This book contains six medical case studies in which hope, or lack of it, played a role in the outcome. Five stories are of Groopman's cancer patients, the sixth the story of his own recovery from severe chronic lower back pain. The book concludes with an account of Groopman's search for scientific answers to the questions that inspired the book: How is the cognitive-emotional complex of hope formed in the mind? How might that complex affect the chemistry of the brain? And how might that, in turn, affect the physiology of the body in a way that would be relevant to healing?


Groopman is a fine storyteller, and these case studies are sharply focused and richly detailed. The cases represent a variety of patient personalities, cancers, and physician styles. Not all doctors do well in every case--including Groopman, by his own estimation. A good part of one chapter is devoted to the challenge of how to balance truth and hope in talking to patients--how to tell the truth without producing despair, how to give hope without misleading.

Groopman's thesis that hope can be a source of healing is illustrated in most detail by the story of his own treatment for chronic back pain. Following a failed lumbar surgery, Groopman suffered 19 years of severe back pain. Nothing seemed to help, and he basically gave up on the medical establishment. He was finally persuaded to see the doctor who had helped Boston Celtics' Larry Bird with his back troubles.

After a careful physical examination, the doctor tells Groopman that it is his fear of pain that is hurting him most, that his ligaments and tendons are contracted from disuse. The prescription? Use them normally, and they will return to their normal state. "Ignore the pain," the doctor tells Groopman. "[It] doesn't mean anything serious. As your mind reorients its beliefs, the pain will lessen."

Groopman is at first incredulous, but slowly realizes, to his chagrin, that he, who believes hope to be a powerful healing force for his patients, has given up hope for himself. An iota of hope stirs, and Groopman begins to visualize doing the many things he had not done for many years. With considerable trepidation, he signs up for the therapy. In three months' time he achieves substantial relief, and in a year almost complete freedom from pain.

In Groopman's stories, hope tends to lead to appropriate treatments, treatments in some cases previously rejected by the patient in despair. Part of this, in Groopman's view, is that hope works at a biological level, as hopeful expectation of success alters brain chemistry in a way that can reduce the body's pain signals that often contribute to patient despair. In his chapter titled "The Biology of Hope," Groopman reviews recent work on the placebo effect that supports his views.


The author is a hematologist-oncologist, professor at the Harvard Medical School and chief of experimental medicine at Boston's Beth Israel Deaconess Medical Center. He has written on numerous medical topics for The New Yorker magazine.


Random House

Place Published

New York



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