How hope works with modern medicine

Dr. Charles Raison, CNNHealth's Mental Health expert and an associate professor of psychiatry and behavioral sciences at Emory University, writes regularly on the mind-body connection for better health.

My mom, whom I’ve mentioned before, is 82 and struggles to walk. But she goes to great lengths each week to attend a church in which she finds comfort, one that teaches that reality can be changed to reflect our desires if our hopeful expectations are strong enough. This idea has been popularized in a widely read book called “The Secret,”which espouses a “law of attraction” such that the universe must respond to the way you think. Thus, positive and negative thinking must always bring about positive and negative physical results in the real world.

My professional life is rooted in scientific endeavors, so you won’t be surprised to learn that I think that idea is wrong. What amazes me, though, is that it is so nearly right. Although the universe does not appear to be obligated to deliver 100% of our fondest hopes and dreams, it turns out that thinking positively really can lead to positive medical outcomes.

The latest example of this effect comes from a recently published study that examines whether one’s expectations of future health status actually affects future health. Researchers at Duke University asked several thousand patients undergoing a cardiac diagnostic procedure what they thought about their likely future health and then followed these patients for 15 years to see what happened to them. A great strength of this study is that in addition to asking about specific health expectations, the researchers collected information on almost every imaginable factor that might also influence cardiovascular health so that the specific effect of these expectations could be isolated and explored.

The researchers found that the most optimistic patients were only about half as likely to die from heart disease as the most pessimistic patients. Of course, it’s easier to be optimistic about your future if your disease is not as bad, if you are not as depressed, etc. Taking these factors into account weakened the association between positive expectations and enhanced survival, but the effect remained large — as large, in fact, as the effect of our most powerful medications.

The practical implications of these findings—along with many similar results from earlier studies—are staggering. Given this, I never cease being amazed that modern medicine seems generally so little interested in exploring ways to maximally harness such a readily available source of therapeutic success. But for us as individuals the message is clear. When disease strikes we should work on ways to develop and nurture a sense of hope for the future. And not just general hope, but hope that is specific to the illness at hand. And in fact, if our hope reaches beyond what the evidence suggests is going to happen to us, so much the better. We should look upon this as a therapeutic strategy, and if we find it difficult we should remind ourselves that other therapeutic modalities—such as surgery or chemotherapy—are at least, if not more difficult.

Said another way, scientific data suggest that realistically developing unrealistic hope is good for our health. Of course, this is a tremendous challenge, because hope is much easier to come by when it appears to be realistic to a person. To knowingly practice unrealistic hope requires significant discipline, willpower and courage.

Notice that I qualified my statements about unrealistic hope with the caveat that we need to develop this hope realistically. This is where I part ways with spiritual views that insist hope is all powerful. Just because something works to some degree doesn’t mean it works completely, and many effective medicines become poisonous if taken at too high a dose.

Almost certainly there is such a thing as too much hope, if that hope causes people to forgo availing themselves of every medical intervention at their disposal. Hope works within the confines of modern medicine; by itself it is a good deal less effective. To see proof of this one need look no further than studies showing that Christian Scientists—who eschew all medical treatment in favor of spiritual healing—die at a much younger age than other Americans.

Still, I don’t want to end a post on hope with such gloom and doom. Perhaps a more appropriate way to close is to rephrase an old Arabic proverb that “He who has health has hope; and he who has hope has everything.” True enough, but it is also true that “He who has hope has health, or at least a better shot at it”.