Hope

Aslak Bråtveit

doi:10.4045/tidsskr.23.0088

Essay

Hope

Norwegian

Aslak Bråtveit

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Aslak Bråtveit

aslak.bratveit@gmail.com

Aslak Bråtveit is a retired specialist in general medicine.

The author has completed the ICMJE form and declares no conflicts of interest.

Article

Hope is the expectation that something good lies ahead. It drives initiative and effort. The limbic system in the brain is influenced by our senses and thoughts and determines our basic mood. Hope grows when the mood is light-hearted, while the melancholic struggles to find a hope to reach for. Humankind searches for coherence and meaning. Our substitutes for religion promise much but give little hope for the ultimate future. What can give us hope?

Illustration: Marianne Gretteberg Engedal

Hope is the engine that keep the wheels turning, that sparks initiative and gives courage. The farmer sows his seed grain with hope, the doctor prescribes a troublesome course of chemotherapy. With anticipation and excitement they dream of the future and await the accomplishment of a goal. But what if the result is disappointing? If the sun scorches the grain, or the troublesome chemotherapy ends with loss of life, a hope that failed? A hope that is crushed may breed despair and eat away at courage and strength. But most will still find new hope. In the future lie new hopes, new choices, new initiatives. Disappointing results need not lead to hopelessness. The very path towards the goal can bring joy, further knowledge, new encounters, more self-insight. My research foundered, but in the struggle I found riches I have cherished ever since. What if, instead of hope, I could have certainty to navigate by? The farmer could save himself from toil and loss of resources. A cancelled course of chemotherapy would spare the patient suffering along the way and the community from undue spending. Would that be of great value? The farmer huddled indoors, the patient discouraged and laid low. The engine, the hope and the faith halted. The zest for life extinguished.

The enigmatic universe and unfathomable nature of life, the recognition of one's own helplessness, draws man towards something greater than himself

Hope can be linked to the fulfilment of needs for a good life, Maslow has postulated and ranked human needs in a hierarchy: primarily physiological, then psychological (need for security, belonging etc.), then the transcendent. Since we are collectors by nature, the project quickly expands: the need for protection against the elements extends to building excessively large houses. The rich want more. Paradigms that prevail at any one time, the spirit of the age, guide our hope into its paths.

Basic mood

When making various choices in life, one should ideally draw up a list of disadvantages and advantages of the idea, survey the list and act on the sum of realistic and logical assumptions. Be rational. Often we do not do that at all, but act on intuition. So we act out the personality or mood of the day. If the choice is made after careful consideration, the arguments for or against are often weighted based on basic mood. The optimist looks forward to the new goal, with great hope and faith in the fulfilment of a dream. The pessimist looks gloomily at the same goal, expecting only loss, even an an impending disaster. In the movie Flåklypa Grand Prix, we meet Solan Gundersen the bird and Ludvig the hedgehog. They each have their different basic moods and react to new proposals and plans in accordance with these. The basic mood also varies with life situation, ability to imagine and experiences of disappointment or happiness. The hope can be weak ('Maybe?') or strong ('I shall!'). Manic-depressive disorder is the ultimate demonstration of these mood swings.

Is it possible to influence the basic mood? Deep in our brains there are several brain nuclei that are affected by our senses, both external and internal. The areas of the brain that governs experiences and thoughts also connects here. Much of the brain's activity is organised from this location. The interaction between these brain centres forms the substrate for feelings, autonomous reactions and basic mood. The area is called the limbic system. Much is still unknown about the functions of these structures.

Smell provides a signal that triggers aversion or attraction. Disgust or desire is turned on. Sight takes in light, both quantity and quality affect mood, degree of activation and courage. Hearing takes in sounds, melodies and harmonies. Music therapy based on diagnoses, and feelings of pure joy engendered by song and music are well known. Tactile signals have different qualities; they soothe or activate. The child is comforted by being caressed. Breathing and cardiac activity send and receive their autonomic signals. Several types of breathing exercises are recommended. Conversations and cognition reach in, we all make use of that effect. It is nevertheless difficult to change dysfunctional thought pathways without the balance in the basic mood Impact on the senses and autonomic functions can help, making the person available for conversation. Doctors use chemistry to block or activate, or they administer ECT (electroconvulsive therapy) to 'reset' following an epileptic seizure. Dopamine and GABA, transmitter substances that affect basic mood, are often mentioned.

Existential hope

The incomprehensible, mysterious nature of life, the coming end, or the many 'whys' – humankind searches for an existential hope. Maslow places this hope at the top of the pyramid. Must all the other needs be met first, before humankind has time for or is capable of wonder, and seeks hope in the hereafter? Access to our basic physiological needs is very unequally distributed. We have more than enough in our part of the world – it is fair distribution that is the challenge. Psychological needs are supported or unmet depending on how generous and friendly the local community is. Societal values, in the gap between them and me, between group and individual, nourish these needs in different ways. We both long and hope for security, good relationships, the experience of belonging, being seen and perceived as valuable. The joy of experiencing this and the despair when relationships break up are constant themes in literature, theatre and films. The enigmatic nature of the universe and unfathomability of life, the recognition of one's own helplessness, draws humankind towards something greater than itself. St Augustine claims that the ultimate proof of God's existence is man's innate search for God. Nowadays, Christianity as a collective faith in Norway is consigned to history. The process is called secularisation, a transition from one belief system to another.

Paradigms in our time

One of today's paradigms is confusingly similar to the old faith in Mammon. In our context, this belief system is not named after that god, but it contains many of the religion's attributes. Things, capital and money must meet needs and give hope. Those who don't have, want to have. Those who have much want more. Funds are needed to cover needs, but how much is too much? From the armchairs in our living rooms we seek narratives and hopes about what wealth can offer us. Lack of money and things becomes a modern hell. In our country there are schemes to remedy grinding poverty. Sooner or later the hope for more becomes meaningless and offers no comfort for the end.

In earlier times the prophets of doom appeared with divine authority. They now come forward with scientific authority and promise fire and torment

Another paradigm of our times is the expectation of eternal youth. To be beautiful, attractive, flawless, fit and healthy, just like Aphrodite and Eros, is the hope. Training, diet, operations and creams are the methods, self-exertion the pious life. Prophets come forward and speak or write their gospel and tell us what kind of penance and conversion is needed. Bodily control, weight, proportions and one's reflection in the mirror are crucial for victories and defeats. The dystopia when this fails may be shown by measurements of young people's mental health. If the health project were to succeed, the prize would be old age. The years run their course, and the project collapses. You are the agent of your own happiness, there is no mercy to expect. Ahead awaits a hell of decay.

Gaia is running a fever. Our wonderful planet, with the blue ocean as the basis of life and the green chlorophyll as its engine, is in a sorry state. Our mother, who lends us atoms and molecules for a time, demands them back with penalty interest. In history the prophets of doom appeared with divine authority. They now reappear with scientific authority and promise fire and torment. Words of judgment resound, the environment is threatened, there may be no hope of restoration for the planet. Our voracious drive is the cause, we have collectively sinned against nature. The only remedy is asceticism, a return to the life of self-preservation that we led before 1960. Will we do that? The judgment is collective, everyone faces the consequences. Is there any grace to be had? Can we have hope for the future?

Where can I find hope?

Life, that precious thing, has harboured the inevitable from birth; there will be an end. I am in the graduating class. My health is still good, but the wrinkles are there, my muscle mass is decreasing, the bike ride takes longer. I received a diagnosis and expected the future to be short. But things have worked out better than I thought. Someday I will go, nevertheless, either alone or in a group of others. The latter is not important.

I am and remain religious. In astrophysics and quantum mechanics, in wonder about life and in the face of threats of losing my health and of death, I hear the voice of a God. Knowledge serves me the wrapping. The content is of a divine nature.

In the Eastern churches incense fills the halls. In churches and assemblies, candles are lit during gatherings and celebrations. Music and hymns hum or resonate between the walls. In some places hands are laid on newly baptised and communion guests. Words of comfort for the present and hope for the future are uttered or proclaimed.

We are entering the season of Easter. In the Jewish faith, it marks the escape from many years of slavery. The hope of one day being free, of entering a country offering everything needed, was about to be fulfilled. In the Christian faith the same hope is proclaimed. Beyond these years of joy and sorrow, shortage and surplus, right and wrong, there lies hope waiting. The Easter message turns everything that I have inverted upright. Despair does not need to overpower us. One day justice will prevail, the kingdom of mercy will open up.

From the Eastern churches the cry rings out: 'The Lord is risen!' We answer with feeble or strong faith: 'He is truly risen.' I received this email a few years ago from a now deceased colleague:

Dear unknown colleague!

I was moved to tears and recognise myself in some of Randi's emotions in the face of death. I grew up with strict and narrow Christianity and I myself have cancer with multiple metastases. After many years and struggles, I have finally found a secure trust in and assurance that God is just and merciful, and that Jesus Christ is the one who will meet me in a new and better world. Without this hope, the future would be unbearable.

I cling to this hope. Disappointments will come. The promises are there.

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Published: 29 March 2023

Tidsskr Nor Legeforen 29 March 2023 Vol. 143.

doi:

10.4045/tidsskr.23.0088

Published: 29 March 2023

Tidsskr Nor Legeforen 2023 Vol. 143.

doi: 10.4045/tidsskr.23.0088

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Hope

Basic mood

Existential hope

Paradigms in our time

Where can I find hope?

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