Importance of Hope for Recovery from Mental Illness

Many studies correlate mental illness with low hope. Loss of hope, for example, has been shown to predict suicide as or more powerfully than depressive disorder (Dyer and Kreitman, 1984; Wetzel, 1976). The principal feature of the syndrome of institutionalization is hopelessness (Barton, 1966). People who evidence extreme reality distortions, i.e., delusions, are very low in hope, and their illusions interfere with the attainment of desired goals. This can be the case with schizophrenia, delusional disorder, mood disorders with psychotic features, etc. (Czuchta and Johnston, 1998).

Moreover, increased hope is considered necessary for healing from mental illness. Psychotherapies "work" fundamentally by increasing hope (Snyder et al., 2000). Hope, for example, is central to the process of reconstruction of a sense of self in patients with chronic mental illness. Shorey and colleagues (2002) note: "Hope provides the belief that positive outcomes are possible and thus engenders a sense of personal empowerment as clients come to see that they can make positive change in their lives" (p. 323). Patients speak most often of accepting their illness, maintaining a hopeful attitude, and having the right kind of support as the most important factors in their recovery (Hatfield and Lefley, 1993).

As mentioned, a sense of hopelessness is common during many forms of severe mental illness, particularly during severe depression. Melges (1982) indicates that "spirals of hopelessness" occur when an individual believes his/her plans of action are no longer effective for meeting desired goals, and this is concomitant with a "constriction of future time perspective" foreclosing consideration of alternative plans (p. 178). People with chronic mental illnesses need to feel hopeful about their efforts to accept or change the realities of their world.

To a certain degree, hope is also preventive. Snyder and colleagues (1991) have shown that hope correlates negatively with anxiety, protecting against perceptions of vulnerability, uncontrollability, and unpredictability. For those with anxiety disorders, increased hope is an important factor in the psychological change precipitated by successful anxiety treatments (Michael, 2000). In my work with clients with generalized anxiety disorder, those who have hope in the treatment tend to be more faithful in doing homework exercises and ultimately more successful in reducing anxiety. Moreover, individuals high in hope report greater social problem-solving abilities than individuals with low hope (Chang, 1998). Individuals high in hope use fewer disengaged coping efforts (e.g., social withdrawal, problem avoidance) compared with individuals low in hope. In a group intervention study for depressed older adults (Snyder, 2002), a 10-session series of hope-based activities lessened the elders' depression and increased their activity level significantly more than Butler's reminiscence group therapy. While hope is not a cure all, one cannot recover without it. As Hatfield and Lefley (1993) state: "Hope is crucial to recovery, for our despair disables us far more than our disease ever could" (p. 122).

58 Creativity, Spirituality, and Mental Health

Many individuals who have never been diagnosed with a mental illness have difficulty envisioning the degree of despair being referred to here. This may be because, as Snyder (2002) suggests, hope is learned, likely much the way other ways of thinking are learned in childhood and throughout life. Hope as a cognition keeps many people out of mental hospitals, despite great ordeals. Others, less equipped with hopefulness and with few or no resources, end up in the hospital, sometimes repeatedly. One of the clients I work with wrote a beautiful poem called "The Shoe," in which she gently points out that there is a fine line between those of us in the hospital and those of us outside of it, one of the differences being that those on the outside have their hearts hardened to those within. She feels this stigma within her own family - sometimes family members do not know how to help her and find themselves exasperated. Once one does become more sensitive to the hopelessness of those with mental illnesses, what can be done about it? How can the hopeless be inspired to hope, and thus begin the work of recovery?