Remaining Positive

For the individual and for the family, cancer has a profound negative impact, yet hopefulness and a positive future orientation are important components for quality of life in cancer survivorship.

What is hope? Is there such a thing? How can it be defined? Is it helpful or harmful? Is it necessary?

Hope is a complex concept, one that often is misunderstood by many people including health care professionals. Part of the confusion is that people define hope differently. Another reason is that health care professionals tend to think in terms of therapeutic hope which is hope that is based on therapy and is related to a cure or remission of disease. There also is generalized hope, such as the hope to maintain a high-quality of life despite a cancer diagnosis, and there is particularized hope which is hope for something specific such as being strong enough to walk without crutches at a child’s wedding.

Hope and Optimism
Many people tend to interchange the terms of hope, wishing and optimism, but there are significant differences. Wishing is usually specific; you wish for something you desire. It almost always refers to a positive outcome and generally it is passive in nature. Optimism primarily emphasizes the positive aspects of a situation, and most people think of optimism as a positive trait. While optimism may be specific in nature, the individual does not necessarily have clear plans for where he or she wishes to go. Sometimes we refer to an overly optimistic person as a “Pollyanna,” a concept based on a children’s book written in 1913 where the main character, Pollyanna, sees only the good side of the bad things that happened to her.  Optimism, then, may close off any painful feelings and it may be inflexible because it only focuses on a positive outcome.

Wishing and optimism both have places in our lives, but to live with a disease like cancer, to get through the rigors of treatment, to navigate the complex health care system, and to fend off society’s negative views about cancer as a death sentence, you have to have a strong sense of hope. Therefore, it is important to understand the meanings and functions of hope.

In his book Anatomy of Hope, Groopman states that there is an authentic biology of hope, and that belief and expectation are key elements of hope. Others define hope in various ways.

  • Hope constitutes an essential experience of the human condition. It functions as a way of feeling, a way of thinking, a way of behaving and a way of relating to oneself and one’s world.
  • Hope means desirability of personal survival and the ability of the individual to exert a degree of influence on the surrounding world.
  • Hope is necessary for healthy coping, its key purposes being the avoidance of despair and the desire to make life under stress bearable.
  • Hope is a cognitive-affective resource that is a psychological asset. The importance of this asset becomes greater in times of threat.
  • Hope is “mental willpower plus waypower for goals.” Willpower, in this definition is “the driving force to hopeful thinking.” It is a sense of mental energy that helps move a person toward a goal. Waypower, the second component in the hope equation, is the mental capacity used to find a way to reach your goals. It reflects the mental plans or road maps that guide hopeful thought.

Hope is a way of thinking, feeling and acting. In fact, hope is a prerequisite for action. Hope is flexible, and it remains open to various possibilities and the necessity to change the desired outcome as the reality changes. These aspects of hope emphasize how important hope is for living with an illness as serious as cancer. Finally, it should be noted that hope is a phenomenologically positive state, and by definition, hope can never be false.

The Changing Mosaic of Hope
Hope has a time aspect and involves a consideration of the future.

It is not a static concept. Hope changes as situations and circumstances change. The phrase “the changing mosaic of hope” is useful for describing the shifting of hope and expectations. For example, when a cancer diagnosis is first determined, the individual almost always hopes for a complete cure. If this is not possible, that hope may be transformed into hope for long-term control of the disease, or for extended periods between recurrences. Even when hope for survival is dim, individuals will find other things to hope for—living to see a grandchild born, control of pain or even a dignified death.

Hope continues, but day by day, and week by week, the mosaic of hope changes as reality changes. When hopes are not realized, “broken hope” may occur. Broken hope requires an adjustment of thinking if you are to regain a balance of hope after a setback or major disappointment.

Hope and Denial
A well-functioning hope does repress doubts and fears, but hope does not equate with denial. True hope is always based in reality. One expert notes that the main difference between hope and denial is that hope transcends reality, while denial avoids it.

Cancer survivors need and desire accurate and honest information about their disease, treatment, potential side effects and prognosis. If presented with compassion and with assurance for continuing support, even bad news can be accepted, and new, more realistic goals can be assimilated into the hoping process.

Hope and Depression
Nothing ever prepares us for the really bad things in life, and we often are overwhelmed when they occur. Cancer is a negative life event, and it is expected that a person diagnosed with cancer will have feelings of sadness and depression at various times during the disease experience. Yet, research strongly suggests that persons with cancer are no more depressed than persons with other similar serious illnesses.

Loss is a cause of much of the sadness and depression that accompany cancer. Just learning your diagnosis—that you have cancer—is depressing; it indicates a loss of good health. Other losses occur and these can accumulate and lead to depression. For example, there is the loss of “normal life” during intensive treatment. Or perhaps there is a loss of a body part due to the need to remove the cancerous tumor, or the loss of a bodily function like the ability to have children. There can be loss of hair, loss of income, loss of relationships and loss of dreams.

This type of depression is called reactive depression because it occurs after a significant and identifiable event (for example, learning about the recurrence of your cancer). These “normal” depressive responses sometimes become severe and they begin to interfere with daily activities, or they can result in very serious symptoms such as thoughts of suicide.

Poorly controlled pain also puts you at risk for depression. When prolonged and severe, depressive symptoms usually require treatment that includes counseling and perhaps medication. If you find that you are having trouble with sadness and depression, talk to your physician or other members of your health care team about your concerns.

Depression often is related to bad news and loss of hope. You begin to feel there is no way to remain positive about the future. No matter how serious the situation, it is important to avoid hopelessness.

The Threat of Hopelessness
Hopelessness suggests the loss of all hope and the acceptance that a feared and dreaded outcome will occur. An acute loss of hope is very serious because hopelessness is a condition of inaction in the face of threat.

Therefore, a hopeless person becomes a helpless person because hopefulness is a necessary condition for action. A hope-lost person appears to be totally separated from, and indifferent to, both the internal and external environment.

Personal circumstances such as serious illness do not inevitably lead to hopelessness. Even foreshortened life does not in itself create hopelessness; in fact, hope has a way of outlasting the facts of the illness. Above all, hope should never be utterly destroyed. Think of the overwhelming impact of the words, “It’s hopeless.”

Maintaining hope is not always easy, and at times of crises, you may need additional support and encouragement from your family, your health care team and other cancer survivors. This is not the time for false reassurances, but instead, it requires helping you to evaluate the situation realistically and to refocus hope. It is clear that hope functions as a protective mechanism, while hopelessness threatens your physical, psychosocial and spiritual health and quality of life.