In this competitive world, big hopes call for smart strategies. According to an article in Psychology Today, “Talent, skill, ability—whatever you want to call it—will not get you there . . . A wealth of psychological research over the past few decades show loud and clear that it’s the psychological vehicles that really get you there.” Athletes are agents of big business, but they play on fields of dreams. In the end, sports stars are powered by hope and determination. So, too, are fans, and fans matter because the energy in the stands can fuel the action on the field.
In 2016, Chicago was taken over by hope for one long summer, and many could not let go. Residents and visitors wrote notes to relatives and friends, departed Cubs fans who did not live to witness baseball history. That practice began as the season progressed, and the team closed in on the title. Messages were scrawled in chalk on a brick wall in the bleachers. After the series, fans climbed ladders and stood on accommodating shoulders to find blank spaces to write to loved ones.
Dr. Kenneth Ravizza is a top sports psychologist who has worked with U.S. Olympians and teams such as the New York Jets as well as college teams such as the University of Nebraska Cornhuskers. Ken and I went to high school together. Ken was a star athlete while I was busy getting thrown off the soccer team for drinking beer. I would be suspended from school later that year, though I really cannot remember why. I was a troublemaker and a malcontent, assuring my future career in the news business.
Ken and I had lost touch years ago. We reconnected at a class reunion in 2003. Each of us had to pass up our fiftieth high school reunion in 2016 because Ken was at the World Series as an integral part of the Chicago Cubs organization and I was busy chasing hope.
In the 2016 season, the Chicago Cubs were hot. So were Cubs loyalists. The spark missing for more than a century had been ignited. The Cubs and their fans became partners, and Chicago became a city of hope. The long-suffering fan base became part of the winning equation, with the energy in the bleachers fused with what was happening on the field.
I wanted to talk to Ken about it, so I reached him at his home on the West Coast, where he had been on the faculty of California State University Fullerton until his retirement in 2015. When we talked, Ken made it clear that he does not speak for the Cubs organization, only for himself. Perfect, I answered. I want to know what you think.
“I think the mental game is a big part of baseball,” Ken began. “Under pressure, a player’s skills get better or they get worse.” Major League Baseball is a high-stakes game for everyone on the field, and the pressure can result in enormous amounts of stress. Learning how to handle pressure is critical. Ken pointed out that the all-powerful self-assured athlete is a mythological character. “Confidence is very fragile with elite athletes. They have swagger on TV. They have all that stuff. In reality, they are human beings like all of us, and their confidence wavers.” Ravizza understands that athletes fear that their game will suffer if there are any cracks in their armor.
Ken works hard to keep his players feeling good, though he knows that, for players, staying focused and sure of themselves 100 percent of the time just is not possible. “Your belief in yourself comes and goes over the duration of the season.”
Ken tries to bring a real-world approach to his work with his players, teaching them that in times of uncertainty and anxiety, they can soldier on past any feelings of self-doubt. “Part of the mental game is getting the guys to believe that they don’t have to feel totally confident all the time. If they do the preparation, they don’t have to feel good to do well. That is a big part of our mental skills program.”
Ravizza takes on the long season one pitch at a time. “I tell a pitcher, before you make the pitch, you have to have conviction. You have to commit to what you are about to do. You are better off with one hundred percent conviction on the wrong pitch than eighty percent on the right pitch.” Whether a player is a batter fighting a strong opposing pitcher or a fan struggling with a dangerous disease, I believe hope feeds the conviction that winning is possible.
Ken, however, does not see conviction and hope as the same thing. “If the guy is hoping he’s going to execute the pitch, that ain’t going to work. You can’t just be hoping and praying. You have to bring conviction to what you are doing.” In my mind, it is not a question of either-or. Conviction implies strength, as if a result can be willed into being. It is all a mind game, and I am convinced hope must creep into a player’s head.
“Hope is survival,” Ken said. “And that is as primal as it gets. The whole body is wired for hope.” There was a momentary silence before I realized Ken was addressing my battles, not telling me about sending a message to his players. “That is what motivates us to do anything.” Perhaps players and patients have a lot in common.
The hope I imagine is not passive. It is not as simple as “just hoping and praying.” Hope requires action. It takes hard work, mental flexibility, a willingness to keep one’s eye on the prize. People have to continually adjust their understanding of just what the prize is.
I play in a different arena from any baseball player. For me, the prize is protecting, even recovering my health. I think of my drive to overcome my many maladies. I am determined to up my batting average and beat them, though I realize that may not even be possible. I have enough of a competitive spirit that I continue to take the field, and my family and friends are in the stands.
If hope has the power to keep us going, how do we explain its work in the body? Is hope simply a mind game, or does hope play out in some mysterious way physically? My bottom-line question was simple: Can hope be self-fulfilling?
I had a chance to find out more about how hope could manifest physiologically when Meredith and I went to Boston on a chilly day in October 2016. We were attending the opening of the new Building for Transformative Medicine at Brigham and Women’s Hospital, which houses the new Institute for the Neurosciences. The Brigham, as the place is commonly called, is one of the sixteen hospitals and research centers affiliated with Harvard Medical School.
There was a homecoming quality for me on this day. I had warm memories of my work on the advisory council of the Harvard NeuroDiscovery Center. A number of physician-scientists I knew from my time there now were part of the fledgling institute at the Brigham.
I am also on the advisory council of the new Brigham Institute. Meredith sits on the advisory board of the Ann Romney Center for Neurologic Diseases, which is part of the institute. She had been asked to interview three prominent physicians on this day at a gathering of donors and guests. This would be the first public event in the new building, and I was pleased to cross paths again with friends and acquaintances.
We were milling around a large sitting area, saying hello and being introduced to new people before the program began. I sat in a comfortable chair and chatted with various folks. After a while, Dr. Martin Samuels ambled over and sat at my side. This tall, thin seventy-two-year-old physician is chairman of neurology at the Brigham and directs the Institute for the Neurosciences.
I had been meeting informally with Marty for more than a year, discussing plans for the new institute and trading ideas. Physicians in leadership positions at Harvard frequently seek counsel from individuals from a variety of backgrounds. When I told him of my questions about hope, he said he thought he could make a contribution. Marty talked quickly because people were beginning to move to the designated space for the event.
I wasn’t able to catch everything he said in that noisy room. I would have loved to have taken notes, but I had nothing to write with and have pretty much lost the ability even to hold a pen. MS is the gift that keeps on giving. I thought I remembered the good doctor use the words voodoo death in our brief conversation. Could I have heard that correctly? We made our way to the ceremony and lost track of each other in the crowd. I was left wondering what he could have possibly meant.
A few months later, I joined Marty in his old office for coffee. The Brigham sits across the street from Harvard Medical School, an elegant fortress in look and feel. To reach Marty’s office required going down endless corridors and around corners, a long-enough hike that I had to use a wheelchair to get there.
Marty picked up our conversation about hope, describing a patient he had treated during his residency at Boston City Hospital. The patient had suffered a spontaneous hemorrhage in his brain, which left him unconscious.
The man also had a very abnormal cardiogram, a measure of heart function. Marty told me he had been intrigued by the fact that this man was afflicted by both conditions. The significance of the apparent coincidence was lost on me, but Marty had the sense this was not a coincidence at all, that there was a link between the two. The young doctor decided to figure this out.
“None of the senior residents knew how the brain could have caused the heart to malfunction. That was the single case that got me turned on to this connection between the nervous system and the heart.” Marty believes he later solved the mystery. Following the brain event, the man had regained consciousness, and it became clear he had lost hope.
Marty continued, “This is the mirror image of what you are writing about. It is the absence of hope, the disappearance of hope, and its deleterious effect.” The doctor was on a roll. “This answers the question, Does hope help? There is no question. The negative effect of hopelessness is backed up by a combination of empirical evidence and anecdote.”
Dr. Samuels presented his case in greater detail when he and I met again in late 2016 at the Library Hotel in New York. He and his wife, Susan Pioli, a longtime medical publisher, joined me for coffee. Marty carried his laptop. He had prepared a presentation to explain the negative power of hopelessness and how it can affect the body. We moved to a large table, and Marty set up the visual presentation.
He began with a display of old photos. The first was a vintage image of Walter Bradford Cannon, one of America’s leading early-twentieth-century physiologists. Born in 1871 and educated at Harvard Medical School, Cannon was a pioneer in understanding the influence of emotion on body function.
“Cannon conceptualized the fight-or-flight dynamic, which argues that when an animal is under a life-threatening stressor, there is a system within the brain that causes the secretion of a hormone, which we call adrenaline.” Adrenaline causes the heart to beat faster, the blood to be transferred from the gut to the brain, and the pupils to dilate for better vision. These reactions are part of what Cannon called the sympathetic nervous system, which exercises control over blood flow and the internal organs of the body.
In 1942, Cannon published a paper titled “‘Voodoo’ Death.” I sat up straight. I had not imagined the phrase after all. “Cannon recounted numerous reports of people in South America, Africa, and elsewhere who had been put under spells or curses and inexplicably died.”
Dr. Cannon tracked down trained observers who had witnessed these deaths to see if they could confirm the accuracy of the reports. They did. There seemed to be no observable cause of death and no underlying illness, no secret poisoning and nothing to explain what had happened.
As Marty described Cannon’s investigation, the narrative took on the feeling of a murder mystery. Who or what had killed these people? What Cannon wondered was “whether an ominous and persistent state of fear can end the life of a man.” If so, what was the physiological basis for such a death?
Cannon decided it was because of the “persistent excessive activity” of the sympathetic nervous system. A person who believes himself under a curse, a situation over which he has no control and in which he has no chance of possible survival, will be terrified. Marty paused for emphasis. “Talk about lack of hope. There it is.”
The historic, if anecdotal, evidence corroborating the effect of this powerful emotion on the body is spellbinding, he went on. It appears as early as the New Testament. In Acts 5:1–10, a man named Ananias and his wife, Sapphira, sold a piece of property. Though Ananias wanted it to appear that he was giving all the proceeds of the sale to the apostle Peter, he brought only part of the money to him and kept the rest for himself. Peter asked Ananias how Satan had so filled his heart that he would lie to the Holy Spirit. “You have not lied just to human beings,” Peter said, “but to God.” When Ananias heard this, he fell down and died.
Hours later, Sapphira returned and was confronted by Peter. “How could you conspire to test the Spirit of the Lord?” Peter asked, and Sapphira fell at his feet and died. “This is a historical document,” Marty pointed out. “It just gives you an idea of how long people have recognized that life-threatening stress can mean sudden death.”
Marty explained that there is story after story indicating that intense emotion, fear, and the feeling of hopelessness can have a deleterious effect on health and become life-threatening. The stories are cataloged on Marty’s computer. A seventy-nine-year-old man hears that his granddaughter has committed suicide and drops dead. A woman dies trying to save her daughter in an earthquake.
A child dies on an amusement park ride. A woman’s coat is caught in an escalator in Boston and she drops dead. A driver hits a cyclist and checks on him; the cyclist is okay but the driver drops dead. Most serious scientists dismiss anecdotal evidence. Many of these stories are referred to as “N-of-one” stories in the medical community. “‘N-of-one’ means it is based on a single case,” Marty explained. Today’s trend is to demand that N equal a thousand, or ten thousand, before anyone takes it seriously. So is the validity of an N-of-one case dismissed by the medical establishment? I asked. “The medical community is not a monolith,” Marty answered. “I take it seriously, as do others.” For him, such cases can be instructive. “You write up one case and you learn what that one case teaches you about an underlying biological principle.”
Marty described perhaps the most famous voodoo death case. Chang and Eng were born in May 1811, in a remote village sixty miles outside Bangkok, in what was then known as Siam. They were conjoined twin brothers, and their condition and birthplace became the basis for the term Siamese twins.
When the twins were in their teens, their mother leased them to a British sea captain who exhibited them at carnivals across the United States and Britain. The boys put on an old-fashioned freak show for crowds of gawkers. The twins earned a sizable cache of money in their years on the road, but eventually they tired of the touring.
They became U.S. citizens and moved to North Carolina, where they built a spacious home and opened a store. The two had been slaves to roaring crowds. Now they were slave owners on a new plantation. The brothers celebrated a joint wedding to sisters in 1843, provoking a national scandal amid claims it was bestial. To the astonishment of the public, their wives bore them a total of twenty-one children.
Chang and Eng lived for sixty-three years in their attached condition. One night, Chang died. “Eng awakened the next day,” Marty recounted, “still attached to his dead brother. Eng announced to a nephew, ‘Your uncle Chang just died, so I have to die.’” He did just that. The twins were autopsied in Philadelphia. Marty said, “The autopsy confirmed Eng’s fear caused the adrenaline storm that killed him.” I just stared wide-eyed.
Even in more conventional relationships, the emotional reaction to a death in the family can be traumatic, and often the “bereavement effect” kicks in—a serious physical condition. When an individual loses someone close, the survivor’s feelings of loss and loneliness sometimes lead to hopelessness. Living without hope can increase the risk of damage to internal organs, including the brain.
“After a major loss, the death of a spouse or child, up to a third of the people most directly affected will suffer detrimental effects on their physical or mental health, or both,” according to the BMJ, the British Medical Journal. “Such bereavements increase the risk of death from heart disease and suicide as well as causing or contributing to a variety of psychosomatic and psychiatric disorders.”
Two days after Christmas 2016, actress and writer Carrie Fisher died from multiple causes, suffered on a plane from London to Los Angeles. Twenty-four hours later, her mother, actress Debbie Reynolds, died from a stroke. Nothing in life can be crueler than the loss of a child. “It creates an overflow of stress hormones, and the heart can’t take it,” said Dr. Suzanne Steinbaum, director of women’s heart health at Lenox Hill Hospital in New York. Dr. Anne Curtis, chair of medicine at the Jacobs School of Medicine at the University of Buffalo, told a New York Times reporter, “I’ve seen estimates that about one percent of perceived heart attacks are because of broken-heart syndrome . . . I think every cardiologist has seen cases.”
Trauma of any kind can threaten lives. Marty described a study undertaken in the days following September 11, 2001. Immediately after the attack, doctors at St. Luke’s–Roosevelt Hospital began compiling data on two hundred patients who had been implanted with monitors and defibrillators. These devices monitor heart rhythms. Doctors found the rate of life-threatening heart rhythms had more than doubled in patients during the month after 9/11 compared to the rate the month before.
A traumatic event more than five thousand miles away occurred on January 18, 1991, when Iraqi Scud missiles slammed into Israel. The BBC reported the incident on its website: “Iraq has attacked two Israeli cities with Scud missiles, prompting fears that Israel may be drawn into the Gulf War. Israel’s largest city, Tel Aviv, and Haifa, its main seaport, were hit in the attacks, which began at 0300 local time, (0100 GMT), when most residents were asleep.”
According to Dr. Samuels, a study of mortality records from the first day of the attacks found a 58 percent increase in the country’s death rate over the previous day and an 80 percent increase in the death rate in Tel Aviv and Haifa, the main targets. Nobody had been hit by the missiles that day.
One of the study’s authors said the analysis of hospital and morgue records reinforced the idea that some people may have been literally frightened to death. “This is the opposite of being hopeful and calm,” Marty explained. “This is being hopeless and frightened.”
Our brains are the neuro-hubs of our bodies, with spokes flaring to connect to every organ and system. The organs, our hearts and kidneys and all the rest, exist in the shadow of the brain. So what we think or feel has a direct effect on these organs. According to the American Psychological Association, “When muscles are taut and tense for long periods of time, this may trigger other reactions of the body.” Such as death.
Marty continued, “People who are in a state without hope are like an animal in the wild trying to escape from jaguars. For each of those attacks, there is damage done to the visceral organs. And it’s cumulative.” That means people who live in a state of hopelessness for extended periods may be putting their bodies under long-term physiological stress.
I had been focusing on hope rather than hopelessness. Now I see it both ways. These stories and studies offered clarity. There is no antidote to hopelessness, nor is there a formula for preventing massive quantities of adrenaline from being released. Increasingly, I recognize that people who suffer from serious illnesses must find a way to hope, if only as a survival mechanism.
Physicians have a critical role to play in this effort. In my years dealing with diseases, I have crossed paths with some of the best and brightest in academic medicine. Too frequently, offering hope does not seem to be on their radar screens. They can quash hope, as my first neurologist did when he offered my MS diagnosis by telephone and basically told me to give up. The human touch is in short supply in a medical establishment overtaken by managed care and high-tech treatments. Hope is far less expensive and may be just as effective.
I asked Marty about the most important lesson he learned in his many years treating the sick. Marty said, “My main job is to give people hope. I have helped way more people, by an order of magnitude, with my words . . . than I have with any drug or medication. I think drugs and technologies are greatly overrated.”
Dr. Jerome Groopman has arrived in the same place. In an address to a medical group in Southern California, Dr. Groopman, author of The Anatomy of Hope, discussed his own journey to understanding the need to offer hope to his patients. “I was walking back from the ward to my laboratory, after seeing people with blood diseases and cancer and AIDS. I asked myself what more I could offer these patients whom I had seen that day? The answer that came to my mind was hope. And that answer was at once both exhilarating and terrifying.”
In his book, Groopman wrote, “Researchers are learning that a change in mind-set has the power to alter neurochemistry. Belief and expectation—the key elements of hope—can block pain . . . Hope can also have important effects on fundamental physiological processes like respiration, circulation, and motor function.”
The mind is a powerful instrument, and hope can become self-fulfilling. What one hopes must be measured and plausible. Hoping my illnesses will disappear will not make that happen. Hope that someday soon, some new treatment will mitigate the crippling course of the disease makes sense. Maybe.
I only hope I can find the courage to take reasonable risks. I have started down that road already. I want to live my life with less anger and more grace. I cannot control my fate, but the coping choices I make are well within my power. Control? Control is fleeting. We control very little in our complicated lives. I am not captain of my ship, only a member of the crew, struggling to control the wheel.