True hope is cleareyed. It sees all the difficulties that exist and all the potential for failure, but through that carves a realistic path to a better future.

False hope can lead to intemperate choices and flawed decision making. True hope takes into account the real threats that exist and seeks to navigate the best path around them.

I feel that I have to do everything better just to be judged as okay. It is something I wish I could let go of. It's something that I wish just wasn't there.

Help, then, is the ballast that keeps us steady, that recognizes where along the path are the dangers and pitfalls that can throw us off; hope tempers fear so we can recognize dangers and then bypass or endure them.

Many years before when I had serious back pain from a sports injury, the surgeons said they would explore my spine and "figure it out." Out of frustration I had impulsively opted for the procedure. They ended up fusing the vertebrae. It left me debilitated. In hindsight, I blamed myself more than the surgeons. I had pressed them for a solution when in fact none was apparent because the cause of the pain was obscure.

I had learned that every patient has the right to hope, despite long odds, and it was my role to help nurture that hope.

There is an authentic biology of hope. Belief and expectation - the key elements of hope - can block pain by releasing the brain's endorphins and enkephalins, mimicking the effects of morphine.