 |
| Hope in the Moratorium Stage: Hopelessness |
Hope in the Moratorium Stage: Hopelessness
In the first stage of recovery, hopelessness abounds. Consumer accounts are rife with descriptions of the hopelessness that follows diagnosis and/or treatment. Those who are trying to help the person can paradoxically have the opposite effect. As noted in Chapter 1, the hope of consumers can be undermined by the lack of hope of their treating clinicians and programmes that are geared towards stabilization and maintenance (Harding, 1987). Many clinicians have been taught that people with schizophrenia never improve, and this is reflected in some psychoeducational programmes (Bassman, 2001; Chadwick, 1997; Strauss, 2005). As Strauss (2005) says, people are often told, ‘You have a disease like diabetes. You will have it all your life. You will have to take medications all your life and there are certain things you will never be able to do’ (p. 51). Chadwick (1997) explains that this analogy to chronic illness can underpin beliefs that there is no chance of recovery. Thus, consumers and their carers learn hopelessness from the attitudes of those trying to help them (Warner, 2004; Strauss, 2005). Bassman (2000), who held a Master’s Degree in Psychology, relates:
He was emphatic in alerting all of us to the chronic life-long course of my disease and explained how I would have to learn to live with my limitations. If I did become able to work, future employment would have to be in a low-pressure, low-stress job.
(p. 1401)
Bassman later earned a Doctorate and at the time of his account had been working in a professional capacity for over 20 years (Bassman, 2001). Hope has been found to be unrelated to the severity of psychotic symptoms (Resnick, Rosenheck and Lehman, 2004). And hopelessness predicts poor rehabilitation outcomes for people with schizophrenia, even when the influence of negative symptoms is taken into account (Hoffmann, Kupper and Kunz, 2000). Hoffman and colleagues found that having already ‘given up’ – as evidenced by depressive-resigned coping strategies – was as strong a predictor of a person’s poor outcome as were negative symptoms.
Hope theory describes hope as ‘. . . a positive motivational state that is based on a . . . sense of successful (a) agency (goal-directed energy), and (b) pathways (planning to meet goals)’ (Snyder, Irving and Anderson, 1991, p. 287). ‘Pathways thoughts’ are the person’s perceived ability to generate routes to goals. That is, the person believes he or she can find a way of attaining his or her goals. ‘Agency thoughts’ represent the person’s belief that he or she will be able to make progress towards a goal. Thus, agency is the motivational component of hope theory (Snyder, 2000a). So in order to hope, the person has to have a goal, perceive a route to the goal, and have the motivation to pursue the goal. Goals are vital to hope; they provide the endpoints of mental action sequences (Snyder, 2000b). There can be no hope if there is no goal, and many people diagnosed with schizophrenia feel that their valued goals in life have been taken from them:
Our pasts deserted us and we could not return to who we had been. Our futures appeared to us barren, lifeless places in which no dream could be planted and grow to reality. (Deegan, 1988, p. 55)
All purposeful human behaviour is goal-directed (e.g. Snyder, 2000b). Avolition, or the inability to initiate and persist in goal-directed behaviour, is one of the negative symptoms of schizophrena. However, rather than representing a symptom, avolition may represent goal-directed ‘self-protective withdrawal’ by someone whose dreams and aspirations have been shattered (Davidson and Stayner, 1997; Deegan, 1996b). Rodriguez-Hanley and Snyder (2000) described the loss of hope when a person’s goals are blocked, tracing a route through rage, despair and finally apathy.
Although these hypothesized stages of loss of hope do not map perfectly onto the consumer accounts of loss of hope in serious mental illness – for some, rage marks the returning of hope (e.g. Unzicker, 1994; Deegan 1996b) – the final stage, apathy, resonates with consumer descriptions. Apathy is a state of loss of interest in things that would normally be appealing or important, a lack of emotions or feelings, and passivity.
Anguish is a death from which there appears to be no resurrection. It is inertia which paralyzes the will to do and to accomplish because there is no hope. (Deegan, 1988, p. 56)
Descent into apathy depends both on the importance of the goal and the perceived magnitude of the barriers to the goal (Rodriguez-Hanley and Snyder, 2000). Clearly, these factors are immense in the case of serious mental illness. The impediments to a person’s goals are often portrayed as insurmountable – as illustrated by the earlier quotes of Bassman (2000), Bjorklund (1998), Deegan (1988) and others, who had been advised to abandon the aspirations they had and replace them with more ‘realistic’ goals.
In a review of the concept of personal hopefulness in the context of psychiatry, Nunn (1996) described hope as having three components: temporality, or future orientation; desirability, or the wished-for future; and expectancy, or the belief that the desired future is possible. Expectancy has to be strong enough to result in behaviour directed towards the desired future. Therefore, in line with Snyder’s definition, hope is the general tendency to construct and respond to the perceived future positively (Nunn, 1996). When expectancy is weak, however, the person will not take action towards the goal. Nunn describes four components of personal hopefulness. These are: (i) mastery – consisting of personal responsibility, personal efficacy, and environmental responsiveness; (ii) purpose in life – the capacity to make sense of one’s experience; (iii) future support – hope borne in the trust of others; and (iv) perceived future self. These components of personal hopefulness suggest links between the four components of recovery described by consumers.
Hopelessness ensues when negative events are attributed to internal and global personal inadequacies that are projected onto the future self (Abramson, Metalsky and Alloy, 1989; Nunn, 1996). Nunn’s and Snyder’s formulations of hope and the descent into hopelessness are instructive on the loss of hope in the Moratorium stage.
Hopelessness develops when the person perceives the disorder and its consequences to be beyond his or her control, becomes demoralized, and gives up believing in a successful outcome (Hoffman, Kupper and Kunz, 2000).
The person feels helpless, eventually abandoning responsibility and active coping strategies:
It is a time of real darkness and despair. Just like the sea rose in January and February, it is a time when nothing seems to be growing except the darkness itself. It is a time of giving up. Giving up is a solution. Giving up numbs the pain because we stop asking ‘why and how will I go on?’ Even the simplest of tasks is overwhelming at this time. One learns to be helpless because that is safer than being completely hopeless. (Deegan, 1996a, p. 5)
In the first stage of recovery, hopelessness abounds. Consumer accounts are rife with descriptions of the hopelessness that follows diagnosis and/or treatment. Those who are trying to help the person can paradoxically have the opposite effect. As noted in Chapter 1, the hope of consumers can be undermined by the lack of hope of their treating clinicians and programmes that are geared towards stabilization and maintenance (Harding, 1987). Many clinicians have been taught that people with schizophrenia never improve, and this is reflected in some psychoeducational programmes (Bassman, 2001; Chadwick, 1997; Strauss, 2005). As Strauss (2005) says, people are often told, ‘You have a disease like diabetes. You will have it all your life. You will have to take medications all your life and there are certain things you will never be able to do’ (p. 51). Chadwick (1997) explains that this analogy to chronic illness can underpin beliefs that there is no chance of recovery. Thus, consumers and their carers learn hopelessness from the attitudes of those trying to help them (Warner, 2004; Strauss, 2005). Bassman (2000), who held a Master’s Degree in Psychology, relates:
He was emphatic in alerting all of us to the chronic life-long course of my disease and explained how I would have to learn to live with my limitations. If I did become able to work, future employment would have to be in a low-pressure, low-stress job.
(p. 1401)
Bassman later earned a Doctorate and at the time of his account had been working in a professional capacity for over 20 years (Bassman, 2001). Hope has been found to be unrelated to the severity of psychotic symptoms (Resnick, Rosenheck and Lehman, 2004). And hopelessness predicts poor rehabilitation outcomes for people with schizophrenia, even when the influence of negative symptoms is taken into account (Hoffmann, Kupper and Kunz, 2000). Hoffman and colleagues found that having already ‘given up’ – as evidenced by depressive-resigned coping strategies – was as strong a predictor of a person’s poor outcome as were negative symptoms.
Hope theory describes hope as ‘. . . a positive motivational state that is based on a . . . sense of successful (a) agency (goal-directed energy), and (b) pathways (planning to meet goals)’ (Snyder, Irving and Anderson, 1991, p. 287). ‘Pathways thoughts’ are the person’s perceived ability to generate routes to goals. That is, the person believes he or she can find a way of attaining his or her goals. ‘Agency thoughts’ represent the person’s belief that he or she will be able to make progress towards a goal. Thus, agency is the motivational component of hope theory (Snyder, 2000a). So in order to hope, the person has to have a goal, perceive a route to the goal, and have the motivation to pursue the goal. Goals are vital to hope; they provide the endpoints of mental action sequences (Snyder, 2000b). There can be no hope if there is no goal, and many people diagnosed with schizophrenia feel that their valued goals in life have been taken from them:
Our pasts deserted us and we could not return to who we had been. Our futures appeared to us barren, lifeless places in which no dream could be planted and grow to reality. (Deegan, 1988, p. 55)
All purposeful human behaviour is goal-directed (e.g. Snyder, 2000b). Avolition, or the inability to initiate and persist in goal-directed behaviour, is one of the negative symptoms of schizophrena. However, rather than representing a symptom, avolition may represent goal-directed ‘self-protective withdrawal’ by someone whose dreams and aspirations have been shattered (Davidson and Stayner, 1997; Deegan, 1996b). Rodriguez-Hanley and Snyder (2000) described the loss of hope when a person’s goals are blocked, tracing a route through rage, despair and finally apathy.
Although these hypothesized stages of loss of hope do not map perfectly onto the consumer accounts of loss of hope in serious mental illness – for some, rage marks the returning of hope (e.g. Unzicker, 1994; Deegan 1996b) – the final stage, apathy, resonates with consumer descriptions. Apathy is a state of loss of interest in things that would normally be appealing or important, a lack of emotions or feelings, and passivity.
Anguish is a death from which there appears to be no resurrection. It is inertia which paralyzes the will to do and to accomplish because there is no hope. (Deegan, 1988, p. 56)
Descent into apathy depends both on the importance of the goal and the perceived magnitude of the barriers to the goal (Rodriguez-Hanley and Snyder, 2000). Clearly, these factors are immense in the case of serious mental illness. The impediments to a person’s goals are often portrayed as insurmountable – as illustrated by the earlier quotes of Bassman (2000), Bjorklund (1998), Deegan (1988) and others, who had been advised to abandon the aspirations they had and replace them with more ‘realistic’ goals.
In a review of the concept of personal hopefulness in the context of psychiatry, Nunn (1996) described hope as having three components: temporality, or future orientation; desirability, or the wished-for future; and expectancy, or the belief that the desired future is possible. Expectancy has to be strong enough to result in behaviour directed towards the desired future. Therefore, in line with Snyder’s definition, hope is the general tendency to construct and respond to the perceived future positively (Nunn, 1996). When expectancy is weak, however, the person will not take action towards the goal. Nunn describes four components of personal hopefulness. These are: (i) mastery – consisting of personal responsibility, personal efficacy, and environmental responsiveness; (ii) purpose in life – the capacity to make sense of one’s experience; (iii) future support – hope borne in the trust of others; and (iv) perceived future self. These components of personal hopefulness suggest links between the four components of recovery described by consumers.
Hopelessness ensues when negative events are attributed to internal and global personal inadequacies that are projected onto the future self (Abramson, Metalsky and Alloy, 1989; Nunn, 1996). Nunn’s and Snyder’s formulations of hope and the descent into hopelessness are instructive on the loss of hope in the Moratorium stage.
Hopelessness develops when the person perceives the disorder and its consequences to be beyond his or her control, becomes demoralized, and gives up believing in a successful outcome (Hoffman, Kupper and Kunz, 2000).
The person feels helpless, eventually abandoning responsibility and active coping strategies:
It is a time of real darkness and despair. Just like the sea rose in January and February, it is a time when nothing seems to be growing except the darkness itself. It is a time of giving up. Giving up is a solution. Giving up numbs the pain because we stop asking ‘why and how will I go on?’ Even the simplest of tasks is overwhelming at this time. One learns to be helpless because that is safer than being completely hopeless. (Deegan, 1996a, p. 5)
