Culture, Medicine, and Psychiatry

, Volume 40, Issue 1, pp 35–58 | Cite as

Ways of Hoping: Navigating the Paradox of Hope and Despair in Chronic Pain

  • Emery R. EavesEmail author
  • Mark Nichter
  • Cheryl Ritenbaugh
Original Paper


In this paper, we explore hope in the context of living with chronic pain. Individuals with chronic pain from temporomandibular disorder(s) were interviewed four to five times over the course of their 18-month participation in a clinical trial investigating the effectiveness of Traditional Chinese Medicine. We sought to understand shifts in participants’ descriptions of expectations and hopefulness, particularly with regard to the work involved in counterbalancing positive thinking with buffers against disappointment. We found hope to be a dynamic and multifaceted mindset as distinct from being a single entity to be measured. Drawing upon Polanyi’s concept of tacit knowing, we explore how different ways of hoping emerge and index one another in participant narratives. We offer a working typology of hope and raise as an issue the manner in which the paradox of hope—hoping enough to carry on while keeping hopes in check to avoid the ever-present possibility of despair—complicates simplistic notions of the relationship between positive thinking and the placebo response.


Hope Chronic pain Tacit knowing Placebo 



Funding for this research was provided by a Grant (U01-AT002570) from the National Center for Complementary and Alternative Medicine, the National Institutes of Health. The authors thank Allison L. Hopkins, Elizabeth Sutherland, Jennifer Jo Thompson, Karen J. Sherman, Samuel F. Dworkin, and our participants and study practitioners for contributions to the research and to the conceptualization of this manuscript.

Compliance with Ethical Standards

Conflict of interest

Emery R. Eaves declares that she has no conflict of interest. Mark Nichter Declares that he has no conflict of interest. Cheryl Ritenbaugh declares that she has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All procedures were approved by the University of Arizona Committee for the Protection of Human Subjects, and the Oregon College of Oriental Medicine Institutional Review Board.


This study was funded by the National Center for Complementary and Alternative Medicine, the National Institutes of Health (Grant Number U01-AT002570).

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Emery R. Eaves
    • 1
    Email author
  • Mark Nichter
    • 2
  • Cheryl Ritenbaugh
    • 1
  1. 1.Department of Family and Community Medicine, School of AnthropologyUniversity of ArizonaTucsonUSA
  2. 2.School of Anthropology, Department of Family and Community Medicine, College of Public HealthUniversity of ArizonaTucsonUSA

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