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While a variant of hopelessness exists in severe schizoid states, the one we are interested in here is a hopelessness that originates in childhood experiences of unpredictable emotional and physical violence. In these situations, children become the receptacles for the evacuation of unbearable psychic matter in an environment from which they cannot escape. Early object relations are characterised by extreme psychic usage by adults who themselves do not have the capacity for guilt and accountability. In this way the interminable cycles of dehumanisation are never broken. These children live in a world of inevitable wrongness and danger. The dissociation incurred by the continual attention to the avoidance of inner catastrophe means that there is little or no available energy for the normal developmental tasks of childhood. They are in a permanent state of crisis.

Unlike the schizoid solution, these children cannot hide. As a result, destructive energy binds the ego into a tightly fastened identification with controlling and merciless bad objects. It is this partnership that buffers the psyche against psychotic disintegration while at the same time fostering a timeless zone of despair and futility.

In its most severe form are found the antisocial, narcissistic configurations and severe borderline and paranoid states, and for many of these individuals the hopeful act of seeking therapy never happens. But what of those that find their way to the therapists rooms? And some do.

In working with these individuals, it may be said that within the therapeutic couple, it is only the therapist who holds the capacity for hope and can therefore suffer the condition of hopelessness. If we understand the absence of hope in the way outlined above, then we can see that the introduction of hope into the therapeutic space may be experienced by the patient as a catastrophic failure of empathy on the part of the therapist. It may increase their sense of isolation, solidifying attachments to bad objects in a renewed defence against unbearable and implosive shame. The early object environment is reproduced in the consulting room where the patient again becomes perpetually wrong. And through projective identification, so does the therapist. In this situation the expectation of hope can be experienced as persecutory and may trigger explosions of rage which are also an attempt to rid themselves of early malignant introjects.

With most patients we can dream them, enter their imaginative playground and introduce our own transitional objects on the road to transformation. However, with severely damaged patients, their world is different. Sometimes it is beyond our dreaming. In the absence of our empathy, they can only make us understand through primitive defensive mechanisms such as splitting and projective identification. Returning to the metaphor of the Gordian knot, perhaps this is not a case for decisive action nor frustrated attempts at disentanglement, but for the courage to be in the presence of what we yet do not understand. To be reminded of the transforming power of humility and therapeutic faith.

There is important work here for therapists as well. It challenges their fantasy of healing their own early objects and in so doing, offers an opportunity to mourn the limitations of their own omnipotence and loss of early parental functions. Something new is called for—a creative abandonment of hope without an identification with the patient’s futility. A place where the patient is not required to be anything they cannot be with a therapist who can tolerate their own hopelessness.

In his novel The Skin of a Lion, which is concerned with naming, history and the entrance into the world of language and symbols, Michael Ondaatjie writes:

“Trust me, this will take time but there is order here, very faint, very human.”).

 

 

 

 

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