essay on hope cures all troubles

Ernest and Isadora Rosenbaum Library

Hope as a Strategy

Ernest Rosenbaum, M.D. and David Spiegel, M.D. 

The Philosophy of Hope

Hope is one of the greatest allies supporting quality of life.

Hope can be a major tool of empowerment and an element for sustaining life and the will to live. We hope for better times. We hope for remission.

We hope to prolong life by averting death through medical treatment and supportive care. Or, if disease progresses, we hope to control pain, side effects, and suffering.  We hope for treatments that can cure or palliate and make the disease stable.

“Hope is the most beautiful of all the affections, and doth much to the prolongation of life, if it be not too often frustrated, but entertaineth fancy with an expectation of good.” Francis Bacon

The Oxford Dictionary defines hope as “to entertain expectations of something desired.” Hope embodies an emotional component beyond expectation that is an important part of human experience. Plants and trees often bend toward the warmth of the sun, which is comparable to a person's hope for improved survival.

Hope is a precious commodity that is often hard to define but is very important to keep alive. It often gives a person a glimpse of the future and is supported by enduring fortitude, courage, and ingenuity, often in the face of adversity. Hope is synonymous with a positive will to live and affects a positive outcome, whatever that might be.

Hope can be a part of one’s upbringing from childhood. It can also be developed through life experiences, passed on from friends, from spiritual or religious philosophy, or from examples in life.

A lot depends on development of one’s personality and how one has dealt with crises during life. The better one copes with crises, the better chance one has of being more hopeful. In contrast, requesting euthanasia at the end of life reflects a feeling of severe hopelessness, a wish only for peace, and an end to suffering. If a patient strives for quality and purpose in this final period of life, then the goal of the medical and social professions is to promote hope, compassion, comfort, and optimal care.

An interesting example is that of Viktor Frankl, a survivor of a German concentration camp during World War II. Facing death, he found that many of his fellow captives continued to maintain a reason and purpose for living. They often fared better than those who found the concentration camp experience nothing but dreadful and overwhelming. At Buchenwald, he saw that prisoners who were physicians kept hope alive by preparing and presenting medical papers, often late at night when fellow prisoners were asleep. They even put together a working X-ray machine. They believed that hopelessness had a significant effect on the human response to illness. This lack of optimism in the form of hopelessness has been shown to predict poorer survival among breast cancer patients

Dr. Karl Menninger was one of the first health professionals to address the concept of hope relating to the treatment of patients with psychiatric disorders. He believed that hope was an important element of humanizing medicine that, in the 20th century, had become more involved with technological therapies. He believed that hope could promote the humanitarian goals that were in danger of being destroyed.

But hope has not always been viewed as a virtue.  The story of Pandora’s box from ancient Greek mythology relates that, when the box was opened, all the evils were dispersed throughout the world and hope was concealed. The Greeks placed hope in a category with other miseries, and felt that was the reason hope was concealed within Pandora’s box.   Buddhists teach that desire is an affliction, tying us to the worldly life rather than allowing us to seek release from it.  Friedrich Nietzsche, in his discussions in Human, All Too Human , stated: “Hope is the worst of evils, for it prolongs the torment of man.”

The Judeo-Christian belief, in contrast, is that hope is related to the congenial spirit of goodness, as conveyed in the saying, “Where there is life, there is hope.” But a fragmentation of hope often glimmers when one is watching, with humility, the prolonged dying of a loved one.

A serious illness is a reminder that life is not infinite.

“You can be told you have a 90 percent, or a one percent chance to survive. But as long as you take that chance, and believe in yourself and are a brave person, and then want to be better than before. ... I’m living proof that you get a second chance, and the second time around is better than the first.”Lance Armstrong, cancer survivor

Plato said that courage is knowing when to be afraid.   Many people have faced serious illness, managed and were not overwhelmed by it. Although they became ill, they did not give up. Their bodies may have suffered, but their spirits remained strong. Indeed, serious illness is a reminder that we are not immortal. Those who respond creatively to a life-threatening illness hear it as a wake-up call; a reminder of how short time is and that life is precious. They do what matters most while they can, experience the joys of living and loving, and let the people around them know how much they are loved and appreciated. They trivialize the trivial, drop useless commitments, eliminate relationships that are taxing and not worth the trouble, and “just say no” to what they think they should do rather than what they want to. Many stories abound of courageous people, who became very ill or faced some other crisis, yet count themselves fortunate.  In the face of a dismal diagnosis or harsh circumstances, they can take stock of their resources and find strength and love.

No matter what stage one’s cancer is, setting short-term and long-term goals will help define and achieve life’s purposes.  Survivors are well advised to hope for the best but prepare for the worst.  They can live with hope for a cure, a remission, or stable cancer without suffering and enjoy high quality of life with family and friends for as long as possible.

Hope can be reduced by loss of empathy and compassion and by withdrawing oneself from reality, from family and friends, and from the medical support team. Patients may experience psychologically depressing or destructive medical or social processes if they feel that life is disappointing and unsatisfactory.  They may involve others in this destructive pattern that has grave psychological implications and indicates a process of utter despair.  So to feel embedded in a network of caring at a time of serious illness is deeply reassuring. The will to live is not the denial of death, but the intensification of a life experience, which comes with the realization of how finite life truly is.

Health professionals believe that a combination of medical therapy, adoption of healthy lifestyles, medical prevention and supportive care offers the best chance to maintain a patient’s quality of life. Such comprehensive care addresses a wide range of needs, from relieving the physical symptoms of cancer and cancer therapy to satisfying the craving for intellectual, creative, and spiritual sustenance. Satisfaction of these diverse needs demonstrates the powerful connection between mind and body. Obtaining relief from pain, nausea, or fatigue, for example, restores a sense of calm. Sufficient sleep, appropriate exercise, and good nutrition are energizing. Discussing one’s negative feelings candidly with others can diminish their effect. Learning to control blood pressure and heart rate through such means as biofeedback and self-hypnosis can foster a sense of personal power. Exploring one’s creative potential can lead to joy and transcendence.

Positive Thinking

When diagnosed with cancer, maintaining a positive attitude can be difficult. Individuals must confront many obstacles, including the side effects of the illness and treatment, as well as feelings of fear, anger, depression, and loneliness. All of this can impact even the most buoyant of personalities. One way to maintain a positive attitude is by setting reasonable, achievable goals. Another helpful hint is to put energy into activities that bring satisfaction. Doing one’s best to maintain a positive attitude helps to cope with illness.

For patients with cancer, the future is often unknown, and hope is what keeps them alive to endure treatments and social and personal adversities. Hope is supported by the positive attitudes of the medical team, but can also be very fragile.  Anything that demoralizes a person can negate the feeling of hope, which can make a difference in accepting or denying the next set of treatments if failure occurs. The feeling of hope and will to live will vary daily depending on one’s current physical status, psychological outlook (depression or elation), and treatment success or failure. The hope is to be kept alive, to live, and to recover through a resilient attitude rather than a feeling of despair. Hope is often a shared feeling with one’s personal team of family and friends because the future is often nebulous.  Hope keeps one alive to fight for another day, a month, a year, and a return to better health. It affords another opportunity to respond to therapy and to live.

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Ernest h. rosenbaum, m.d..

Clinical Professor of Medicine, University of California, San Francisco, Comprehensive Cancer Center; Adjunct Clinical Professor, Department of Medicine, Stanford University Medical Center; Director, Stanford Cancer Supportive Care Programs National/International, Stanford Complementary Medicine Clinic, Stanford University Medical Center, Stanford, California.   More 

Ernest H. Rosenbaum’s career has included a fellowship at the Blood Research Laboratory of Tufts University School of Medicine (New England Center Hospital) and MIT. He teaches at the University of California, San Francisco, Comprehensive Cancer Center, was the cofounder of the Northern California Academy of Clinical Oncology, and founded the Better Health Foundation and the Cancer Supportive Care Program at the Stanford Complementary Medicine Clinic, Stanford University Medical Center.

His passionate interest in clinical research and developing ways to improve patient care and communication with patients and colleagues has resulted in over fifty articles on cancer and hematology in various medical journals. He has also participated in many radio and television programs and frequently lectures to medical and public groups.

He has written numerous books, including Living with Cancer: A Home Care Training Program for Cancer Patients; Decisions for Life: You Can Live Ten Years Longer with Better Health; Cancer Supportive Care: A Comprehensive Guide for Cancer Patients and Their Families; Nutrition for the Cancer Patient; Everyone’s Guide to Cancer Therapy; and Everyone’s Guide to Cancer Survivorship. For Everyone’s Guide to Cancer Therapy, Ernest Rosenbaum, M.D., Malin Dollinger, M.D., and Greg Cable received and Honorable Mention in 1991 from the American Medical Writers Association for Excellence in Medical Publications. Ernest and Isadora Rosenbaum received the same award in 1982 for their book, A Comprehensive Guide for Cancer Patients and Their Families.

David Spiegel, M.D.

Dr. David Spiegel is Willson Professor and Associate Chair of Psychiatry & Behavioral Sciences, Director of the Center on Stress and Health, and Medical Director of the Center for Integrative Medicine at Stanford University School of Medicine, where he has been a member of the academic faculty since 1975.    More  He is Past President of the American College of Psychiatrists, and Past President of the Society for Clinical and Experimental Hypnosis, and a member of the Institute of Medicine of the National Academies. He has published ten books, 368 scientific journal articles, and 156 book chapters on hypnosis, psychosocial oncology, stress physiology, trauma, and psychotherapy. His research has been supported by the National Institute of Mental Health, the National Cancer Institute, the National Institute on Aging, the National Center for Complementary and Alternative Medicine, the John D. and Catherine T. MacArthur Foundation, the Fetzer Institute, the Dana Foundation for Brain Sciences, and the Nathan S. Cummings Foundation.

Blog / Finding Hope and Purpose in the Midst of Your Suffering

Finding Hope and Purpose in the Midst of Your Suffering

Suffering is an unavoidable part of the human experience. If someone tells you that all you have to do is a, b, and c and no harm will ever come to you, you’re being sold a bill of goods. Demand your money back and run away as fast as you can. Each of us will at some point experience loss, heartache, trauma, depression, anxiety, and misery. Suffering is not reserved for just some people; it comes to us all. Sometimes it comes at our own hand, and other times at the hand of another. However it comes, I encourage you to accept this fact of life rather than try to resist it or avoid it. In fact, I encourage you to embrace the idea of suffering, because it is coming—with or without your permission.

If you are in the midst of great hardship in any form, know this: the trial you are enduring may well lead to your purpose or be the stepping-stone that enables you to achieve greatness. Have you ever read heroic stories of those who overcame seemingly insurmountable odds? Or cheered for those who have suffered great loss but persevered and claimed victory in the end? Or rooted for the underdog? If so, then you have what it takes to be the hero in your own story—to overcome, to persevere, to be the underdog who beats the odds.

If we are willing, even the most severe suffering can produce character in us—the kind of character that emerges only from the fires of intense grief (see James 1:2-4 ). Great duress forms unwavering integrity. Insurmountable odds create unshakable convictions. Dark nights of the soul give birth to a humble heart.

Suffering is not sent down from God above to crush us frail humans. It is a gift in disguise that unlocks the hero within us.

Whether your suffering takes the form of sickness, grief, or violence isn’t what matters most. What matters most is knowing that you can find safe ground again and a renewed purpose after pain has swept you off your feet. You can write the next chapter in your story in any way you wish. You can be the underdog who doesn’t quit, no matter the cost. With every decision you make, you can choose to be the hero—or not. Never give up on your God-given purpose!

My suffering took many forms. One of the most devastating was being raped by my uncle for many years. God didn’t do this to me. I do not shake my fists toward heaven, cursing the Almighty for my wounds. A man took his free will and used it for evil instead of good. Do I believe that God could have slayed my perpetrator in the act at any moment? Yes, I surely do. I don’t know why God didn’t intervene, but I trust him. I have a rock-solid faith in his unending love for me, and I believe he can do all things. Which means that nothing is impossible for those who believe (see Mark 9:23 ). Small and big miracles happen every day. I also know this: all of my suffering in the end has brought me to this place—a place of victory. I am the hero in my own story because I have hope and a purpose.

I am afforded opportunities today not because of a privileged upbringing, but because of all the unbelievable grief I bore. Trust me when I say that suffering does not have to be a dead end. If you’re willing, it can be a door that leads you into a whole new life.

It’s not hard for me to write these words now as I sit in a cozy farmhouse miles away from civilization. No one is more thankful than I am to have this moment of peace. There are no words in the English language to articulate how deeply grateful I feel simply for this moment. All of my suffering has enabled me to enjoy life—to relish it for the precious gift it is—a hundred times more than I would have if I’d never suffered . A simple walk outside among the trees, the hug of a friend, a meal from my fridge, a shower at any time—the smallest things are my greatest joys because I know what it is to suffer.

Nothing can prevent pain from entering our lives, but we must never give up hope. God is for us, not against us (see Romans 8:31 ). When the seas of life rage, he can tame the winds, calm the waters, and bring us safely back to shore. We must not fear doomsday, but boldly live our daily lives with hope. We do that when we allow suffering to do its perfect work within us, drawing us into deeper relationships with others and with our Creator. My most cherished bonds were formed under great stress.

Who I am as a woman, sister, friend, and leader has been shaped by my adversities. I have credibility, not in spite of what I have endured, but precisely because of what I have endured. Who wants to hear about hope or overcoming difficulties from a person who has never struggled?

Suffering is a door that opens to a world of purpose.

Our heartaches can have meaning. Even when life takes every opportunity to crush us into powdered ash, we can choose to look ahead, beyond our current circumstances, beyond the anguish we feel. We press into pain with great expectation, knowing that at some point, the pain will cease. Remember this when you’re experiencing deep despair. In time, things will change.

My years of suffering were measured in decades, but God took something horrendous and made it into something good. How many children, young people, and adults have I encouraged by sharing my journey the last few years? Enough for me to say that my CinderGirl childhood was worth enduring. I believe that with all my heart. It is an honor and privilege to bear the burdens of grief with others. It is my greatest joy to tell others who are suffering that their wounds can be healed, that they too can be filled with hope. I believe that we all have a story to tell, and that God wants to use our stories to empower others—to usher in a global movement of healing and positive change.

It is my greatest desire to take away the suffering of the world. I’d take away your suffering if I could. I hate seeing another human being in pain. I can’t shield you from suffering, but will you allow me to encourage you—to tell you that life isn’t over after a savage blow knocks you to the ground? You can get back up and fight. You can persevere. You can seek light amidst what seems to be crushing darkness.

I can’t shield the world from suffering, but I can work hard in my little corner of it to ensure that those around me are offered fundamental human rights. I can work hard so that abused children have viable options for healing, so they can grow to be healthy and whole adults.

I can’t rid the world of evil on my own, but I can join hands with you and others to face it head on. There are countless ways that we, together, can help our fellow human beings to overcome evil and suffering.

The system that failed me as a child is the one I’ve now dedicated my life to fixing. I have chosen to fight the good fight in the hope that one child at a time will hear my voice and believe that they too can overcome their sufferings. I pray that the flame blazing inside me will ignite a flame within the heart of every suffering child—that they will hear the still small voice of hope and believe that their lives can and will be redeemed from the ashes.

As seen on the TODAY show ! Growing up, she rarely heard her own name. Today, she’s here to help you claim the inherent worth that is yours.

Born into a large working-class family in upstate New York, Christina Meredith endured years of abuse before entering the foster care system as a teenager. With nowhere to turn after she graduated from high school, Christina lived in her car for almost a year, working three jobs to survive.

As she prayed in her car every day, Christina had no idea that in just a few years, she would be crowned Ms. California. She had no idea that her suffering would one day help others find healing. But she did know that she was destined for more, and she would not give up hope no matter the circumstance.

In CinderGirl , Christina tells her piercing and poignant story of leaving behind homelessness to become Ms. California and the founder of a nonprofit organization that provides advocacy for foster care children. With stunning vulnerability, Christina invites us into her childhood home and the heart of a child longing to be loved. She asks us to journey with her across the country and deep into a growing faith. She invites us to dig deeper into our own personal courage, even in the most grim of conditions.

CinderGirl is the riveting story of one young woman’s determination to overcome hardship in order to help others know they are not alone and that they too can achieve anything they dream.

Christina Meredith is a foster care activist, mental health advocate, national speaker, and the founder of the nonprofit Christina Meredith Foundation. A former homeless foster youth who was later named Ms. California, Christina today dedicates herself to protecting children from abuse and advocating for foster care reform. Christina concurrently serves in the US military. Learn more at ChristinaMeredith.org .

Related posts:

• How Reading Aloud Can Change the World
• Good God and Suffering: An Interview with Lucas Miles
• Pushing Through My Season of Suffering
• Two Scriptures I Rely On When Life Hurts—A Reflection from Jack Deere
• The Only Way to Deal with Your Pain and Mistakes

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Descartes on the Vital Relationship Between Fear and Hope

By maria popova.

Hope — a faculty decidedly different from and far more muscular than optimism — remains our most potent antidote to the passivity and resignation of cynicism . The great humanistic philosopher and psychologist Erich Fromm admonished against the common laziness of optimism and pessimism , but he extolled the counterpoint to both — active hope that empowers us “to think the unthinkable, yet to act within the limits of the realistically possible.”

“Hope is a gift you don’t have to surrender, a power you don’t have to throw away,” Rebecca Solnit wrote two generations later in her lucid and luminous manifesto for our grounds for hope and action in dark times . The philosopher Jonathan Lear termed those grounds “radical hope” — the kind of hope that “anticipates a good for which those who have the hope as yet lack the appropriate concepts with which to understand it.” But such anticipation of the unimaginable is inherently in constant dialogue with the unknown — with the fearsome possibility of not obtaining the object of hope and with the concomitant potential for despair.

That necessary complementarity of hope and fear in the face of the unknown is what the great French philosopher, scientist, and mathematician René Descartes (March 31, 1596–February 11, 1650), patron saint of reason , explores in a section of The Passions of the Soul ( public library ) — his final published work, which gave us Descartes on the cure for indecision and how we acquire nobility of soul .

Descartes writes:

The mere fact of thinking that a good may be acquired or an evil avoided is sufficient to produce the desire for this to come to pass. But when, over and above this, we consider whether our desire is likely to be satisfied or not, the idea that it is likely arouses hope in us, and the idea that it is unlikely arouses fear, of which one variety is jealousy.

He considers the common root and complementarity of hope and fear:

Hope is a disposition of the soul to persuade itself that what it desires will come to pass, which is caused by a particular movement of the spirits, namely, by that of mingled joy and desire. And fear is another disposition of the soul, which persuades it that the thing will not come to pass. And it is to be noted that, although these two passions are contrary, one may nonetheless have them both together, that is, when one considers different reasons at the same time, some of which cause one to judge that the fulfillment of one’s desires is a straightforward matter, while others make it seem difficult. And neither of these passions ever accompanies desire without leaving some room for the other.

Descartes argues that a severe imbalance of the two is equally deleterious, whichever direction it may tip in — just as an excess of fear may drive out all hope and leave us paralyzed to act, an excess of optimism that drives out all uncertainty and fear is just as paralytic to fruitful action, for it renders us complacent. In a sentiment that calls to mind Kierkegaard’s insistence that anxiety powers rather than hinders creativity , Descartes writes:

When hope is so strong that it altogether drives out fear, its nature changes and it becomes complacency or confidence. And when we are certain that what we desire will come to pass, even though we go on wanting it to come to pass, we nonetheless cease to be agitated by the passion of desire which caused us to look forward to the outcome with anxiety. Likewise, when fear is so extreme that it leaves no room at all for hope, it is transformed into despair; and this despair, representing the thing as impossible, extinguishes desire altogether, for desire bears only on possible things.

Half a millennium later, The Passions of the Soul remains a masterwork of extraordinary insight into the workings of the human mind, heart, and spirit. Complement this particular portion with Victoria Safford on what it means to stand at the gates of hope and E.B. White’s remarkable letter to a man who had lost hope for humanity , then revisit Descartes’s twelve timeless tenets of critical thinking .

— Published December 12, 2016 — https://www.themarginalian.org/2016/12/12/descartes-hope-fear/ —

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Hope for health and health care

• Scientific Contribution
• Published: 21 May 2014
• Volume 18 , pages 41–49, ( 2015 )

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• William E. Stempsey 1 , 2  

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Virtually all activities of health care are motivated at some level by hope. Patients hope for a cure; for relief from pain; for a return home. Physicians hope to prevent illness in their patients; to make the correct diagnosis when illness presents itself; that their prescribed treatments will be effective. Researchers hope to learn more about the causes of illness; to discover new and more effective treatments; to understand how treatments work. Ultimately, all who work in health care hope to offer their patients hope. In this paper, I offer a brief analysis of hope, considering the definitions of Hobbes, Locke, Hume and Thomas Aquinas. I then differentiate shallow and deep hope and show how hope in health care can remain shallow. Next, I explore what a philosophy of deep hope in health care might look like, drawing important points from Ernst Bloch and Gabriel Marcel. Finally, I suggest some implications of this philosophy of hope for patients, physicians, and researchers.

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Hope: A Health Promotion Resource

Beacons of Hope in a Challenging World: Conclusions and Directions for Future Research and Practice

Hope in Health Care: A Synthesis of Review Studies

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Acknowledgments

This article was inspired by the hope of Paul H. Wenger, my college roommate and friend of over forty years, in his final year of life. My initial thoughts on hope and medical innovation were presented at the 27th European Conference on Philosophy of Medicine and Health Care, 14–17 August, 2013, in Basel, Switzerland. Thanks to the anonymous reviewers who prompted me to think more deeply about hope.

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Stempsey, W.E. Hope for health and health care. Med Health Care and Philos 18 , 41–49 (2015). https://doi.org/10.1007/s11019-014-9572-y

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Essay on Hope

Students are often asked to write an essay on Hope in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

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100 Words Essay on Hope

Introduction.

Hope is a powerful feeling that pushes us to strive for better. It’s the spark that lights up dark times, a beacon guiding us through life’s storms.

The Essence of Hope

Hope is believing in the possibility of a brighter future. It’s the trust that things will improve, no matter how bleak they seem.

Hope in Everyday Life

We see hope in small things: a seed sprouting, a sick friend recovering, or a new day dawning. These give us strength.

Hope is essential. It’s the force that keeps us moving forward, even when the road is tough.

Also check:

• Paragraph on Hope

250 Words Essay on Hope

Introduction to hope.

Hope, a seemingly simple four-letter word, carries profound implications for our lives. It is a psychological construct that serves as a beacon, illuminating the path amidst the darkest moments, and a driving force that propels us forward in the face of adversity.

Hope: A Psychological Perspective

From a psychological standpoint, hope is not merely a passive state of desire; it’s an active state of mind, a dynamic process involving goal setting, planning, and motivation. It is a cognitive function that allows us to envision a better future, fostering resilience and facilitating recovery from setbacks.

The Power of Hope

The power of hope extends beyond the individual. It can influence interpersonal relationships, community dynamics, and societal changes. When hope is shared, it can spark collective action, leading to transformational changes in communities and societies. It can bridge gaps, heal divisions, and inspire movements.

Hope and Well-being

Hope has a profound impact on our well-being. Numerous studies have shown a direct correlation between levels of hope and mental health. High levels of hope can mitigate the effects of stress and anxiety, promote optimism, and enhance life satisfaction.

Conclusion: The Necessity of Hope

Hope, therefore, is not just a luxury, but a necessity. It is the fuel that keeps the engine of life running, the thread that weaves the fabric of our existence. As we navigate through life’s complexities, hope remains our guiding light, a testament to our innate capacity for resilience and growth.

500 Words Essay on Hope

Hope is a powerful and transformative human emotion, a beacon of light that pierces the darkness of despair and uncertainty. It is often described as the expectation of a positive outcome or the belief in a better future, irrespective of the current circumstances. It is this feeling of anticipation and trust that fuels our resilience and propels us forward, even in the face of adversity.

The Psychology of Hope

From a psychological perspective, hope is not merely a passive waiting but an active engagement with the future. It involves setting goals, having the tenacity to pursue them, and believing in one’s ability to achieve them. This is echoed in the words of psychologist Charles R. Snyder, who proposed the Hope Theory, arguing that hope consists of ‘agency’ (the motivation to achieve goals) and ‘pathways’ (the ability to generate ways to reach those goals).

Hope as a Catalyst for Change

Hope is not just an emotion; it is a catalyst for change. It is the spark that ignites action and the fuel that keeps it going. When we hope, we are not only envisioning a better future but also setting the wheels in motion to bring it about. Hope inspires creativity, innovation, and perseverance, turning dreams into reality.

Hope in the Face of Adversity

In the face of adversity, hope serves as a protective shield, buffering us against despair and disillusionment. It provides us with the strength to endure, to keep going when the odds are against us. It is hope that gives us the courage to confront our fears, to face our challenges, and to overcome our obstacles.

The Power of Collective Hope

Hope is not just an individual experience; it is also a collective phenomenon. Collective hope, or the shared anticipation of a better future, can be a powerful force for social change. It can motivate communities to come together, to work towards common goals, and to effect meaningful change. The civil rights movement, the fight against climate change, and the global response to the COVID-19 pandemic are all testament to the power of collective hope.

In conclusion, hope is a powerful and transformative emotion that fuels resilience, inspires action, and drives change. It is the belief in a better future, the strength to endure adversity, and the collective anticipation of positive change. As philosopher Ernst Bloch once said, “The work of this emotion requires people who throw themselves actively into what is becoming, to which they themselves belong.” It is hope that propels us forward, that keeps us striving, that makes us human.

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Ways of Hoping: Navigating the paradox of hope and despair in chronic pain

Emery r. eaves.

School of Anthropology and Department of Family and Community Medicine, University of Arizona, ude.anozira.liame@eyreme

Mark Nichter

School of Anthropology, Department of Family and Community Medicine, and College of Public Health, University of Arizona, ude.anozira.liame@rethcinm

Cheryl Ritenbaugh

Department of Family and Community Medicine and School of Anthropology, University of Arizona, ude.anozira.liame@uabnetir

In this paper, we explore hope in the context of living with chronic pain. Individuals with chronic pain from temporomandibular disorder(s) (TMD) were interviewed four to five times over the course of their 18-month participation in a clinical trial investigating the effectiveness of Traditional Chinese Medicine. We sought to understand shifts in participants’ descriptions of expectations and hopefulness, particularly with regard to the work involved in counterbalancing positive thinking with buffers against disappointment. We found hope to be a dynamic and multifaceted mindset as distinct from being a single entity to be measured. Drawing upon Polanyi’s concept of tacit knowing, we explore how different ways of hoping emerge and index one another in participant narratives. We offer a working typology of hope and raise as an issue the manner in which the paradox of hope—hoping enough to carry on while keeping hopes in check to avoid the ever-present possibility of despair—complicates simplistic notions of the relationship between positive thinking and the placebo response.

INTRODUCTION

“Without differentiation of its subtypes, the term hope can become reified as a biological entity or a magical pill, an entity presumed to have direct causal relations to health and disease.” ( Averill and Sundararajan, 2005 )

Over the course of conducting a clinical trial testing the effectiveness of Traditional Chinese Medicine for Temporomandibular Disorders (TMD), we were struck by the different ways participants spoke about hope. Multiple waves of interviews with 44 participants over the eighteen-month duration of their participation in the five-year study revealed that participants maintained several coexisting concepts of hope and the prominence of particular concepts shifted over time. Our aims in this paper are three fold. First, we wish to call attention to the paradoxical nature of hope—hoping enough to carry on while keeping hopes in check to avoid the ever-present possibility of despair. This paradox, we argue, commonly arises when contemplating new treatment. Second, we identify different ways hope is thought about and experienced by those living with chronic pain. Third, we consider the impact of the paradox and work of hope on the placebo effect.

Placebo, latin for “I shall please” historically referred to an inert substance given to appease a patient, or to give them hope, in the absence of other treatment options ( Moerman, 2002 ). Spontaneous healing in response to an inert substance is called the “placebo effect” in an individual and its average across a group is referred to as the “placebo response” ( Thompson, et al., 2009 ). Despite being poorly understood, placebos serve as the baseline against which other treatments are measured—the “control” in a randomized controlled trial—because patients given placebos often improve as a result ( Thompson, et al., 2009 ). Placebo responses are catalyzed by and pertain to a broad range of human experience, from changes in the meaning an individual ascribes to their illness ( Kaptchuk, et al., 2009 ; Kirmayer, 2006 ; Moerman, 2002 ; Tambiah, 1977 ) to evolutionarily patterned and deeply embodied responses to conditioned action (such as the taking of a pill)( Thompson, et al., 2009 ; Hahn & Kleinman, 1983 ; Kirmayer, 2011 ). Although the placebo effect is often narrowly attributed to positive expectancy, it is far more complex and multidimensional ( Kirmayer, 2011 ) and participants in healing rituals cannot be characterized as uniformly positive (Kaptchuck, et al., 2011). Moreover, while participants in healing rituals and participants undergoing novel treatments often report being generally hopeful, they are also realistic and aware of the possibility that the ritual or therapy may not “work” ( Stone, et al., 2005 ; Kaptchuck, et al., 2011). The paradoxical nature of hoping enough to continue seeking treatment and live day-to-day with illness, yet not hoping so much as to risk despair when yet another treatment fails, complicates already tentative understandings of the placebo effect as individuals simultaneously describe being both hopeful and hopeless.

What is hope and why does it matter?

In the context of chronic pain or illness, hope has been characterized in multiple ways: as a process of making meaning ( Antelius, 2007 ; Corbett, et al., 2007 ); as an existential state ( Kaptchuk, et al., 2009 ); as a posture toward the world ( Barnard, 1995 ); as a practice involving significant work ( Mattingly, 2010 ); and importantly, as inherently paradoxical ( Barnard, 1995 ; Chesla, 2005 ; Mattingly, 2010 ). Although hope has rarely been considered in discussions of expectancy and the placebo response, we find that hope to is central to how people living with pain assess new experience over time and adjust their expectations to find meaning in individual treatment narratives.

Hope is fundamental to human existence. It is paradoxical in its duality, however, as its very existence implies the possibility of despair ( Lynch, 1962 ). This dialectic between hope and despair is central to considerations of chronic illness management, as well as to studies of the relationship between expectations and the placebo effect ( Corbett, et al., 2007 ; Ratcliffe, 2011 ). Hope influences expectation, but is a distinct and multifaceted cognitive, embodied, and broadly existential experience ( Mattingly, 2010 ). In order to maintain hope when faced with a situation that appears hopeless, individuals must navigate multiple contradictions between reality and possibility, embrace cultural notions of what is deemed acceptable to hope for, and be attentive to the hopes and concerns of significant others ( Averill and Sundararajan, 2005 ; Chesla, 2005 ; DelVecchio Good, et al., 1990 ; Sulmasy, et al., 2010 ; Brown, 2015 ).

The observation that negative information about an illness may dash hope and increase suffering has long been recognized as an ethical problem. Medical educators thus ask when a clinician should dispassionately inform a patient about hard “evidence-based” facts of their case, and when they should consult with family members to determine whether unfiltered information is likely to demoralize the patient, compromise their quality of life and negatively affect their prognosis ( de Pentheny O’Kelly, et al., 2011 ; Oliffe, et al., 2007 ; Pergert and Lützén, 2012 ) as well as minimize the placebo effect ( Caspi and Holexa, 2005 ). 1

Hope is deeply personal and difficult to describe ( Barnard, 1995 ; Marcel, 1962 ). At the same time, hope is collectively produced, culturally interpreted, and linked to broader social and economic processes ( Clarke, 2003 ; DelVecchio Good, et al., 1990 ; Novas, 2006 ). Biomedical research institutions, pharmaceutical companies, and patient organizations are involved in a “political economy of hope” ( DelVecchio Good, et al., 1990 ; Novas, 2006 ; Rose and Novas, 2005 ) wherein hope is both generative of and generated by market interests, research directions, and the possibility of breakthroughs in medical treatment ( Novas, 2006 ; Rose and Novas, 2005 ; Sulmasy, et al., 2010 ). Hope itself is thus a source of biovalue for each of these stakeholders. For the afflicted and their families, hopefulness is a quality expected of good citizens ( Novas, 2006 ; Rose and Novas, 2005 ; Sulmasy, et al., 2010 ) much like the “achieved status” of good health ( Nichter and Thompson, 2006 ). Hope scales—metrics for measuring hope—produce “modes of self-management and codes of affective decorum” ( Brown 2015 :121).

Marcel (1962) described hope as a “mystery” and argued that rationalizing or placing it into categories flattened or distorted our understanding of it. Like Marcel, Polanyi observed that, “Every time we concentrate our attention on the particulars of a comprehensive entity, our sense of its coherent existence is temporarily weakened; and every time we move in the opposite direction towards a fuller awareness of the whole, the particulars then become submerged in the whole” ( Polanyi, 1969 :460). Drawing upon Polanyi we approach multiple ways of hoping as forms of tacit knowledge. Hope is something that we know “subsidiarily in terms of something else” ( Polanyi, 1962 :600).

While this observation would appear, at first blush, to run counter to the task of categorizing multiple forms of hope, Polanyi also recognized that “every dismemberment of a whole adds more to its understanding than is lost through the concurrent weakening of its comprehensive features” ( Polanyi 1969 :460). We concur and proceed with our categorization of ways of hoping acknowledging our limited ability to describe hope as a complex human state of think/feel ( Wikan, 1990 ). First, we call attention to hope and the existential paradox posed by chronic disease. We then identify types of hope that emerged in treatment narratives and address how different types of hope alone and in combination are employed in what we describe as the “work of hope”. We further consider how hope influences the experience of the treatments one receives, and how the experience of treatment in turn influences hope.

The Existential Paradox of Chronic Illness

Barnard (1995) described an “existential paradox of living with chronic illness” wherein people living with chronic illness straddle a boundary between hope and despair. To hope, Barnard explains, “means to project oneself beyond one’s present definition of reality, but with no guarantees against disappointment” (48). On the other hand, despair can be a defense against the inherent risk of disappointment in allowing oneself to hope ( Barnard 1995 ).

Chesla (2005) further develops Barnard’s concept of the paradox of hope by making clear what the paradox is not.

“Dialectic relations between hope and despair, necessity and possibility, have been called the existential paradox of chronic illness ( Barnard, 1995 ). Living the paradox means that those with chronic illness simultaneously confront their limitations and losses at the same time that they lean toward possibility, hope, and new openings. In trying to understand this paradox, it may be helpful to see its multiple oppositions, what this paradox is not. One opposite is surrender to one’s limitations and losses, what Kleinman (1988) calls demoralization , without the balancing thread of hope. Or, another opposite is hopefulness that denies the limitations and losses that are a part of chronic illness, what some would call delusion .” ( Chesla 2005 :373).

Mattingly (2010) similarly describes hope in existential terms as a “practice” as well as a paradox. Mattingly explains, “Paradoxically, hope is on intimate terms with despair. It asks for more than life promises. It is poised for despair.” (2010:3). In the context of chronic illness, hope “emerges as a paradoxical temporal practice and as a strenuous moral project” (3). Mattingly’s informants describe hope as a moral call, bound up with what it means to be a “good person”. For the families in her study, “hope has represented a stance toward reality that requires careful cultivation” ( Mattingly, 2010 :4).

Among chronic pain sufferers offered new treatment, the paradox boils down to the struggle to simultaneously maintain hopes high enough to embrace (or at least not to undermine) any potential effects of the treatment, while at the same time avoiding hoping for too much and risking disappointment if not despair ( Barnard, 1995 ; Mattingly, 2010 ). We will argue that it is through employing multiple Ways of Hoping that individuals actively navigate this paradox, and attempt to live up to culturally valued notions about sustaining hopefulness while also being “realistic” ( Averill and Sundararajan, 2005 ; DelVecchio Good, et al., 1990 ; Sulmasy, et al., 2010 ).

In the 1990s several medical anthropologists collected illness narratives from individuals with TMD attending residential pain clinics, pain treatment centers, and chronic illness support groups (see DelVecchio Good, et al., 1992 ). One of their observations was that when treatments failed, a sense of hopelessness emerged associated with the omnipresent existence of the ailment and its unpredictability ( Garro, 1992 ; Good, 1992 ). In what follows, we provide examples of ways our trial participants avoided hopelessness by engaging in multiple ways of hoping. We describe these ways of hoping in terms of cognitive experience, spiritual experience, and embodied experience. These distinctions are by no means intended to draw strict boundaries between cognitive and embodied experience or among ways of hoping. They are merely intended to show hope in its multiple forms and multiple levels to illustrate hope as a complex and sometimes arduous experience. We draw from literature on multiple ways of knowing ( Aickin, 2010 ; Geurts, 2002 ; Polanyi, 1962 ; Polanyi, 1969 ; VanMannen, 1977 ; Yorks and Kasl, 2006 ) to gain a clearer understanding of the elusive concept of hope and how it impacts and is impacted by evaluations of new information and experiences. 2

RESEARCH CONTEXT

Participants.

The semi-structured, open-ended interviews on which this analysis is based were conducted as part of a dual-site (Tucson AZ, Portland OR) randomized phase 2 trial of Traditional Chinese Medicine (TCM) for Temporomandibular Disorder (TMD) (For the full description of the overall study and sample characteristics, see Ritenbaugh, et al. (2012) ). Recruitment involved community outreach and newspaper advertisements that described a study evaluating TCM for jaw and facial pain.

One hundred sixty-nine participants were enrolled in the trial. Of those enrolled, approximately every second participant (about half the sample) was approached prior to initial randomization and asked to complete a series of semi-structured, open-ended interviews over the course of study participation. To adequately represent men’s voices in our sample, men were over-sampled in the qualitative study due to low overall enrollment in the study. Although not all participants completed all follow-up interviews, no participants declined to participate in a pre-treatment qualitative interview. Participants were between 18 and 70 years, rated worst facial pain > 5 on a 0-10 scale, had TMD diagnosis confirmed by standardized clinical exam [ http://www.rdc-tmdinternational.org/ ] performed by trained dentists, and had one of 10 pre-specified Chinese medicine diagnoses. By design, most participants ultimately entered the TCM treatment arm. Once in the TCM arm, participants could receive up to 20 treatments over one year. Qualitative sub-study participation consisted of a series of up to five interviews planned to occur: 1) prior to beginning any study activities; 2) prior to beginning TCM treatment; 3) after two to three months of experience in treatment; 4) at the end of treatment; and 5) two to three months after treatment was completed. Ultimately, 44 participants completed at least three of the follow-up interviews and were included in this sample (See Table 1 for detailed interview numbers). All procedures were approved by the University of Arizona Committee for the Protection of Human Subjects, and the Oregon College of Oriental Medicine Institutional Review Board, and all individuals participated under informed consent.

Total Interview Numbers

Data Collection

Baseline interviews were designed to cover 14 broad themes targeted at understanding participants’ experiences and views as they entered the study, and at specific points during and after treatment. The results presented in this paper are based primarily on participant responses to open-ended questions surrounding expectations and hope.

The following questions specifically elicited information about expectations and hope. Baseline Interviews:

• 1) What do you hope to get out of participating in this study? OR What would you consider to be a benefit from participating in this study?
• 2) What are your expectations for this study? About the self-care arm? Herbs? Acupuncture?

Follow-Up Interviews:

• 1) Did you experience “ups and downs” during the treatment? Times when you felt more or less relief? More or less hopeful?
• 2) Do you plan to continue this treatment after the study has ended? Why or why not? (Get at management strategy or cure)
• If not, how do you feel about going through all the study activities and feeling little change? Has it changed the way you feel about your pain?

All interviews in Tucson were conducted by EE, and interviews in Portland were completed by two interviewers trained by MN. Regular conference calls were held to maintain consistency in approach and solve problems as they arose.

Data Analysis and Interpretation

Interviews were transcribed verbatim and analyzed using a phenomenological approach attentive to the interview context, the subjective and shifting nature of individual experience, and the possibility of multiple voices or conflicting selves arising in interviews ( Tanggaard, 2009 ). Initial interview transcripts were hand-coded and considered by the authors for emergent themes. These themes were then compared with relevant literature to create a codebook for coding in ATLAS.ti ( Muhr, 2011 ). Attempting to map initial expectations onto later expectations and reported “outcomes”, we explored the possibility of trajectories in hopes or expectations or relationships between high or low levels of hope with satisfaction. In these iterations of analysis, which included a secondary re-coding of statements broadly related to hopes or expectations for more intricate themes, the present focus on multiple ways of hoping emerged.

We were attentive to multivocality as well as performative aspects of our informant’s illness narratives ( Goffman, 1959 ; Labov, 2013 ; Strauss, 1997 ; Tanggaard, 2009 ). It was commonplace to encounter different “voices” representing various aspects of informants’ lives and stances toward their illness in the same interview. Although we asked informants about their expectations and hopes from therapy at baseline and in later interviews, these questions were located at the end of interview guides and were not a central point of questioning. The centrality of statements indexing different ways of thinking about hope emerged unsolicited in discussions of many areas of life.

REFLECTIONS ON HOPE AND EXPECTATIONS OVER TIME

Initially, we sought to explore participants’ expectations prior to trying TCM and, through longitudinal analysis, to determine whether initial expectations impacted the way they experienced treatment. We found, however, that expectations could not be disentangled from hopes in participants’ descriptions. Further, “hope” worked to moderate expectations, often in unexpected ways. Over the course of the study we recorded shifting narratives as participants assessed whether their expectations had been met and whether they felt “more hopeful” or “less hopeful” after participating in a novel alternative treatment. These narratives were often multivoiced as participants presented themselves as both more hopeful and less hopeful at the same time.

Intuitively, we hypothesized that participants who were surprised by a positive treatment outcome would report increased hope as a result, and that participants who were not happy with treatment would report a decrease in hope. We found no such pattern, however, and were faced with a conundrum of how to make sense of varied response and expressions of surprise or disappointment that seemed unrelated to either initial expectations or the reported “outcome” of TCM treatment in terms of pain relief. Further, as has been reported in other studies of expectations, participants were often forthcoming with expressing hopes, but reluctant to voice expectations ( Eaves, et al., 2014b ; Kaptchuk, et al., 2009 ; Stone, et al., 2005 ). Helen, below, explained that her expectations were low but she had hopes before starting treatment.

Having already tried a few things on my own and, and not saying that they’ve had like stellar results, I guess the cynic in me would say, I have hopes but I don’t have expectations… (laughs) um, I guess my expectation is that I’m going to learn something new. And that’s as high as I would rate it. (Helen, 57, Interview 1)

After treatment, Helen reflected on her initial hopes, explaining that there is always some hope “on a deep level” that a new treatment will be “the thing that makes it all better”.

I had some subtle expectations about the study that yeah, finally it’ll be the thing that makes it all better… I don’t think that’s ever true for anything, and I’m just, and I know that on a deep level but you always still want it to be the thing that will make it wonderful… And I, and I think that’s why we get out of bed in the morning. Because we still have hope. (Helen, 57, Interview 5)

Notably, the changes described by participants like Helen not only index changes in expectations over time, but also changes in the framing of one’s assessment of initial expectations in light of new experience. In part, this reassessment and exercise of reflexivity may have been prompted by our interviews. It is our sense, however, that many respondents experienced shifts in expectation that impacted and were moderated by the way they experienced hope.

WAYS OF HOPING ON MULTIPLE LEVELS OF EXPERIENCE

What follows is a typology of ways of hoping gleaned from participant narratives. After identifying these distinct ways of experiencing hope we will consider how participants used different ways of hoping concurrently in their “work of hoping”. Our intent is not to provide an exhaustive list of ways of hoping, but to draw attention to the co-occurrence of ways of hoping as a means to address what may appear to be discontinuities in explanations of hope, but turn out to be part of a complex coping process.

Multiple ways of hoping are key features in the work of both being hopeful—a balancing act required for daily coping and seeking treatment—and appearing to be hopeful—living up to the often conflicting expectations of significant others and cultural ideals (see also Eaves et al. 2014b for a preliminary typology). For heuristic purposes, we have divided hope into overarching categories. First, hope is considered in terms of cognitive experience or ways of hoping that participants engage intellectually. Second, we describe hope as an embodied experience, sometimes more deeply felt than intellectually considered. Third, we consider hope as intertwined with experiences of faith. The categorization is not intended to distinguish between cognitive, embodied, or faith-centered experience, but rather, to emphasize that hope is practiced at all of these many levels of experience.

HOPE AS A COGNITIVE EXPERIENCE

Realistic hope (or practical hope).

Realistic hope includes any hope for a reasonable or probable outcome in terms of normal or expected outcomes on the part of the broader medical community (cf. ( Lohne and Severinsson, 2004 ; Webb, 2007 ; Wiles, et al., 2008 )). In this sense, hoping for a small reduction in pain is a reasonable, or realistic hope. In most cases, participants considered “reasonable” whatever they would not be hesitant to disclose to their health care practitioners. 3

Being realistic is a way of hoping that allows individuals to live up to cultural ideals of realism and adherence to evidence while still maintaining openness toward the possibility of positive change.

For myself, I really hope to lessen the pain, but get, get better tools of dealing with it, physically, and just more able I guess to reduce my own stress. You know, or know what would help more. Whether that’s an herbal thing or a physical thing. And it’s certainly not like I’m going to be depressed if there’s no change or whatever, but I’m hopeful that there is going to be. And that I’m going to get better at dealing with it. (Sarah, 42, Interview 1)

Utopian Hope

Webb (2007) describes utopian hope as a collectively oriented hope that group action can lead to a better future. This way of hoping is outwardly focused and does not require individuals to factor prognosis or practical considerations into their hope. In our study this hope appeared as a pragmatic hope that being part of research would help others in the future by contributing to overall knowledge about TMD. This type of altruism is often found in study participants ( McCann, et al., 2010 ).

I’m really excited about the study happening. I’m excited about it for myself and I’m excited that it’s being done because I feel like it’s important that things like [research studies] start being- you know, I hate that it has to be proved to those people that don’t believe in it. But then it can start being, becoming more available for people that have health insurance that never normally would cover something alternative or these ideas, and just the more they’re being talked about the more people will believe in them more and get helped. (Kyra, 30, Interview 1)

Wishful Hope

Wishful hope includes very high hope that is not necessarily “realistic” (hope for cure, stories of miracle outcome experienced by others, very high hopes) (cf. ( Lohne and Severinsson, 2004 ; Wiles, et al., 2008 ). Wishful hopes were rarely expressed in participants’ narratives without simultaneous descriptions of realistic hope. Participants further avoided appearing unrealistic by explaining that hope is necessary for continuing to seek treatment and to cope with pain on a day-to-day basis.

I really do [believe it could be cured]. ‘Cause I think um, well if I didn’t believe that it, it’d be a lot harder to try to deal with it… I also feel like, oh acupuncture has the magic ideas (giggles) you know, like there’s some magic that’s going to happen if I go get acupuncture. (Jessica, 30, Interview 1) 4

Positive “illusions” have been described as a way to maintain hope in the face of dire circumstances ( Barnard, 1995 ; Taylor, 1983 ; Taylor and Brown, 1988 ). Wishful hope as a way of hoping may allow individuals to develop, nurture, and ultimately be restored by illusions ( Taylor, 1983 ) while adapting to the contingencies of daily living by adjusting other hopes.

Transcendent Hope (Or existential hope)

Transcendent hope encompasses three types of hope described by other social scientists. The first is Webb’s characterization of “Patient Hope”, which is “directed toward an objective which defies any attempt to map it”; “a hope that everything will work out well in the end” ( Webb, 2007 :69). Webb draws from Marcel (1962) , who argues that hope is open-ended and does not make conditions on the future. Transcendent hope also encompasses “generalized hope” ( Corbett, et al., 2007 ; Leung, et al., 2009 ) and “universal hope” ( Hammer, et al., 2009 ). Like “generalized hope”, Transcendent hope is not directed toward a specific outcome. In this case, it may not be concerned with the pain itself, but rather on the possibility of a good life in general. When hope that is connected with time and object is threatened, hope for general good provides a defense against despair or “giving up”.

As it relates to our participants, transcendent hope describes a stance of general hopefulness not tied to a specific outcome or goal. This way of hoping is expressed as a general attitude of hopefulness, but refusal to imagine or define the future.

[I’m looking for] Answers, if not a cure today. I recognize that this is research. So I’m looking for tools to help me either manage it, or make it go away. And I know I’m asking for a lot. But if I’m able to find tools to help me manage it, or help it subside to such a degree that it’s not such a part of my life. So, I mean I know. I’m asking for the moon here… It’s like, you know, there’s definitely hope. That’s what I’m looking for, a little hope that there’s something out there for me. (Eleanor, 42, Interview 1)

Conversely, the absence of transcendent hope may be experienced as deeply felt hopelessness. Whereas a lack of hope for a specific outcome may not impact participants’ overall outlook, a lack of hope for any good in the future is more difficult to overcome. Lisa’s statement below articulates that such hopelessness, in and of itself, can be painful, perhaps more so than the physical pain.

The pain that I was feeling before this acupuncture started was complete suffering and fear. And as I started working through the layers of that, like an onion, I started realizing, and being able to pinpoint what has affected that, what caused it, and how to move forward. And that’s through the advice of the acupuncturist… And so through the layers of moving through, and, and specifically, the pain before the acupuncture was completely different. It was more deep-seated hopelessness . [emphasis added] Whereas now it was just a physical- it was like bruising your knee. Just like healing a physical thing that you can actually see. (Lisa, 30, Interview 4)

HOPE AS AN EXPERIENCE OF FAITH

Hope as religious faith.

Faith is closely aligned with hope both cognitively and emotionally. In the Christian tradition, “faith is the substance of things hoped for” (Hebrews 11:1, as cited in Sulmasy, et al., 2010 ). To hope is equated with having faith ( Sulmasy, et al., 2010 ). In Judaism hope and faith are linked and among believers, to lose faith is equivalent to giving up or turning one’s back on God (despair) ( Lamm, 1995 ).

Religious-based faith is one important way for individuals to find hope, and may be particularly important for those who lack other ways of finding hope through work or family support ( Hall, 1994 ). Among our study participants, religious faith was a way of taking care of oneself, a way of being uplifted, and a way to feel as though one is part of something larger and “not alone”.

I go to church. I am a believer in Christ. I can take care of myself spiritually I, you know, knowing that I have salvation through God, you know, in God. I, that uplifts me, in that I have salvation for eternity. (Larry, 52, Interview 1)

As Amalia explains below, faith is part of working with the mind and soul, often overlooked in considerations of pain’s physical impact. Finding hope, in this case, is not explicitly mentioned. Amalia does explain, however, that through spiritual practice she has found peace and feels she can “handle anything”. We consider this feeling of peace of way of being hopeful in daily experience.

I went to this little chapel and started taking classes in spiritual healing… I went to the chapel, every Sunday and learned how to work with the mind and the spirit and just, the soul. So that’s what brought me the happiness, so that stays with me, a very important part of my life, that I stay connected to the source. Which some people call God, and other call it all kinds of different names… and I notice that, it works, it really works. … It brings you a lot of peace. It makes you feel like you can handle anything, because you’re not alone. (Amalia, 63, Interview 1)

Hope as Faith in Bioscience or Biomedicine

Faith as a way of hoping is not limited to religious faith. Sulmasy et al. (2010) found that faith was a common theme in participants’ narratives about hope in living with cancer. Among their participants, however, faith in science and medicine was more common than religious-based faith. We found a similar trend among participants, although often expressed in terms of loss of faith or difficulty keeping faith in medical science.

It’s kind of hard after 20 years to have any faith that [pain] can really be made to go away. But, there’s a part of me that feels like we’re gonna be able to do something with the pain that allows us to take chronic conditions and, at least, change how they’re perceived and felt. I think we’re gonna make major breakthroughs in pain control in the next few years because there’re so damn many of us baby-boomers hurting. And there’s more and more women doctors looking at things. And there’s more and more of us that have been affected by these things, who are in the medical industry. So, I believe there’re a number of factors that are gonna lead to good breakthroughs. And, I want to think they’ll be in my functional lifetime. (Evelyn, 47, Interview 1)

Amalia compared her faith in doctors’ ability to heal to faith in God. In seeking alternative treatment, however, she admits that this faith has waned.

I was kind of trusting [of doctors]. That they know what they’re doing you know. So that was, I was very much trust of doctors. Whatever they say, you know, was it. Because, (short pause) I don’t know, because they were the doctors, you know how that goes. They’re almost like god (laughs) to us, to a lot of us you know. If they can make you feel better. (Amalia, 63, Interview 1)

Faith in bioscience and biomedicine is not necessarily based on current knowledge or technology. Individuals living with illness for which there is little possibility of cure often put their faith in technological or scientific breakthroughs ( Brekke and Sirnes, 2011 ).

The way, if, if medicine is changing at a fraction of the rate that computers are changing, we’re gonna know so much about the human body in the upcoming ten, fifteen years, it’s gonna be incredible. And I’m banking on that. (Taylor, 53, Interview 4)

Among participants in this study, we noted comments directed toward faith in alternative medical paradigms. Unlike cancer or other high-profile (and high market potential) terminal illnesses, chronic pain is positioned in the medical establishment as an elusive, intractable, and troubling illness category, sometimes even characterized as lacking a biophysical component ( Crowley-Matoka and True, 2012 ; Good, et al., 1992 ; Jackson, 2005 ; Jackson, 2011 ). While some study participants continued to hope for medical breakthroughs, many had long since given up on biomedical treatments. Some of these participants were now turning toward alternative medical paradigms rather than religion as a way to regain or maintain hope.

I really believe in Chinese medicine. I’ve used it all over the world for many years. I’ve gone to Chinese medicine doctors, and I know that they are— but it’s a much more precise kind of medicine practice and descriptive, sorry, prescriptive. In other words, the herbs are always combined for exactly what the person needs. So I had a kind of faith in them. (Louise, 53, Interview 4)

HOPE AS EMBODIED EXPERIENCE

Faith in Hope Itself: faith in the body’s ability to heal

Many researchers have discussed a pervasive cultural belief in the power of hope, positive thinking, or individual will to change the course of illness ( Cassel, 1982 ; Clarke, 2003 ; DelVecchio Good, et al., 1990 ; Herth, 1992 ; Scheper-Hughes and Lock, 1987 ; Sulmasy, et al., 2010 ). This faith in hope is often intertwined with deeply felt personal convictions that the body has the ability to heal itself.

Because there’s so much out there that we don’t know, that can help… because we can make our bodies healthy and new again. It’s just a matter of finding what works. Because our cells you know, rebuild them- ourselves… we shouldn’t be old because our cells renew our, every, I forgot how often it happens… the whole body, all the cells renew themselves every certain time. And they say if we’re able to rebuild our cells like that, then there’s no reason for us to grow old. She said the reason we grow old is because we’re programmed to, that we’re gonna grow old. We’re programmed to grow old and die, so that’s why she says we grow old and die, but not if you tell yourself, “you are young.” You’ll stay young. So, who knows? There’s gotta be an answer out there somewhere we just haven’t found it. So that’s why I’m always willing to learn about new things. And I believe in it, I believe that with certain things that, the pain will go away, you know? (Amalia, 61, Interview 1)

Such a conviction is strengthened by individuals’ awareness of the existence of the widely reported yet little understood placebo response ( Kaptchuk, et al., 2009 ; Moerman, 2002 ). Media coverage of the placebo effect, spontaneous healing, and the power of positive thinking engenders hope in the lives of individuals living with pain and chronic illness. Brian, for example, explains a belief in the power of positive thinking as capable of curing even the most “mysterious diseases”.

I think anything’s curable… I mean, yeah, people have cancer and there’s just no way you know? Which is like cancer’s one of the biggest things that we don’t understand, it’s one of the most mysterious diseases, it’s huge. I mean it kills millions and millions of people a year and it’s like, some people will just have it and then it just goes away, for some reason, and maybe it’s mental you know? I mean, someone decides they don’t want it and, or maybe they actively changed it, their lifestyles and that, maybe that affects it too. (Brian, 28, Interview 1)

The way people intuitively grasp what they perceive through bodily sensation and imagination is complex ( Yorks and Kasl, 2006 ). Sensing, or “bodily ways of gathering information in the world” are basic to how we perceive and experience the world ( Geurts, 2002 ). Ratcliffe (2011) argues that in cases of loss of hope or hopelessness, there is a hope that remains. This visceral sense of hope, in his view, is neither an intentional state nor a non-intentional bodily feeling, but rather “is a ‘pre-intentional’ orientation or ‘existential feeling’” (600). Faith in the body’s ability to heal can counterbalance despair that one’s body has somehow let them down, and feed hope that a treatment may be out there that can trigger the body’s natural healing capacity. Some participants who had turned to CAM treatments held out this possibility.

People really want to believe in the myth of the permanently fit body. You know, instead of the temporarily able body that we actually have…But my housemate got sick one time with something that her MD doctors couldn’t identify and she went to a holistic practitioner who gave her some drops in bottles and I swear to god three days later she was up out of bed. And she had been sick for a month and a half. So, I kind of had a fantasy that maybe I would go drink this dirt and a week later I’d be back at work or something. (Taylor, 53, Interview 3)

THE WORK OF HOPE IN THE CONTEXT OF CHRONIC PAIN

Maintaining hoping when one is experiencing chronic pain requires vigilance not only requires against impending despair, but also against biographical disruption that may ensue if pain undermines one’s sense of self and identity ( Bury, 1982 ; Eaves, et al., 2014a ). Below, we consider how people living with pain engage in the work of hope. Areas of work include managing the paradox of hope as well as working to appear hopeful in the presence of significant others regardless of what one feels at any given moment.

The Work of Having Hope

Having expectations, whether high or low, was considered a source of vulnerability. High expectations made one vulnerable to disappointment if those expectations were not met. On the other hand, having low expectations was regarded as negatively impacting the outcome of treatment. Dennis, below, explicitly refers to multiple sides of himself—a “hopeful side” and a “cynical side”—which allow him to remain open despite his acknowledgement of the paradoxical nature of hope.

My cynical side or my hopeful side? Um, (pause) I’m trying to remain, honestly I’m trying to remain open. I’m trying not to have expectations. I’m trying to let the interaction do whatever it’s supposed to do. If I expect that I’m going to be cured and it’s not, I’ll be unhappy. And if I expect that nothing will happen, and I go into it thinking that nothing’s going to happen, nothing probably will happen. So I’m trying to remain pretty open to whatever, you know, whatever comes along. (Dennis, 32, Interview 1)

Chesla (2005) , describes “small moments of suffering” in daily life with chronic illness that can lead to either hope or despair. Individuals living with chronic pain work to maintain a “safe” space between the vulnerability of overly-inflated hopes and the vulnerability of losing hope. Beth explains in the following statement that she feels safe from the vulnerability of having high hopes by remaining somewhat pessimistic. In this sense, pessimism is a protective strategy, avoiding the much more daunting possibility of despair.

I guess there are, I just have days where I feel like completely pessimistic about everything. Um, and taking those into account it’s hard for me to say, yes I have a lot of hope for the future… I think that’s one of the ways that I keep myself down. You know? Keep myself in this very small place. Um, and for some reason, that’s where I feel safe. So, if I’m down on myself then, then I’m staying in my place . You know? Um, and I don’t want to stay in that place anymore, but stepping out of it, too, feels really scary. (Beth, 30, Interview 4)

In life with chronic pain or illness, finding hope is part of appropriately working toward mastery over one’s condition ( Rose and Novas, 2005 ). 5 Individuals living with chronic pain must therefore work to live up to the expectation of being hopeful while avoiding hope that denies the everyday reality of living with chronic pain ( Chesla, 2005 ).

The Work of Describing Hope

In interviews, participants worked to convey their hopes for treatment while taking care not to appear unrealistic or uninformed. They avoided statements they felt could jeopardize the possibility of benefit from the TCM treatment, but also kept their enthusiasm in check. Humor was a common way for participants to express high hopes while avoiding vulnerability. Subtle uses of humor often index more serious underlying ideas or emotions ( Bletzer, et al., 2011 ; Crowley-Matoka and True, 2012 ). In Angelica’s statement below, she laughs at herself as she admits that the possibility offered by a novel treatment allows some hope to surface.

I’m really, I ha- I guess I, kind of have higher expectations on the Chinese medicine side, just, just from common knowledge of what everybody, they’re healthy people (chuckles). You know, for the most part, and ac- that everybody swears acupuncture does wonders so, I guess I have a little higher expectations on that, that side of it. But I really, honestly don’t know what to expect from it. Just, I can only hope that it does what I would like it to do, and ideally teach me to manage it with the least amount of medications, that’s my best explanation. (Angelica, 37, Interview 1)

A chuckle or laugh following a statement of very high hopes allows the participant to appear as though they are not seriously harboring such hopes, which are often called “false hope” and discouraged by nurses and other caregivers ( Crites and Kodish, 2013 ; Simpson, 2004 ; Brown, 2015 ).

I was just hopeful to the end, you know? Hoping a miracle would happen. Even [a TMD specialist] was telling me, you know, there’s no cure [chuckling]. I hope someday there will be a cure. Just for like all diseases we hope there will be cure for cancer, all our problems. (Lin, 71, Interview 5)

Chronic pain sufferers in this study were, for the most part, aware that there is no cure for their condition. Catering to the hopes and expectations of significant others, like describing hope to medical practitioners or researchers, requires a delicate balancing act. On one hand, sufferers are expected to continue to seek treatment and to display appropriate desire to become well, despite the difficulty they experience in trying to live a “sick role” ( Glenton, 2003 ). On the other hand, sufferers are expected to be realistic, to live in spite of pain, and to avoid burdening others or becoming a drain on family resources.

WORKING THROUGH THE PARADOX OF HOPING IN EVERYDAY PAIN

In daily life and in broader experience, our informants faced the continuous experience of pain. Hope, in this context, presents a paradox and requires constant and onerous work. Some modicum of hope is necessary for carrying on with daily living ( Cassel, 1982 ; Good and Good, 1991 ; Kaptchuk, et al., 2009 ; Kylma, 2005 ). At the same time, hope represents a daunting source of vulnerability ( Ratcliffe, 2011 ; Simpson, 2004 ). Those living with chronic TMD pain work to keep their hopes at a level resistant to being dashed from either side (hopes too high present the risk of disappointment, whereas hopes too low make it difficult to cope in daily living). Much research on hope has focused on individuals facing death or coming to grips with terminal illness who grapple with a similar paradox (e.g. Barnard, 1995 ; Chesla, 2005 ). Similar to Mattingly’s (2010) informants, our study participants were keenly aware of this paradox and of the need to manage hope. Here are two examples:

I don’t really have any expectations. If something goes well I’ll be delighted. I still hold back on, basically I feel like I’ve got a structural issue, so any of these things might be able to provide me relief, but it’s not going to fix the real problem. So for me it was just like if I can get some relief, that would be great and I- but I didn’t want to, I don’t have any expectations that I’ll get tremendous relief cause then if I don’t I don’t want to be disappointed. (Stephanie, 36, Interview 1)

It doesn’t seem like after all this amount of time that it could be cured. But I’m hopeful. But I’m not, I mean it’s, yeah a miracle can happen but, um, I’m hopeful. That’s why I’m here. If I thought there was nothing else to do, I wouldn’t try anything so. (Evelyn, 47, Interview 1)

As Good and Good (1991) point out, maintaining a sense of hope often requires thinking about an illness “in the subjunctive (what if) mode.” Some semblance of possibility must be maintained in order for participants to continue to seek treatment ( Good and Good, 1991 ; Kaptchuk, et al., 2009 ; Kaptchuk, 2011 ; Kirmayer, 2006 ).

I kind of, it’s one of those things that I want it to be curable so even if somebody says it’s not I’m kind of like looking long term, yeah, I think it’s curable. It’s one of those things, you gotta think it’s curable because nobody wants to live without hope you know what I mean? Even if it’s not, tell me that it is anyway. Make me think it’s curable. (John, 33, Interview 1)

Implications of Ways of Hoping for the Placebo Effect

Hope itself has been referred to as a “magical pill” able to produce an effect similar to that of the placebo ( Averill and Sundararajan, 2005 ). Engendering hope is central to arguments concerning the role of the therapeutic relationship in enhancing the placebo effect ( Moerman and Jonas, 2002 ). Health care providers are thus expected not only to treat illness, but to assist patients in cultivating reasonable or appropriate hopes ( Corbett, et al., 2007 ; DelVecchio Good, et al., 1990 ; Sulmasy, et al., 2010 ) while at the same time informing them of prognosis and the risks and benfits of treatment options ( de Pentheny O’Kelly, et al., 2011 ; Oliffe, et al., 2007 ; Pergert and Lützén, 2012 ). 6 The afflicted are faced with the paradox of needing to remain hopeful enough to maximize their chances of positive outcome from a new treatment yet not setting themselves up for despair by hoping for too much. This need to balance ways of hoping may well have an impact on the placebo effect at different points in a treatment trajectory as perceptions shift and life contexts change.

Unlike expectation, which typically describes rational, logical projections about what will occur, hope describes a range of cognitive, emotional, spiritual, meaning-centered, and embodied experiences. Whereas expectation may be amenable to bounding, to consideration in terms of a single experience, hope, in its many forms, requires that time horizons remain open ( Good, 1994 ). As such, hope must be viewed in context and as a dynamic state of being. While some forms of hope may be elevated briefly by the possibility of a new treatment, other forms may compensate and counterbalance. Mattingly (2010) has rightly pointed out that finding or maintaining hope is a central feature in the lives of chronically ill patients and their families. Finding or maintaining hope relates not just to one’s immediate experience and the demonstration of the effect of a treatment, but to one’s life overall. Similar to the paradoxical (compensatory) response by the body, sometimes responding in the opposite direction to a conditioned stimulus ( Thompson, Ritenbaugh, and Nichter 2009 ), hope may impact placebo responses in complex ways.

The ability to imagine a better future or to remain open to alternate possibilities, even if it necessitates some reliance on illusion or imagination, is crucial to maintaining hope when one is experiencing chronic pain ( Barnard, 1995 ; Chesla, 2005 ; Kirmayer, 2006 ; Taylor and Brown, 1988 ). At the same time, one must buffer against unrealistic expectations that can end in disappointment and further exacerbate pain. Barnard asks, “What happens when distorted views of reality are disproved by experience? If positive illusions are adaptive in the face of threat, what happens to one’s adaptation when the illusions that sustain it must yield to the ways things ‘really are’?” ( Barnard 1995 :44). We would answer that multiple ways of hoping enable sufferers to adapt to contingencies and experiences such that they can remain hopeful and open to the possibility of aid on the horizon.

Hope is significant in the lives of individuals with chronic pain or illness in multiple ways. Statements about hopes and expectations are performed for several purposes. Expressing high hopes or downplaying one’s hopes can reassure family members or significant others that one is maintaining an appropriate level of hopefulness ( Chesla, 2005 ; Sulmasy, et al., 2010 ). In a culture in which hope and optimism are positively valued and expected, expressions of appropriate hopes may also express adherence to cultural expectations of hopefulness and striving for one’s best possible future ( Adams, et al., 2009 ; DelVecchio Good, et al., 1990 ; Rose and Novas, 2005 ). Expressions of hopefulness may further serve as personal reminders of the importance of maintaining hope, staying positive, and embracing the magical power of words ( Tambiah, 1968 ). Hope is also associated with embodied ways of knowing, memories of past treatment experiences, and quite possibly with evolutionarily patterned responses to adverse circumstances ( Hahn and Kleinman, 1983 ; Thompson, et al., 2009 ).

The phrase “ways of knowing” has been used to describe the acquisition and application of knowledge, understanding, and embodied experience ( Aickin, 2010 ; Geurts, 2002 ; Polanyi, 1962 ; Polanyi, 1969 ; VanMannen, 1977 ; Yorks and Kasl, 2006 ). Ways of hoping similarly describes the work of reconciling practical knowledge, prior experience, and phenomenological perception in one’s experience. Geurts (2002) draws attention to a gap between cognitive models of perception and phenomenological levels of sensation, existence, and bodily experience. Related to Polanyi’s (1962) description of “things we know but cannot tell,” Geurts (2002) cites Desjarlais’ (1992) description of bodily knowing as “a lasting mood or disposition patterned within the working of the body” ( Desjarlais 1992 :150, as cited in Geurts 2002 :5). While expectation is thought to be related to reason, hope is often characterized as an emotion or feeling, albeit active and creative ( Averill and Sundararajan, 2005 ; Lynch, 1962 ; Pruyser, 1986 ). In this paper we have argued that hope is a process of feelings, thoughts, and embodied dispositions that are looped and affect each other in context and in response to feedback. Hope is not a denial of reality, but is part of continuous re-evaluation of reality in light of other possibilities ( Pruyser, 1963 ).

A concept such as hope is difficult for an individual to characterize at any point in time, particularly given that much of our understanding is built on things we cannot know objectively, but rather know as “lived reality” ( Clarke, 2003 ). As Polanyi points out, “Every time we make sense of the world, we rely on our tacit knowledge of impacts that the world makes on our body and the responses of our body to these impacts” ( Polanyi 1962 :605). As such, ethnographic inquiry needs to be attentive to sensations associated with embodied memories, as well as to reasoning, if we are to better understand feelings of fear and vulnerability, or conversely, of well-being and protection ( Nichter, 2008 ). Future ethnographic accounts of hope should consider sensorial, embodied, cognitive, and emotional aspects of hope, as well as cultural norms and expectations associated with religious or spiritual values, social and gender norms, and interpersonal dynamics associated with managing strong emotions. We would re-iterate that division of hope into categories is not intended to imply that there are separate components when in fact we are dealing with an integrated whole. We have used these categories as tools to explore multiple ways of hoping as a complex experience of tacit knowing and varied states of think/feel ( Wikan, 1990 ). A greater appreciation of the work of hoping and the roles played by different ways of hoping in context will offer depth to our understanding of both the placebo effect and the process of coping with chronic pain and illness in everyday experience.

ACKNOWLEDGEMENTS

Funding for this research was provided by a grant (U01-AT002570) from the National Center for Complementary and Alternative Medicine, National Institutes of Health. The authors thank Allison L. Hopkins, Elizabeth Sutherland, Jennifer Jo Thompson, Karen J. Sherman, Samuel F. Dworkin and our participants and study practitioners for contributions to the research and to the conceptualization of this manuscript.

1 Contemporary evidence-based medical culture in the U.S. intensely values truth-telling, full disclosure of prognosis, realism and adherence to “the facts” ( Caspi and Holexa, 2005 ; Oliffe et al. 2007 ; Pergert and Lützén 2012 ; DelVecchio Good et al. 1990 ). This has not always been the case. Indeed, it runs counter to the values espoused by clinicians in U.S. medical culture in the not too distant past ( DelVecchio Good et al. 1990 ), where greater credence was paid to both the psychosocial state of the afflicted, and the wishes of family members responsible for a patients’ therapy management who may desire to provide a more peaceful and positive treatment environment where hope is sustained ( Kagawa-Singer and Blackhall, 2001 ; Kodish and Post, 1995 ). The issue of disclosure and the weighing of autonomy versus non-malfeasance is a particularly sensitive in end of life issues or in cultures where dashing the hopes of chronically and terminally ill individuals is considered immoral ( de Pentheny O’Kelly, et al. 2011 ; Gongal, et al. 2006 ; Harris, et al. 2003 ).

2 It is beyond the scope of this paper to map ways of hoping onto ways of knowing. We draw from this framework as a useful way to explore the range of cognitive to embodied experience subsumed under the term hope.

3 This mode of hoping is comparable to Webb’s (2007) “estimative hope” (described as evidence-based hope), Lohne and Severinsson’s (2004) “small hope” (described as possible hope), and Wiles et al.’s (2008) “hope-as-expectation” (described as the high end of a continuum of probability of a desired outcome).

4 We chose to include wishful hope due to its resemblance to widespread usage of the term hope in studies of expectation ( Lynch, 1962 ; Leung 2009). Hope is often described as similar to expectations, but a wish or want, rather than a realistic projection. Among our participants, this form of hope was not widespread and was represented clearly in only a few participant statements. The relative absence of this form of hope supports the need for a more nuanced understanding of the experience of hope in chronic pain and illness.

5 In contemporary Western culture, hope has become a moral imperative ( Rose and Novas, 2005 ). Ignorance, resignation, and hopelessness in the face of the future are deprecated. In cases where there is little hope for resolution in a realistic sense, individuals are encouraged to pin their hopes on the promise of new technology and medical advances ( Brekke and Sirnes, 2011 ).

6 Hope presents a paradox for the afflicted and clinicians alike. For the afflicted, hope is needed, but too much hope risks disappointment to the point of despair. For the conventional medicine practitioner, “truth-telling” (and full disclosure of the facts, costs and benefits, etc.) is deemed the ethical thing to do by the standards of evidence-based medicine, which favors rational decision-making. Yet in practice clinicians often face an ethical dilemma when trying to balance truth with inspiring hope ( de Pentheny O’Kelly, et al., 2011 ; Oliffe, et al., 2007 ; Pergert and Lützén, 2012 ). This dilemma will only grow with increasing evidence that hope is a powerful healing mechanism ( Clarke, 2003 ; Herth, 1992 ; Nekolaichuk, et al., 1999 ; Snyder, et al., 1991) and ethical arguments identifying hope as an existential aspect of the individual that must be treated with respect and sensitivity ( Kodish and Post, 1995 ). CAM practitioners appear to be particularly sensitive to the hope dilemma and to the impact of their words and actions on the patient’s healing response ( Caspi and Holexa, 2005 ; Schafer, et al., 2012 ). The paradox for clinicians is therefore to consider the patient’s right to be informed while at the same time to avoid undermining both the placebo response (the body’s natural ability to heal) and the emotional necessity of continuing to hope.

Conflict of Interest : Emery R. Eaves declares that she has no conflict of interest. Mark Nichter Declares that he has no conflict of interest. Cheryl Ritenbaugh declares that she has no conflict of interest.

COMPLIANCE WITH ETHICAL STANDARDS: Ethical Approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All procedures were approved by the University of Arizona Committee for the Protection of Human Subjects, and the Oregon College of Oriental Medicine Institutional Review Board. Informed consent: Informed consent was obtained from all individual participants included in the study.

Contributor Information

Emery R. Eaves, School of Anthropology and Department of Family and Community Medicine, University of Arizona, ude.anozira.liame@eyreme .

Mark Nichter, School of Anthropology, Department of Family and Community Medicine, and College of Public Health, University of Arizona, ude.anozira.liame@rethcinm .

Cheryl Ritenbaugh, Department of Family and Community Medicine and School of Anthropology, University of Arizona, ude.anozira.liame@uabnetir .

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Reflections: LIVING IN HOPE

 december 2006.

The three virtues that Paul sets forth as being of greatest importance in the believer’s life are faith, hope, and love (1 Corinthians 13:13). Although in our day faith and love are spoken of far more often than hope, it remains true that hope plays a vital role in faithfully following Jesus Christ.

The importance of hope is highlighted by C.S. Lewis in his book,  Mere Christianity , when he says—

Hope is one of the Theological virtues. This means that a continual looking forward to the eternal world is not (as some modern people think) a form of escapism or wishful thinking, but one of the things a Christian is meant to do. It does not mean that we are to leave the present world as it is. If you read history you will find that the Christians who did most for the present world were just those who thought most of the next. The Apostles themselves, who set on foot the conversion of theRoman Empire, the great men who built up the Middle Ages, the English Evangelicals who abolished the Slave Trade, all left their mark on Earth, precisely because their minds were occupied with Heaven. It is since Christians have largely ceased to think of the other world that they have become so ineffective in this. Aim at Heaven and you will get earth “thrown in”: aim at earth and you will get neither. It seems a strange rule, but something like it can be seen at work in other matters. Health is a great blessing, but the moment you make health one of your main, direct objects you start becoming a crank and imagining there is something wrong with you. You are only likely to get health provided you want other things more—food, games, work, fun, open air. In the same way, we shall never save civilization as long as civilization is our main object. We must learn to want something else even more.

Most of us find it very difficult to want “Heaven” at all—except in so far as “Heaven” means meeting again our friends who have died. One reason for this difficulty is that we have not been trained: our whole education tends to fix our minds on this world. Another reason is that when the real want for Heaven is present in us, we do not recognize it. Most people, if they had really learned to look into their own hearts, would know that they do want, and want acutely, something that cannot be had in this world. There are all sorts of things in this world that offer to give it to you, but they never quite keep their promise. 1

Sadly, many of us are so tethered to this world and the things it offers that we scarcely take thought of the world to come. Yet it is precisely by reflecting often on the joys, beauties, and satisfactions of eternal life in the world to come that we find a hope that empowers us to live fully for Christ today.

If then you have been raised with Christ, seek the things that are above, where Christ is, seated at the right hand of God. Set your minds on things that are above, not on things that are on earth. For you have died, and your life is hidden with Christ in God. When Christ who is your life appears, then you also will appear with him in glory. COLOSSIANS 3:1-4 (ESV)

1  C.S. Lewis,  Mere Christianity  (San Francisco: HarperSanFrancisco, Harper edition, 2001), pp. 134-135.

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Prayers of Hope and Healing: Resources for troubled times and special circumstances

• Joyce Borger

When words fail us, whether in times of joy or sorrow, it is often the words penned by another that help us give voice to our soul’s prayer. Maybe the written prayer expresses our thoughts so profoundly we use the same text, or maybe it helps free our own tongue to form a new prayer. But where do we find those prayers? There are many great prayer books, but another readily accessible source is the Internet. Many good sites provide prayers and other worship resources free for use in congregational worship. Most of the following prayers were gleaned from a few of those sites and may be used in congregational worship without further permission.

At a Child’s Funeral

Father, you know our hearts and share our sorrows. We are hurt by our parting from ____, whom we loved: when we are angry at the loss we have sustained, when we long for words of comfort, yet find them hard to hear, turn our grief to more patient faith, our affliction to firmer hope in Jesus Christ our Lord. Amen.

—from Common Worship: Pastoral Services, Church House Publishing,

© 2000, The Archbishops’ Council.

http://cofe.anglican.org/commonworship/index.html. Used by permission.

God of compassion, you make nothing in vain and love all you have created; we commend to you ____ and ____ ’s child ____ , for whom they poured out such great love, for whom they cherished so many hopes and dreams. We had longed to welcome [him/her] among us; grant us the assurance that [he/she] is now encircled in your arms of love and shares the resurrection life of your Son, Jesus Christ. Amen.

For Those Suffering from Dementia and Their Caretakers

Lord, in weakness or in strength we bear your image. We pray for those we love who now live in a land of shadows, where the light of memory is dimmed, where the familiar lies unknown, where the beloved become as strangers. Hold them in your everlasting arms, and grant to those who care strength to serve, patience to persevere, love to last, and peace that passes human understanding.<> Hold us in your everlasting arms, today and for all eternity; through Jesus Christ our Lord. Amen.

Note: See also Songs for the Season, “When Eyes That We Once Knew as Keen,” page 28.

For a World Confronted by AIDS

Loving God, as we hold before you a world confronted by AIDS, we pray in hope for your will to prevail: Where lives are short, may they yet be full. When a cure is far off, may there yet be healing. Where bodies are weak, may spirits yet be strong. When silence is destructive, may there yet be courage to speak out. Where judgments are hasty, may minds yet be open. When reality is overwhelming, may there yet be response. Where faith is tested, may we yet find you there. In the name of Jesus. Amen.

—Simeon Mitchell, Christian Aid. http://www.christian-aid.org.uk/worship/prayer/index.htm. Copyright Christian Aid (2003). Used by permission.

For a Troubled Marriage

God, whose love is like strong eagle’s wings bearing us up in times of hurt and anger: carry those whose marriages are falling and failing. Break the cycle of blame, retaliation, and all words that wound. Help each to come to the inner spring of hope. Let each experience your strength and protection so that both discover the courage to be vulnerable instead of vicious. In that vulnerable place make hearts open to your purpose and love in this troubled time. Guide them to do justice, to love mercy, and to walk humbly with you, even if it means keeping distance from each other until the dust settles and the storm gives way to the light, through Christ our Lord. Amen.

—from The Book of Common Prayer

For the Unemployed

Heavenly Father, we remember before you those who suffer want and anxiety from lack of work. Guide the people of this land so to use our public and private wealth that all may find suitable and fulfilling employment, and receive just payment for their labor; through Jesus Christ our Lord. Amen.

—from The Christian Resource Institute. www.cresourcei.org.

from The Book of Common Prayer.

When Crisis Threatens

Caring God, we acknowledge before you our fears; we acknowledge before you our anxieties; we acknowledge before you our doubts. Help us to recognize in the depths of our being that we are not alone, but that you are truly present in this painful hour. We pray that you might ease our burdens by the assurance of your companionship, by the knowledge of your abiding love, and by the hope we share in Jesus Christ, in whose name we pray. Amen.

—from Book of Worship: United Church of Christ, © 1986 Worship and Education Ministry Team, Local Church Ministries, United Church of Christ, Cleveland, Ohio. Used by permission. http://cofe.anglican.org/commonworship/index.html.

Following a Natural Disaster

God of Creation, you set our lives on a planet where both beauty and danger are found. Hear our prayers for those who have been overcome by disastrous [famine/flood/earthquake/fire] in [place]. Help heal the pain of those who are injured. Strengthen with your presence all who are numb with fear and distress. Guide those who anxiously search or wait. Amen.

—from Service Book for the Use of Ministers by the United Church of Canada,

United Church Publishing House, 1969. Used by permission. http://cofe.anglican.org/commonworship/index.html.

For the Criminal Justice System

God, we pray for all the people in the criminal justice system. for the whole law is summed up in a single commandment, “you shall love your neighbor as yourself.”.

Forgive our self-righteousness

when we judge others and ignore our own sins.

Do not speak evil against one another. . . . There is one lawgiver and judge who is able to save and to destroy. So who, then, are you to judge your neighbor?

[James 4:11-12]

We pray for all who are in prisons and jails. I was in prison and you visited me. [Matt. 25:36] We pray for all victims, for families, for all who are hurt by crimes. If one member suffers, all suffer together with it;

if one member is honored, all rejoice together with it

. [1 Cor. 12:26] We confess that we are a part of a system and a society that reflects sexism, racism, poverty, injustice.

Woe to you, scribes and Pharisees, hypocrites! For you . . . have neglected the weightier matters of the law: justice and mercy and faith.

[Matt. 23:23] Help us to look at our priorities as we build more prisons and jails instead of rebuilding lives and communities.

The Lord . . . executes justice for the oppressed. . . . The Lord sets the prisoners free.

[Ps. 146: 5, 7] O Lord, we pray for strength in our commitment and courage in our service.

And what does the Lord require of you but to do justice, and to love kindness, and to walk humbly with your God?

[Micah 6:8]

—Adapted from Task Force on Criminal Justice, Southern California Synodical Association

(United Presbyterian Church, 1979).

http://www.pcusa.org/criminaljustice/cjsunday02.pdf. Used by permission.

God of the past, present, and future, we thank you for the gift of life and the joy of being in community with one another.

We grieve the losses suffered by others daily because of violence and crime, especially the disproportionately large losses suffered by people of color. We pray for victims and offenders of crimes and for the communities that bear the scars of crimes. Show us how to usher in your new community of justice and peace, O God. Take away our fear and fill us instead with the confidence of your Spirit’s presence. We pray in Jesus’ name. Amen.

—from Sharon K. Youngs, Close Encounters of the Justice System Kind

(Louisville: Presbyterian Church USA, 1997), p. 31. Used by permission.

http://www.pcusa.org/criminaljustice/cjsunday02.pdf.

For Guidance

O God, by whom the meek are guided in judgment, and light rises up in darkness for the godly: Grant us, in all our doubts and uncertainties, the grace to ask what you would have us to do, that the Spirit of wisdom may save us from all false choices, and that in your light we may see light, and in your straight path may not stumble; through Jesus Christ our Lord. Amen.

—from Christian Resource Institute.

http://www.cresourcei.org/prayers.html#Family.

For the Unity of the Church Amid Conflicts

O God the Father of our Lord Jesus Christ, our only Savior, the Prince of Peace: Give us grace seriously to lay to heart the great dangers we are in by our unhappy divisions; take away all hatred and prejudice, and whatever else may hinder us from godly union and concord; that, as there is but one Body and one Spirit, one hope of our calling, one Lord, one Faith, one Baptism, one God and Father of us all, so we may be all of one heart and of one soul, united in one holy bond of truth and peace, of faith and charity, and may with one mind and one mouth glorify you; through Jesus Christ our Lord. Amen.

http://www.cresourcei.org/prayer.html#church.

At the Dedication of a Church

For the worship of God in prayer and praise, for the preaching of the Word, for the celebration of the holy sacraments,

We dedicate this building.

For the comfort of those who mourn, for the help of those who are perplexed, for the guidance of those who seek strength,

For the support and nurture of families, for the guidance of children, for the calling of youth to a life of service,

For guarding against evil,

for fostering faithfulness,

for promoting peace and justice in all the earth,

For the opening of minds to your truth,

for the care of the needy,

for the giving of hope and courage,

For the unity of all believers in Christ, for the carrying of the gospel into all the world, for the furtherance of the unity of all people,

For the consecration

of life and service,

in grateful remembrance of those who have gone before us,

and in gratitude for our life together in this church,

We dedicate this building to the glory of God, to the honor of Jesus Christ, and to the praise

of the Holy Spirit.

Thanks be to God!

—adapted from A Service for the Dedication of a Church Building Free of Debt

© 1964, 1965 Board of Publication of the Methodist Church, Inc. Renewed

© 1971, 1972 by Abingdon Press; © 1984 Abingdon Press;

© 1992 United Methodist Publishing House renewed

© 1992 United Methodist Publishing House. Adapted by permission.

http://www.gbod.org/worship/.

For a Church Anniversary

Lord God, heavenly Father,

for calling us to faith through your Word and bringing us together in the body of Christ;

for awakening us to the urgency of your mission;

for the privilege of taking your Word into all the world;

We give you humble thanks and praise.

This day, O Lord, we remember the past:

We remember the missionary vision of those who first came to ___________;

We remember their determination to show others how beautiful it is to live with Jesus;

We remember their willingness to say, “Here am I! Send me!”

Give us, we pray, that same vision and determination.

This day, O Lord, we reflect on the task:

we reflect on being equipped with the power of your Word;

we reflect on being chosen as your ambassadors;

we reflect on being entrusted with the message of reconciliation.

Cause our reflection to lead us to action.

This day, O Lord, we look forward to rejoicing that will last;

to the rejoicing that will be ours in heaven;

to the rejoicing others will experience through our missionary efforts;

to the rejoicing that takes place in heaven when one sinner repents.

May that future joy be ours now and always. Amen.

— http://www.wels.net/worship. Used by permission.

At the Close of a Church

Heavenly Father, we are gathered here to give thanks for the long years you have permitted us to use this building in your service. We thank you for watching with loving care over our children, our people, our teachers, and the pastors who have served you here throughout the years. Forgive us for the sins and errors we have committed along the way. Help us to remember those who have gone before us to the home above, and give us the grace and determination to follow in their faithful steps until we complete the journey you have set before us. And finally, O Lord, be our strong refuge all the day long, until the shadows lengthen, and the evening comes, and the busy world is hushed, and the fever of life is over, and our work is done. Then, in your mercy grant us a safe lodging, a holy rest, and peace at the last; through Jesus Christ, our Lord. Amen.

—from Christian Worship: Occasional Services,

© 2004, Northwestern Publishing House http://www.wels.net. Used by permission.

At a Farewell

Our church family is constantly changing. People come and go. Babies are born. Children grow up. People commit themselves to one another. Loved ones and friends among us come to the end of their lives. Individuals move into our community and church life. Others leave us, moving away to new places, new experiences, and new opportunities. It is important and right that we recognize these times of passage, of endings and beginnings. Today we share the time of farewell with [a friend/friends] who [is/are] leaving. O God, we give thanks for remembered times when we, together, have shared the life of faith.

We thank you for the moments we have shared with _____________ in worship, in learning, in service. We pray that _________ will be aware of your Spirit’s guidance as [he/she/they] move(s) to [a new and unknown place/new and unknown places], in the name of Jesus the Savior.

—adapted from An Order of Farewell for Church Members © 1992 United Methodist Publishing House. Adapted by permission. http://www.gbod.org/worship/ .

Internet Prayer Resources

Calvin Institute of Christian Worship http://calvin.edu/worship

Christian Aid Organization http://www.christian-aid.org.uk/worship/prayer/

Church of England http://cofe.anglican.org/commonworship/index.html

Evangelical Lutheran Church America http://www.elca.org/dcm/worship/about_worship/

Reformed Church in America http://www.rca.org/worship/liturgies/

The Christian Resource Institute http://www.cresourcei.org/prayers.html

United Methodist http://www.gbod.org/worship/

Wisconsin Evangelical Lutheran Synod

http://www.wels.net/worship

Rev. Joyce Borger is senior editor of Reformed Worship and a resource development specialist at the Calvin Institute of Christian Worship.

Speeches > John H. Groberg > There Is Always Hope

There Is Always Hope

John h. groberg.

of the Seventy

June 3, 1984

I want to visit with you this evening on a level that is both mutually understandable and mutually profitable. In order for that to happen I ask for your faith and prayers on behalf of all of us, that what is said and what is heard will be influenced and touched by the Spirit of God. I appreciate that. (It’s good to pray for one another; it helps everyone.)

The subject I wish to speak on is one that I hope you will appreciate. I know I do. It is simply this: there is always hope.

I have read and heard from different psychologists and teachers that we must hear something at least twenty times before we really hear it. My experience with my own children is that twenty times is far too few. But, in any event, to make sure we all hear, I will use the phrase “There is always hope” not just twenty, but at least thirty times this evening. I hope that you don’t get tired, but that you understand.

Do We Listen to the Words?

There is always hope. No matter how dismal things appear, no matter how problem-prone we seem to be, no matter what reversals and setbacks we suffer, there is always hope. Hope is the thing that keeps us going. We sing the hymn “ We Thank Thee, O God, for a Prophet ” all the time, but do we listen to the words? What do you feel when you sing “When dark clouds of trouble hang o’er us And threaten our peace to destroy, There is hope smiling brightly before us, And we know that deliverance is nigh” ( Hymns,  no. 196)? Do we really believe that?

Part of the thirteenth article of faith reads, “We believe all things, we hope all things, we have endured many things, and hope to be able to endure all things.” Do we really believe that? Are we literally supposed to hope all things?

What do we mean by hope? What is hope? Why should we have hope? What do we hope for? What are some of the signs of true hope? How do we get more hope? Let’s take these questions and discuss them.

Hope Is Light

What is hope? I suppose that it is like trying to define faith or love; it is very difficult, but we can use some examples. As near as I can tell, hope is light. It is a light within us that pierces the darkness of doubt and discouragement and taps into the light (hope) of all creation—even the Savior.

I think that in some instances we may be able to substitute the word  hope  for  light  and get some understanding in the scriptures, i.e., we talk about Christ as being the light of the world—he is the hope of the world (see Mosiah 16:9 ).

The Lord sent the everlasting gospel to be a light unto the Gentiles—to be a hope to the Gentiles (see Acts 13:47 ). The Spirit giveth light to every man—the Spirit giveth hope to every man (see D&C 84:46 ). Christ is the true light that is in all men—Christ is the true hope that is in all men (see D&C 88:50 ).

You will have to think of your own definition, but one other is:

And if your eye be single to my glory, your whole bodies shall be filled with light  [be filled with hope] , and there shall be no darkness in you  [no discouragement] ; and that body which is filled with light  [filled with hope]  comprehendeth all things  [isn’t that what the article of faith says, we hope all things?] .  [ D&C 88:67 ]

Hope, in a word, is the Savior. Hope is a part of the deity in us that attaches us to the Savior. Don’t let that thread be cut. No matter how tenuous or thin it might be, there is always hope.

A Need for Hope

Where does hope come from? Why should we have hope? Why do we keep on hoping even after we blow our diet or get a bad grade or lose a close game or get turned down in some way or another?

In all ages of time and in all dispensations, people have felt a need for hope. There is a saying—a proverb—in Tongan that goes, “ ’Ikai ke’i ai ha mamahi hange ha ’amanaki to noa.” That means, “There is no pain so great as a hope unfulfilled.”

I’m sure if I were familiar with other cultures—French or Russian or Chinese or another—there would be something similar, because it is in all people.

Hope Is Eternal

Why do we keep on hoping? They say, “Hope springs eternal,” and it’s good it does, for it gives us something to live for, to strive for, to hope for. But why? Why does hope spring eternal? Why do we keep coming back and back after so many defeats? Simply because God is eternal and God is hope (as well as love—and they may be the same) and we are his children. Therefore, as he is the embodiment of hope and has a fullness of hope, there is planted deep within each of us something we cannot deny, for it is part of the very essence of ourselves and that is what we all, in mortality, hope. A person without hope is like a person without a heart; there is nothing to keep him going. As the heart gives life to the body, so it seems that hope is an enlivening influence to the spirit—which is the real us. It is a fact that there is always hope, for our spirits are eternal. No matter what people try to say, it’s always there—that hope is within us. It just depends on how brightly we allow it to shine in our lives. The degree of “shining” (or the strength) of this hope that is in all of us is in direct proportion to our faith in God and particularly to our faith in (belief in, love of, hope in, etc.) Jesus Christ. Specifically then, the basis of all righteous hope is the person of our Lord and Savior Jesus Christ. In him all hope has its existence. Without him there is no hope. But because he was and is and ever will be, there is always hope—hope in all areas. He is hope.

We All Hope for Different Things

What do we hope for? I suppose in your situation you hope for good grades, you hope that a certain boy will ask you out or that special girl will say yes, or you hope your car won’t get ticketed (and I understand that’s a pretty vain hope on this campus), or you hope the teacher won’t give you too hard an assignment, or you hope you can just make it through another day. Maybe you hope to lose weight, or maybe you hope your children will turn out okay or you will get a good job offer, or you hope you will have good health or better health. We all hope for different things at different times, depending on our maturity level—all the way from an infant hoping for a bottle to a student hoping for good grades to an adult hoping for love and understanding. Ultimately, we all hope for the greatest of all gifts—immortality and eternal life. In fact, in order to have a true saving hope, that hope must transcend this mortal sphere.

So what do we hope for? Remember the article of faith? All things. Listen to the words of Moroni in the Book of Mormon:

And again, my beloved brethren, I would speak unto you concerning hope. How is it that ye can attain unto faith, save ye shall have hope?

And what is it that ye shall hope for? Behold I say unto you that ye shall have hope through the atonement of Christ and the power of his resurrection, to be raised unto life eternal, and this because of your faith in him according to the promise.

Wherefore, if a man have faith he must needs have hope; for without faith there cannot be any hope.

And again, behold I say unto you that he cannot have faith and hope, save he shall be meek, and lowly of heart.

If so, his faith and hope is vain, for none is acceptable before God save the meek and lowly in heart; and if a man be meek and lowly in heart, and confesses by the power of the Holy Ghost that Jesus is the Christ, he must needs have charity; for if he have not charity he is nothing; wherefore he must needs have charity.  [ Moroni 7:40–44 ]

I am not going to go into the difference between faith, hope, and charity. It might be that faith plus hope equals charity, and charity, as we know, is the pure love of Christ. I will just talk about hope this evening—that is a big enough subject. Let me just say that all three—faith, hope, and charity—are traveling companions. They travel together. They go together.

Signs of True Hope

What are some of the signs of true hope? Calmness, optimism, or all those things that are the opposite of downheartedness or being disturbed. You can almost measure the level of hope you have in the Savior by the depth and frequency of depression and discouragement you allow yourself to sink into.

Just as discouragement and depression feed on themselves (can’t you just hear Satan saying, “You can’t do it, you are no good, you’ll never make it”—sometimes he says that right to your heart, and sometimes he uses others as his agents), so does hope regenerate itself. Can’t you likewise hear the Savior saying, “You can do it, you can make it, you are worth something. I laid down my life for you. I love you. I redeemed you. I paid for you because I know you can make it. You can come home. Trust me. Follow me.” Again, sometimes he speaks directly to our hearts and sometimes uses others as his agents. But there is always hope in him.

Don’t Judge People

Another sign of true hope is that we don’t judge other people—including ourselves. I often hear people talk of hope in another sense. They say, “Well, I hope he gets what’s coming,” or, “I hope justice is done.” Don’t worry about that. He or she will. The ones we ought to worry about are ourselves.

We spend so much time and effort seeking remedies or justice (on spiritual things especially) “here and now” when, in fact, much, if not most, of justice will be done “there and then.” We ought to spend time and effort here and now to prepare for there and then. Most “justice” occurs after this life. We ought to be glad it does, for so much went on before and will go on after of which we are not aware—but God is aware.

If we are to have a fullness of hope (and that is our goal—hope in all things), our hope must transcend this mortal existence. It had better, or as Paul indicated, “If in this life only we have hope in Christ, we are of all men most miserable” ( 1 Corinthians 15:19 ). One who has true hope in Christ will not judge others.

From a remarkable talk give by President Stephen L. Richards in April of 1956, let me quote:

The Lord has said, “I, the Lord, will forgive whom I will forgive, but of you it is required to forgive all men” ( D&C 64:10 ). If we were more liberal in our forgiveness, we would be more encouraging to repentance. Someone has said that the supreme charity of the world is in obedience to the divine injunction, “Judge not.” When the Savior gave that injunction, he was well aware of the limitations of human understanding and sympathy. We can see overt acts but we cannot see inner feelings nor can we read intentions. An all-wise Providence in making judgment sees and knows all the phases of human conduct. We know but few of the phases, and none very well. To be considerate and kind in judgment is a Christlike attribute.  [Stephen L. Richards, April Conference, 8 April 1956]

Those with hope, then, do not judge. When I hear of people making judgments (and we all do more than we want to—we do too much—and it is a sign of our having less hope than we should), I think, “Who do we think we are anyway? The very best of us, the most kind or most loving and forgiving among us is only, as it were, in kindergarten—or lower.”

Let me read something on this point written by Elder Orson F. Whitney, one of the Twelve Apostles some years ago:

You parents of the wilful and the wayward: Don’t give them up. Don’t cast them off. They are not utterly lost. The Shepherd will find his sheep. They were his before they were yours—long before he entrusted them to your care; and you cannot begin to love them as he loves them. Our Heavenly Father is far more merciful, infinitely more charitable, than even the best of his servants, and the Everlasting Gospel is mightier in power to save than our narrow finite minds can comprehend.

See how important it is to follow the admonition given by King Benjamin in Mosiah 4:9:

Believe in God; believe that he is, and that he created all things, both in heaven and in earth; believe that he has all wisdom, and all power, both in heaven and in earth;  [most of us will go along with that, but the last part]  believe that man doth not comprehend all the things which the Lord can comprehend  [sometimes we, by our actions, think we are smarter than he is] .

Let’s not spend our time hoping or worrying about justice being done to others. It will be done. Let’s spend our time being just ourselves.

One of Satan’s ultimate weapons (if not the ultimate) is to remove hope from your life. He tries to convince you that you can’t do it, that there is no hope. Thus, by removing hope, he removes Christ from your life, for Christ is hope. Satan can never quite accomplish that fully—at least not here—because it is a lie. There is hope built within all of us. There is always hope.

On the other hand, the thing Satan cannot fight is one who is full of hope—for he is then full of the Spirit of Christ—and when that hope is perfected or full, Satan has lost completely.

Encourage Others

Another sign of having hope is the encouragement we give to others. Let me assure you that if by our words or our actions or by our very being we tell people (or even give the impression), “You can’t do it, you are no good, you’ll never measure up, you’ll never make it,” or (maybe worst of all) “I won’t forgive you” (and all of these things apply doubly to our reaction to ourselves and to our own faults), if that be the case, then we are moving away from God and not toward him, for he gives hope and says, “There is always hope.” Don’t ever say there isn’t.

If we, to others or to ourselves, fail to give full measure of hope (remember the scripture, full measure, pressed down and overflowing [ see   Luke 6:38 ]), we do less than Jesus would do and less than he would have us do.

Now, as in all things, to receive anything good we must give it away. Maybe the reason we don’t have more hope is because we don’t give enough hope to others. If we want more hope, let’s give more hope to others—be more encouraging.

The spirit of hope is the Spirit of the Savior. He is always encouraging.

Now you might say, “Okay, I believe that. Doctrinally it’s correct, but what does it mean to me? I want more hope. How do I get more? If it’s there, if it is within me (and it is), how do I allow it to shine forth and fill my life and move me forward in this light of hope?”

Let me read two verses form the Book of Mormon:

And the remission of sins bringeth meekness, and lowliness of heart; and because of meekness and lowliness of heart cometh the visitation of the Holy Ghost, which Comforter filleth with hope and perfect love, which love endureth by diligence unto prayer, until the end shall come, when all the saints shall dwell with God.  [ Moroni 8:26 ]

Wherefore, ye must press forward with a steadfastness in Christ, having a perfect brightness of hope, and a love of God and of all men. Wherefore, if ye shall press forward, feasting upon the word of Christ  [which are the scriptures, of course] , and endure to the end, behold, thus saith the Father: Ye shall have eternal life.  [Isn’t that what we are hoping for?] [ 2 Nephi 31:20 ]

Those two key verses lay out so clearly what we need to do. The key elements are repentance, remission of sins, meekness, lowliness of heart, love of God and of all men, feasting on the words of Christ, studying the scriptures, praying, enduring to the end—quite opposite from some of the success formulas in the world.

As near as I can tell, if you don’t have hope, you either don’t have the Holy Ghost or you aren’t listening to him, for it states clearly, “which Comforter filleth with hope and perfect love.”

Press Forward

The scriptures talk about a “perfect brightness of hope.” Think about that. Wouldn’t you like to have that—to never be down, never be discouraged? That would be great, wouldn’t it? I think all of us would agree. But will it ever happen here? Like a lot of things, it is difficult, but it can happen, else why the injunction from the Lord to Nephi to “press forward with a steadfastness in Christ, having a perfect brightness of hope, and a love of God and of all men” ( 2 Nephi 31:20 )?

But like anything else good, it is not easy, it does not come without effort. Satan will try to diminish your hope or keep it away from you altogether if he can. The Savior will help you increase in hope.

So you see, the battle lines are clearly drawn. Satan and his forces (the world) will do everything in their power to have you lose hope—to be constantly down on yourself, always discouraged, despondent, etc. We know people like that because we have been like that sometimes. Satan wants to discourage you, for he knows discouragement and hope cannot exist together. So if he gets you discouraged enough, out goes hope.

On the other hand, the Savior will do just the opposite. He will do all in his power to encourage you, lift you up, give you hope, help you in every way possible, so that with a “steadfastness in Christ” we may attain to that “perfect brightness of hope” and then discouragement and despair are gone. Can you see how clear that is?

Darkness, discouragement, pessimism, depression, anger, lack of hope—all come from Satan and his forces, whereas optimism, light, encouragement, hope, even to a perfect brightness of hope—all come from the Savior.

Now some may say, “Well, you are bordering on calling discouragement a sin, and we know that we all get discouraged sometimes. It’s just human nature.”

True enough, it’s human nature. All humans get discouraged sometime. All humans die sometime, too. But through the Savior we will overcome death and through him we must overcome discouragement as well, and we can.

I am not saying that discouragement or pessimism is necessarily a sin (for it may be a test, or a growing experience). But what I am saying is that Satan is here (on the left) with discouragement and darkness, and we want to get out of there as soon as we can. And the Savior is here (on the right) with hope and light (and maybe hope and light are synonymous) and encouragement. We have to move from the left to the right. When we find ourselves on the left, we must go to the right.

Rely on the Savior

Those of the world are betting that this life is it. You have heard the statement “Better red than dead.” That is all based on the assumption that there is nothing after this life. To them there is no hope for the future. To them it’s eat, drink, and be merry, and get what you can, when you can, how you can. That is not true. Hope is available. Hope is here. Hope (and this is really hope in Christ) is the essence of life.

To say “There is no hope for me” is to say there is no Savior, for he is hope and he does exist, so there is hope for you. He is forever, so there is always hope!

Basically, those without hope are those who rely only on themselves, who have not tapped into that power beyond themselves, even the Savior himself—and there are far too many in the world that way today. They rely totally on themselves. While it is good to be self-reliant, you have to rely on yourself and on the Savior.

As you know, the Savior came to the earth to do several things—fulfill the plan made in heaven before the earth was, do the will of the Father, work out the infinite atonement, break the bands of death and become the first fruits of the resurrection, fulfill all prophesy, and on and on and on. I’m not sure but that much, if not all, of this that he came to do could be summed up in the phrase, “He came to give us hope. He came to show us that indeed there is always hope,” for he is always and he is hope.

Is there anything more universal than a need for hope? We all do things wrong; we need hope to have them taken from us. We all have problems; we need hope that they will go away. If there were not hope, we would be lost forever.

Think of the hope that genealogy and temple work give us and millions of others. Think of the total depth and breadth the hope of the Savior gives us in the gospel plan. You just can’t comprehend it. Remember, we hope all things. Do we? The gospel is hope-giving.

I hear some people say, “The gospel is too restrictive,” but we must look at the other side. It is really not restrictive at all. It is hope-giving. It gives us a pattern to follow whereby we can gain hope. There is hope, and that is what the Church is about. That is what the Savior is about. He came to give us hope.

Sure we must change, and we can. When we say we can’t change—that this is just us—we are on the left and we need to get on the right where there is light and hope. “I can change; there is always hope” is the message of the true gospel of Jesus Christ. There is always hope for all of us. We can choose and improve and become as he is.

Remember the quotation from 1 John 3:2–3:

Beloved, now are we the sons of God, and it doth not yet appear what we shall be: but we know that, when he shall appear, we shall be like him; for we shall see him as he is.

And every man that hath this hope in him purifieth himself, even as he is pure.

Hope is a purifying, refining process.

The Atonement Is for Everyone

How do I know there is hope for all? Because it was a universal atonement. As the scriptures tell us, “For behold, I, God, have suffered these things for all, that they might not suffer if they would repent” ( D&C 19:16 ). That is, there was no holding back on the Savior’s part. He paid the full price for all—full measure, pressed down, overflowing.

President Spencer W. Kimball said at an area conference:

I want to be sure that I am well understood. The Lord said, “Wherefore all manner of sins shall be forgiven unto men, except the sinning against the Holy Ghost and the committing of murder.” (See Matthew 12:31 .) None of us will commit sin against the Holy Ghost (generally we do not know enough), and few of us will ever be involved in a murder. Therefore, the sins of mankind can be forgiven. But not by ignoring them; one must go to the proper ecclesiastical officials and clear his problems.  [Spencer W. Kimball, Amsterdam Area Conference, August 1976, p. 4]

Well then, if there is always hope, and I, or we, or any of us don’t have much hope, how do we go about getting more hope? That is what we really want to know. You pray for it, you ask for it, you listen to your leaders, you follow them, you repent, and according to the scriptures you become meek and lowly in heart, you serve others, you read the scriptures. It is interesting, this feasting upon the words of Christ and reading the scriptures. I want to testify to you that there is not a single situation you or I or anyone can become involved in for which the principle for resolving is not contained in the scriptures.

You gain hope (or uncover it) a little at a time. If the scriptures do have the answers, then read them. One of the best ways is to read about the life and acts of the Savior—the things he did. If he is hope, then certainly what he did should give hope to us or help us discover the hope within ourselves.

Situations from the Savior’s Life

Let me give a few examples from the Savior’s life (and what beautiful examples they are) that cover many, if not all, of the situations in which we need hope.

You are familiar with the incident of the people bringing the man who was sick with palsy to Christ. But they couldn’t get to the Savior, so they let him down through the roof. The Savior healed him because of the great faith—the great hope—that those around him had ( see   Luke 5:18–26 ).

There is a lesson to learn here. It wasn’t easy. They had to put forth some effort when they let him down through the ceiling. If we want a blessing from hope that is based on having strong faith and strong hope, then we had better be prepared to overcome some obstacles, because our hope isn’t sufficient to receive the blessing that we hope for.

Let me read a story from Matthew 9:18–26:

While he spake these things unto them, behold, there came a certain ruler, and worshipped him, saying, My daughter is even now dead: but come and lay thy hand upon her, and she shall live.

And Jesus arose, and followed him, and so did his disciples.

And, behold, a woman, which was diseased with an issue of blood twelve years, came behind him, and touched the hem of his garment:

For she said within herself, If I may but touch his garment, I shall be whole.

But Jesus turned him about, and when he saw her, he said, Daughter, be of good comfort; thy faith hath made thee whole. And the woman was made whole from that hour.

[And Jesus proceeded on.]  And when Jesus came into the ruler’s house, and saw the minstrels and the people making a noise,

He said unto them, Give place: for the maid is not dead, but sleepeth. And they laughed him to scorn.

But when the people were put forth, he went in, and took her by the hand, and the maid arose.

And the fame hereof went abroad into all that land.

In Christ there is always hope. Here is another story, from Mark 10:46–52:

And they came to Jericho  [that is, Jesus and his disciples] : and as he went out of Jericho with his disciples and a great number of people, blind Bartimaeus, the son of Timaeus, sat by the highway- side begging.

And when he heard that it was Jesus of Nazareth, he began to cry out, and say, Jesus, thou Son of David, have mercy on me.

And many charged him that he should hold his peace  [in other words, “Be quiet, you are making a fuss”] : but he cried the more a great deal, Thou Son of David, have mercy on me.  [You see what he is trying to get across, “Don’t get discouraged just because people tell you ‘Don’t go see the bishop; he is this, that, and the other’; or ‘Don’t go to conference; it’s boring,’ etc. Cry out louder, ‘Thou Son of David, have mercy on me.’”]:

And Jesus stood still, and commanded him to be called, And they call the blind man, saying unto him, Be of good comfort, rise; he calleth thee.

And he, casting away his garment, rose, and came to Jesus.

And Jesus answered and said unto him, What wilt thou that I should do unto thee? The blind man said unto him, Lord, that I might receive my sight.  [Oh, how often do we need to receive sight. “I have difficult problems, Lord; if I could just understand what I am to do, I might see more clearly.”]

And Jesus said unto him, Go thy way; thy faith hath made thee whole. And immediately he received his sight, and followed Jesus in the way.

Isn’t that the point? Don’t let people talk you out of these things. Hang in there, as it is. In Christ there is always hope.

Another illustration is from Luke 7:36–47:

And one of the Pharisees desired him that he would eat with him. And he went into the Pharisee’s house, and sat down to meat.

And, behold, a woman in the city, which was a sinner, when she knew that Jesus sat at meat in the Pharisee’s house, brought an alabaster box of ointment,

And stood at his feet behind him weeping, and began to wash his feet with tears, and did wipe them with the hairs of her head, and kissed his feet, and anointed them with the ointment.

Now when the Pharisee which had bidden him saw it, he spake within himself, saying, This man, if he were a prophet, would have known who and what manner of woman this is that toucheth him: for she is a sinner.

And Jesus answering said unto him, Simon, I have somewhat to say unto thee. And he saith, Master, say on.

There was a certain creditor which had two debtors: the one owed five hundred pence, and the other fifty.

And when they had nothing to pay, he frankly forgave them both. Tell me therefore, which of them will love him most?

Simon answered and said, I suppose that he, to whom he forgave most. And he said unto him, Thou hast rightly judged.

And he turned to the woman, and said unto Simon, Seest thou this woman? I entered into thine house, thou gavest me no water for my feet: but she hath washed my feet with tears, and wiped them with the hairs of her head.

Thou gavest me no kiss: but this woman since the time I came in hath not ceased to kiss my feet.

My head with oil thou didst not anoint: but his woman hath anointed my feet with ointment.

Wherefore I say unto thee, Her sins, which are many  [that is important to note] , are forgiven; for she loved much: but to whom little is forgiven, the same loveth little.

She hoped. Her hope was rewarded. In Christ there is always hope. I am sure she did more than hope. She changed, and we must also.

One final example from the New Testament, from Luke 22:54–62. You all remember Peter, the great stalwart apostle, and the problems he had to begin with.

Then took they him, and led him, and brought him into the high priest’s house  [this was when they took the Savior to Caiaphas].  And Peter followed afar off.

And when they had kindled a fire in the midst of the hall, and were set down together, Peter sat down among them.

But a certain maid beheld him as he sat by the fire, and earnestly looked upon him, and said, This man was also with him.

And he denied him, saying, Woman, I know him not.

And after a little while another saw him, and said, Thou art also of them. And Peter said, Man, I am not.

And about the space of one hour after another confidently affirmed, saying, Of a truth this fellow also was with him: for he is a Galilaean.

And Peter said, Man, I know not what thou sayest. And immediately, while he yet spake, the cock crew.

And the Lord turned, and looked upon Peter. And Peter remembered the word of the Lord, how he had said unto him, Before the cock crow, thou shalt deny me thrice.

And Peter went out, and wept bitterly.

Think about it. How could you feel worse—denying the Savior? How could you be more down on yourself, and how could you be more discouraged? Why then did Peter come back and become the strength that he was? Some people think that there was a look of anguish or distrust on the Savior’s face as he looked at Peter at that critical moment; but I testify to you that while there can be sternness in the Savior, the Savior I know is a kind, smiling, helpful Savior—one who constantly encourages—and he did thus with Peter. His look to Peter said, “Come to me. Come home to hope. You know better. You can do better, you will do better. There is always hope. There is always hope in me.”

We Must Not Let Discouragement Overwhelm Us

That feeling of hope that emanated from the Savior was constantly with Peter. The recurring vision and feeling of his loving eyes and beckoning face came back and back again to Peter—and they will to us—and Peter came back and was strong—what a strength he was. And we must come back and be strong. He didn’t allow discouragement to overwhelm him. He grasped that hope in the Savior and held onto it till it became a “perfect brightness of hope.” And so must we!

We could go on and on and give example after example, and some may say, “Sure, but that is the Savior and that is 2000 years ago. I am me and my problems are mine. I live now in 1984 and he isn’t around. I can’t touch the hem of his robe, etc., and no one understands my problems, and my problems are different.”

To all of those comments I just say, “He isn’t around—oh, isn’t he? No one understands—oh, doesn’t he? My problems are different—oh, are they?”

Our Day Is No Different

Oh, my young friends, if you think that way—that they are different—I want to assure you nothing could be further from the truth. Time is measured only to man, not to God. Life is all one great “now” to him. Nineteen eighty-four is no different than 31 A.D. You have essentially the same problems and feelings as those living in Palestine two millenia ago. You might worry about an atomic holocaust rather than the Roman legions, but it is the same thing. His Spirit is just as present, he understands just as much, he is just as loving and kind and anxious to help as he ever has been, and miracles (if you want to call them that—they are really just his power manifested among men) today are just as real and just as evident as they have ever been, for faith is among the children of men. Hope is among the children of men. Some of you may question that. Don’t. It’s true.

Let me give you just one example in our day. I am going to use this as a sort of composite so that no one will identify it with one particular person. All the incidents that I’ll mention are true, but there were three different people involved.

The Power of Hope

Shortly after I was called to be a General Authority, I was asked to interview a young girl who wanted to go on a mission. She had had some problems. I had been a mission president, but I wasn’t all that experienced. When she came in and we went over all the problems that she had, I thought, “What is she doing here? No way can a girl like that go on a mission with all those problems.” But there was something radiant about her honesty. She wasn’t holding anything back. She was completely honest, and I suppose, as I look back now, that I could sense that she had a real hope. She really wanted to go on a mission.

I wanted to just say no, because, as I say, I had been a mission president and I wouldn’t have wanted someone with that kind of record in my mission. But there was something that said, “Wait a while.” So I didn’t say no. I said, “Why don’t you come back next week? Let’s pray about it and think about it.” I was planning to tell her no.

I got a call shortly after that, and the place I was supposed to go for a stake conference assignment was, for some unknown reason, changed. I was to go someplace else.

I went to this other place. The stake president picked me up. The plane got there a little before we needed to be in meetings. He said, “We’re having a family reunion, and that is where we are going to have lunch.”

I said, “Fine.”

We went out to the family reunion. Now, this is hundreds of miles away from where I was before. As we were eating, some of the older members of the family were getting up and giving reports about their families.

The president said, “Well, it is time to go. We had better leave.”

Just as he said that, a lady stood up. I said, “Well, I hate to walk out when someone is talking. Let’s just wait until she is through.”

He said, “Okay, but that is Aunt Cloe and she might talk for a long time.”

I said, “Well, let’s see.”

She started, and she gave a report of her family and then she said, “And as all of you know, we have had a lot of heartache and trouble with my granddaughter, so-and-so.” The name rang a bell. It was the same as that of the girl I had interviewed. She said, “But we are so hopeful. We have heard that she is actually thinking of going on a mission, and, oh, we hope she will be able to go.”

As the tears came down this grandmother’s face and I realized as I was sitting there that I was the one who had to make that decision, I thought, “Wow, the power of hope—the hope of a young girl, the hope of a grandmother, and I am sure the hope of her mother as well—some way got those schedules switched around and got me sent up here to sit down and listen to that grandmother.”

When we left I talked to the stake president. I said, “Now, who is that, and who is her granddaughter?”

He explained, and it was exactly the same person.

Of course, you know what happened. She came back the next week and I said, “Well, we will give it a try. You have a lot of hope. You have a lot going for you.” What she had going for her was that she wanted to go.

So, she went. I kept in close touch with her stake president. She served a wonderful mission—a tremendous mission. I would call regularly, or he would call me and say, “I got a letter and things are going fine.” Then I realized that the time was just about up. She was to be coming home.

About a month before she was to come home, I got a call from the stake president.

“Elder Groberg?”

“I have some bad news.”

“Oh, no, what?”

“Our friend is home—excommunicated.” One month before her mission was up.

Well, she was a determined and repentant girl and came in and wanted to apologize to me. “I blew it. I am sorry.”

As I recall, it was a busy time and there could have been a feeling, “Well, I guess we shouldn’t have tried,” but that wasn’t the feeling. The feeling I had when I talked to her was, “Don’t forget, there is always hope. Keep trying.”

There were so many problems, you can’t imagine—a change of mission president, a change of stake president, papers getting lost. Years went by, but I kept in touch. Little by little, things came together. She married a fine young man. And not very long ago I had the opportunity of sealing her and her husband and two little children. It took years, and there was a lot of pain, but as I looked down upon that beautiful tearstained face so full of joy and love and especially of hope, I softly breathed those beautiful words that had meant so much to us for so long. “You see, there is always hope.”

Miracles in All Ages

My dear young friends, could there be a greater miracle in any age? Are not all the essential ingredients basically the same? You think you are so different. You think your problems evade solution. You think the Savior and his works and love belong to a different time and place? No, they are here now. They have been and ever will be available to all men and women everywhere, regardless of the complexity, the severity, the terribleness, the duration, or the supposed deepness of the problem. There is always hope. In Christ who lives and loves and works miracles now, there is always hope. Listen again and again and again. There is always hope—now, today—there is always hope. There is always hope. He lives. He loves. He saves. In him there is always hope.

What would life be like without hope? Terrible. We can’t conceive of it. Remove the Savior from your life and you remove hope. But we can’t, and we won’t. He is there and he will always whisper to us and assure us, “There is always hope.” We just simply have to have hope.

Listen again to Moroni in the Book of Mormon:

Wherefore, there must be faith; and if there must be faith there must also be hope; and if there must be hope there must also be charity.

And except ye have charity ye can in nowise be saved in the kingdom of God; neither can ye be saved in the kingdom of God if ye have not faith; neither can ye if ye have no hope.

And if ye have no hope ye must needs be in despair; and despair cometh because of iniquity.  [ Moroni 10:20–22 ]

No matter what price we have to pay, or how long we must suffer, there is always hope. No matter how deep the wound, how dark the night, keep up hope. It is worth it. There is always hope!

No matter the fasting, the struggling, the praying, the weeping, the searching, the confessing. No matter the so-called embarrassment or loss of face or pride or whatever other terms or feelings Satan uses in his attempt to dissuade us from obtaining that saving hope and from securing that glorious hope in the Savior. It is worth it.

From Ether 12:4, 32:

Wherefore, whoso believeth in God might with surety hope for a better world, yea, even a place at the right hand of God, which hope cometh of faith, maketh an anchor to the souls of men, which would make them sure and steadfast, always abounding in good works, being led to glorify God.

And I also remember that thou hast said that thou hast prepared a house for man, yea, even among the mansions of thy Father, in which man might have a more excellent hope; wherefore man must hope, or he cannot receive an inheritance in the place which thou hast prepared.

Oh, to search, to seek, to struggle, and then to see the smiling face of the Savior as over and over again he says, “Come, come to me. I will heal you. In me there is always hope.”

Oh, my beloved young friends, remember there is always hope, for you and for others! How do I know that? Because the Savior came and paid the price for all.

For behold, I, God, have suffered these things for all, that they might not suffer if they would repent.  [ D&C 19:16 ]

That’s pretty inclusive. The Savior was, in our vernacular today, a great optimist, wasn’t he? Actually, he was full of hope, or had a fullness of hope. As far as I know, there is not a thing you will do (except what President Kimball said), that is not covered by the love and the atoning sacrifice of the Savior—nothing. That ought to give you hope, hadn’t it?

Listen to President Stephen L. Richards, another great leader:

Let no brother or sister in the whole family of God  [now that is not only members of the Church but the whole family of God]  feel that he or she has gone beyond the point where error and sin may be left behind and true repentance enlighten the soul with hope and faith.  [Stephen L. Richards, April Conference, 8 April 1956]

You see, there is always hope.

Well, that is at least twenty-nine times. I hope by now we are all beginning to really hear, and I mean hear and feel deep in our eternal souls, the truth of that marvelous phrase “There is always hope.” I know there is because of the Savior, our Lord and friend, even Jesus Christ.

To all those who ask the plaintive question “Is there any hope for me?” the answer is a resounding “Yes! Yes! Yes! There is always hope.” Reverberating through all eternity, all creation exults: “In Christ there is always hope.” I know whereof I speak.

Oh, seek after him in all ways and at all times until you can sense his smiling countenance saying to you, “Come unto me and I will give you rest. I am the hope of the world. In me there is always hope.”

Let me conclude with my testimony. I know that God lives and loves us. I know that Jesus Christ is his Son. I have hope in Christ—a sure hope. You can have one, too. I know he lives, I know he smiles. I know he always gives hope. I know that the miracles referred to this day not only occurred 2000 years ago, but similar manifestations of faith and hope have and will continue to bring down the blessings of heaven on the heads of those faithful, as needed. There is reason and justification for the hope that is within me and should be within all of us.

I testify of him. I have heard his voice on many occasions in my heart. I have felt his precious presence at various times and in divers places. I have seen his influence over and over again and I have witnessed his power and majesty as he continues to work his miracles among the children of men in our day—largely through the hope that emanates from him and to him and through him and around him and by him through all eternity.

I know by the sure witness of the Spirit that he lives and loves and forgives and heals and saves and restores and that in him there is always hope.

May our hope in him ever be vibrant and active and sure—“unto a perfect brightness of hope”—I do humbly pray in the name of him in whom there is always hope, even Jesus Christ. Amen.

© Intellectual Reserve, Inc. All rights reserved.

John H. Groberg was a member of the First Quorum of the Seventy of The Church of Jesus Christ of Latter-day Saints when this fireside address was given at Brigham Young University on 3 June 1984.

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The Healing Power of Hope

Being hopeful can improve mental health treatment outcomes..

Posted May 16, 2023 | Reviewed by Hara Estroff Marano

• What Is Trauma?
• Find counselling to heal from trauma
• Hope is a powerful tool for addressing some of our most prevalent mental health concerns.
• People who have hope for recovery see improved treatment outcomes of many mental health issues.
• Addiction, trauma, depression, and anxiety all show improved treatment outcomes among those who feel hopeful.
• Developing hope, even with mental health issues, is possible and fosters recovery.

At one time or another, most of us have lost hope. Situations don't always turn out as we would like. Yet hope can be one of the most powerful perspectives for healing.

In particular, hope can help individuals with mental health issues find meaning, purpose, and motivation in their lives. It can help them persevere through difficult times and overcome the challenges they face.

What is Hope?

Hope is defined as an expectation or desire that something will happen. It is also defined as an experience of trust. We might hope that our favorite sports team will win the championship or that the commute to work will be traffic-free. When we apply hope to our mental health issues, we often see improved treatment outcomes and reduction of symptoms.

Hope in Addiction Treatment

Addiction is a complex health issue that affects millions of people worldwide, often having a devastating impact on individuals and their families. However, hope can be a powerful force in overcoming addiction. Hope is associated with positive outcomes in addiction treatment, including reduced substance use and improved mental health.

Hope can help individuals with addiction stay motivated to overcome their challenges and remain committed to their recovery. In short, people who believe, at least part of the time, that they can overcome their addiction often do experience recovery.

Hope in Trauma Recovery

Traumatic experience often has a significant negative impact on individuals' lives. Trauma can result from a wide range of experiences, including physical or sexual abuse , natural disasters, or military combat. Trauma can lead to symptoms such as flashback memories, nightmares, and hypervigilance. These symptoms at times can be resistant to treatment. However, hope can provide individuals with the strength and motivation to heal from trauma. Hope in trauma recovery is associated with improved outcomes, including reduced symptoms of post-traumatic stress disorder ( PTSD ). As with those experiencing addiction, trauma survivors can use hope to motivate them through the difficult work of healing.

Finding Hope While Experiencing Depression

Depression affects millions of people in the U.S. and around the world. People experiencing depression often have extended periods of feeling sadness, hopelessness, and/or worthlessness. However, hope helps people heal from depression, too. Believing, even if only now and again, that recovery is possible is associated with reduced depression symptoms and improved quality of life. Hope allows a person to experience the impermanence of depression symptoms, sometimes just for a moment, and know that depression, too, can resolve.

Hope for Recovery from Anxiety

Anxiety is the most common mental health issue in the U.S. Anxiety symptoms include excessive worry, fear , and panic attacks, symptoms that can feel difficult to manage and frightening to experience. However, research indicates that hope plays a pivotal role in shaping individuals' perceptions of their ability to cope with anxiety, instilling a sense of resilience and determination.

Hope can foster a positive mindset, empowering individuals to confront their fears and embrace effective therapeutic interventions. Hopeful individuals show a strong correlation between hope and treatment adherence, indicating that hopeful individuals are more likely to actively engage in therapy and follow through with recommended recovery strategies.

Becoming Hopeful

How does one foster hope? Developing hope while dealing with significant mental health issues is a multifaceted process, but it is possible with the right support and strategies.

One crucial aspect is fostering a sense of connection and social support, whether through therapy, support groups, or trusted relationships. Setting realistic goals and focusing on small, achievable steps can provide a sense of progress and accomplishment.

Engaging in activities that bring joy, practicing self-care, and maintaining a healthy lifestyle as much as possible can contribute to overall well-being. Cognitive-behavioral techniques, such as challenging negative thoughts and replacing them with positive ones, can help people reframe their perspective. Seeking professional help from mental health providers who specialize in evidence-based interventions can provide valuable guidance and assist in developing personalized strategies for cultivating hope.

Hope is a powerful tool for resolving mental health issues such as addiction, trauma, depression, and anxiety. Hope can provide individuals with the strength and motivation to overcome their challenges and persevere through difficult times. Hope is associated with improved outcomes in mental health treatment, including reduced symptoms and improved quality of life.

If you are struggling with a mental health issue, it is important to remember that there is hope and that many issues will resolve with support. There are resources available to help you overcome your challenges and find a way forward. Remember, if you believe something is possible, you have taken the first step toward potentially achieving it.

Alipoor, A., Noorbala, A. A., Abedi, M. R., & Ghaeli, P. (2016). Hope and mental health in patients with major depressive disorder admitted to a psychiatric hospital in Tehran. Iranian Journal of Psychiatry and Behavioral Sciences, 10(3), e4143.

Brewer, J. A., Grant, J. E., & Potenza, M. N. (2016). The treatment of addiction: Understanding the mechanisms of change. Harvard Review of Psychiatry, 24(5), 266-272.

Chen, J. I., Chang, C. M., Liu, C. Y., & Chan, E. C. (2020). A randomized controlled trial of the effectiveness of group cognitive-behavioral therapy for patients with generalized anxiety disorder in a community mental health setting. Journal of Anxiety Disorders, 71, 102205.

Dworkin, E. R., Menon, S. V., Bystrynski, J., Allen, N. E., Chad-Friedman, E. F., & Lumley, M. A. (2017). The impact of hope on trauma-related outcomes in women with posttraumatic stress disorder: A pilot study. Journal of Interpersonal Violence, 32(1), 119-142.

Hirsch, J. K., Matheny, N. L., & Luebbe, A. M. (2016). Hope and coping as predictors of anxiety and depression in older adults. Archives of Gerontology and Geriatrics, 66, 38-43.

Kelly, J. F., White, W. L., & Roth, J. D. (2011). New addiction-recovery support institutions: Mobilizing support beyond professional addiction treatment and recovery mutual aid. Journal of Groups in Addiction & Recovery, 6(2-4), 206-223.

National Institute of Mental Health (NIMH). (2021). Mental Health Information: Helping Children and Adolescents Cope with Mental Health Disorders. Retrieved from https://www.nimh.nih.gov/health/publications/helping-children-and-adole…

Mental Health Foundation. (n.d.). How to Increase Hope for Better Mental Health. Retrieved from https://www.mentalhealth.org.uk/a-to-z/h/hope

Salimi, S. H., Eftekhar, H., & Nedjat, S. (2016). Hope and mental health: The role of psychological resilience. Iranian Journal of Psychiatry and Behavioral Sciences, 10(4), e3926.

Schuettler, D., Boals, A., & Siewert, C. (2015). The role of hope in the relationship between PTSD symptoms and academic functioning among college students. Journal of Traumatic Stress, 28(2), 135-138.

Constance Scharff, Ph.D., is a bestselling author and speaker who works with those overcoming addiction and trauma.

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At any moment, someone’s aggravating behavior or our own bad luck can set us off on an emotional spiral that threatens to derail our entire day. Here’s how we can face our triggers with less reactivity so that we can get on with our lives.

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Opinion Nicholas Kristof

The Case for Hope

Credit... Cecilia Carlstedt

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By Nicholas Kristof

Opinion Columnist

• May 9, 2024

Mr. Kristof is the author of a new memoir, “Chasing Hope: A Reporter’s Life,” from which this essay is adapted.

More than three-quarters of Americans say the United States is headed in the wrong direction. This year, for the first time, America dropped out of the top 20 happiest countries in the World Happiness Report. Some couples are choosing not to have children because of climate threats. And this despair permeates not just the United States, but much of the world.

This moment is particularly dispiriting because of the toxic mood. Debates about the horrifying toll of the war in Gaza have made the atmosphere even more poisonous, as the turmoil on college campuses underscores. We are a bitterly divided nation, quick to point fingers and denounce one another, and the recriminations feed the gloom. Instead of a City on a Hill, we feel like a nation in despair — maybe even a planet in despair.

Yet that’s not how I feel at all.

What I’ve learned from four decades of covering misery is hope — both the reasons for hope and the need for hope. I emerge from years on the front lines awed by material and moral progress, for we have the good fortune to be part of what is probably the greatest improvement in life expectancy, nutrition and health that has ever unfolded in one lifetime.

Many genuine threats remain. We could end up in a nuclear war with Russia or China; we might destroy our planet with carbon emissions; the gap between the wealthy and the poor has widened greatly in the United States in recent decades (although global inequality has diminished ); we may be sliding toward authoritarianism at home; and 1,000 other things could go wrong.

Yet whenever I hear that America has never been such a mess or so divided, I think not just of the Civil War but of my own childhood: the assassinations of the 1960s; the riots; the murders of civil rights workers; the curses directed at returning Vietnam veterans; the families torn apart at generational seams; the shooting of students at Kent State; the leftists in America and abroad who quoted Mao and turned to violence because they thought society could never evolve.

If we got through that, we can get through this.

My message of hope rubs some Americans the wrong way. They see war, can’t afford to buy a house, struggle to pay back student debt and what’s the point anyway, when we’re boiling the planet? Fair enough: My job is writing columns about all these worries.

Yet all this malaise is distorting our politics and our personal behaviors, adding to the tensions and divisions in society. Today’s distress can nurture cynicism rather than idealism, can be paralyzing, can shape politics by fostering a Trumpian nostalgia for some grand mythical time in the past.

The danger is that together all of us in society collectively reinforce a melancholy that leaves us worse off. Despair doesn’t solve problems; it creates them. It is numbing and counterproductive, making it more difficult to rouse ourselves to tackle the challenges around us.

The truth is that if you had to pick a time to be alive in the past few hundred thousand years of human history, it would probably be now.

When I step back, what I see over the arc of my career is a backdrop of progress in America and abroad that is rarely acknowledged — and that should give us perspective and inspire us to take on the many challenges that still confront us.

I think of a woman named Delfina, whom I interviewed in 2015 in a village in Angola. She had never seen a doctor or dentist and had lost 10 of her 15 children. Delfina had rotten teeth and lived in constant, excruciating dental pain. She had never heard of family planning, and there was no school in the area, so she and all the other villagers were illiterate.

A young journalist following in my footsteps today may never encounter a person like Delfina — and that’s because of the revolution in health care, education and well-being that we are in the middle of, yet often seem oblivious to.

I have implored President Biden to do more for the children and babies dying in Gaza. I’ve been unwavering about the need to support the people suffering bombardment in Ukraine . And I regularly report on the conflicts and humanitarian disasters in Sudan, Myanmar, Yemen and elsewhere that garner less attention.

Some people see my career covering massacres and oppression and assume that I must be dour and infused with misery, a journalistic Eeyore. Not so! Journalism is an act of hope. Why else would reporters rush toward gunfire, visit Covid wards or wade into riots to interview arsonists? We do all this because we believe that better outcomes are possible if we just get people to understand more clearly what’s going on. So let me try with you.

Just 100 years ago, doctors could do nothing when President Calvin Coolidge’s 16-year-old son developed a blister on a toe while playing tennis on the White House court. It became infected, and without antibiotics the boy was dead within a week. Today the most impoverished child in the United States on Medicaid has access to better health care than the president’s son did a century ago.

Consider that a 2016 poll found that more than 90 percent of Americans think that global poverty stayed the same or got worse over the previous 20 years. This is flat wrong: Arguably the most important trend in the world in our lifetime has been the enormous reduction in global poverty.

About one million fewer children will die this year than in 2016, and 2024 will probably set yet another record for the smallest share of children dying before the age of 5. When I was a child, a majority of adults were illiterate, and it had been that way forever; now we’re close to 90 percent adult literacy. Extreme poverty has plunged to just 8 percent of the world’s population.

Those are statistics, but much of my career has been spent documenting the revolution in human conditions they represent. In the 1990s I saw human traffickers openly sell young girls in Cambodia for their virginity; it felt like 19th-century slavery, except most of these girls were going to be dead of AIDS by their 20s. Trafficking remains a huge problem, but the progress is manifest. In Kolkata, India, where I’ve covered this issue for decades, one study found an 80 percent reduction in the number of children in brothels since 2016.

Two decades ago, AIDS was ravaging poor countries, and it wasn’t clear we would ever control it. Then America under President George W. Bush started a program, Pepfar , that allowed the world to turn the corner on AIDS globally, saving 25 million lives so far. One reason you don’t hear much about AIDS today is that it’s among the great successes in the history of health care.

It’s not just that the world has in our lifetimes seen the greatest improvement in human wellness that we know of since the birth of our species. Despite some setbacks for democracy — and real risks here in the United States — I’ve learned to doubt despotism in the long run.

One of my searing experiences as a young journalist was covering that terrible night in June 1989 when Chinese Army troops turned their automatic weapons on unarmed protesters in Tiananmen Square, including the crowd that I was in. You never forget seeing soldiers use weapons of war to massacre unarmed citizens; I still have my notebook from that night, stained with the sweat of fear.

“Maybe we’ll fail today,” my scribbles record, as I quoted an art student nearly incoherent with grief. “Maybe we’ll fail tomorrow. But someday we’ll succeed.”

Yet I also remember a day five weeks earlier in the democracy movement, April 27, 1989, when Beijing students prepared for a protest march from the university district to Tiananmen.

Students knew that if they marched, they were risking expulsion, imprisonment or worse. The evening before, some students spent the night writing their wills in case they were killed.

I drove out to the university district that morning and saw roads lined with tens of thousands of People’s Armed Police. I slipped onto the Beijing University campus by pretending to be a foreign student and watched as a frightened band of 100 students emerged from a dormitory, parading with pro-democracy banners. Gradually other students joined in, and perhaps 1,000 marched, clearly terrified, toward the gate. Rows of armed police blocked their way, but the students jostled and pushed and finally forced their way onto the road. To everyone’s surprise, the police didn’t club the students or shoot them that day. Once the vanguard broke through, thousands more students materialized to join the march.

Word spread rapidly. As the marchers passed other universities, tens of thousands more joined the protest march, and so did ordinary citizens. Old people shouted encouragement from balconies and shopkeepers rushed out to give drinks and snacks to protesters. The police tried many times to block the students, but each time huge throngs of young people forced their way through.

By the time they reached Tiananmen Square, the protesters numbered perhaps half a million. Then they marched triumphantly back to their universities, hailed by the people of Beijing screaming support. That evening at the gate of Beijing University, the students were met not by phalanxes of armed police but by white-haired professors waiting for them, crying happy tears, cheering for them.

“You are heroes,” one professor shouted. “You are sacrificing for all of us. You are braver than we are.”

It was a privilege to witness the heroism of that day. There is much to learn from the commitment to democracy shown that spring by Chinese students.

The exhilaration of that march to Tiananmen Square didn’t last. But in my reporting career, I’ve learned first to be careful of betting on democracy in the short run, and second, to never bet against it in the long run.

Some day, I hope to see the arrival of democracy in China, as well as in Russia, Venezuela and Egypt.

Commentators are always predicting the end of American primacy. First it was the book “Japan as No. 1” in 1979 by Ezra F. Vogel, then Patrick Buchanan’s 2002 right-wing “The Death of the West” and Naomi Wolf’s 2007 leftist “The End of America.” It seemed for a time that Europe might surpass us, while in the longer run China appeared poised to overtake America and become the world’s largest economy.

Yet the United States maintains its vitality. World Bank figures suggest that the United States has actually increased its share of global G.D.P., measured by official exchange rates, by a hair since 1995. Europe today is leaderless and has anemic growth. Japan, China and South Korea are losing population and lagging economically. “Uncle Sam is putting the rest of the world to shame,” The Economist noted recently.

China’s struggles today are particularly important, for it was China that was the foremost challenger to American pre-eminence. Many people around the world thought that China had a more vibrant political and economic model. Yet today China is struggling and even with its population advantage it is no longer clear that China’s economy will ever eclipse America’s. The United States is the undisputed titan in the world today.

As I see it, the possibility of a Donald Trump election hangs as a shadow over America. Yet even if Trump were elected, there is a dynamism and inner strength in America — in technology, culture, medicine, business, education — that I think can survive four years of national misrule, chaos and subversion of democracy. Indeed, Trump might wreck Europe and Asia — by abandoning NATO and Taiwan — even more than he would damage America, in a way that would perversely cement U.S. primacy.

Note that one of the dominant issues in this year’s general election will be immigration. That’s partly because of the determination of people around the world to come to America, just as my dad risked his life to escape Eastern Europe and make his way here in 1952. Desperate foreigners sometimes see our nation’s resilience more clearly than we do.

I have seen that faith in America in surprising places, even when I periodically slipped into Darfur to cover the genocide there in the 2000s. I couldn’t obtain a government pass to get through checkpoints, but I realized that U.N. workers were showing English-language credentials that the soldiers surely couldn’t read. So I put my United Airlines Mileage Plus card on a lanyard, drove up to a checkpoint and showed it — and the soldiers waved me through.

Recklessness caught up with me, and eventually I was stopped at a checkpoint and kept in a detention hut decorated with a grisly mural of a prisoner being impaled by a stake through the stomach. It was a frightening wait as the soldiers summoned their commander. He eventually arrived and ordered me released — and then one of my captors who previously had seemed ready to execute me sidled up.

“Hi,” he said. “Can you get me a visa to America?”

I share the view that a Trump election would pose immense damage to American political and legal systems. But in the scientific world we would continue to move forward with new vaccines for breast cancer, new drugs to combat obesity and new CRISPR gene-editing techniques to treat sickle cell and other diseases.

How can we weigh democratic decline against lives saved through medical progress? Of course we can’t. As my intellectual hero, Isaiah Berlin , might say, they are incommensurate yardsticks — but that does not mean that they are irrelevant to our well-being.

And no one can accuse me of ignoring the problems that beset us at home and abroad, for they have been my career. They’ve left me a bit too scarred to be a classic optimist. Hans Rosling, a Swedish development expert, used to say that he wasn’t an optimist but a possibilist. In other words, he saw better outcomes as possible if we worked to achieve them. That makes sense to me, and it means replacing despair with guarded hope.

This isn’t hope as a naïve faith that things will somehow end up OK. No, it is a somewhat battered hope that improvements are possible if we push hard enough.

In 2004 I introduced Times readers to the story of an illiterate woman named Mukhtar Mai, whom I met in the remote village of Meerwala in Pakistan. She had been gang-raped on order of a village council, as punishment for a supposed offense by her brother, and she was then expected to disappear in shame or kill herself. Instead, she prosecuted her attackers, sent them to prison and then used her compensation money to start a school in her village.

Instead of giving in to despair, Mukhtar nursed a hope that education would chip away at the misogyny and abuse of women that had victimized her and so many others. Then she enrolled the children of her rapists in her school.

Mukhtar taught me that we humans are endowed with strength — and hope — that, if we recognize it and flex it, can achieve the impossible.

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Nicholas Kristof became a columnist for The Times Opinion desk in 2001 and has won two Pulitzer Prizes. His new memoir is “ Chasing Hope: A Reporter's Life .” @ NickKristof

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