are important and consequential is what drives us to take the next steps.
While hope is an emotion, it is also a process. I must admit that at times I still need to work on calming the mind to shake my fears and ruminations, before I can even approach hope. What I have learned is that working with people in the hospital and with my inner circle of friends and family is a good place to practice hope, and to develop my hope mindset. I am not ready for formal hope therapy, but I love the idea of my own informal hope therapy to help fire up that spark of enthusiasm and agency so critical to move forward in the presence of obstacles.
At work, I intend to treat hope in much the same way as physical therapy or medical therapy; it’s an important tool to bring well-being to my patients. Entering a hospital room is an opportunity to foster a sense of hope, even in the face of inevitable grief and loss. I encourage us all to intentionally see hope in the little things we do each day as a next step.
As the blogger and essayist Maria Popova writes: “These days I am less certain I will see the rosy outcome I would like, but I am more determined to meet the future with the best version of myself.” I love this—the determination, the commitment. At its core, hope is about bringing our best self to the world.
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