Despair is the absence of connections or the severance of connections and the consequent sense of emptiness and impotence. Hope is about connecting, relating, being part of a healthy matrix and the consequent sense of agency that can come from this.

This talk explores the particular quality of disconnectedness in our more disturbed patients where hope and despair move in cycles without any sense of a functioning centre that can keep hold of the pieces and understand how they fit together. Parallels are drawn between our patients' internal worlds and the external world in which we are located and work.

Developing a sense of personal agency within a meaningful social matrix in a therapeutic community is contrasted to the state where the organization is always on the edge of unpredictable catastrophe and patients remain in a condition of despairing helplessness.