The Case Against Hope

I read an interesting column in the Guardian the other day in which Oliver Burkeman, argued that what is often called hope is really deception—hoping for things that are virtually impossible. For example, hoping that one wins the lottery or that the victims of an accident have survived when their deaths are near certainties.

By contrast letting go of hope often sets us free. To support this claim he refers to “recent research … suggesting that hope makes people feel worse.” For instance: the unemployed who hope to find work are less happy than those who accept they won’t work again; those in the state of hoping for a miraculous cure for a terminal disease are less happy than those who accept the hopelessness of the situation; and many become more active in working for change when they stop hoping for others to do it. Perhaps there is something about giving up hope and accepting reality that is comforting.

Reflections – I generally stress the importance of hope—that we should hope for the best, that life has meaning, that justice prevails, etc. Still, Burkeman is correct that false hopes are futile, and lead to inevitable disappointment. If I hope to become the world’s most famous author or greatest tennis player, my expectations are bound to be dashed. Much better to hope that I enjoy writing and tennis despite my shortcomings in both.

When confronted by the reality of the concentration camps, Viktor Frankl did not hope to dig his way out of his prison. That was not possible, and such hopes would soon have been thwarted. Instead, he controlled his own mind, and (probably) vaguely hoped for something realistic—that the war would end and he might be freed. That is the difference between false and realistic hope. The former is delusional, the latter worthwhile. Sometimes only fools keep believing; sometimes you should stop believing.

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2 thoughts on “The Case Against Hope

  1. This is an interesting topic. I don’t know exactly why, but there seems to be a very thin line between being hopeful in grim circumstances and being realistic and accepting that our power is sometimes limited. For example, I used to work very closely with very sick cancer patients. Some of them I got to know pretty well, over a long time. I also lost my best friend to cancer, and walked with him through that journey. What struck me over and over is the strong-arming that occurs with patients who are terminally ill/in the very late stages of disease–strong-arming them into projecting this perfect portrayal of hope for survival. Do not misunderstand me—I am not saying that positive outlook and motivation and openness is not important when one is facing a serious illness. And I am not talking about every cancer patient here. I am talking about the cases where the patients involved were in a dire situation, and had certainly maintained hope and effort up until the point the situation became so dire. I saw over and over 2 things play out: first, there was a pre-conceived construct of how a patient in that situation was “supposed” to react; and second, physicians sometimes seemed to be the ones unable/unwilling to admit futility–sometimes to the detriment of the patient.

    Regarding #1—It was not uncommon to see this happen: Doctor tells patient that their illness has progressed, that their prognosis was not good, that their estimated time remaining was X. Then the very next thing they would do is say that they were writing a prescription for anti-depressants, since patients “have a hard time dealing with this”. It was as if, by doing this, the message was “If you weren’t clinically depressed before, you sure will be now!” and also that any emotional reaction to the loss of further options and imminent death was aberrant and pathological. I still remember when my dear friend was in this situation–he said to the physician, “I am not depressed. I am upset. Am I not allowed to be upset?” The physician definitely seemed used to his patients agreeing with his plan of Abortive Grieving. This phenomenon got even worse when patients dared to choose to stop active treatment. I suppose it would be important to screen a patient in any scenario for symptoms of actual comorbid depression, and to make sure their decisions are being made based on facts and careful consideration and not something sketchy they read on an internet forum. But our medical establishment can be very suspicious and uncomfortable with patient autonomy. The leap tends to always be, “patient wants to cease aggressive treatment, they must be crazy.” And then they wind up in the psychiatrists office. Which brings me to #2—many times these patients who expressed a wish to cease further treatment were offered major surgeries, really radical treatments that were held out as a “last ditch effort.” I am not saying that clinical trials and experimental treatments are always bad, because thats not the case at all. But it can be bad when the patient has expressed the wish to end treatment, has extensive illness, and has then been essentially convinced they are clinically depressed for feeling a sense of sadness and loss at their imminent demise. Some of them consented to radical surgeries that did not extend their lives at all, and they ended up expressing regret afterwards. It was unsettling to see this play out again and again. I don’t get it—its an understood fact that there is no current cure for many cancers. I do get that physicians would feel uncomfortable when they cannot fix a patient, or when many of their patients wind up dead. But that discomfort can lead them to wanting to force limitless hope on their patients, just to make themselves feel better. Futility makes them squirm. And what I saw was people who were being sold so much hope that they never got to move on to acceptance, and that was very unfortunate.

  2. Thanks for the wonderful and thoughtful comment Kristin. I will address this topic more in the next few days and perhaps quote from your comments. – JGM

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