Hope

I wish to impress on you and emphasize that what you say [to a person who is ill] is weighty far beyond your concept. Should you find any hope for his recovery and make that your report, like a thrill of lightning dipped in the sea of love, his vitality dances with joy. He is warmed up soul and body. But if you should be indiscreet enough in your report to remove every ray of hope, you have chilled the vital energy, you have silenced it, and the vegetable energies take possession of your patient and drag him with lightning speed to the valley of death. If you have any generalship you will evade anything like reporting that there is no hope for your patient. If you should analyze his substances and by your analysis see that there is no hope, be careful. Tell your patient that he is in such a condition that you wish to observe his case for a few days, weeks or months; that while man is alive he is not dead, and you hope to do him some good, though you and he both know his case is serious. Then if the patient concludes to stay and take a few days treatment always come to him as though you wanted to do him all the good in your power, then he will be satisfied, and not break down in despair. This advice I offer to the young graduates. I think from long experience it is good, and wish you would govern yourselves accordingly. I am giving you the advice that is based upon my experience of many years.

                      -- A. T. Still

Andrew Taylor Still, the first Osteopath, manifested the unity of his worldview through his practice and teaching of Osteopathy. He gave us Osteopathy, a complete and independent system of healing. His genius was demonstrated in the totality of his vision of Osteopathy as a teachable system of healing that could not only alleviate suffering, but also restore hope.

Many physicians who practice 21st century western medicine are destroyers of hope. The western trained doctor is taught protocols aligned with clinical guidelines based upon the current standards of medical and surgical care that are interwoven with legal codes. The overwhelming majority of western medical principles are based upon the linear characteristics of science, negating or diminishing the qualitative aspects relating to the art of medicine.

The art of medicine, or any healing system, is not based upon units of measure or productivity goals. The art of medicine is founded upon real life interactions and relationships between two human beings: one seeking help and the other offering assistance and care.

The partnership, or relationship between the doctor and patient is not founded upon negativity, or upon what should not be done. In other words, the relationship between doctor and patient must not be founded upon the philosophy of "first do no harm." The relationship between doctor and patient must have its foundation built upon possibility or the fundamental force of hope.

Hope is a concept filled with potential and inspiration. In an Osteopathic context, hope is a phenomenon that is potent, or filled with potency. William Sutherland, DO spoke of the potency of the cerebrospinal fluid in an enigmatic way. He identified potency as the "fluid within the fluid." He taught that the potency is the power that resolves problems or truly treats the patient. The potency appreciated by an Osteopath during a treatment is the same potency, or what Dr. Still might call the vital energy, that is activated when we "find hope" in or for our patients.

Hope is often defined as a feeling of what is wanted or a feeling of what will happen. It is based upon trust and reliance. There is a quality, in hope, of expectation beyond our current situation. In hope we seek more. Hope is derived from the Middle English word hopen and the Anglo Saxon word hopian, which means to expect or to look for. It is linked to the Greek word hoffen, which means to "bend and spring on" or to expect to get by springing.

To me, the foundation of hope is being expectant, as in the impending birth of a child. And we don’t just wait passively for hope, we move toward and spring into hope. Hope also contains a sense of trust imbued with potential.

When we are ill or vulnerable it is with hope that we spring or bounce back to Health or the healthy condition. Hope is the energy that propels us out of despair and hope is directly linked with vitality. Dr. Still reprimands us by declaring, ". . . if you should be indiscreet enough in your report to remove every ray of hope, you have chilled the vital energy, you have silenced it . . ." If we as Osteopaths deny hope, we rob our patients of the opportunity to find Health. According to Dr. Still, to remove hope is an indiscretion. To remove hope is careless, reckless, and unkind. Denying hope is to offer a dis-service which is based upon dis-ease. Destroying hope not only demonstrates a lack of wisdom, it inflicts an iatrogenic type of suffering.

To restore hope is "like a thrill of lightning dipped in the sea of love." When we, as Osteopaths, maintain and restore hope, our patient's "vitality dances with joy." The art of Dr. Still's Osteopathy demanded that he engage in metaphor and poetry to describe the glorious magnitude of what occurs during the process of healing. Hope is so powerful it can ignite love. That means that destroying hope, denies love.

According to Dr. Still, hope is not the same as vitality or vital energy. By restoring hope, the rhythm of vitality is activated. To remove hope we freeze the vital energy. Restoration of hope warms the soul, as well as the body.

How does an Osteopath find and restore hope? Restoring hope partially requires what we tell patients verbally. In this way, we are helping to find hope for our patients. We discreetly tell our patients the truth based upon possibility; even "though you and I know his case is serious" as Dr. Still cautions. We engage what is good and healthy in our patients even in the presence of serious or even terminal disease. Finding Health in the presence of overwhelming disease is concordant with one of Dr. Still’s most important teachings. "To find health is the object of the doctor. Anyone can find disease." Deep in our hearts, we all know that a person can be dying of a terminal disease and achieve a “healing,” though he will not be cured. Healing is a holistic spiritual process that does not require the body to be cured in a material manner.

As Osteopaths, we also restore hope in a non-verbal and non-material way when we make contact with our patients during an Osteopathic Treatment. In this way, we are finding hope in our patients. We do this by engaging the "fluid within the fluid," the potency, or the vital energies. There is a type of therapeutic connection we make with our patients that is not dependent upon fixing or renovating. Osteopathic philosophy is based upon trusting that Nature does the work of healing. Dr. Still asked for us to ". . . have unbounded faith that Nature's chemistry is the doctor and the only one on whom we depend for relief." When a person loses hope, they misplace their faith in Nature to heal. They come to us, as Osteopaths, not just to fix but to restore their hope and to make their "vitality dance with joy."

When I see a patient, who is lost in despair, I first aim to restore their confidence, that is, to find hope. I ask that a patient trusts me. However, I don't ask that they trust that I will fix them. I ask them to temporarily trust that I trust that something inside them can heal them. I emphasize that I have "unbounded faith" in their innate healing abilities. I am not repairing them. I am helping to remove the obstructions to healing so they can fix themselves. I restore their hope by helping them re-establish trust in Nature or their inherent natural abilities to heal.

Dr. Still offered his advice of restoration of hope to the young graduates of the American School of Osteopathy in Kirksville, Missouri in the late 1800’s. His advice was based upon wisdom gained from decades of clinical experience as a physician. His council is just as essential in the 21st century as it was in the 19th century. His enlightened leadership applies equally to young graduates and to seasoned physicians who may have forgotten that the art of Osteopathy is, arguably, more important than that science of Osteopathy.

When we are with a patient we have a choice. We can choose to be indiscreet and chill the vital energy, silence vitality, and drag our patient to the valley of despair and ultimately to death. Or, we can find hope like we find Health. We can make our patient's vitality dance with joy.

We could reword Dr. Still's most famous quote to read like this: "To find hope is the object of the doctor. Anyone can find disease." Hope, like Health, is essential and indispensable to any and all categories of healing.

This advice I offer to all Osteopaths: restoring hope is like the thrill of lightning dipped in the sea of love, choose hope over despair and select love above all else.

Steve Paulus, DO