The Anatomy of Hope: How People Prevail in the Face of Illness (Hardcover)

~ Jerome Groopman (Author)

Editorial Reviews

From Publishers Weekly

In this provocative book, New Yorker staff writer and Harvard Medical School professor Groopman (Second Opinions; The Measure of Our Days) explores the way hope affects one's capacity to cope with serious illness. Drawing on his 30-year career in hematology and oncology, Groopman presents stories based on his patients and his own debilitating back injury. Through these moving if somewhat one-dimensional portraits, he reveals the role of memory, family and faith in hope and how they can influence healing by affecting treatment decisions and resilience. Sharing his own blunders and successes, Groopman underscores the power doctors and other health care providers have to instill or kill hope. He also explains that hope can be fostered without glossing over medical realities: "Hope... does not cast a veil over perception and thought. In this way, it is different from blind optimism: It brings reality into sharp focus." In the final chapters of the book, Groopman examines the existing science behind the mind-body connection by reviewing, for example, remarkable studies on the placebo effect. By the end of the book, Groopman successfully convinces that hope can offer not only solace but strength to those living with medical uncertainty.
Copyright 2003 Reed Business Information, Inc.

From The New England Journal of Medicine

In this book, Jerome Groopman shares with readers what he has learned about the need to keep hope alive, especially in the face of serious illness. The key themes he explores are the extent to which hope features in the experience of patients with chronic and terminal illnesses; the importance of hope in enabling patients, families, friends, and physicians to meet the challenges of serious illness; the various forms that hope can take; and the role of the physician in fostering or at least not extinguishing hope. Groopman discusses these problems through a series of thoughtful case histories, which will doubtless resonate with both clinicians and nonmedical readers. He then adds a summary of some current research into the physiological basis of what we call hope. The brief foray into the scientific understanding of hope, though of some interest, is in many ways a diversion from the main focus of this thoughtful book. The Anatomy of Hope is not about the science of medicine but, instead, examines the art of medicine. Reading it, I had a strong sense that a driving force behind the writing of this book was the author's wish to speak directly to clinicians, specifically to those responsible -- especially through example -- for the education of future generations of doctors. Groopman has learned the hard way about the important role hope can have in the experience of illness, and he wants to share these lessons. Just as parents know how painful it can be to watch one's child learn through painful mistakes, experienced doctors realize that the art of medicine is rarely acquired without mistakes. Unfortunately, when doctors make errors, patients must also pay the price, and in appealing to doctors not to underestimate the part they can play in fostering hope, Groopman clearly believes that both doctors and patients have something to gain. Somewhat lost within the text of this lovely book is a chapter in which the author tells of his own painful experience of a temporary loss of hope, the result of debilitating back pain. This understated chapter would have merited placement at the forefront of the book with a clear statement about why it was included. If I had to guess, I would say that as a result of his experience, Groopman knows the dreadful price that patients can pay when hope is lost, and the pivotal role that physicians can have in fostering and restoring that hope. He knows how ill prepared young doctors are for this task, how deeply older physicians regret lost opportunities, and how grateful patients are when physicians care. Deborah Kirklin, M.B., B.Ch.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

See all Editorial Reviews

Product Details

• Hardcover: 272 pages
• Publisher: Random House; 1 edition (December 23, 2003)
• Language: English
• ISBN-10: 0375506381
• ISBN-13: 978-0375506383
• Product Dimensions: 9.4 x 6 x 1.3 inches
• Shipping Weight: 1.2 pounds
• Average Customer Review: 4.2 out of 5 stars  See all reviews (26 customer reviews)
• Amazon.com Sales Rank: #35,449 in Books (See Bestsellers in Books)

  Popular in these categories: (What's this?)

  #7 in	Books > Health, Mind & Body > Psychology & Counseling > Physical Illness & Psychiatry
  #13 in	Books > Professional & Technical > Medical > Nursing > Research & Theory
  #13 in	Books > Science > Medicine > Nursing > Research & Theory

Customer Reviews

Most Helpful Customer Reviews

42 of 43 people found the following review helpful:

5.0 out of 5 stars This Amazing Book Will Make Your Sing!, March 1, 2004

By	H. F. Corbin "Foster Corbin" (ATLANTA, GA USA) - See all my reviews (TOP 500 REVIEWER)    (REAL NAME)

Amazon Verified Purchase

If I had to sum up THE ANATOMY OF HOPE in one sentence, this would be it: this amazing book will make you sing. I would have finished it the day it arrived in the mail had I not had a house guest I had to tend to. After finishing the book the next night, I was so hyped up that I couldn't go to sleep for hours. I wanted to give it to everyone I care about, including my doctor.

Dr. Groopman discusses hope and its impact on the ability of patients to fight serious, sometimes life-threatening illnesses. He gives the examples of several patients of his over the years and the effect that hope had on their recovery from illness. He also traces his own growth in helping patients. Dr. Groopman learns how to relate to patients through trial and error. "I was still feeling my way on how to communicate a poor prognosis to patients and their families. Not once during my schooling, internship, or residency had I been instructed in the skill." The first patient he discusses, Esther, he saw while he was still a medical student. She believed she deserved to have breast cancer because she had had an extra-marital affair. He later learned that she sought treatment too late and died at the age of thirty-four. Dr. Groopman assists another doctor with the treatment of the second patient. She interprets "remission" as a cure for a serious malignancy. The other physician had given her part of the truth but not the whole truth. When she ultimately learns she is dying, she and her family are angry at the doctor. "I guess he [the doctor] doesn't think people like us are smart enough, or strong enough, to handle the truth."

Along Dr. Groopman's journey, he encounters a physician patient who insists on a difficult and painful treatment that Dr. Groopman didn't recommend. This patient was alive many years after his cure. "It took George Griffin [the doctor patient] to teach me that omniscience about life and death is not within a physician's purview. A doctor should never write off a person a priori." There is a Vietnam veteran seriously ill with a cancer that calls for immediate treatment or he will surely die. The patient is obstinate about not having therapy, that it will not work. Dr. Groopman is able to bargain with him. The patient has the right to stop treatment at any time and must understand that he is in the "driver's seat" all the way.

The most poignant patient for me was Barbara, a 67 year-old woman whose breast cancer has metastasized. We meet her in the chapter called "Undying Hope." The good doctor probably would say that he learns far more from her than she gets from him although he of course gives the patient his best. After many months of harrowing treatment, she does not want to stop, however. "'There are many moments during the day that still give me pleasure,'she said. 'Let's keep going.'" The moment comes when the doctor must tell Barbara that there is nothing else he can offer to help her. After "heavy silence," she responds that he can still give her the "medicine of friendship." The patient ultimately dies. "Although I had expected this outcome for quite some time, I felt a gnawing pain of loss. I accepted that medicine had its limits. It was just that I cared for her so much; it was impossible not to. But I also felt deep gratitude. Barbara had opened herself to me in a way no patient had before. A patient's revelation of her deepest feelings and thoughts is one of the most previous gifts a doctor can receive. It has happened with me when I have reached the level of relationship I did with Barbara, of friendship beyond the professional." And finally, "there are some patients whom a doctor grows to love. . . Barbara had sparked that love in me."

The author is not talking here about false hope, denial or the information that the Louise Hays of the world dispense when they blame the victim, that patients who don't get better have a need not to and are weak individuals. I still remember someone saying about a friend with AIDS in the 80's who had come down with pneumonia: "I refuse to go to see him because he had a need to get pneumonia." (This kind of thinking is maddening.) The author gives us hard data and looks at the changes in the brain when we have hope: "It turns out that we have our own natural forms of morphine--within our brains are chemicals akin to opiates. These chemicals are called 'endorphins' and 'enkephalins.' Belief and expectation, cardinal components of hope, can block pain by releasing the brain's endorphins and enkephalins, thereby mimicking the effects of morphine."

Dr. Groopman is obviously a brilliant and competent practitioner, but he is also wise beyond measure. "I try hard to let patients read in my eyes that there is true hope for them. . . Doctors are fallible, not only in how they wield a scalpel or prescribe a drug but in the language they use." So much wisdom here, much about faith and how it differs from hope. At one point the doctor says that hope has wings. I wonder if he knew that the poet Emily Dickinson said that "hope is the thing with feathers."

I repeat: this amazing book will make you sing.

38 of 40 people found the following review helpful:

5.0 out of 5 stars Wise and Well-written, February 8, 2004

By A Customer

In an easy to read style, this book offers wise insight into the powerful connections between mind and body. It is hopeful and inspiring without ever being simplistic or sappy. The writer, a physician, displays unusual insight and humility. Human stories are well balanced with science, and there is respect for the spirit. This is not a simplistic self-help book. I have been asked a lot about who should read this book. Someone who is suffering with a life-threatening illness, and is feeling hopeless, may feel misunderstood and negated if you give this book as a gift. Better will be for you to read it and see if you can gather some ideas on how to be most helpful. People who have chronic pain may find this book a very welcome read.I cannot imagine many readers who wouldn't find this book thought provoking and hope affirming.

32 of 33 people found the following review helpful:

5.0 out of 5 stars Scientific Alliance of Mind and Medicine, February 9, 2004

By	Dr Cathy Goodwin (Seattle, WA USA) - See all my reviews (TOP 500 REVIEWER)    (REAL NAME)

This book has two types of chapters: narratives (not quite case studies) of specific patients who dealt with serious illness with varying degrees of hope, and Groopman's search for scientific understanding of the emotion we call hope.

Groopman describes two patients who refused treatment, one an Orthodox Jewish housewife he met as a medical student, the other a Vietnam veteran who ultimately responded. Two patients maintained hope, despite a depressing prognosis, and one recovered. He remembers one patient who felt betrayed by her physician's unrealistic optimism.

Describing these patients, Groopman shares his frustration: there's a good chance they can be cured, yet at least some of them resist. One physician (not Groopman's patient) insists on aggressive treatment, living fourteen years after initial diagnosis. "Don't give up!" seems to be the message.

Like most physician-writers, Groopman presents cases from a privileged world. All these patients had access to teaching hospitals, presumably without financial worries. All but one had families and careers waiting for them. One reluctant patient had a loyal wife at his bedside. Only the first patient, the housewife in a hostile marriage, had nothing waiting for her.

It would be interesting to contrast these patients with others for whom illness represents a financial as well as physical burden. And, given research on social support, I would have expected to see some discussion on the role of the family in maintaining hope. Few people can survive a regimen of chemo and radiation without meaningful support, which is just not available to everyone.

I particularly enjoyed the chapters on the science of hope, which can be related to the placebo effect. Groopman warns that optimism will not cure serious illness, but will motivate people to initiate and continue painful, debilitating treatment. However, he reports evidence that resilient people respond more positively to flu shots, and that some people respond more strongly to placebos than others.

Seeking relief from his own back pain, Groopman encountered a specialist who roared, "Don't be ruled by your pain!" And, as I read, I wondered if care-avoiders -- people who avoid visiting doctors -- may create their own placebo effects and refuse to be ruled by pain.

Readers of Groopman's New Yorker pieces may find this book written in somewhat looser style, with more of a first person account than a journalistic report. Groopman carefully avoids any hint of woo-woo, while appreciating the widening boundaries of scientific discourse. Overall, he does a masterful job of offering the lay reader access to technical subjects, without sacrificing rigorous thinking.