Is it better to be hopeless?

I am skeptical about “hope.”  It seems to me that no problem has ever been solved, no disease cured, by hoping things would get better.  Hope can be a tease, a distraction.  I would rather that my patients control, understand, attack, overcome.  Better to cope, than just hope.

I understand the place of hope when things look dark.  It fills our hearts when choices lack, trust wanes and tomorrow is hollow, unknown.  Hope can take the place of action, when we are not certain which fork to take or if there is any path forward at all.  Hope can get us through tough days and nights.

However, hope can make us lose focus and can cost us valuable opportunity, distract us from the battle.  Patients delay critical therapy on the hope things will get better.  They fail to take medications, avoid important treatments and may choose useless or destructive alternatives.  Those that survive learn to cope, instead of waiting to hope.

Until recently I saw hope as a false choice, but I failed to understand a greater danger.  Then, I read the 2100 year-old writings, by the Stoic philosopher, Hecato of Rhodes.  In this ancient work, I stumbled upon a remarkable idea.

Hecato felt that hope was not solely a response to future demons.  He taught that “hope” was the cause of one of mankind’s deepest and most prolific challenges.  We are told that hope is a way to deal with the unknown.  Not so, said Hecato.  Hope is the cause of fear.   “Cease to hope,” he said, “and you will cease to fear.”

This is a fascinating way to look at what it means to be human.  Alone among the animals we have the ability to consider future events.  We worry about what may happen in an hour, day or year.  We understand that terrible things are possible, even likely, and we wait for them to happen, while we hope that tomorrow will be good.  However, because we dare hope for peaceful, healthy, positive tomorrows, we are constantly reminded of the possibility of loss.  This causes us to fear the future.

When first diagnosed with cancer, the question most people ask is, “what is my prognosis?”  The doctor must predict the future.  What can the patient “hope” for?  What is likely or unlikely?  As soon as a patient starts to think about tomorrow, to hope for a good prognosis, no matter how reassuring is the doctor’s answer, terror infiltrates body and soul.  Fixating, worrying about tomorrows we cannot control, fills us with fear.

What if we were able to live now?  In the moment, if you will.  Cease to be pulled down by the ephemeral anchor of hope with its heavy chain of fear.  Focus on the right now.  Absolve ourselves of the obligation to worry.  Accept that after we have chosen a path, the future is completely out of our control.  We are given this moment and it is all we will ever have.

Is existing in this time, neglecting this possibility of tomorrow, the same as denial?  I think not.  Rather, denial is the pathologic child of hope; we take hope too far.  Denial is when we decide that because we desire a perfect future we do not have to plan or cope with tomorrow at all. We deny our natural responsibility to plan and choose our path; it is hope with a blindfold.   Not to fear tomorrow does not mean neglecting the future.  Rather it is making decisions now and then absolutely accepting whatever future will follow.

For most of us, most of the time, this sort of isolated mindfulness, focused completely in this moment, is only a dream, a hope if you will.  Nonetheless, there is a valuable lesson to be learned regarding that which drives us.   At those moments when tomorrow is likely to be filled with healing and happiness, we are made strong, invigorated to go on.  However, when we doubt what is around the bend, we are poisoned by fear and robbed not just of tomorrow, but of today.  We must strive to make decisions, cope and plan for tomorrow, and then put aside dreams so that we bath in the sunrise, hold close those we love and be, right now.


  • Harry Jones
    Excellent, thoughtful piece. My only issue with this is the comment that "we, alone among the animals, have the ability to consider future events". How do we know that? How do we know much of anything about what other animals think? I often watch my dogs, lying on my bed, rolling their eyes and moving their heads to look at something and wonder what they are thinking, because they surely do....
    • D Someya Reed
      Thank you Harry Jones. I agree with you completely. I've been around many types of animals all my life and have always thought this way, too. Simply watching a dog waiting at the that not thinking of a future event when someone will walk through that door? Maybe it's simply for the reward of food or a walk but it's still thought beyond the moment. How easily we write off the animals with which we share this planet and of whom we are also one but with maybe a little something extra. Too often, though, that something extra is arrogance.
      • Harry Jones
        My thought exactly. I have often read comments by so-called animal experts stating that animals have no feelings, no emotions, can't think the way humans do and my thoughts are, "what an arrogant person".
        • D Someya Reed
          Can't agree with you more.
  • Thank you for the reminder of that amazing concept; accepting. A tough one for me, and so necessary. But I see women patients I follow online filling each day with beauty! They know. There is only now.
  • Such an important essay. Thank you for this, Dr. S. When I worked in hospice palliative care, we often talked about the concept of "hope", which as you know tends to look very different in end-of-life care. Hope changes as our health changes. At first, when we hear the frightening diagnosis, we hope for a cure. We hope that this surgery, this treatment, this drug will work to heal us. When it doesn't, we hope that our doctors will be able to manage our pain and other symptoms so we can remain comfortable. We hope that those who love us will not suffer too much because of what's happening. We hope to walk in the rain again, or to watch the baby robins hatch outside our window before our time comes. We hope to live until the new baby is born, until our next birthday, for one more Christmas. We hope that those who love us will not suffer too much because of what's happening, that they'll be okay after we're gone. We hope that the end, when it comes, will be peaceful and with those we love surrounding us. We live in the smallest moment, but we never seem to lose that essence of hope.
    • D Someya Reed
      Yes, the hospice & palliative care industry "talks" about hope and its variations and modifications. They often say that hope must be "redefined." However, if a patient's version of hope does not match theirs then, surprise, you're in denial! I disagree with Dr. Salwitz on any relationship that hope has with denial. Particularly, this is based upon the common conception of denial as it is used by medical and quasi-medical staff today. If the patient does not agree with what they are being told by their clinician (of any type) they are in denial. Denial, as it is less likely used today, is the "complete" refusal to believe that anything untoward is going on. For instance, if a patient is diagnosed with cancer, shown all the results including images and still states, "I don't have cancer" that's "real" denial. Most of what is termed denial among patients today is not anything like this scenario above. However, it always is a fundamental disagreement between doctor and patient. But Dr. Salwitz said "At those moments when tomorrow is likely to be filled with healing and happiness, we are made strong, invigorated to go on." Well you, as someone who has dealt with hope (for even the hopeless), isn't the word "likely" used as a "hopeful" word? And, isn't the likelihood of tomorrow being filled with healing and happiness largely dependent upon the skills of prognostication and application of the medical professionals involved? Unfortunately, Dr. Salwitz has seen and written about the poor prognostics skills of today's practitioners and, to be fair, it ain't easy. So why should we give up hope? Hope is something that's ingrained within us. We hope for everything in one way or another. To remove hope out of some fear that patients may be less compliant and/or choose to follow a path that may end with "real" denial, well, it is still their life and their choice isn't it? Or, are patients now expected to be obedient robots? I know the world that I want to live and die in whether it be the "moment" he spoke of or years upon years of remaining lifespan. What I hope for is what "I" hope for. No one could or should take that away from anyone especially to ensure compliance.
  • Liz
    Personally I think you can't learn to live in the moment until after you have dealt with the fears, hope, lack of hope... whatever the individual situation... "thing". In coping with the emotional earthquake that is cancer you hope, you fear, you circle around all these emotions. In my personal opinion hope and fear are on different continuums. Ditching one does not mean you will ditch the other. I think that ancient philosopher dude is dead wrong. And some of us deal with fear by information, which includes information about tomorrow, whether or not the doctor has a crystal ball. And some of that information includes information that gives us hope that we might be the lucky one (yeah they think that too with lottery tickets LOL). That may or may not remove some fears... again the two are not tied to each other (in my opinion). Personally it took me close to 18 months after my dx to get a grip on the fear thing and that was not related to the hope thing. Dealing with fear is a process that takes time, with or without hope.
  • "We must strive to make decisions, cope and plan for tomorrow, and then put aside dreams so that we bath in the sunrise, hold close those we love and be, right now." I don't see this as an either/or situation for everyone. Rather, I see hope as a "resting place" for those times when one can't turn off the ping-ponging chatter of "Will I die? or Will I survive and get better? We can make decisions, cope, & plan AND hope, so we can begin to return to the present moment. This may be semantics, but I liken hope to the stump at the end of the book "The Giving Tree," a place to hold the fear, etc for a little while. "I wish that I could give you something... but I have nothing left. I am an old stump. I am sorry..." "I don't need very much now," said the boy, "just a quiet place to sit and rest. I am very tired." "Well," said the tree, straightening herself up as much as she could, "well, an old stump is a good for sitting and resting. Come, Boy, sit down. Sit down and rest." And the boy did.
  • Michele Donato
    Dear Dr. Salwitz, Although I have not commented on your deeply philosophical posts, I read them with great interest and fascination. It is incredible that a man as busy as you can take time to share these meaningful and personal insights. When my dearly departed husband was diagnosed with cancer, I deliberately chose not to ask questions of his prognosis, the stage of his cancer and his future life. I chose instead to be his companion, to enjoy the moments we shared, to care for him and to comfort him to the best of my ability. We spent our last Sunday together listening to the birds that were chirping and flying within a few feet of us. Peter had built beautiful birdhouses for our little sparrows and they visited us with joy. Peter left us unexpectedly only a day later. He was brave and optimistic to the end. That moment will remain in my memory forever. I attended most of Peter's chemotherapy sessions and marveled at his valiant approach. I tried to overcome my distaste for the entire concept of chemotherapy and the anxiety that it induced in my spirit. As an environmentalist, my inner self wrenched as a result of a system that poisons the person but does not address the cause of the cancers that afflict so many of us. I silently queried how you or any medical professional can endure through these circumstances. It takes a special person to treat cancer with compassion. As I read your posts, I increasingly respect your commitment to your patients. I am honored to have met a man of your dimension. Michele
  • Michele Donato
    I forwarded this post to my dear friend. This is her response. "What a deep and thoughtful man. The burden he must bear in the treating his patients as humans and not as just cases. Amazing. "
  • Michele, your comment (and your friend's response) are a testament to Dr. a caring physician and brilliant writer. (PS Your own eloquence touched me deeply. The picture you painted beautifully with words about your husband's last Sunday with you and the joyful birds will stay with me forever, too. I can think of no better send-off.)
    • Michele Donato
      Janice, I still feel his presence in that beautiful little area. Thank you for your kind words. Practicing mindfulness, feeling compassion and expressing gratitude are keys to a good life. Michele

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