Hope in Health

The Socio-Politics of Optimism

Kenneth A. Loparo, Alan Petersen

• Publisher: Palgrave Macmillan
• Year: 2015
• Print ISBN: 9781349595679, 9780230361935
• eBook ISBN: 9781137313867
• Topic: Psychology
• Subtopic: Education General
• Index: Psychology

Health professionals have shown a growing interest in the therapeutic value of 'hope' in recent years. However, hope has been examined mainly from psychological and biomedical perspectives. Importantly, Hope in Health explores how hope manifests and is sustained in various arenas of health, medicine and healthcare.

1

The Politics of ‘Hope’ in Health

The loss of hope and courage can have a deadly effect.

(Frankl, 1984; orig. 1946)

Hope is the worst of all evils, for it protracts the torment of man.

(Nietzsche, 1986; orig. 1878)

The theme of hope and its significance has been of enduring concern. It can be found in the writings of philosophers, novelists, patients, clinicians, religious authorities, politicians, and social activists. References to ‘hope’ stretch back to ancient times and figure in social and political movements of diverse persuasion. However, increasingly, ‘hope’ saturates both popular and political discourse and is seen to have some essential quality needed to unite communities and achieve change. According to a growing body of writing, ‘hope’ is a major motivator of action, a source of resilience, and a means of overcoming adversity—in times and contexts of social and physical constraint, limited options, and despair. Barack Obama’s ‘Hope’ poster has become iconic in representing both the 2008 Obama presidential election and the aspirations for a brighter future held by many people following the pessimism and paranoia of the Bush era.

A burgeoning scholarship in the field of health and healthcare, including biomedicine, contributed in large part by psychology and the health sciences, documents the value of ‘hope’ for patients’ wellbeing, if not for their recovery, or at least for their ability to cope with their suffering and the apparent ‘hopelessness’ of their present circumstances. The last three decades has seen a significant increase in the number of articles published in the health sciences focusing on the topic of hope, with a large proportion dealing with promising biomedical innovations or treatment regimes. During this period, many writers have described the dimensions of ‘hope’ and its benefits in health and healthcare, with a number of ‘hope scales’ or ‘indices’ developed and used to measure its influence and impacts (Brown, 2014). Indeed, since the early 1990s, in the sphere of health, there has emerged a substantial body of ‘hope theory’.

The benefits of ‘hope’ for one’s survival in this life or beyond (spiritual wellbeing) have long been recognised by the religious, the sick, the oppressed, and the interned (e.g. prisoners of war) (see, e.g., Frankl, 1984; orig. 1946). For example, Viktor Frankl, a Holocaust survivor, explained, in his book Man’s Search for Meaning (1984; orig. 1946), that life has meaning and purpose even under conditions of despair. His psychotherapeutic method involved imagining a better world in the future. He noted that the way prisoners imagined the future affected their prospects for survival. However, through its history, ‘hope’ has had its detractors. Friedrich Nietzsche’s quote above captures a view on ‘hope’s’ diversionary, if not dangerous, affects. In the late nineteenth century, Karl Marx warned of the dangers for underclasses of the ‘false hopes’ of utopianism and religion that blinded ‘men’ to their true interests, although he himself had been portrayed as offering a utopian vision of a socialist future. According to these writers, ‘living in hope’ shifts attention from people’s current material conditions and suffering and the actions needed to effect change. Through history, there have been many constructions of ‘hope’. Indeed, as I explain in Chapter 2, one can trace a shift in the discourses of hope from the pre-modern to the contemporary period, when ‘hope’ increasingly becomes imbued with strong positive connotations and is seen as something to be ‘instilled’, ‘fostered’, ‘promoted’, and ‘sustained’.

This book offers a sociological perspective on this shifting landscape of ‘hope’ in the contexts of health and healthcare. While not denying the benefits that may accrue from an optimistic outlook or disposition for individuals and groups, I wish to step back somewhat from current debates on the personal or therapeutic value of ‘hope’ to offer a socio-political perspective on the discourses of hope. I examine the ways in which the concept and the language of hope are increasingly deployed in diverse contexts to legitimate certain policies, programmes, and practices, to engender particular ways of thinking and acting, and to help shape the future. I seek to explain the relatively recent rise of the discourse of hope in relation to health and why it has achieved wide salience. I explore the programmes and expertise employed for engendering ‘hope’ in health and healthcare as well as the implications of ‘hope-engendering’ policies and practices for patients and families, for different communities (e.g. healthcare workers, patient groups), and for political action oriented to bringing about the kinds of social changes that are most likely to improve people’s health and wellbeing. In Chapter 3, I discuss the concept and significance of ‘false hope’ and ‘realistic hope’, which suggests that one is able to make a judgement on a subject that is generally seen as ‘purely personal’ and subjective. My starting premise is that ‘hope’—its meaning and applications—is socially constructed and thus subject to change across time and place. Further, discourses of hope have served particular political agendas, increasingly those associated with neoliberalism. More and more, citizens are called upon to adopt a ‘hopeful’ outlook and to conduct their lives in an optimistic manner. This is congruent with the broader emphasis on the optimisation of ‘health’ and the value of an entrepreneurial approach to life (Chapter 4). My perspective then differs from the majority of other writings on this topic that explicitly or implicitly view ‘hope’ as a psychological construct or cognitive orientation or a biologically ‘hard-wired’ disposition or emotion (Chapter 2). Indeed, I seek to draw attention to the dangers of the tendency to view ‘hope’ in psychological or biological terms and to highlight the inescapable socio-political implications of the imperatives surrounding the adoption of ‘hopeful’ outlooks and actions.

While many writers have written about the ‘power of hope’ to motivate actions—as though ‘hope’ had some essential quality or essence—most have failed to examine the socio-political implications of the discourses and practices of hope, that is, the ways in which efforts to engender ‘hope’, including its particular objects (that which are ‘hoped for’), are bound up with broader projects oriented to shaping selves and society in particular ways. I am interested in the shifts in the workings of power associated with hope-engendering health policies and programmes and in exploring the implications of practices of ‘hope promotion’. In Chapter 2, I offer a genealogy of ‘hope’ that acknowledges how the discourses of hope are intimately connected to the workings of politics and power. My approach to ‘hope’, then, offers a corrective to the excessive optimism of the present and to the assumption that a ‘hopeful’ approach in health and healthcare should necessarily always be positively valued. In developing my argument, I seek to contribute to a rethinking of the object of the sociology of health and illness, strongly focused as it is on the ‘sufferings’ associated with biomedically defined conditions and with the practices of biomedicine (Chapter 6). ‘Hope’ and ‘suffering’, like ‘love’ and ‘fear’, are significant categories for articulating human experience; however, sadly, the sociology of health and illness, and sociology more generally, has failed to offer a sustained analysis of these categories and the implications for understanding the human condition and rethinking more familiar concerns such as ‘health inequalities’, ‘medical dominance’, and ‘consumerism in health’.

This chapter provides an introduction to the seminal literature on the concept of hope and makes explicit the assumptions that guide my analysis in the chapters that follow. This literature, while diverse and informed by often very different concerns, I believe, offers the basis for a distinctive sociology of hope in the contexts of health, medicine, and healthcare. As will be seen, this work is nourished by and in turn nourishes diverse strands of social thought that have different practical implications. However, all writings on ‘hope’ need to be appreciated in the socio-cultural contexts in which they arise and which are characterised by some common concerns.

The different levels of the socio-politics of ‘hope’

The socio-politics of ‘hope’, I argue, operates at a number of different levels—personal, interpersonal, and societal—that I seek to elucidate in this book. Increasingly, citizens are expected to assume a ‘positive outlook’, to remain ‘hopeful’, and to play an active role in the project of advancing and optimising health. The political and practical significance of what is a largely psychological and therapeutic framing of ‘hope’ has been sadly overlooked in writings on hope that have tended to be largely uncritical in relation to the bodies of knowledge and ways of understanding brought to this topic. Insofar as ‘hope’ is considered at all, the concept tends to be viewed as a subject of knowledge rather than as a method that can serve to reorient knowledge. As Miyazaki (2004) argues, with reference to Ernst Bloch’s classic three-volume The Principle of Hope (1986; orig. 1959), philosophy and anthropology—and one could add sociology and other fields of social inquiry—are contemplative forms of knowledge. They offer retrospective epistemologies in that they reflect on past events and hence fail to capture the social dynamics of knowledge production and the ever-shifting links between power and knowledge. Miyazaki, an ethnographer/anthropologist, suggests that ‘hope’ can serve as a method of knowledge to offer a more prospective or future-oriented approach to knowledge. An investigation of ‘hopeful moments’, as in relation to the Savavou (Fijian) people’s land claims that he examines, for example, can provide insight into how groups construct their worlds, develop self-knowledge, and orient their actions.

Viewing ‘hope’ primarily through a psychological lens and in therapeutic terms has obscured ‘hope’s’ significant socio-political implications. The project of ‘instilling hope’ or ‘engendering hope’ has been an aspect of the growing field of positive psychology that promotes the health and wellbeing-enhancing benefits of ‘positive thinking’ (Ehrenreich, 2009) (Chapter 2). Positive psychology is a largely US innovation, but its knowledge has influenced thinking in many parts of the world in line with the globalisation of economic, political, and cultural ideas. Positive psychology has been bound up with the privatisation of hope (Thompson and Žižek, 2013), whereby broad utopian visions and collective endeavours of change have been largely replaced by a focus on individual aspirations defined and constrained by present concerns. Despite the increasing influence of discourses of hope in various domains of social life, sociologists have paid surprisingly little attention to the concept of hope, notwithstanding some nascent references to it in classical sociological texts (Swedberg, 2007), to which I will refer. This book then offers a sociological contribution to understanding the discourses of hope, in particular how they have shaped and may shape thinking and action in various domains of health and healthcare. These include the practices of health policymaking, policy and public responses to fields such as anti-ageing medicine and stem cell science, patients’ and their families’ decision-making in relation to treatments, and decisions by clinicians in relation to predictive and diagnostic testing and treatment paths. A sociological understanding of ‘hope’ is not of ‘purely’ theoretical interest: it has practical implications for those engaged in policymaking and professional practice in the field of health and healthcare as well as for patients and families who are called upon to adopt a ‘hopeful’ stance when faced with illness, disability, and the prospect of death. However, I contend that the implications extend beyond the arena of health, medicine, and healthcare and affect everyone regardless of their current health status.

The meanings of ‘hope’ in health and healthcare closely parallel the meanings of ‘hope’ in the sphere of religion. As I will explain, the themes of salvation, resurrection, and redemption increasingly have infused the meanings of ‘hope’ in the sphere of health, medicine, and healthcare. Health itself has become a new religion and, for many people in contemporary society, serves as a substitute for engagement with the formal institutions of religious worship. In discussions of hope, particularly those influenced by psychological and psychoanalytic perspectives, one can often see extensive use of religious language and references. In his psychoanalytic analysis of technological society, The Revolution of Hope, published over four decades ago in the context of the Cold War, Erich Fromm pointed to the close links between ‘hope’ and ‘faith’—that is, ‘the conviction about the not yet proven, the knowledge of the real possibility, the awareness of pregnancy’ (1968: 26). Fromm emphasised the ‘activeness’ of ‘hope’, which he believed was a ‘state of being’ involving an ‘inner readiness’ (1968: 24). Faith and hope, he argued, ‘are by their very nature moving in the direction of transcending the status quo, individually and socially’ (1968: 28). This ‘moving quality’ of life, he contended, is necessary if the individual is to grow ‘stronger’, ‘wiser’, and ‘more courageous’ and is actively pursued by the individual. Society, like the individual, must never remain static or it will ‘decay’ (1968: 29). ‘This concept of personal and social transformation’, he argues, ‘allows us and even compels us to redefine the meaning of resurrection, without any reference to its theological implications in Christianity.’ In its secular conception, ‘resurrection’ involves ‘the transformation of this reality in the direction of greater aliveness’. As Fromm explained:

Man and society are resurrected every moment in the act of hope and of faith in the here and now; every act of love, of awareness, of compassion is resurrection; every act of sloth, of greed, of selfishness is death. Every moment existence confronts us with the alternatives of resurrection or death; every moment we give an answer. This answer lies not in what we say or think, but in what we are, how we act, where we are moving. (1968: 29)

Fromm argued that ‘Faith and hope and this-worldly resurrection have found their classic expression in the messianic vision of the prophets’ (1968: 29). The ‘most significant expression’ of ‘messianic hope’ in its secular manifestation, he observed, was Marxist socialism, at least before it was ‘corrupted and destroyed by the communist distortion of Marx’ (1968: 31). In his classic work, The Principle of Hope (Volume 1), Ernst Bloch, too, saw Marxism as offering the route to the hope of the better life (1986; orig. 1959: 17). However, Bloch offers a complex perspective, drawing from German idealism and historical materialism and involving diverse historical, metaphorical, and utopian elements. Again, the active, productive character of ‘hope’ is emphasised. In this account, works of the past contain ‘the premonitory and pre-figurative images of the next stage of society’ (Plaice et al., 1986: xxvii). The Principle of Hope provides a kind of encyclopaedia of those cultural influences (e.g. novels, visual art, music) and figures that have provided the guiding images that enable humans to ‘venture beyond’ the present, to imagine that which is, in his terminology, ‘Not-Yet-Conscious’ (Plaice et al., 1986: xxix). This ‘Not-Yet-Conscious’ involves an ‘individual psychological dimension as well as social and political expression’ (1986: xxix). It is interesting to consider the context in which these influential works arise: Fromm’s work was written against the background of the Cold War and the spectre of nuclear annihilation, while Bloch’s three-volume The Principle of Hope was produced in the context and immediate aftermath of the Second World War and the violence of fascism. In other words, these books themselves are artefacts of periods of despair and foreboding that engender efforts to articulate the preconditions for a more optimistic future.

The healthy self

Fromm’s and Bloch’s view on the ‘activeness’ of ‘hope’ finds resonance in later formulations of neoliberalism and the entrepreneurial self (Rose, 2007), where individual hopes are strongly attached to the ‘freedoms’ to pursue certain suggested practices or ‘technologies of the self’. Over the last three decades or more—corresponding with the rise of ‘neoliberal’ philosophies and policies in many countries—sociologists have documented the rise of the ‘healthy self’ and the phenomenon of ‘healthism’ (Crawford, 1980, 1994; Skrabanek, 1994), where the norms of individual ‘healthy lifestyle’ and an often-obsessive attention to one’s bodily functioning and appearance dominate discourses of health and serve as the basis for a new form of morality. Healthism promises salvation of the self—resurrection or transcendence through intensive work on the self through attention to exercise, correct diet, adequate sleep, ‘healthy’ sexual practices, and so on. Striving for the optimisation of health has become a kind of religious practice (Chapter 4). However, rather than worshipping some external deity, individuals worship their body, in some cases to an obsessive degree, utilising diverse expertise and technologies in pursuit of an idealised conception of ‘health’. While the obsession with health and ‘correct’ diet and weight have characterised earlier periods in human history, such as in ancient Greece (Foxcroft, 2011) and mid-twentieth century fascism (Theweleit, 1987), increasingly health is ...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright
• Contents
• Acknowledgements
• 1 The Politics of ‘Hope’ in Health
• 2 The Power of ‘Hope’
• 3 Technologies of Hope
• 4 Hope in Optimising Health
• 5 Hope of Immortality
• 6 ‘Hope’ in the Future
• References
• Index