When hope is cruel….

broken shellIn reality, hope is the worst of all evils, because it prolongs man’s torments.

Friedrich Nietzsche


Can we survive the stormy seas of life, as we are tossed and turned? The broken shell is a symbol of hope that even the most delicate of us can survive.  But even shells break eventually…

Hope may be cruel at the harshest extremes of life: death, madness, paralysis, situations where there is so little hope. Yet without hope, how can we go on? Even the tiniest spark of hope may be essential to our physical or psychological survival.

In Honor’s Ghost, Honor takes part in clinical trials for a mood drug, Instil, for those patients who seemed to have little hope of recovery from anxiety and depressive disorders.  Honor wonders what impact Instil will have: maybe it would instil peace, or simply hope.  As she guides her patients through the trials, she must also confront her own hopes and hopelessness:

“She put her hand to her tummy, where she had felt a twang, like an overstretched rubber band finally snapping.  Something was unravelling, releasing the tension, the hope she had been clinging to.  Hopeless. Unbearable.” Honor’s Ghost

In 2003, Dan Nicholls, an eighteen year old on his gap year in Australia, dived into a wave on Bondi Beach, Sydney. He had no idea that a sandbank lay beneath: he was instantly paralysed from the neck down. His father, David, flew to Australia to bring Dan home, where he spent the following year in a leading hospital for spinal injury.

David promised his son that he would find a way to cure paralysis.  A Doctor, overhearing him, took David aside and suggested it was cruel to make such a promise; and yet David’s promise was the catalyst for him to set up a charity devoted to spinal injury research and treatment.

This year, a breakthrough happened: transplanting cells found in the nose into the damaged spinal cords could enable severed nerve fibres to grow.  A cure is still a long way off, but this finding has already led to promising results in one patient.

Was it cruel of David to make this promise to his son? Maybe we can only make that judgment with hindsight.

Whilst there’s an ethical consensus in medicine that it’s wrong to give patients with physical illness false hope, what about patients with mental health problems? Might the provision of unrealistic optimism be a vital part of their treatment? Or might this serve only to prolong their suffering?

These delicate issues were explored by Psychiatrist Justine Dembo at the  Sunnybrook Health Sciences Centre. She found that most psychologically healthy people are prone to numerous positive illusions:

  • We’re better than average
  • We have more control over our lives than we really do
  • An unrealistically optimistic take on our futures

These positive illusions, that most of us enjoy, are absent or reversed in people diagnosed with depression and anxiety; they tend to believe that they are below average, with no control of their lives and the future looks grim.

For this reason, Dembo believes that instilling hope and optimism in people with mental illness can be an important part of their recovery; a positive mindset can result in greater sociability and creativity, and the benefits of that can lead to a virtuous circle of recovery.

But what if a therapist or psychiatrist truly sees no recovery for a patient? False hope may then lead to years of suffering and toxic treatments.  “I would argue that hopelessness in those with mental illness may, at times, be well founded,” says Dembo.

At the start of her work, Dembo believed that good mental health resulted from an unbiased appreciation of reality; following her research she concluded that:

“since positive illusions can so greatly enhance an individual’s quality of life, productivity, health and social connections, then perhaps it can be ethically permissible to encourage these illusions to some optimal extent.”

Dembo’s research suggests that Ernest Becker’s famous quote was right:

“A full apprehension of man’s condition would drive him insane”

Broken shell illustration by Melanthe Grand

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