Responses from Palliative Care: Hope Is Like Water

I

Hope is like water, existing in different states, exhibiting different properties.

In the solid form, hope is manifest as specific hopes: I hope for this, I hope for that. In these concrete forms, solidified hope can become firm and fixed, for better and for worse. Dogged determination aimed at achieving a fixed hope is a very good characteristic—that is, until the continued pursuit of this specific solid hope becomes foolish, harmful, unwise. At the other end of the spectrum, in the gaseous form, hope is amorphous, a glowing feeling that one has to tune into to detect, akin to optimism. In between these two states, hope is liquid. Flowing. Assuming the shape of whatever holds it. Carving, eroding, even dissolving, solid objects. The ultimate change agent.

When we talk about hope, though, we often do not take care to note what form of hope we are talking about, much to the detriment of hope in our lives.

II

Hope is in our human nature.

I mean this quite literally, even if my argument is only part fact and part conjecture. As human animals, we have two basic ways of grappling with our environment: approach or avoid. These primal behavioral motifs, arising from the limbic system, may be embellished by the cortex into an almost infinite variety of specific behaviors—but look carefully and we see people either moving towards something they desire or away from something they fear.

Because of the approach/avoid behavioral dichotomy, the necessity of hope is essentially hardwired into us. For what happens when we seek to approach what we desire but need to traverse something we wish to avoid? As brains evolved and became more capable of perceiving the obstacles between us and our increasingly complex desires—including the obstacles arising from the evolving self-awareness about the uncertainty of our efforts—we also evolved an enlarged capacity of mind to foster and sustain positive motivation over longer spans of time and greater adversity. We call this capacity hope.

III

In every story of hope, there is longing, and within that longing a sense of pain.

Perhaps this is just me, but I cannot listen to stories of hope in the setting of serious illness—such as the story of flickering hope recounted on these pages of a daughter confronting the five-day demise of her father following a heart attack—without feeling at least twinges of the emotions of sadness, fear, anger, or some other color of pain. Even in stories of hope triumphant, amidst the thrill there is the threat of failure, which is to say the risk of some sort of pain.

To be a master of hope, one has to become well acquainted with the fear of darkness that hope helps us to surmount, to become comfortable and capable of confronting this darkness directly. Why? Because whenever we talk about false hope, the true underlying problem isn’t hope (solid, gaseous, or liquid) but rather unconfronted fear. In such cases, the avoid reflex is so strong that what we notice, and blame, is where that avoidance takes us—namely, towards a solid hope that provides a safer haven. But the treatment here is not to disbar that refuge of hope, but instead to address the fear that hounded us there.

IV

Should we try, when confronting heartbreak, to live with less hope?

Embedded in this question is an essential circular irony: for in the desire to be liberated from the attachment we can have to specific solid hopes, we hope for something different, something unattached and ineffable—but still a state of being, however elusive, that we hope for.

I believe hope is—unless we are deeply depressed—inevitable. If we are deeply depressed, to the point where we can move neither forward nor in reverse, to the point where we neither approach nor avoid—well, with good reason the state of hopelessness is often equated with depression. But this is (with deep respect for people who have depression) not a state to aspire to.

What we really need is to become better...