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Should Have KnownYou Will Know Me
Jerome Groopman's ability to weave
together moving tales of his patients with thoughtful reflections on the nature
of medicine has been well established in his previous books, Second Opinions
and The Measure of Our Days. In The Anatomy of Hope, he
ruminates on the possibility of hope in patients with extremely serious
diseases. Most of the patients in these stories have cancer with often-fatal
consequences. He starts off with the case of a devout Jewish woman he met when
he was only a medical student, who lacked the will to fight her breast cancer
because she believes it is a punishment from God. Eventually, too late, her
doctor convinced her to accept the treatment which might have saved her life,
but Groopman's training didn't include any discussion of what the doctor said
to the patient to change her mind. Later on in his career, when he himself was
a young doctor acting as an apprentice of another well-established doctor, he
was troubled by the case of a patient with incurable cancer who was misled into
believing that her treatment could achieve a cure. The chemotherapy she
received could provide a remission of the cancer, but it was virtually certain
that she would eventually die from the disease. In Groopman's view, this false
hope was a disservice to the patients, and ultimately cause them to feel
bitterness and disappointment, and can also lead the doctors to feel guilt or
This experience led Groopman to be
much more open with his patients about the truth of their prognoses. He came
to believe that patients need the truth and it is counterproductive to try to
stop patients from worrying by hiding facts from them. Yet he also found that
the blunt telling of grim medical statistics can drain patients of hope and
life. As with many doctors, Groopman found it almost impossible when treating
patients with terrible disease to find some middle ground between false hope
and depressing truth. His central quest in this book is to explore how to
create such middle ground.
In the other cases, Groopman tells
stories of oncologists who themselves get cancer. Some insist on painful
experimental treatment in full knowledge that the chances that it will provide
a cure are slim. Sometimes, they are driven by hope, but in other cases, by
desperation. In other cases, the afflicted doctors give up the fight against
cancer prematurely, as if they are unable to summon up the hope they tried to
give to their patients. Finally, Groopman tells his own story, not of cancer,
but of a disabling back problem that threatened to significantly curtail his
life. He tried several different therapies, but they didn't seem to help, and
even made the problem worse. Finally, he himself gave up hope in his own
recovery, and just tried to live with the progressively worsening problem, with
his life becoming ever more circumscribed. It was only through meeting a
specialist who confronted him with his own refusal to hope that he came to find
a cure. This personal experience gave him further insight into the ways that
fear can overcome hope.
Groopman's discussion of hope fits
in very well with a great deal of other work on the mind-body connection.
While he is skeptical about the overblown claims of some alternative medicine
that the right attitude can in itself end serious disease, he does explain some
of the evidence that one's mental attitude can have a powerful impact on the
course of one's recovery. Hope can have both direct and indirect beneficial
effects in fighting disease. Therefore, it is an essential element in
treatment, so it is very troubling that specialists are not given more training
in how to enable their patients to become hopeful.
While The Anatomy of Hope is
an excellent discussion of the relation of emotion and illness, it says very
little about mental disorders. For people with chronically disabling mental
illnesses, it is all too easy to become hopeless, and this itself makes the
illness worse, and can lead to substance abuse or suicidal actions.
Psychiatric patients need hope, and their clinicians and families need to know
how to help them become hopeful. Groopman's book may provide some clues, but
clearly this is an area that needs much more exploration.
Groopman himself reads the abridged
audiobook. His performance is a little wooden at times, with rather slow and
methodical pronunciation of each individual word. Nevertheless, his words are
always eloquent enough to hold one's attention, and at other points his reading
is more natural and fluid.
© 2004 Christian Perring. All
Perring, Ph.D., is Academic Chair of the Arts & Humanities
Division and Chair of the Philosophy Department at Dowling College, Long Island.
He is also editor of Metapsychology Online Review. His main
research is on philosophical issues in medicine, psychiatry and psychology.