The Anatomy of Hope

by Jerome Groopman
Random House Audio, 2003
Review by Christian Perring, Ph.D. on Apr 1st 2004

Jerome Groopman's ability to weave together moving tales of his patients with thoughtful reflections on the nature of medicine has been well established in his previous books, Second Opinions and The Measure of Our Days. In The Anatomy of Hope, he ruminates on the possibility of hope in patients with extremely serious diseases. Most of the patients in these stories have cancer with often-fatal consequences. He starts off with the case of a devout Jewish woman he met when he was only a medical student, who lacked the will to fight her breast cancer because she believes it is a punishment from God. Eventually, too late, her doctor convinced her to accept the treatment which might have saved her life, but Groopman's training didn't include any discussion of what the doctor said to the patient to change her mind. Later on in his career, when he himself was a young doctor acting as an apprentice of another well-established doctor, he was troubled by the case of a patient with incurable cancer who was misled into believing that her treatment could achieve a cure. The chemotherapy she received could provide a remission of the cancer, but it was virtually certain that she would eventually die from the disease. In Groopman's view, this false hope was a disservice to the patients, and ultimately cause them to feel bitterness and disappointment, and can also lead the doctors to feel guilt or embarrassment.

This experience led Groopman to be much more open with his patients about the truth of their prognoses. He came to believe that patients need the truth and it is counterproductive to try to stop patients from worrying by hiding facts from them. Yet he also found that the blunt telling of grim medical statistics can drain patients of hope and life. As with many doctors, Groopman found it almost impossible when treating patients with terrible disease to find some middle ground between false hope and depressing truth. His central quest in this book is to explore how to create such middle ground.

In the other cases, Groopman tells stories of oncologists who themselves get cancer. Some insist on painful experimental treatment in full knowledge that the chances that it will provide a cure are slim. Sometimes, they are driven by hope, but in other cases, by desperation. In other cases, the afflicted doctors give up the fight against cancer prematurely, as if they are unable to summon up the hope they tried to give to their patients. Finally, Groopman tells his own story, not of cancer, but of a disabling back problem that threatened to significantly curtail his life. He tried several different therapies, but they didn't seem to help, and even made the problem worse. Finally, he himself gave up hope in his own recovery, and just tried to live with the progressively worsening problem, with his life becoming ever more circumscribed. It was only through meeting a specialist who confronted him with his own refusal to hope that he came to find a cure. This personal experience gave him further insight into the ways that fear can overcome hope.

Groopman's discussion of hope fits in very well with a great deal of other work on the mind-body connection. While he is skeptical about the overblown claims of some alternative medicine that the right attitude can in itself end serious disease, he does explain some of the evidence that one's mental attitude can have a powerful impact on the course of one's recovery. Hope can have both direct and indirect beneficial effects in fighting disease. Therefore, it is an essential element in treatment, so it is very troubling that specialists are not given more training in how to enable their patients to become hopeful.

While The Anatomy of Hope is an excellent discussion of the relation of emotion and illness, it says very little about mental disorders. For people with chronically disabling mental illnesses, it is all too easy to become hopeless, and this itself makes the illness worse, and can lead to substance abuse or suicidal actions. Psychiatric patients need hope, and their clinicians and families need to know how to help them become hopeful. Groopman's book may provide some clues, but clearly this is an area that needs much more exploration.

Groopman himself reads the abridged audiobook. His performance is a little wooden at times, with rather slow and methodical pronunciation of each individual word. Nevertheless, his words are always eloquent enough to hold one's attention, and at other points his reading is more natural and fluid.

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Christian Perring, Ph.D., is Academic Chair of the Arts & Humanities Division and Chair of the Philosophy Department at Dowling College, Long Island. He is also editor of Metapsychology Online Review. His main research is on philosophical issues in medicine, psychiatry and psychology.

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