Hope and Schizophrenia

Hope has recently come back into vogue as a concept in psychopathology. Erikson1 mentions it in a recent book as part of the newer frontiers of the human psyche; J. D. Frank2 discusses the part it plays in the psychotherapeutic process; and Melges and Bowlby3 correlate hope and hopelessness with the various psychopathological conditions. In my own work with schizophrenic patients I have observed that the chronic schizophrenic is perhaps the least hopeful of all patients, and this finding does not exclude the manic-depressive, who more than anyone else lives in darkness during his episodes. Upon further reflection it has occurred to me that hope and schizophrenia might be more intimately related than merely that the hopelessness is the effect of a long-drawn-out, wearing-down mental process based on regression. For example, in my experience, the mothers of schizophrenic patients are hopeless people; they seem generally a concrete, low-feeling, pessimistic group. If this is generally true, what part should such maternal life attitudes play in the general hopelessness which forms in schizophrenic patients, being visible even in them in the nursery school?

One of the significant functions of the ego is to provide hope. I define hope as a state of being in which a heightened expectancy overrides the objective possibilities of the moment. Hope abridges the probability of an event by the expectation of a greater return than the probability would indicate. Only a small amount of hope is perfectly correlated with reality—that is, when one hopes for what is directly possible. But hope may sometimes change the probability of an event occurring. The basic determinism of all biological structure, which on a philosophical level comes to be named “the human condition,”