Thanks in part to Karl Menninger’s writing, hope has long been prominent in thinking about treatment at The Menninger Clinic.
Inspired by this tradition, my colleagues and I have incorporated hope into patient educational groups for many years. In these group sessions, we start with a general discussion about our understanding of hope.
After the general discussion, we routinely ask each individual, “What gives you hope?” We write all the answers on a big white board and use them to expand our initial discussion.
My rationale for patient education comes from Aristotle, who asserted that we are more likely to achieve our aim when we have a target. Thus, to cultivate hope, we must first aim to understand what it involves. Here are some common themes:
- Hope entails positive expectations for the future, a vision of a better future.
- Hope emerges in the context of uncertainty and unpredictability.
- Hope is needed in dire or tragic situations, not when all is going well.
- Arising in dire situations, hope is intertwined with fear, doubt and despair; without these, hope would not be needed.
- Oscillating with fear, doubt and despair, hope is not established once and for all; it is a project.
- Hope requires facing reality; the positive expectations for the future must be sound and reasonable.
- Wishful thinking can be a diversion from hope, an inclination to escape reality.
- Unlike wishful thinking, which is passive, hope is active, requiring effort to bring about positive expectations.
- Sometimes you must rely on borrowed hope, that is, the hope that others have for you and which you are unable to have for yourself.
- For many persons, hope is rooted in faith and spirituality.
Hope vs. depression
Depression is the enemy of hope, potentially robbing sufferers of any positive feeling or vision for the future. Notoriously, depression is associated with hopelessness.
In my view, hopelessness entails an unreasonable sense of certainty: The future will turn out badly. My favorite response to the question, “What gives you hope?” was this: “I can be surprised!”
Hopelessness is one reason that many depressed persons must rely on borrowed hope. There are many potential lenders of hope, and patients most often respond to our question (What gives you hope?) by referring to family members and other loved ones.
Other factors in hopelessness
Along with depression, isolation and alienation play a major role in hopelessness. Establishing hope commonly requires reestablishing a sense of connection and belonging. Karl Menninger’s colleague and my mentor, Paul Pruyser, emphasized connection in his inspiring view of hope as based on a belief that there is some benevolent disposition toward yourself somewhere in the universe, conveyed by a caring person.
I love the open-endedness of this view of hope, which allows for spiritual as well as human connections. Pruyser’s reference to a caring person brings in the fundamental human need for attachment and the feeling of security that is essential to our wellbeing – from the cradle to the grave, as John Bowlby put it. It is little wonder that Karl Menninger homed in on the centrality of hope in conjunction with treatment at The Menninger Clinic.
Many patients who seek treatment at The Clinic struggle to maintain hope, and they need foremost to reestablish a sense of connection. Pruyser was right on the mark: They need a sense of a benevolent disposition directed toward them, conveyed by caring persons. This need is evident in all forms of psychiatric treatment, but especially so in the frequently dire circumstances that lead patients to seek intensive inpatient treatment.
Editor’s note: Don’t forget to check out some of Dr. Allen’s other blog posts:
- We need our prefrontal cortex to work
- POT: What’s new in plain old therapy?
- Was the Sandy Hook mass shooting “evil?”
Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books
Menninger, K.A. (1959/1987). Hope. Bulletin of the Menninger Clinic, 51, 447-462.
Pruyser, P.W. (1987). Maintaining hope in adversity. Bulletin of the Menninger Clinic, 51, 463-474.