Dr. Maggie Phillips

The Biology of Hope


Did you know that there is actually a biology of hope? Dr. Jerome Groopman, Professor of Medicine at Harvard Medical School and a staff writer in medicine and biology for The New Yorker magazine. He has also written several books, including The Anatomy of Hope, published in 2004. The information that follows is excerpted from a speech prepared by Dr. Groopman on this topic in October, 2003.

Dr. Groopman shared that through his experience with patients, he'd come to believe that “giving a patient hope was as important as any prescription I might write or any procedure I might perform.” He began a serious quest to understand how to distinguish true hope from false hope, whether a person should ever relinquish the right to hope, how what we hope for might change during the course of an illness, and, most important, whether there was an authentic biology to hope.

Early on, he was a major skeptic, turned off by new-age claims, such as the belief that meditation can help your pancreatic cancer go into remission, or that positive thinking can boost your immune system and bring your HIV condition under control. Yet Groopman also realized that if there is a biology of fear, a biology of anger, and a biology of depression and other emotional states, there must be a biology of hope.

He began by asking himself what he had learned from his patients. He believed that the core of medicine was to create circumstances where hope could flourish as the belief that the actions each person can take can bring a future different from the present.

One of Dr. Groopman’s greatest lessons came from one of his physician mentors, who specialized in the treatment of stomach cancer. When this colleague himself was diagnosed with stomach cancer that had already metastasized, he insisted on fighting the cancer aggressively even though he had only a 1% - 3% chance of living as long as 12 months. He not only surpassed that benchmark, but went into remission and lived a long and healthy life. It turned out that Groopman’s colleague was well aware of the odds against him, but because he wanted so much to live, he decided that he must fight with a full arsenal of every possible treatment. The kind of hope his story illustrates is the hope that fuels determination and the strength to fight illness and health imbalance, hope and strength to sustain the battle, and the will to prevail. Such a full-on assault is not for everyone, but it is important that you know that it is a workable option.

The biology of hope is rooted in the placebo effect, which depends on belief and expectation. Dr. Groopman cites studies conducted on pain by Fabrizio Benedetti in Italy. Researchers inflated blood pressure cuffs around the arm of volunteers and bring it up high enough to create a measurable pain stimulus. The volunteer is medicated with a low dose of morphine, which helps to reduce the pain. Then as the procedure is continued, patients are told that they are receiving more morphine; instead, however, they receive saline. Most volunteers report a dramatic drop in pain levels. This occurs because the placebo effect, created by the belief that the morphine will help, releases endorphins and enkephalins that diminish the pain response in the brain.

Similar studies in asthma look at the positive effects of belief and expectation on respiration and the opening of bronchi. And, a study on Parkinson's disease that appeared in Science, examined patients with moderate Parkinson's disease. Patients in the research group were given a drug that released the drug dopamine and, of course, they had more voluntary muscle movement. Then the same patients were given a placebo but they believed they were receiving the dopamine drug again. What happened? A large number of patients got better with the placebo. Their belief and expectation caused the same pathways in the brain to release dopamine. Hope in this way improved them in an objectively measured way.

One of the scientists investigating this area is an experimental neuropsychologist named Richard Davidson. A rigorous scientist, Davidson sees hope as having two components: one a cognitive component and the other an emotional component. To have true hope means to have information that allows you to meticulously examine everything in a given health situation--all the obstacles, all the pitfalls--and then find that path that can bring you to the future. That's the cognitive part. The second part is the affective part. We talk about wings of hope, or being uplifted by hope. There is an energizing feeling that we experience with hope. Davidson and other scientists now are trying to develop experimental methods to assess the biological impact of that energizing feeling, of that uplifting sense on cortisol levels, catecholine levels, and other important physiological parameters.

So the hope in the Reversing Chronic Pain learning program is to provide you the kind of experiences that will feed your beliefs related to hope and help you discover the uplifting feelings of hope as well.


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