Hope

You with the sad eyes
Don't be discouraged
Oh, I realize
It's hard to take courage

In a world full of people
You can lose sight of it all
And the darkness there inside you
Makes you feel so small

But I see your true colors
Shining through
I see your true colors
And that's why I love you

So don't be afraid to let them show
Your true colors
True colors
Are beautiful like a rainbow
-- Cyndi Lauper

There is a fundamental disconnect in my brain when it comes to hope. I know the placebo effect helps some people actually get better. I know prayer makes some people feel better and, so, with the mind-body connection, at the very least can work like the placebo effect. I know a positive mental attitude can be the only tool that will bridge the gap between success and failure.

But when it comes to medicine there has to be an actual, quantifiable difference between a given treatment's effects and a person's belief that a "snake oil" will lead to the effects. So I find it odd that a suggestion, in any medical field but particularly in mental health, would be to remain positive that a given treatment will help. It is not isolated -- every mental health professional I have worked with in one way or another has emphasized the importance of staying positive. If I were able to stay positive, I would not need help for depression!

So I fake it. I do the closest impersonation I can to remaining positive. I tell others I am positive. I tell myself I am positive. I write positive messages on the lock screen of my phone. I read inspirational quotations. I watch inspirational movies. I listen to inspirational songs. But I still feel like the subtext of "staying positive will help your treatment" is if I don't stay positive (what does that even mean -- is 75% of my waking hours sufficient?) then my failure to stay positive is the reason the treatment did not work. By extension when multiple treatment modalities do not work, I am the reason I continue to have depression. Hell, maybe there was a time when I was not depressed then I decided to start looking at the downsides of life which resulted in my downward spiral -- blame the victim because everything is my fault!

Okay so I took that idea to a ridiculous conclusion (except to the most zealous victim-blamers) but I still assert that any authority figure including a doctor that tells a patient that "staying positive will help your treatment" is setting the patient up in a couple ways. One way is as I just illustrated: if the patient puts a large emphasis on staying positive but gets sicker then on some level the patient will feel blameworthy.

The other way is insidious: if the patient puts a large emphasis on staying positive but would get better no matter what, a false association can form between the necessity of staying positive and a better outcome. The cumulative effect of false associations over time understandably leads to a superstition. Eventually the patient's ritualized positivity can seemingly fail when she gets sicker from something. The patient, trying to make sense of this, may think "hoping for a good outcome helped me many times before but something is wrong now so either I am knocking on death's door or I lack the necessary faith or I need to double-down..." on what had no causal link all along.

I think recommendations from healthcare workers should incorporate a realistic view told with compassion and empathy. Deal with reality on reality's terms so if a given disease for a given person has a 25% survival rate, accept those odds and prepare for every outcome with more emphasis on the more likely outcomes. And if the odds change to a 30% survival rate for hopeful patients, then the doctor ought to explain exactly the sort of hope that bumped up the survival rate. Rarely if ever have I heard survival rates reported in such a way because the impact of hope is not quantified so neatly (at least not with our present understanding).

But people in all levels of the medical industry do have training in how to present hope to patients. I suspect doctors, particularly ones who had formal training most recently, not only know how much hope can impact common situations but also how to most effectively present "how to hope effectively" to patients and families to improve outcomes. As doctors likely have less face time with patients as nurses, techs, pharmacists, administrators, etc have, I would "hope" that the non-doctors are trained to avoid pitfalls I discussed above. Unfortunately too many non-doctors I have interacted with have been misinformed (likely their training, if it existed, was informal) and tend to fall back on whatever faith tradition they were raised with and for patients who do not share their concept of faith, this can be disrespectful or worse.

On that note if you find yourself in the above hypothetical and are part of a Judeo-Christian tradition, God has a plan for you and I bet that that plan corresponds with 25% of folks like you probably not meeting Him for some time. For the rest of you, good news: odds are His plan corresponds with you meeting Him soon! Pray all you want for a miracle but that certainly seems like you want and even expect God to change His plan for you which implies all sorts of odd things (you knowing better than God, you thinking God will make an exception for you, you not understanding that the laws of the universe were written by Him and most miracles would break at least one of those laws, etc). But for the sake of your sanity if you do go with prayer and you get sicker, please do not make yourself feel guilty due to not having enough faith or whatever like some denominations teach -- this can cause stress which is absolutely associated with worse outcomes.