A time for hope



    Hoping is more than believing that all will eventually be well.

    Photo: Einar Nilsen
    Photo: Einar Nilsen

    In the Christian tradition, Easter is the season of hope. In this issue of the Journal of the Norwegian Medical Association, Odd Terje Brustugun explains how hope still has a role in doctors' encounters with seriously ill patients (1), while Aslak Bråtveit shares his thoughts on how we can find hope both inside and outside the confines of the church (2). But what is hope, really?

    Psychology distinguishes between two dimensions of hope (3). The first one consists of three parts: a desire to achieve something, a plan for how to achieve it, and finally the ability to implement the plan, even if success is not guaranteed (3). In other words, this dimension of hope emphasises imagination, cognitive aspects and the ability to act. The other dimension of hope is emotional, meaning the ability to believe that a positive outcome is in fact possible.

    Hope may appear to resemble optimism, but is in fact something different. The optimist believes that things will go well regardless, and that nothing needs necessarily to be done to make changes happen. To quote the ecologist David Orr: 'Hope is a verb with its sleeves rolled up. Hopeful people are actively engaged in defying or changing the odds. Optimism leans back, puts its feet up, and wears a confident look, knowing that the deck is stacked' (4).

    Hope is also important for collective commitment and activism

    Hope is thus more than wishful thinking and different from optimism (5). It is the thought of a meaningful (or well-paid or prestigious) job that makes students spend endless hours in the library. It is the thought of a life more worth living that later leads the exhausted and disillusioned doctor to look for a way out of the public health services. For the student to pass the exam, or for the doctor to find a job they can live with, they need hope. This entails imagining that the goal is achievable, as well as the ability to read that book, learn that text or send that application.

    Hope is positively charged, but requires the presence of something negative, i.e. uncertainty and something that can be changed or improved upon. Without darkness, we do not need the light that hope provides. Hopelessness, on the other hand, is associated with passive withdrawal and despondency, and is correlated with depression (3). We know that hopeful people are better off than others. However, positive expectations are only weakly correlated with what psychologists refer to as subjective well-being. Cognitive and emotional hope, i.e. the belief that you can be the creator of your own happiness, is far more important (3).

    When used correctly, hope is an important clinical tool (1, 6, 7). But what impact does hope have on combatting health crises that affect us all (albeit unequally), such as climate change? Considerable, according to the authors of an editorial article in the BMJ (8). In addition to current and future effects on physical health, concerns for the future of the planet and despair over the lack of action on the part of the authorities are a prominent cause of mental afflictions among young people (8). Some feel that the future is so devoid of hope that they choose not to obtain an education or have children (9). Hope is also important for collective commitment and activism (8). A hopeful attitude to climate change – that the goals set are achievable and that working for change is meaningful – is required to achieve both individual and structural change (8).

    How hope can be applied to the climate question has become a separate area of research. Hope as the ability to envisage a goal and strive to achieve it correlates positively both with commitment and green choices (10). The association with hope as an emotion is more complicated. The dividing line between it and excessive optimism and denial is blurred (10). What is important is to strike the right balance between realistic information and realistic hope, as doctors are accustomed to doing in their encounter with patients (1).

    Easter is a time of hope. In church, on the ski tracks, relaxing outside the mountain lodge or on duty in a health service that cannot take an Easter holiday. Then it's time to roll up one's sleeves and greet the spring, no matter how the deck is stacked.

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