When hope is not enough


	Alan Bodnar, Ph.D. is the Co-Director of Psychology Training at Westborough State Hospital, Mass. and a consultant in the field of leadership development.

By Alan Bodnar, Ph.D.

It is an axiom in medicine that good things happen slowly but bad things can happen in an instant. If this is the rule for other kinds of disease, then why should we expect mental illness to follow a different course? Recovery takes a lifetime but relapse can happen in a heartbeat. So I learned the morning I took my seat across the table from a relatively new patient who looked me in the eye and calmly announced that she was at peace. After decades of imprisonment and a few years in the hospital to continue treating the mental illness that had derailed her life, she was tired of trying to convince the authorities that she would be safe in the community. The court's surprise request for yet another evaluation of the woman's risk for violence was more than her fragile hope could bear. And so she simply said no.

By refusing to submit to a simple assessment which she could easily "pass," my patient was in all likelihood consigning herself to spend the rest of her life in an institution. As if to underscore her point, she also announced that she would no longer participate in group or individual therapy. However, she would continue taking the medication that she had come to value for its ability to quiet her racing thoughts and help her identify the more preposterous ones as delusions. From that moment forward, she would spend each day on a locked unit watching television, reading, pleasantly conversing with peers and staff and thinking about the better world that would eventually emerge through the miracles of science and technology.

The suddenness and finality of the woman's decision took me by surprise and lingered far longer than many more dramatic and tragic events that psychiatric hospitals serve up on a regular basis. Suicide, self-mutilation and violent assault may shake us to the core but the extremity of these behaviors makes it easier to distance ourselves from those who would resort to such drastic measures. You have to be extremely troubled or severely mentally ill to do those kinds of things. And, since you and I would never even consider such behavior, then it follows that we are neither extremely troubled nor severely ill. But what do you say about someone who is tired of being disappointed?

What do you say about a person who has decided to live a simple, constricted existence rather than risk shattering her hopes time and again on the chance that she will one day be permitted to enjoy the basic freedoms of a normal life? To say that she has trouble living with uncertainty is to say something about us all. Facing an uncertain future, we have several options for thinking, feeling and doing. If we can find a way to be optimistic, expecting good things from the unknown, then uncertainty can lead to eager anticipation and excitement.

If we are stuck with a gloomy world view, uncertainty becomes the breeding ground of melancholy and depression. It doesn't matter that we can't predict the future; at least we know it will be some version of the same misery we've always had. Add a tincture of hope to the gloom and we're lucky to come away with anxiety. Look at the bright side, the world might not end today, but maybe tomorrow or the next day. Never knowing when the death blow will fall but ever vigilant against the possibility will send us quickly enough to the medicine cabinet, the liquor store or a rigid belief system that guarantees our own safety even at the expense of the infidel.

So what are we to do? How are we to live with the lack of clarity that is the very fabric of our environment? We presume that fish do not notice the water in which they swim but this is an art we humans have yet to master. We live and breathe in an ambiance of uncertainty but we cannot stop noticing this shifting medium in which we have our being. And, once that medium is noticed, our vague imaginings of the unknowable future can blind us to the only thing of which we can ever be sure - the present moment. It is no surprise then that saints, sages, psychologists and people with old-fashioned common sense have always valued the art of living in the moment.

And now as December darkness encroaches on the dying light, we need more than ever a way to seize and celebrate one day at a time. I would like to tell my patient and remind myself that we do not have to choose between being at peace and continuing to strive toward our goals. We can do both - working for a better future and doing all we can to improve and savor the present moment. There is nothing new about this insight. It is one of those foundational ideas from which all of our speculating and philosophizing begin. Having embarked on the journey, we can say with T.S. Eliot: "We shall not cease from exploration/And the end of all our exploring/Will be to arrive where we started/And know the place for the first time."

When hope is not enough (December 2007 Issue)

By Alan Bodnar, Ph.D.

When hope is not enough
(December 2007 Issue)