THE MEDICAL USES OF HOPE
by William M. Buchholz, MD
Hope is the thing with Feathers
That perches in the soul and sings the tune without the words
And never stops at all.
-Emily Dickinson
Too frequently patients will complain, "The doctor gave me no HOPE," as if it were a sample or prescription that should have been offered along with the rest of the treatment. If HOPE were a medicine and listed like other drugs in the PDR, the entree might look like this.
Clinical Pharmacology:
HOPE is a naturally occurring substance created by an individual’s ability to project himself into the future and imagine something better than what exists in the present. It serves as a co-factor for most purposeful behavior and is necessary for coping with fluctuating feelings of despair, depression, fear, anxiety and uncertainty.
HOPE has three components: The individual hoping; the projection into the future (expectation); and the object, event, or state desired.
Individuals experiencing HOPE vary with respect to the density and binding constants of HOPE Receptors. There is both up- and down- regulation of receptors depending on the danger of the circumstances , the individual's sense of vulnerability, and the support system available. Certain individuals have a pathological need for HOPE and are susceptible to False HOPE.
Expectation, comprised of the subunits Credibility and Attainability, is conveniently measured as a vector having units of distance and difficulty (X,Y). Even if there is a strong belief that a goal is possible (Credibility), if the individual perceives it to be too difficult to attain, or that it is impossible to project himself into the future, Expectation will be low. Both intellectual and emotional Expectancies must be above threshold levels for HOPE to be effective.
The Object Desired is the most visible aspect of HOPE and may be expressed concretely or implied, (e.g. "I hope the surgery will cure the cancer. I hope everything turns out all right.") The strength of HOPE often depends on the meaning or importance (Preciousness) of the Object.
Pharmacokinetics: