A Philosophical Psychology of Hope with Dr. Allison Postell - HippSoc Conference 2026

At the 2026 Hippocratic Society Annual Conference, Dr. Allison Postell presents on the nature of hope. Is hope an emotion? Is it a virtue? Can we deliberately foster hope in our own lives, in our patients, and in medical practice as a whole? Dr. Postell addresses these questions through a variety of lenses, drawing mainly from the philosophical and psychological framework of Thomas Aquinas.

1 hour 3 minutes • Published Jun 29, 2026 • Download • Transcript

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Hi and welcome to the Hippocratic Society Podcast. In this series of episodes, we break from our usual content to share presentations from the 2nd Annual Hippocratic Society Conference, during which physicians, trainees, and students from across our chapters came together to reflect on what it means to live out the virtue of hope in medicine.

We hope you enjoy.

So I have the distinct pleasure of inviting up Dr. Allison Postell.

Dr. Postell is an associate professor of philosophy at Hillsdale College. She specializes in Aristotelian ethics and metaphysics and its application to contemporary virtue ethics.

Before Hillsdale, Dr. Postell taught philosophy and was director of Classics at U Colorado Colorado Springs.

She's one of the faculty sponsors of our Hillsdale chapter and our unofficial scholar in residence,

our native Aristotelian. So, Dr. Postell, please.

Allison Postell

Good morning, everybody. It's great to be here with you and to see people who have become friends over time, and hopefully that will be true of many more of you by the time the conference is over.

Allison Postell

I am a philosopher, not a physician, not that kind of doctor, as we like to say.

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But I'm going to be giving a Philosophical Psychology of Hope presentation today.

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And so let's begin.

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So I'm going to begin with one of my favorite passages from Aristotle's Nicomachean Ethics. And Aristotle's ancient Greek philosopher lives from 384 to 322 BC,

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and the Nicomachean ethics is named after his son Nicomachus. And so in a way, you think,

oh, this is like a, you know,

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a talk from a father to a son about how to live well, except for that. He says, well, the Nicomachean ethics are not written for the youth because they're too guided by their passions.

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And you can't become ethically virtuous by reading a book anyway. And so I'm like, what is the point. Point of this thing?

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But he's got a passage in book two, chapter four,

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where he says this. Let's see here. He says,

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this is, I promise I'm not going to quote bomb you all day, but this is one I want to begin with. He says, actions then are called just and temperate when they are such as the just or temperate man would do.

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It is well said then that it's by doing just acts that a just man is produced, and by doing temperate acts, the temperate man. And without doing these, no one would even have a prospect of becoming good.

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But most people do not do these,

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but they take refuge in theory, and they think they're being philosophers and will become good. In this way behaving somewhat like patients who listen attentively to their doctors, but do none of the things that they are ordered to do.

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And as the latter will not be made well in body by the by such a course of treatment, the former will not be made well in soul by such a course of philosophy.

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And so the point is clear.

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Ethical virtue is an activity that involves us doing things in the world rather than contemplating the nature of virtue.

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It's something that has to be cultivated daily and intentionally by each of us in our lived circumstances.

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And we need to develop good habits by doing things if we want to live flourishing lives.

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And the theme of this conference is Hope,

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Hope in Medicine. And it's a good theme. I didn't come up with it. Whoever did, well done. Because it seems essential to have hope in order to practice medicine well,

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it seems to me that a physician who thinks her work is futile will not be a great healer.

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And yet there are puzzles about what exactly hope is.

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And so it makes it worthwhile to contemplate hope for a bit, even if ultimately what Aristotle's saying is true, that

we need to be people of hope

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rather than merely think about it.

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And so today what I intend to do is think about in a more contemplative mode,

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because it's actually a challenge to describe what hope is.

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It led one group of scholars to write this.

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Hope, by its very nature,

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can often be somewhat vague, unspecific and elusive.

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It's not that theories about hope are in short supply in psychology alone. So not including philosophy, theology, sociology, anthropology.

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In psychology alone,

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one article studies studied 26 theories of hope and 54 definitions of the term.

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And so I think theories inbound in part because we all realize that we ignore this supposedly elusive concept to our own detriment.

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Patients come to physicians in the hope that the physician can help them heal or control their symptoms or lessen their pain or slow their degeneration.

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And they would not come to a physician if they hoped for nothing.

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Statistically, patients who have hope fare better than those who don't.

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And many of you know better than I do what it means for a patient in your care to struggle to hope in the face of a serious diagnosis,

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either by tipping towards despair or towards an unwarranted presumption that everything's going to be just fine.

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And what's more, the struggle to find hope amid a disappointing diagnosis can be wrenching on a personal level. A 73 year old in law of mine recently asked me what to say to her widowed best Friend who received an Alzheimer's diagnosis that spring had to give up her driver's license,

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has already had two brain surgeries to help control her severe tremors unrelated to the Alzheimer's.

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This spring she fell and broke her hip during one of her many frequent falls.

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Last month she fell on the sidewalk and cut open her head to the skull. And just last week she fell and broke her collarbone.

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Her three children with young families are unable or unwilling to be caregivers in significant ways. And she watched her own mother decline from Alzheimer's over a period of nearly 20 years.

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Though a person with religious commitments, she asked my mother in law this question,

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would God **** her if she took her own life?

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Wouldn't a merciful God forgive her desire to escape what she thinks is an increasingly hopeless existence?

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And so patients can struggle with hope, right?

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But it's not just patients.

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It's the rate of burnout that physicians can face. It's the rate of burnout is high.

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Many medical students report a sort of moral training that is informed by a so called hidden curriculum of how physicians act behind the scenes in hospitals.

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They learn an informal training of seeing people complain about their institutions, the nature of their work, their patients and their patients families, which has the demoralizing effect of choking out hope.

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And on a practical level, it's challenging to remain hopeful when the frustrating reality is that some patients practically won't engage in the changes you're asking them to make to help them heal,

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despite your ability to help them.

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And in other heartbreaking cases, patients would do exactly what you asked them to do, but there is not a cure and they leave us far too soon. Seemingly the admirable witness of Tatiana Schlossberg and currently Ben Sasse come to mind and both are receiving or received the best that medicine can offer.

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And so for many reasons hope matters, right? And for many reasons it can be difficult to sustain.

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It matters for patients, it matters for physicians, and it matters for their relationship with each other.

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But what exactly is it? Okay,

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how do we cultivate it? And why is it important?

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So today what I'd like to do is explore what hope is from a philosophical perspective within the virtue ethics tradition. And I'm going to focus on philosophical anthropology.

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Okay?

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And what I mean by that is like an understanding of what hope is in a conception of human nature. I'm going to focus on a Thomistic view of the human person,

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but I'm going to begin with a very brief taxonomy of philosophical views on hope, because there are actually a lot of different approaches to this topic.

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And then I'll turn to Aquinas's account of hope and some leads that we. We get from him for how to cultivate hope on a practical level.

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And then I want to raise a final challenge, which is the reality of death, the inescapable reality of that,

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and how to think about that given.

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Given the conception of hope, I want to articulate. And then we'll draw some conclusions. Okay,

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and so I'm going to begin with this taxonomy of philosophical views on hope.

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Approaches to hope, I think, fall into about,

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like, three buckets. There's. There's these sort of philosophical anthropologies, and then there are actually some critics of hope,

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people who actually don't think cultivating hope is a good thing. You think that's kind of strange, but they have their reasons.

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And then there are some transcendent views of hope.

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And finally, I'll briefly touch on some Eastern and Islamic views.

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And so let's begin with that first bucket of approaches to kind of get our bearings on some philosophical psychologies of hope.

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So there's general agreement in this camp that hope. We hope for things that we don't yet possess,

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but that we could possibly get okay.

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And so that makes hope different from a mere wish, because I can wish for things that I don't think are possible to get. Like, I wish I could echolocate for a day.

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I think that would be amazing.

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But I don't really have any hope of that happening anytime soon.

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And so we hope for things we think we could possibly get future goods, but we also hope for things that we want. I've never met a person who hopes to get the flu,

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right?

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And so we hope for things that we think are good and lovable.

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And that doesn't mean we're always correct about our judgments, of course. Like, we can be certainly mistaken about the goodness of the things we hope for.

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The unfortunate expression I hope you rot

in hell came to mind as a

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pointed example that embodies a bad thing for which to hope.

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Broadly, though, philosophical psychology has maintained this, that hope regards a sort of future good that I could possibly get okay.

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And they involve a kind of emotional component and an intellectual component. These views do. And so there's sort of two ingredients to this approach.

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There's an emotional component that talks about some sort of, like, passion or desire or emotion pertaining to a future good that's combined with an intellectual component of assessing the likelihood of attaining that thing.

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And so we see this throughout a variety of different thinkers from different time periods. Plato,

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the ancient Greek philosopher and his Philebus, wrote that hope is a pleasure of anticipation, right? So you see that the emotional component, the pleasure of anticipation, of estimation of a future possible good.

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Descartes wrote that hope is an emotional state that generates action following a judgment of probability.

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And so in Descartes vision, then you've got the emotional state,

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but it makes you act in the world because you think you can get the things that you judge as possible.

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Thomas Hobbes is similar to Descartes on this front. He writes that hope is an appetite, right? There's that appetitive component with the opinion for obtaining.

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And the Scottish Enlightenment philosopher David Hume wrote that hope is a passion that depends on a judgment of probability. So you see some similarities in these approaches, right? They've got this intellectual component and this emotional component.

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Hope regards future possible goods. Okay,

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There are also some critics of hope,

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and I raise a couple for you so you can see what they would be.

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The first century Stoic philosopher Seneca thought that hope actually undermines the goal of the ethical life.

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He wrote this in one of his letters.

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Fear keeps pace with hope.

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Both are mainly due to projecting thoughts far ahead of us instead of adapting ourselves to the present.

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What's the problem with that?

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The problem with hope on this Stoic view is that it undermines the ideal of ataraxia, or a state of freedom from disturbance, which is the goal of a Stoic life.

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And so to hope for something is to have a desire for change rather than an acceptance of what is.

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And as such it undermines inner tranquility, which is the goal of a Stoic life. And so he's a bit of a critic of hope, actually.

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Baruch Spinoza, who lived in the 17th century,

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was hard, causal determinist, and he thought hope was irrational because in a world that is determined through and through, where there is no freedom,

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it is

irrational to hope for things that can't change.

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And one more critic of hope I put in this camp is Friedrich Nietzsche. He wrote this in human all too human hope is the worst of all evils because it prolongs the torments of man.

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On Nietzsche's view, hope is connected with the desire for reality to be better than it actually is. It's a kind of escapism. And that's one of his main criticisms of religious traditions,

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particularly Christianity,

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which he

calls Platonism for the people.

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Nietzsche was of the view that reality ultimately is absurd and to live well in the face of that requires owning that fact rather than trying to escape

from it by building up an imaginary,

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imaginary world where someday everything will be put right again.

And so on his view, hope can, can actually prolong what, what ails people, which is an inability to stare unblinkingly in the face of a pointless existence.

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These, these critics of hope argue that hope in some way fails to align with reality.

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The reality of how to truly acquire a well ordered soul from Seneca's point of view,

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the reality of hard causal determinism in Spinoza's view,

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or the reality

of the absurdity of being in Nietzsche's position.

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On the other end of the spectrum, there are also transcendent views of hope. Okay?

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Immanuel Kant is somebody who famously gives an argument for that in the Critique of Pure Reason.

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He argues that it is reasonable to hope that the moral life, which for Kant consists in doing one's duties despite whether one enjoys what one is doing,

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that the moral life will one day combine with personal happiness.

And he calls this the summum bonum.

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Okay? And hope, for Kant, is an expression that follows from the reasonableness of the postulate that if human beings have this desire not only to do good, but

to farewell that one day that might happen.

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And so the way that would happen is not to hope in this veil of tears that everything will be put right, but that God exists and is

the grounds for the cause of hope, that the melding of doing well and

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faring well will one day occur in the afterlife.

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Kierkegaard is another proponent of transcendent hope,

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and he defines hope this way in his works of Love.

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He says, to relate oneself expectantly to

the possibility of the good is to

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hope, which cannot be any temporal expectancy,

but is an eternal hope. And so he casts hope in a

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sort of transcendent register as well.

And then, like very broadly speaking in Judaism, hope can carry multiple valences, including putting worldly concerns in a proper perspective and having a trustful reliance on the Creator.

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If we shift to some other views that don't fit cleanly in any of these three, three buckets at some the Eastern views.

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Hinduism speaks more of desire and wish than it does of hope as a concept. From what I've seen,

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I was not able to find any English language discussions on hope in Islam and so happy to learn more about it if somebody knows.

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And then Buddhism puts hope in a more negative register because it involves clinging to specific desires.

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So a wide array of views, you know, and it raises some questions about like what exactly is hope, right? And is it good?

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And situated within this landscape is a 13th century thinker, Thomas Aquinas, he lives from 1225 to 1274.

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I chose to focus on his philosophical psychology today because it's nuanced and I think it generates fruitful reflections on today's topic. So Aquinas's answer to the question of what hope is is unique.

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He speaks of hope in two different senses, natural and theological, okay?

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So these are two different kinds of hope, and they are related to each other analogically, but they're not identical and they're addressed in completely different parts of his multi volume work, the Summa Theologica.

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Natural hope he calls a passion,

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whereas theological hope is a virtue,

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Natural hope,

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okay, is not a virtue, actually,

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it's a passion of the soul.

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And theological hope is a virtue.

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Natural hope can be cultivated, as I'm

going to talk about in a moment,

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only indirectly through virtue formation.

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And theological hope is a God given gift.

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And so Aquinas's account of natural hope most closely engages with the psychological views that I just examined.

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And like the others, like Plato and Hobbes and Hume and Descartes, Aquinas's account of natural hope has both intellective and emotional components.

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However, he argues that hope is actually a passion or an emotion that is roused by the sense appetite, okay?

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And so as an emotion,

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hope is actually not directly subject to rational control.

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And that's what makes it unlike an ethical virtue,

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which can be cultivated by

deliberate habitual choices for excellence pertaining to action.

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And yet it's not impossible to cultivate hope, okay, even if it's not directly controllable through command.

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Aquinas's account of emotions turns out to be complex because emotions can be indirectly shaped by virtuous habits that are formed deliberately.

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And so Aquinas's moral psychology of hope then turns out to be nuanced. And I want to look at why he thinks hope isn't a virtue on the natural register and how it is connected to virtues in his philosophical psychology.

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And then I want to turn to

what virtues most affect cultivating hope.

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So, as I mentioned, Aquinas's account of natural hope is connected to appetite.

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And he has three different kinds of appetites.

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Natural, so like a stone has a natural appetite to fall to the center of the earth. He kind of got hammered for his doctrine of natural place once, you know, physics advanced.

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And then there's sensuous appetite and intellective appetite. But all these three different kinds of appetites cause a thing to stretch out for a telos or for an object that is the source of the appetite.

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And then appetites differ on account of the objects that give rise to them. Okay?

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And so hope. Hope is going to be a passion that pertains to the middle kind of appetite, sensitive appetite, as Aquinas describes it.

Then here's what he thinks a passion is, because hope is a kind of passion or emotion.

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We can use that word, too.

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Passions are motions of sense appetites that are roused by sensory perception of an object,

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and they involve a bodily change.

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Okay, so the word passion means, like patient, physician, patient, relationships, the same root. It means undergo a change,

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and a change that's initiated by an agent of the change.

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Okay,

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so an object in the world initiates a sort of undergoing in the

agent that feels a passion, and that's

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the rousing of a sense appetite.

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And then, crucially for Aquinas, passions always involve a bodily change.

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And so, for example, if the passion of fear is aroused, a person could start sweating,

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right? Or have an increased heartbeat.

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And so passions are embodied things. They draw embodied persons to or away from objects.

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And then he further subdivides passions into two kinds. I promise this is my last division.

Okay, you're hanging with me here.

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There are concupiscible appetites, sense appetites and irascible sense appetites. Okay,

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so concupiscible. That's kind of fun to say. Actually,

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a concupiscible appetite is being drawn directly towards an object that appears as

good or being repelled by an object that seems harmful.

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And so, for example, a lovely smelling cookie draws the sense appetite toward it, right? The sense appetite of smell gets activated

and draws a person towards the kitchen,

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whereas the smell of rotting chicken repels and causes a person to take out the trash.

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Those are different from what he calls irascible appetites and passions.

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And that is being drawn toward or away from an object that is arduous.

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And for for an object to be an arduous object, it means you've got to overcome some kind of obstacle to

obtain the object that is giving rise to the appetite and hope.

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He puts in this category. Hope pertains to trying to get an arduous object where something needs to be overcome in order to get the object that is desired.

So we're finally to the point about what he thinks hope is.

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What is the object that gives rise

to the passion of hope? And he calls hope like a kind of lightening of spirit, whereas despair is a kind of collapse. He talks about kind of collapsing on oneself. But hope sort of opens a person up to the object that gives rise for hope when he's talking about the bodily change.

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So the object that gives rise to hope can have four characteristics.

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It's a future good, right,

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Versus joy, which is the enjoyment of a present good. But hope pertains to future goods, not present goods,

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and it pertains to goods rather than things that are considered bad.

Whereas fear is oriented towards avoiding something that's considered bad. Hope is being drawn towards something good,

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and it pertains to something that's arduous.

Right?

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So there's a desire that belongs to

trying to obtain an object where we have to overcome something in order to get that good.

But.

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But the arduous nature of trying to get that good isn't impossible to overcome.

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And so we could say hope. For Aquinas, then he describes it as a passion of being drawn towards a future possible,

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arduous good.

Okay? And so five qualifications there. It's a passion rather than a virtue, and it's drawn towards an object that has four qualities. Future, possible, arduous, and good.

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So the hallmark of hope is that it all it operates in the face of uncertainty and difficulty, right? Hope pertains to goods that are possible but not guaranteed.

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And its opposite is despair,

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which is a passion that occurs when a future

arduous good is considered to be impossible to attain. And then a person withdraws from it.

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And this also shows the difference then between hope and optimism. Hope is different than optimism because optimism has a more cognitive flavor to it.

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It's a belief that it's possible to attain a future good.

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And it's more akin to a cognitive attitude. But hope is an appetite. It's an appetite that draws us to

act, to try to overcome something that's arduous in order to attain a good.

And so if sort of optimism locates a good, hope is like the fuel that helps us get to what optimism has lit up as possible.

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And this points to hope's import.

It helps drive us to overcome something that's arduous for the sake of. Of a greater good.

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And so, as embodied beings who act in the world, appetites fuel us to go after things that are good. And hope is the appetite that propels

us to seek an arduous good.

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And so Thomas,

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I think, comes to an important point.

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Notice that I've said a couple times, Aquinas doesn't call hope a virtue. It's a passion of the irascible appetite.

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And he's explicit that ethical virtues can't be the same things as passions,

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because passions are movements of the sense appetite. But ethical virtues are produced by the will, which is a rational appetite rather

than a sense appetite.

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And this affects Aquinas's moral theory about the emotions because the emotions are not directly controllable by the will,

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their sense appetites, rather than rational appetite,

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they're not as such, like they're not strictly speaking morally good or evil.

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So hope in itself isn't morally good or evil because it can't be controlled directly by the will, which is a rational appetite.

And you can see the point with an example. Years ago when we were living in

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Colorado Springs, there was a guy who was mountain biking and a mountain lion,

lion jumped on him and like attacked

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him, meant to kill him,

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and he choked out the mountain lion. He somehow wrestled his weight free from it and it made the nightly news survey. Like a guy choked out a mountain lion. The mountain lion did not survive the attack, the human being did.

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But had the mountain lion survived, like nobody would have put the mountain lion on trial for assault. Right.

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And why is that? Well, it's because we don't think the mountain lion made this deliberate decision out of malice to harm another person.

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Whereas, like, if I were to do

that, you know, that would be a problem.

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And so the thing about the emotions is that like, because they're not subject to rational control, they're not subject to sort of moral approbation in the same way as a sort of deliberate decision would be.

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And that's a key point for Aquinas.

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Okay,

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so Thomas is also explicit that ethical virtues can't be passions. Because ethical virtues are subject to rational appetite, we can directly cultivate them.

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And this affects then his moral theory of the emotions. Okay,

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now let me reorient myself here.

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So I take Aquinas's point here to be in line with some teachings in cognitive behavioral therapy,

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which I also take to affirm the moral neutrality of the emotions because they are not directly subject to the will's commands.

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And so, for example,

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we can't command ourselves verbally to stop being afraid or anxious.

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We can't command ourselves directly to feel joy.

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And somebody who feels the emotion of despair then also seemingly can't command himself to be hopeful.

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And yet this seems kind of like a bleak outcome if this is true. Because if we can't directly choose to have hope,

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is there any non feudal way to cultivate it? Right.

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This might go too far in the

other direction, which means some people are hopeful and some people aren't.

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Okay,

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that would be kind of depressing actually.

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But that's not Aquinas's view. He actually thinks Even though the passions are not. You can't directly sort of control them through the will.

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There is a way to shape them.

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And the virtues are actually deeply connected to the emotions. In his psychology,

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even if virtues are distinct things, they're called cultivated differently than the emotions. And in fact, the whole point of moral virtue is to perfect the appetitive

appetite of the soul.

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To make it conform with virtuous habits.

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This, in fact, is the. Is the very point of the ethical life.

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And so, describing the connection between virtue, which we. Which we can rationally cultivate, and the emotions or the passions,

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he writes this moral virtue. Virtue perfects the appetitive part of the soul by directing it to good, defined by reason.

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So moral virtue directs the appetites in. In a way,

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he says, moral virtues are about the passions. And they cannot be without the passions.

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Moral virtue is a habit of choosing the mean determined by reason.

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But that also perfects the appetitive powers of the soul.

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Moral virtue is the perfection of the appetitive part of the soul.

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Because reason is the measure and rule of the appetitive movement in respect of appetible objects.

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Moral virtue, then, doesn't seek to suppress or eliminate the emotions,

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but rather to harmonize them with one's highest ideals so as to bring interior harmony to the soul.

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And so the connection works this way. Okay,

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we form virtuous habits by making repeated choices for the good,

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intentionally choosing to act excellently.

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And when we do this repeatedly, it forms good habits, which in turn define our characters. So characters can be good or bad. Right? But a virtuous character is one where a person is habitually disposed to choose the mean to choose a virtue.

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And here's the key connection for our talk today.

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Indirectly, though, that shapes the emotional life that shapes a person's passions.

Allison Postell

How does this habituation of passion happen?

Allison Postell

Remember, we can't directly command ourselves to stop being afraid, to stop being anxious, to stop feeling despair.

Allison Postell

But Aquinas, following Aristotle, uses an analogy from politics to explain how virtues do habituate desire indirectly.

Allison Postell

While the will cannot directly command the passions like a despot, it's not a tyrant.

Allison Postell

And the passions are not its slaves. That it can make do what it commands them to do.

Allison Postell

It can lead them democratically or politically, rather than despotically.

Allison Postell

And it's akin to how the emotions get shaped indirectly is akin to a kind of political persuasion.

Allison Postell

Just as citizens have a certain freedom and right of opposition to political rulers, so do the passions.

They don't always follow.

Allison Postell

Nevertheless, the passions can participate in reason indirectly and on this analogy, then what a virtuous formation of a habit does is it heads in one direction, like a political leader says, we're going to adopt this policy.

Allison Postell

And then in time, the emotions start to follow and conform to where the leader goes.

Allison Postell

And I see something analogous happening in safety learning and cognitive behavioral therapy, like using overcoming anxiety as an example,

Allison Postell

because anxiety occurs when the amygdala detects a threat and sounds the alarm by releasing a draft.

Allison Postell

And here we have the hallmarks of a passion.

Allison Postell

An object is perceived as a threat is detected. There's a bodily change, an adrenaline release,

Allison Postell

and then the passion leads the person to flee the source of anxiety,

Allison Postell

and verbal commands to stop feeling anxious are futile. The amygdala doesn't listen to a verbal command, but it will watch behavior.

Allison Postell

And if you engage with what is perceived as a threat, the amygdala learns to lower its threat label for next time.

Allison Postell

And the threat label will lower and lower and lower, which is called safety learning.

Allison Postell

And so how then is adrenaline shaped? How is the passion of anxiety shaped? Well, it's shaped through behavior, through deliberately engaging in safety behavior rather than threat learning.

Allison Postell

And this indirect formation seems to also work with the passions more broadly. In Aquinas's psychology,

Allison Postell

somebody who wishes to grow towards the ideal of temperance is somebody who is going to deliberately engage in behaviors that develop them, that activity, that habit. And over time, the desire for whatever it is that you're going for lessens.

Allison Postell

I know this at least from starting to work out anybody who's starting a new workout routine.

Allison Postell

The resistance to doing the routine is always high in the beginning, and it seems to habituate. And as the passions habituate over time, then you're ready to take on new challenges that then enable you to take on different strengths and goals.

Allison Postell

And so on this account, then what we have is that a deliberate moral formation and a virtue leads to indirect passion formation.

Allison Postell

And the goal ultimately is to redirect passions and then be primed to grow in deeper challenge, engagement.

Allison Postell

And so what virtues, then, if hope isn't a virtue, on Aquinas's account, what virtues. Virtues do shape the passion of hope.

Allison Postell

Hope is most directly sustained by the virtue of fortitude.

Allison Postell

And so fortitude is the virtue of willingly bearing toil and danger for the sake of a greater good.

Allison Postell

And that sort of willingly bearing something can eventually develop a sort of passion for the good that is being sought through the virtue of fortitude.

Allison Postell

And particularly,

Allison Postell

species of fortitude is magnanimity,

or megalopsuchia, which is such a great Greek word.

Allison Postell

Greatness of soul.

Allison Postell

But magnanimity is the virtue of aiming for the highest possible ideal or good out of a love for its greatness,

Allison Postell

and then willingly engaging arduous obstacles for

the sake of that thing.

Allison Postell

So that can be cultivated deliberately. And on Aquinas's theory of the emotions, then this directs hope to its highest possibilities.

And eventually, like that political analogy suggests that the passion habituates over time.

Allison Postell

How then do we cultivate hope?

Allison Postell

Well, we've just seen that virtues habituate the passions only indirectly and over time.

Allison Postell

And so a main suggestion I see in what Aquinas is saying then, is a prerequisite for cultivating hope has got to be sort of good practical judgment on the ground about the reality of one's situation.

Allison Postell

Despair is bad when there's good to be attained that a person doesn't see or doesn't see, it's possible.

Allison Postell

And so developing a sort of keen sense of judgment about the reality of one's situation, attending to the aspects of that give cause for hope,

Allison Postell

is a way to cultivate hope, actually. And that seems to me to be the practice of reframing,

Allison Postell

of looking at a situation and trying to discover a real opportunity.

Like in my.

Allison Postell

In. In this patient's context or in my daily work,

Allison Postell

where are the real not. Not made up, not imaginary, but the real opportunities for growth in that give me cause to try to grow in a skill today, or to grow towards an ideal today, or to deepen a

bond today, given the challenges of my life.

Allison Postell

And so the reframing enables us to see, like cognitive aspect of hope, to see what's possible, to attend to aspects of reality that give us cause for hope.

Allison Postell

And then secondly, there can be a kind of behavioral activation that occurs with hope.

Allison Postell

Aquinas says that hope is caused by love.

And if.

Allison Postell

If a person finds herself sort of waning in hope,

Allison Postell

a good practice seems to be to attend to not only the goods that are available, but to attend to, like, why are they so good? Why is this worth striving for?

Allison Postell

What are. What are sort of meditative or reflective practices we can engage in, to try

to sort of prime the pump of thinking about why it's worth striving to overcome something arduous for the sake of the good? Can we sort of entice hope by reflecting on what's lovable about the good

Allison Postell

that is sought and then sometimes, just like, activating it? Right. So virtues are acting in the world and sometimes acting out of fortitude and reflecting on causes for the loveliness of

a thing can start to reignite the passion of hope.

Allison Postell

And I want to end then today

with a sort of final challenge, like,

Allison Postell

let's say you're doing your work and you're feeling hope and how to help patients sort of navigate the difficulties of their life. You're feeling, attending to the aspects of what you can do to grow today and the challenges that come through work.

Allison Postell

But then there's a sort of final challenge, which is it all sort of ends in death, right?

Allison Postell

And Aquinas doesn't think death is a good thing. He says virtue sorrows moderately for all that thwarts virtue, no matter how.

Allison Postell

And medicine is a practice that ultimately at some point fails to be efficacious in terms of sustaining life. And what do we, you know, what

do we make of that?

Allison Postell

It's. It led one person to hold a

view, at least that is a challenge to Aquinas.

Allison Postell

And this, this thinker writes this hope is on intimate terms with despair because it asks more than life promises. It is poised for despair because it

always ends in death.

Allison Postell

Right. In medicine. That's not Aquinas's view. Okay,

Allison Postell

Aquinas, here's where we shift the other kind of hope I was talking about in Aquinas, and it's his account of theological hope.

Allison Postell

Aquinas maintains that, like, you've got to

see death in light of, like, something

Allison Postell

broader if this quote is going to be falsified.

Allison Postell

And he maintains that human beings have reason to hope in something that's awesome and audacious, that the end of a human being is actually to live in everlasting, loving communion with God.

Allison Postell

And it's here in this context that he speaks about hope as a virtue and not a passion.

Allison Postell

He calls it a theological virtue. And theological hope for Aquinas, is the kind of confident and patient expectation of eternal beatitude that is made possible by God's grace.

So, like God's redemptive act is, is what makes this kind of hope possible.

Allison Postell

And the patient expectation that that redemptive

act will be fulfilled is what theological hope as a. As a virtue is as a grace given virtue.

You.

Allison Postell

Okay, so let's take stock.

Allison Postell

It seems to me that hope is crucial to the medical profession.

Allison Postell

The nature of your work deals daily with objects that give rise to hope, namely with future possible arduous goods.

How you deal with those in spades.

Allison Postell

And underneath the burnout that so many physicians report is a deeply enduring truth

that I think is captured nicely by

Allison Postell

German philosopher Josef Paper, who says man's

self realization is linked to hope.

Allison Postell

It's what causes us to strive for future possible arduous goods. It's what causes us to try to point that out to patients and to try to cultivate the virtues and practical

wisdom that enable us to discern how to live that out in our daily lives.

Allison Postell

And so thank you for being a small part of this conversation.

And that's what I've got for, for today.

Allison Postell

All right, any questions or are we good?

Wow, that was a beautiful talk. Thank you so much. My name is Chris from Washu.

I just imagine it's such a beautiful virtue of a physician to be able to give a patient hope. But I imagine it's also very unvirtuous to give a patient an unrealistic idea of what their future may hold or give false hope.

My question to you is, how can we as human beings, whether it's a patient or whether it's a family, family member,

help reframe someone's idea of what they conceptualize as a possible future for them or their hope to a more virtuous or realistic idea of what that can be?

Allison Postell

I mean, I think it's gotta be

really patient, centered on the individual person. I don't know if I can give a prescription, right. Because different people have different struggles. And so I think it's going to involve cultivating a sort of sensitivity that you have to the person sitting before you and thinking through what opportunities do I have to communicate with you?

Where are you willing to sort of dialogue with me so that we can have a conversation that helps us get to clarity about what I know and what I don't know and causes for hope that I have and don't have.

So I think the really abstract answer is going to be it depends on the person sitting before you. But it's got to start with communication with this particular, particular person in front of you, who's a person, right.

Who has a sort of history and relationship with you and you think through how can we communicate well, given our relationship?

Just fantastic talk. William Stagall from Fort Worth, University of Dallas. Hips.

Allison Postell

Hi.

My bias is I don't want to dichotomize hope into this infused virtue on one side. And that's where reason would, would, would have some play and just a passion. Right. And so you, you've done a great job of showing.

Well, that's where, that's where the moral virtues are coming in. But Aquinas isn't call hope a moral virtue. So it's kind of subsumed into like fortitude. Right.

So where the arduousness nature of the object of hope. I think it's really interesting because it seems like we're like built to desire hard things.

So maybe drilling into that, maybe not. We're not built to desire specifically hard things, but hard hardness is a biomarker for goodness,

something like this.

Allison Postell

So marker of growth. Right. You've got to engage challenge if you want to grow.

Oh, okay, that's. I love that. That's that. Okay.

So to his question around the physician, given the false hope, that kind of thing,

your patients come in and they have got this passion of hope,

period. They're, they're, they're an animal. And therefore there is a passion for a good and the goods that are hard then have the passion of hope.

So then the cultivation of hope. As the physician,

how do you,

how do you.

Isn't it good to want hard things?

So then hope and suffering, hope and your patients are having a problem,

but this problem actually is a good thing. Saying it's hard.

So will you sort of walk through like how not to say offer your prayers,

you know,

in a professional way of this,

this difficulty, this growth is

Allison Postell

possible because I would want to think

through how much time or what's the relationship or context in which I can speak with a patient about thinking about possibilities that still remain right for you to grow in the face of this challenge.

And so that might be bonds with other people that you, you can repair.

That could be,

if a person is a person of faith, a sort of deepening of one's spirituality.

It can be trying to heal if that, if that is possible. Even though like chemotherapy is very painful or something like that, saying like this

Allison Postell

is something you, this is a challenge

that you can engage in. Right. And I have hope that, that it will at least it gives you a possibility of getting better.

Allison Postell

And hear, here's what I know and

here's what I don't know.

Allison Postell

But I think there are lots of

different domains where you can talk about

Allison Postell

to specific people and their specific circumstances,

about what they can hope for,

what

they can hope for.

The physician's role, it seems to be, is most directly connected to what we can hope for in terms of bodily health.

And so that seems to be the main objective. Right.

But also it seems like patient centered care to ask, is there any other

Allison Postell

ways I can support you?

Because how you fair with respect to whether you think you can grow in getting something out of the challenges that face you is also going to actually impact chances for bodily healing as well.

Yeah.

Allison Postell

Are you a Dominican?

That's Right.

Allison Postell

I'm scared.

Not at all.

I'm Father Columba. Thomas. I'm from town.

And thank you first of all for a very lucid discussion of a complicated topic. It's not easy to summarize what Aquinas said on this, so thank you for that. You did focus a lot on the relationship between the will and the passions or the emotions.

And when you talked about natural virtues that relate to hope, you focused on virtues that are rooted in the will.

I'm wondering, what about the intellect? Do you think the intellectual virtue is really importantly related to the passion of hope as well?

Do our thoughts stir up passions?

And could you speak to kind of the interplay between the intellect and the will in regulating our emotions and perhaps stirring up the ones that we desire?

Yeah.

Allison Postell

I mean, part of what I think hope is rooted in is an accurate

assessment of the good that is an aspect of an arduous good. And that's going to affect the intellectual

Allison Postell

virtue of prudence, which is an intellectual

virtue of being able to actually intellectually recognize the good that is available in an arduous process.

Allison Postell

So that's an intellectual virtue that I

think is really directly connected to cultivating hope, because if you don't see what's really there, it's hard to have hope. And also if you misjudge that, you

Allison Postell

can have false hope.

And so I see the intellectual virtue of prudence as being really directly connected with it.

Allison Postell

And then there are these cognitive attitudes

like optimism that I think is also, really is cognitive, but also a sort of appetite that's connected to hope too.

Allison Postell

But I would most directly connect it

with the intellectual root virtue of prudence.

I'm way too tall for this. Hi, Allison, thanks for your talk. Matt Shea from Baylor. So as a, as a fellow Thomistic philosopher, I. That resonated very strongly with me.

I wanted to kind of friendly, give a friendly nudge to talk more about what you didn't focus on the part you left out, which is hope as a. As a theological virtue.

So I guess my question is really how much mileage can we get out of a non theological kind of natural, animal monologue of hope?

And I think it's. It's really, to me, illuminating that the, the great kind of prophets of despair. You mentioned some, but people like Nietzsche and Schopenhauer and Russell.

Allison Postell

Prophets of despair.

When.

Allison Postell

I'd hate to be one of those.

Yeah, I am some days. Yeah.

So I don't think it's an accident that a lot of these prophets of despair. Right. They're atheists and they appeal to God's non existence as really fundamental to their whole worldview.

That hope a lot of times is really irrational. Right. Despair is the proper attitude to reality given God's non existence and suffering and death.

So and as you mentioned, and as you know, right, for Aquinas, hope is. There is no natural virtue. It's only a supernatural theological virtue that depends on God in different ways.

So I think where it comes into play in medicine,

without bringing in the full blown,

not just theism, but like the Christian worldview with the whole story which Aquinas has as part of hope,

how valuable or how useful can a non theological kind of secular analog of hope be given that not every physician, not every patient is going to share the Christian worldview?

I guess to me it would be,

it would kind of diminish the value of hope in medicine if it was essentially dependent on a whole Christian worldview and religious. Religious beliefs.

Allison Postell

Right.

So I'm wondering how much mileage can we get without. Or maybe you think we just need to go there and then that needs to be part of it.

Allison Postell

So a point to sort of strengthen your question against myself and then, and then a reply. On the one hand, natural hope, like purely natural hope, because it's a passion, it, it's, it can tip either way.

Allison Postell

It can be neither good nor bad. Like it can be directed towards ends that are good or, or ends that are not good.

Like I said that you can come up with phrases like I hope you and then you say something.

Allison Postell

And so natural hope isn't always directed towards good objects.

And I acknowledge that.

Allison Postell

At the same time,

and I do think Aquinas anthropology is sort of fundamentally theological. At the end of the day, he thinks that the telos of a human being is eternal beatitude. So I grant that too.

Allison Postell

At the same time, I think in

the natural register there's plenty of space to talk about ideals people have or things that people want, like cultivating relationships or bonds with other people with the time that they have left if there's a terminal diagnosis or how it is that I can sort of grow in the face of a challenge,

even a medical challenge,

there's space to have those conversations. I think that would be in keeping with the kind of moral psychology that I'm talking about.

Yeah.

Thank you for such a beautiful and inspiring talk.

I couldn't help but think, as I was listening to you, about a kind of ontogeny of hope and how hope emerges in a child over the course of his or her development and how Intimately related, that is,

to the presence of a caregiver, the relationship with a caregiver in opening up the space of what constitutes a difficult good, but that is possible and attainable,

and how the example and the presence of that adult is essential for a child in perceiving those possibilities and then beginning to act in accord with them.

And it struck me that the same could be said of the relationship between a clinician and patient, that there's almost a structural factor that becomes a near occasion of hope when you have a relationship,

that becomes this presence of certainty and the possibility of an arduous good.

So I'm interested in hearing any reflections that you have on the sort of social and structural factors that could be present within one's hospital system or one's medical practice that act similarly, that provide near occasions of exercising those virtues that enkindle hope within a patient.

Especially thinking of the example that you gave at the beginning of this woman with the recent Alzheimer's.

Thank you.

Allison Postell

Yeah. The thing that comes to mind most is the talk that I heard on

a HippSoc remote talk on the hidden curriculum and how physicians can sort of demoralize students going through medical school by the way they talk about the systems they're a part of.

And I think there's a lot of uplifting that can be done just by how we can engage our work.

I'm not a physician, but I am a part of a university system, and there's plenty of complaining there, too.

Allison Postell

I think there's a lot of work that you can do just in daily

living, of living a hopeful life, doing

Allison Postell

your work in a way that engages

challenge rather than complains about it, because

Allison Postell

complaining is a way of seeing a challenge negatively.

We only complain about things that are hard for us that we don't want to engage in. Right.

Allison Postell

And so engaging challenge without complaining seems to me to be a very practical

thing you can do on a daily level that, like, you don't see, but it lifts people up around you.

Allison Postell

And so I think that's a really

practical thing people can do in the work environment that would make a big difference.

To be somebody who's leaning into seeing opportunities for growth rather than complaining about the challenges that need to be overcome

Allison Postell

in the first place. And then you can,

Allison Postell

with patience, I think, like a practical discernment then, about how it is that you model that. Right here we've got a challenge, and I see it for what it is, but I can also attend to all the aspects of the real challenge before me and having that sort of Clarity of vision.

I think it goes a long way combined with not complaining.

Yeah,

thank you for that wonderful talk.

I wanted to get your thoughts. Thoughts on the idea of Sabbath or the role of Sabbath in this work of cultivating hope.

You said that we have to make a rational judgment about whether hope is actually the proper response in our situation.

And it seems like you truly have to believe that, you know, it's kind of worth having hope.

And that seems a little different than something like just prudence or fortitude kind of, you know, pushing yourself to this point where,

okay, I believe it. Like, I believe it, you know, trying to just get yourself to.

To believe in it. It seems like,

I don't know, maybe Sabbath or rest has something to do with that, like true belief in a cause for hope.

So, yeah, I'm just.

I'm curious about your thoughts or reflections on that.

Allison Postell

Yeah, I mean, it's certainly true that we.

One cause of burnout, which seems to me to be a kind of despair, is being exhausted and feeling like your work is futile and rest is an essential part of a thriving life.

Right. And so at least aristotle in Book 10 of the Nicomachean Ethics, says we need to play once in a while. And he says we play in order to go back to work.

But play or leisure, like respite is really important too,

because we're made well, because we have bodies and we have limits and we have ways in which we can't be engaged and work all of the time.

Allison Postell

So with respect to hope, I think

if I were to try to connect the concepts of like a Sabbath and Sabbath, of course, has religious connotations too. So I'm not focusing on that as much as I'm focusing on the idea of rest.

But that would be important for hope as well,

because a lead source of burnout is going to be overwork and feeling like effort becomes futile from lack of rest.

Yeah.

Allison, thank you. I practice palliative medicine and in our caring for people who have advanced illness, there's frequently in the air the concern to not take away people's hope,

but also not to foster false hope.

And it just. Listening. I think Matthew's question really has force about how much mileage we can get without the theological hope. Because if it is true that there's nothing more than this awful existence of dying from cancer as one thing after another falls apart,

that can seem a counsel for despair. And yet I just going to propose it seems to me that in.

So part of the challenge for the good clinician is to help the patient and their family,

not hope vainly. Right. Which requires prudence to clarify the things that it is reasonable for which to hope with respect to medical outcomes and so on and be able to say something like, well, it's of course we wish you might get off.

Your loved one might get off the ventilator.

We really don't hope for that because that's as far as we know, not possible.

But. But do that in a way that doesn't carry despair.

And it seems to me there is something about part of the. To me, the adventure, the beauty of medicine is that across religious traditions,

across, you know, people's,

whether they believe something or not, we kind of in our actions can witness to the.

To the fact that. Or the claim that this person's existence remains good in the time that they remain with us. And we are what we can at least,

even if not explicitly said,

what can be some kind of ground of hope is we will be in with you. There will be fellowship,

there'll be solidarity.

There will be a kind of practice of recognition that it is good that you exist. And along with the lament that you're going away.

And that seems to me to be something that appears to strengthen even those who don't have any beliefs to make sense of all that.

Allison Postell

Yeah.

And I've actually learned this from reading

Allison Postell

your own work far.

It's shaped my own views and I'm very thankful that you've published in this area.

This notion of solidarity and accompaniment is really important because even for somebody who may not think that there's another chapter after mortal life,

the way you treat somebody's loved one, the way you treat a patient,

treating them with care and with dignity, recognizing like their. Their personhood, that their existence matters and that you will treat them with the. With, you know, the respect that is accorded with the dignity that they do in fact possess goes a long way.

It's adjacent to hope, I think, but it, it sort of is a form of accompaniment that's very powerful in the face of these end of life life cases.

Yeah.

And it's a good that the physician can provide through the witness of excellent care.

Yeah.

Thank you so much for a very elegant and interesting talk.

Imad Ahsan from Texas Medical center here in Houston.

I'm interested in the interface between faith and hope.

And I feel in our practice,

I do a fair bit of surgical oncology. So I meet these patients who have metastasis everywhere, stage four,

and they're far beyond the scalpel of a surgeon.

So I also recall Sir Peter Medawar book The Limits of Science.

When we as clinicians hit the roof and we can't break through, and this is the limits.

And

I find it very difficult and I struggle with patients who don't have this transcendent view of life and faith.

And because as like St. Paul said, and if we have faith in this world, only we are the most stretched people.

And he repeats that theme of the unseen realm and the interface again between faith and hope.

So any comments that can help us as clinicians when we face this situation?

Right. I mean,

Allison Postell

I think the tools you've got, so far as I see it,

the tools you've got in your toolkit in a situation like that are going to be the ones that far is talking about, which is a witness of accompaniment and solidarity with somebody who is suffering,

as well as an openness to talk about any sort of leads you can pursue with that particular person in terms of bonds that they can cultivate with other people or ways in which they can sort of take on the burdens in a way that help them sort of grow.

But I acknowledge what you're saying. I hear you. And so I think,

though,

it's not the job of the physician to evangelize or something like that, but I think accompaniment is a really fitting response in cases like that.

Allison Postell

Yeah.

Thank you.

Thank you very much for joining and reflecting with us today.

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