Hope is an Overused Word, But the Real Thing Can be Powerful

Most of us know the myth of Pandora's box as the story the ancient Greeks told themselves to explain the presence of bad things in the world. Things like disease and pestilence were sent down as a "gift" with Pandora, the first woman. She was created by Zeus to blight humans and punish their creator, Prometheus, for giving them fire. But how many of us remember the part where, after all the other ills of the world escape, hope gets stuck in the box and remains behind? I sure didn't.

Even today, philosophers debate the meaning of that detail. If hope is the last of the evils, why did it get stuck? On the other hand, if hope is the remedy for evil, maybe it was being kept safe for us. Millenniums later, we still can't agree on the meaning and role - even the definition - of hope. Throughout history and across disciplines, the concept has continued to raise questions. Does hope help us or harm us? Is it an illusion or a virtue?

When I started working on this story, the world hadn't heard of COVID-19. Since then, the virus has turned our lives upside down. But even before the pandemic, the word "hope" was so ubiquitous we couldn't have a polite conversation without it. You couldn't scroll far on social media before coming across #hopefor____ (insert your favourite charity or crowdfunding cause). From cars to soap to pharmaceuticals to presidential elections, millions of dollars are spent on advertising campaigns that peddle hope because it appeals to our hearts even when our minds know better. Now, more than ever, the use - or should I say "misuse" - of the word risks making it meaningless. And yet, maybe we need it now more than ever.

As a university-educated, secular gen-X realist, I find it hard to take hope seriously. I mean, what's the point? Hoping my 11-year-old remembers his tuque will not keep his head warm at recess. Hoping my mother's breast cancer doesn't metastasize won't give her more time with her grandkids. Hoping the Earth's temperatures cool down won't slow rising sea levels. See what I mean? Silly.

So when I found out that the University of Alberta is a world leader in hope research, I wanted to know more. What is the value of hope and is it something we can learn? What I discovered is that hope is something we all have, whether we think we believe in it or not. Research is revealing that it can be a powerful tool for better mental health as well as a robust predictor of well-being.

From anxiety to aging to chronic pain, it turns out that hope is good for our health.

*****

Denise Larsen, '88 BA, '92 BEd, '95 MEd, '99 PhD, has studied hope for 18 years and can define it without hesitation: it's the ability to envision a future in which we wish to participate.

As a young elementary school teacher in the early '90s in Edmonton's inner city, Larsen met kids facing incredible obstacles. "We had children who were going through very difficult situations with parents with addiction, or where there was no food in the house, or where in the wintertime there was no electricity or heat," she says. "They would climb into bed after school to stay warm and they would stay there until they got up in the morning to go to school. The family would all sleep in the same bed to stay warm."

One little boy, Jeremy, has never left her thoughts. "He just had the biggest, brightest smile the moment he'd see me," Larsen remembers. One day, while working one-on-one with Jeremy, she asked him how he got so many red marks along his arm. He told her they were burns from his mom's cigarettes. "It's how she woke him up in the mornings."

Larsen couldn't understand how Jeremy managed to stay so cheerful despite his trauma. "I began to wonder what hope looks like for children and what it is that allows them to stay so excited about life when it's that hard, particularly when a little one is so vulnerable."

She followed these questions to graduate school at the U of A, where she studied counselling psychology and worked with children and adults who had cancer diagnoses. "I would work with people who had very uncertain prognoses yet who seemed absolutely committed to engage in life and were insistent that they not be treated as if their situations were hopeless." It was yet another experience that turned her assumptions on their heads.

"Given what hope seemed to do for people, I began to be curious about what we could do to foster hope. How can we help people access it?"

Larsen couldn't have been at a better place to research hope and the ways it could help people. The U of A was at the forefront of hope studies under the leadership of Ronna Jevne, '70 BEd, in the Faculty of Education.

In Jevne's case, it was her work as head of psychology at the Cross Cancer Institute in the 1980s that first sparked her curiosity about hope. She was struck by the disconnect between the language of her profession and the language her clients used. "People didn't walk into my office and use the psychological jargon of our discipline like, 'Oh, my self-efficacy is weak,' she says. "They would walk in and say, 'I don't know what to hope for anymore' or 'I never gave up hope.' " In her practice, she observed people who had lots of coping skills and support in life, and they still didn't act on their own behalf. "So I said, 'Something's missing, and I think that thing is hope.' "

Later, as a U of A professor, Jevne worked with community leaders to found the Hope Foundation of Alberta research lab in 1992. While others around the world focused on measuring hope and its effects, Jevne wanted to know what hope looked like in practice. "What should a physician say or do differently if he wants his patient to feel hopeful? What do we need to do in schools if we want people to be hopeful?"

The foundation took the form of an integrated clinical, research and educational centre. It was one of the first community-university partnerships at the U of A. In 2003, Larsen took over as research director at what is now Hope Studies Central. She and her research team have developed and tested easy-to-learn and easy-to-implement strategies to build hope with students and clients. Their studies have examined the role of hope in many contexts, including schools, addiction clinics, medical clinics and the child welfare system, as well as in people with chronic conditions such as Parkinson's disease or chronic pain.

Nowadays, Larsen and the Hope Studies team speak publicly to more than 3,000 people a year - evidence of the deep thirst in our society for hope and for practical ways to apply it.

Those practical applications of hope are already taking root at a school in northwest Edmonton thanks to a U of A project.

I'm trying to ignore my numbing fingertips and understand how a tree is a message of hope.

"We took a picture of one standing tree, surviving in the winters to last in the summer," says Raheem Chamberlin, 11. "It's committing to standing strong the whole winter. So in the spring and summer, it can get all its leaves back."

Raheem and his Grade 6 classmates are walking around their snow-covered schoolyard taking photographs of things that symbolize hope. The class is part of two U of A pilot projects in Edmonton working with the Strengths, Hopes and Resourcefulness Program (SHARP), research led by Larsen and Rebecca Hudson Breen, an assistant professor of counselling psychology at the U of A. The team is gradually developing resources and expanding the program within Edmonton Public Schools and beyond to other Edmonton-area schools. Eventually, materials will be available to schools across Alberta.

The program teaches teachers and students how to foster hope in their lives and build resilience. For a long time, Larsen says, educators didn't believe kids could talk about hope. They argued it was too abstract to apply in the classroom. Remarkably, she and her team are finding that hope is exactly what kids should be talking about. "Hope holds meaning for kids," she says. Talking about hope is making explicit the need for kids, and for all of us, to connect, to cope and to find our strengths.

Raheem's teacher, Amy Badger, '01 BEd, sees the need first-hand. "Our kids are really struggling emotionally and it's manifesting physically," she says. "You have kids with headaches, you have kids with stomach aches. And they just don't cope. An 11-year-old is not developmentally able to cope with something like divorce or being bullied. They can't. They're not ready for it; they don't know how."

The SHARP model focuses on developing "soft skills," like critical thinking and resilience. Badger incorporates hope-focused learning activities into every subject on a daily basis. Listening, self-awareness, community service and reflection are the central pillars of a SHARP classroom. One lesson asks students to reflect on their own "hope suckers" - things that cause them stress and anxiety - and the strategies or "hopeful behaviours" they can use to feel better. Raheem says his hopeful behaviour is to "take a break and come back stronger."

Raheem is outgoing and articulate. He seems confident. And yet he's new to the school this year, his teacher tells me. He misses his old friends. Plus, he says, his dog was killed by a car last year, which was really hard for him. Learning about hope has not only made school more fun, he says, it has also made him more hopeful. He has learned that hope is more than resilience. "It's way more than just getting up and keeping going. It's working together as a community and caring for each other."

Badger, who has embedded hope in her teaching for close to a decade, sees the impact every day. "They take it home with them. As a teacher you want everything to transfer to real life. But this is one of the things that really does connect to their real life."

Jacki Newman knows that hope works. It saved her life.

Newman, a physiotherapy aide at the time, was diagnosed in 1993 with a rare nerve disease. Now known as complex regional pain syndrome (CRPS), it caused excruciating pain through her right arm and shoulder, pain so extreme that she couldn't work or care for her two young children. Doctors tried everything - pain medications, anti-seizure drugs, even a nerve-blocking procedure - but nothing worked for long. One time she drove to the High Level Bridge in Edmonton planning suicide before thoughts of her husband and children made her turn back. Her husband had heard Jevne speak at a conference and urged his wife to see her.

At her first counselling session with Jevne, Newman was belligerent. She didn't think anything could work. After the third session, she told her husband, "She's going to save my life." The hope strategies varied. Once, Jevne took a photo of Newman holding a doll and asked her, "If you were a child, what would you say to this child?" Newman replied, "You can do this." Another time, Jevne asked Newman what her idea of hope was. "I realized I had no hope. So many doctors had taken it away from me."

It wasn't smooth sailing. There were setbacks, more thoughts of suicide. At one point, Jevne sent Newman to take photos that symbolized hope to her. She took one of a closed barn door, symbolic of closing the door on thoughts of suicide. Eventually, she started painting, writing and finding distractions from the pain. Today, she says, hopeful activities continue to give her the ability to deal with her illness.

"I have a chronic illness. I will never get better," she says. "But hope has taught me to live in the moment. It's the hope of enjoying the moment I am living. … Physically it didn't make any difference. But it gave me the coping skills to understand what was happening with the pain in my body. I can make it worse by doing or feeling certain things. I learned to start protecting myself with hope. … Hope is energy in your body."

Having Jevne and her family physician listen to her - empathize, not sympathize - was a key piece in her recovery, Newman says. She has joined Jevne on panels and lectures for nurses, physicians, graduate psychology students and others to help them understand the value of hope. "I don't want sympathy or pity. I want to inspire people to find their own hope and to live a good life even if you are in pain. Because it's possible."

The skills she has learned are still helping her cope, even as her children and husband have encountered health challenges of their own. "Hope has allowed me to draw on my strength and keep the family going. Hope is like a life‑jacket that is keeping me afloat."

Despite stories like Newman's, not everyone is convinced about the tangible benefits of hope.

"There are people who don't believe that hope is an asset, rather that it gets in the way, sedates people into inaction," says Larsen. Research, hers and others', refutes that idea. In 2014, for example, her team facilitated a hope group with chronic pain sufferers, a population that often struggles with depression and self‑isolation. After a six-week intervention, the participants had an enhanced sense of hope and a decreased focus on the problem.

"The problem didn't go away - and we never promised that it would - but they actually engaged in life. They self-reported going out and doing more things, becoming more involved, becoming more engaged," says Larsen. A similar trial published in 2019, led by Larsen and Janis Miyasaki of the Department of Medicine's Parkinson and Movement Disorders Program, used the SHARP model with people with Parkinson's disease and yielded similar results.

The bottom line, Larsen says, is that although hope may have a soothing quality, it's not passive. On the contrary, it's highly motivating. "When we can imagine a future that we hope to participate in, we're energized. We're mobilized to take action to do something different."

Jevne believes some of the skepticism comes from the intangible nature of hope. "You can't draw blood and see whether people have it," she says. While quantifiable tools to assess people's hope, such as the hope scales, have been used by practitioners and researchers for decades, Jevne says hope is best identified and understood through observation and narrative, which don't always satisfy the quantitative research paradigm.

"We keep trying to put it in a box. You can't put it in a box. You can't wrap it. But you can know components. You can know aspects of it."

And as research provides more and more quantitative evidence that hope does work, physicians and scientists are coming to see its potential as powerful medicine.

"It's backed by evidence," says Peter Silverstone, a U of A neuroscientist and psychiatry professor who researches mood, anxiety and self-esteem. "The science is clear that hope or optimism impact many medical outcomes as well as psychological outcomes. … Those patients who have greater hope or optimism tend to do better in terms of clinical outcomes."

One of the big questions is how hope alters our brain chemistry. Scientists know that certain regions in the brain are involved in a variety of emotional states, but there is still much to learn about how those emotions work, Silverstone says. "Understanding emotions scientifically is very hard. We cannot yet, for example, even understand very profound psychological changes in the brain. I cannot point to a brain or a scan and say, 'This defines schizophrenia or bipolar or major depression or attention deficit disorder or obsessive-compulsive disorder.' So it's no surprise that we can't define less 'hard' concepts such as hope and optimism." Silverstone predicts our understanding will grow tremendously in the coming years, thanks to big data and developments in artificial intelligence.

"Over the next 10 years, maybe 15, we are going to see dramatic increases in our understanding of what may underlie both mental health issues and the way people think," he says. "We're starting to marry the power of artificial intelligence with the extreme amounts of information captured in more detailed imaging techniques. We're just at the cusp of that."

*****

Wendy Duggleby, '90 MN, came to hope studies through death.

As a registered nurse living in Texas in the 1990s, Duggleby was also doing doctoral research on the experience of pain in elderly hospice patients. One day she went to interview an 80-year‑old man. "I took one look at him and I thought, he's not doing well." She offered to return in a few days, but he insisted on doing the interview. "I won't be here in two days," he said. Duggleby could tell he wanted - needed - to tell her something. His words jarred her. "I don't have much pain because I have hope." Two days later the hospice co-ordinator called to tell her he had died. She was the last person to speak with him.

His revelation flew in the face of the assumption that people who are dying don't have hope. It inspired Duggleby to turn her attention to hope and its role in end-of-life care. She set out to define the phenomenon and figure out a way to help other people find their hope.

"Hope is the possibility - not an expectation - of a better future, but that future can be defined in moments," she says. "For someone who's dying, it might be: in the next couple of minutes I'm going to be able to breathe better, or I hope to see my family, or I hope to talk to my family, or I hope that my wife is going to be OK after I die."

Duggleby is now a professor and, until recently, was research chair in aging and quality of life in the U of A Faculty of Nursing. Her studies and pilot projects have worked to better understand hope and the role it plays for patients, families and caregivers dealing with chronic illness, dementia, Alzheimer's disease or terminal illness. Just like studies into new pharmaceutical treatments, these studies use randomized control trials and other proven research methods. The goal has been to create tools and strategies to help people cope on an individual level and also help health professionals and long-term care facilities better care for their patients.

Her research with hundreds of hospice patients has found that the biggest barrier to hope is their uncertain futures. And so she encourages them to plan the future in small moments. One man planted a tree. One woman wrote letters to her family and hid them in her house to be found after she died. Another woman wrote a thank-you note in her community newsletter. One woman in palliative care started to knit. "Her daughter was pregnant and she didn't know if she'd be alive when the baby was born, but she was wanting to leave this. And she talked about how that gave her hope," Duggleby remembers.

These examples are from participants in Duggleby's Living With Hope research project, an initiative to evaluate the effect of psychosocial interventions in palliative care patients. The research has identified strategies, tools and exercises people can use to find hope. The activities help palliative patients find meaning and purpose in their lives and decide what is important to them. Duggleby has also developed a Living With Hope program to help family caregivers of people in palliative care.

An important component of the Living With Hope program - which is available for anyone to access and apply to their own lives - is to actively recognize, allow and encourage hope. "We can go a long way just by making hope more obvious and making it a part of what we talk about," says Duggleby. "When we don't look for hope or when we negate others' hope, we actually lessen their joy."

She says each of us will find hope in a different place because it's a personal journey. "Hope is about small things, not about big things," she says. It's about looking at the things you can control. Who will you choose to talk to? What music will you listen to? Is there one small thing you can do today that would give you hope?

"Through all the studies I've done, hope is so essential," she says. "It's highly, significantly correlated in a positive way with our well-being and our quality of life."

I don't consider myself a spiritual person. So it's probably just a coincidence that my last interview for this story was with a spiritual counsellor. Named Augustine. On Christmas Eve.

Augustine Parattukudi is a registered psychotherapist who teaches counselling psychotherapy at St. Stephen's College on the U of A's North Campus. Born in southern India and raised Catholic, Parattukudi grew up surrounded by religion. He remembers waking up every morning to the woven sounds of church bells, Hindu temple music and the Islamic call to prayer. He studied theology and philosophy and took a particular interest in Buddhism and its emphasis on compassion, which led him to the counselling profession, first as a hospital chaplain and then as a registered therapist.

When I started researching hope, I wondered how researchers were able to carve out an investigative space for hope that didn't include faith. But even Parattukudi does not link hope to any one faith. "For me, hope is much more existential," he says. "It is beyond a spiritual or religious language. It's the essence of human living and is just as true as suffering. It's as true as any human experience. I think hope is just sort of language for the next moment."

We all have hope but sometimes we need each other to help find it, Parattukudi says, because hope is not a product you can build or borrow. It's something you have to experience or awaken to through human connection and compassion. "Cultivating hope is cultivating human connection."

Even those who appear hopeless may not be, which is why it's important to seek it out and talk about it. Even the act of going to a therapy session is hopeful, he says. "When a person says 'I'm hopeless,' they are really looking for someone to help. They're actually speaking the language of hope."

This reminds me of a story Larsen shared. One of her studies asked clients to watch a video of a recent counselling session they had attended. They were then asked by the researcher, who was not their therapist, to stop the video at the moment they most felt hope. "One of the first places they find hope is when the therapist really listens to the problem and takes them seriously," Larsen says.

Connection is recognized in nursing, education and psychology as important to build hope. In that connection is communication: being explicit about hope, sharing why we need it, when we feel we've lost it and how we might find it again.

"That is a true source of hope," says Larsen. "To be heard and understood."

I thought writing this story would make me more hopeful. I was only half right. I remain suspicious but I've come to see hope in a new light.

The hope I am taking away from this story is the hope of school kids who cope with sadness and anxiety, the hope of people who talk through their depression and the hope of hospice patients who wake up each morning and live. This hope is not a cure-all. It's a mindset. It's an orientation, as Jevne puts it. "Because if you're oriented to the world by fear, you're always looking for what you're afraid of, what could hurt you," she says. "If you're oriented towards hope, you're looking for what might make a difference."

I see now that people can learn how to find hope, even in the most drastic situations, and that it's a powerful tool, especially when placed in the hands of the helping professions. Trailblazers like Jevne, Larsen and Duggleby have forged ahead, even in the face of resistance, to better understand hope because they have seen the impact first-hand. Their work shows that hope is rooted in connection. And that we take hope for granted, or even dismiss it, when it is exactly the thing we should be talking about.

The more we understand hope - how it works and how to talk about it - the more we can learn and teach how to be resilient in the face of whatever the future brings.