How can hope in serious illness be kept alive, and does being realistic kill hope? Read about the forms hope takes for patients, their families and carers.
Picture a family: as they leave the doctor's office, one of them says happily, "The doctor said there's hope, she'll get better," while another whispers, "But he also said it's going to be a hard road." They both heard the same sentences but understood different things. The patient, meanwhile, stands between them, not knowing what to say to either side. Hope in serious illness lies at the heart of the questions everyone facing a serious or chronic illness asks at some point: Does being hopeful mean ignoring reality? Does being realistic kill hope? In this article I look at what hope is, how it can coexist with realism, how hope can change shape at different stages of an illness, and how family and friends can support this balance. For all questions about treatment options, the course of the illness and medical expectations, the patient's own doctor is the right source.
What Is Hope in Serious Illness, and What Is It Not?
Hope is often equated with a single thing: making a full recovery. This is a very understandable wish, and for many patients it is indeed their greatest hope. From a psychological point of view, however, hope is a broader concept than an expectation locked onto a particular outcome.
Put simply, hope is the feeling that something meaningful is still possible in the future. This "something meaningful" can take different forms for different people and at different times:
- The treatment working
- Pain being brought under control
- Living to see a grandchild's birth or a child's graduation
- Being able to spend time at home with loved ones
- Making peace with someone you have fallen out with
- Completing or leaving behind something meaningful
- Going through the process in comfort and with dignity
What is hope not? Hope is not denying reality. Hope is not having to look cheerful all the time. And hope is not a "willpower" that determines the course of the illness. Sentences such as "If you don't lose hope, you'll recover", although said with good intentions, place a heavy burden on the patient: if things get worse, is it because they weren't hopeful enough? No. The course of an illness does not depend on a person's mood or way of thinking.
Does Being Realistic Kill Hope?
Many families hold back from telling the truth to the patient or to one another, because they are afraid the truth will destroy hope. The thought "Let's not tell him, let's not bring his spirits down" is very common among patients' relatives in Turkey.
Yet in most cases the opposite is true. A patient who does not know the truth, or knows only half of it, senses the tension around them but cannot make sense of it. This uncertainty can increase anxiety and deepen the sense of loneliness. A patient who knows the truth, on the other hand, can direct their hope towards realistic goals, take part in their own decisions and build a more open relationship with their loved ones.
Realism and hope are not opposites; they complement each other. In psychology, an outlook similar to the expression "hoping for good things while also being prepared for the hard ones" is sometimes used to describe this balance: a person can hope for good developments while also being able to talk about difficult possibilities and make plans. These two feelings existing at the same time is not inconsistency, but maturity.
How and how much of the truth is shared varies from person to person. Some patients want to know every detail; others want only the general picture. Asking the patient how much they want to know is a way of respecting both the truth and hope. These conversations should take place together with the doctor and at a pace that suits the patient.
Hope in Serious Illness at Different Stages
Hope does not stay fixed throughout an illness; it changes direction and shape.
At diagnosis: In the first stage, hope often focuses on the treatment working. Shock, fear and denial are also common at this stage. Allowing the person to experience these feelings helps hope grow on healthy ground.
During treatment: Hope can rise and fall with every check-up and every test result. This fluctuation is natural. At this stage, small, near goals (completing one more round of treatment, having one more good week) can make hope easier to carry.
When the illness becomes chronic: When a full recovery is not possible, hope can turn towards living well with the illness: pain easing, being able to continue loved activities, the illness not taking over the whole of life.
In the final stage: Even when the illness has progressed and curative treatment is no longer possible, hope does not disappear completely; it changes shape. A comfortable process, being with loved ones, saying what needs to be said, a meaningful farewell… At this stage, the support of the palliative care team can play an important role. For more on this transition, you can take a look at the article on the move to palliative care.
Hope is sometimes recovering, sometimes having a good day, and sometimes being able to hold a loved one's hand; none of these is smaller than the others.
Hope by Age: Child, Teenager, Adult and Older Person
The shape hope takes also differs according to the patient's age and stage of life.
In an ill child: Children's hopes are often concrete and close at hand: going back to school, playing with friends, going home for the holiday, eating a favourite meal. It is important to explain the truth to children in language suited to their age and to support these small hopes. Instead of firm promises such as "Everything is going to be wonderful", saying "The doctors are working very hard to help you, and we are always with you" is an approach that is both honest and reassuring.
In an ill teenager: Young people's hopes are intertwined with their plans for the future: university, a career, relationships, independence. When illness makes these plans uncertain, young people may experience anger, hopelessness or denial. Respecting a young person's right to receive information about their own illness and involving them in decisions supports both their autonomy and their hope.
In an ill adult: For adults, hope is often linked to responsibilities: raising their children, returning to work, not being a burden on their family. In this age group, the tension between hope and realism becomes especially apparent when planning for the future. For some adults, making practical arrangements is not killing hope, but an expression of the wish to protect their family.
In an ill older person: In older patients, hope is often built on meaning and connection: seeing their grandchildren, telling their life story, living with dignity. Older patients' own wishes may be overlooked by the family out of the worry "let's not upset them". Yet an older person having a say in their own process is one of the most important parts of their hope.
For Family and Friends: How Can We Support Hope?
The attitude of family and those around the patient greatly affects the patient's balance between hope and realism. The sentences below are fictional examples.
Sentences that carry hope and truth together:
- "Let's try to understand together what the doctors said. Shall we write down your questions?"
- "How are you feeling today? There may be days when you feel hopeful and days when you feel scared."
- "What makes you happy right now? Let's make more room for those things."
- "Whatever happens, I'll be by your side."
- "If there's something you want to talk about, however hard it is, I'll listen."
Sentences that turn hope into pressure or hide the truth:
- "Don't think like that, don't lose hope!" It stops the patient from expressing their fears.
- "If your spirits are high, you'll beat the illness." It ties the course of the illness to the patient's mood and creates guilt.
- "Doctors don't know everything. Look, the neighbour's son got up and walked again." It belittles realistic information and can draw the patient away from medical decisions.
- "Let's not tell her, she won't be able to bear it." It can take away the patient's right to receive information about their own life.
It is also very common for family members to hold different attitudes about hope. One may talk positively all the time while another may want to think about the bad possibilities. These differences can create tension within the family. Seeing each person's feelings as legitimate and putting the patient's preferences at the centre can ease this tension.
Carrying Hope in Everyday Life
Hope is not experienced only in big decisions or in the doctor's office; it is usually carried within ordinary days. For patients and their relatives, the small steps below can help spread the balance between hope and realism into everyday life.
- Set near goals. Small, achievable goals such as "sitting in the garden this weekend", "doing a drawing with my grandchild" or "being at home for the holiday" ease the weight of thinking about the future as a whole.
- Notice the good moments. Remembering or noting down a moment of the day that went well, however small, at the end of the day balances the mind's tendency to focus only on difficulties. This is not an obligation to "be positive", but seeing that the good moments are real too.
- Make room for fear as well. Being hopeful does not mean suppressing fear. Talking about your fear with someone you trust often reduces its power.
- Get information from the right source. Random stories or figures found on the internet can create both false hope and unnecessary fear. Asking your doctor questions about your own situation puts your hope on solid ground.
- Remember your sources of meaning. Faith, family, nature, music, making things… The things that give a person meaning can also carry hope during an illness.
Let's say a patient who has been in treatment for a long time has to accept that they will no longer be able to work as before. Their first reaction might be "It's all over." Over time, they may find a new area of hope, such as telling a young relative about the profession they have retired from and guiding them. This is not something smaller that replaces the old hope, but a different and equally real hope.
When Does Hopelessness Become a Cause for Concern?
It is entirely natural for someone living with a serious illness to feel hopeless from time to time. A bad test result, a painful night or a long hospital stay can shake hope temporarily. It is important to allow these feelings to be expressed.
In some cases, however, hopelessness may be a symptom of depression and may require support:
- Hopelessness that lasts for weeks and does not ease at any point during the day
- Loss of interest in everything that once gave meaning
- Thoughts of worthlessness, being a burden and guilt
- A wish to stop treatment altogether (this must always be discussed with the doctor)
- A wish to die or thoughts of self-harm
You can find more about the general features of hopelessness in the article on the feeling of hopelessness. If you notice the patient saying things like "I don't want to live any more", or thoughts of self-harm, do not brush this aside; share it with the treatment team and, in an emergency, call 112 (emergency services). Depressive symptoms can be common in serious illnesses and can be treated; an assessment by a psychiatrist may be important here.
How Is Hope in Serious Illness Addressed in Therapy?
Psychological support does not replace the medical treatment of an illness and does not promise false hope. However, it can help the patient and their family strike a healthy balance between reality and hope.
Areas frequently worked on in therapy in relation to this include:
- Noticing catastrophising thoughts ("It's all over") and developing a more balanced outlook, without dismissing real worries in the process
- Identifying the values and goals that give a person meaning, and thinking about how room can be made for them alongside the illness
- Developing skills for living with uncertainty
- Working on communication skills so that difficult conversations within the family become possible
- Making sense of grief and loss in periods when hope changes shape
While cognitive behavioural therapy helps in noticing and balancing thought patterns, approaches that focus on meaning and values can also support a person in clarifying how they want to live alongside the illness. Individual therapy offers both patients and their relatives a safe space to talk about moving back and forth between hope and fear. For patients with limited mobility, online sessions can also be an option.
Frequently Asked Questions
Will telling the patient the truth crush their hope?
In most cases, sharing the truth in suitable language and to the extent the patient wishes does not crush hope; on the contrary, it helps the person direct their hope towards realistic goals. It is important for these conversations to take place together with the doctor and at the patient's own pace.
Does being hopeful bring about recovery?
The course of an illness does not depend on a person's mood or level of hope. Hope can help the process be lived in a more meaningful and less lonely way; but nobody gets worse "because they weren't hopeful enough". Knowing this distinction protects the patient from unfair guilt.
Everyone in our family thinks differently. How can we find common ground?
It is very common for family members to stand in different places when it comes to hope and realism. Putting the patient's own preferences at the centre, seeing everyone's feelings as legitimate and, when needed, getting support from the treatment team or a mental health professional can make it easier to find common ground.
Does it make sense to talk about hope in the final stage?
Yes. In the final stage, hope can take forms such as a comfortable process, spending time with loved ones or being able to say important things, instead of recovery. These hopes are real too, and they deserve to be supported.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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