Coping with Hopelessness: A Mental Health Quandary
An 18 years old female patient was admitted in AKUH with the diagnosis of severe depression and suicidal ideation. She was admitted with complains of severe headache, anorexia and insomnia, lack of motivation and interest in activities of daily living. According to the patient, she had depression since 2 years due to some family problems.
While exploring the history I found out that there was some conflict between her father and mother. She said that “I can’t forget that moment when my father’s behaviour hurt my mother , I cannot help her out and I also feel ashamed to discuss this thing with others due to which I feel hopeless, my life is worthless and meaningless so I also tried to kill myself to get rid of all these problems”.
Patient continuously thinks about her family problems, therefore she has lost all motivation in other activities of life. The aim of her treatment and care was to motivate her towards making her desired future goals for her life and to give her hope so that she can live her life purposefully.
Life is full of emotional ups and downs and people feel many emotions in their life time. One of the most difficult feelings anyone can experience is hopelessness. Many people experience hopelessness in critical situation. They may have a negative response and they do not see a way out of the situation. So these worsening feelings undermine a person’s ability to help themselves and make a person more fearful about his/her future life.
According to Marsigila et al (2011) “Hopelessness is conceptualized as an individual’s negative expectancy regarding the future and it is characterized by negative emotions, pessimistic expectations, and loss of pleasure in life”. Similarly in my patient felt hopeless since she couldn’t do anything to resolve the conflict between her parents.
When I searched and analyzed the concept of hopelessness, I found a number of factors that lead to hopelessness. Physiological factors like chronic diseases and physical disabilities, social factors like family conflicts, unemployment , poverty and psychological factors like trauma, abuse and fear of someone or something can all cause hopelessness.
Similarly in my patient the major cause of hopelessness is parental conflict and verbal abuse by her father which gave her the feeling that the future will be too painful to live through, and she thinks that there is no solution to the problem. According to Ebenuwa and Obiunu (2011), “The children who witness family violence and experience abuse develop emotional, psychological, personality and academic problems. The consequences are manifested in the victim’s personality in form of inferiority complexes, low self esteem, aggression and hopelessness among other personality disorders”.
There are many researches done to identify the effects of hopelessness on mental health. One of the researched done by Marsigila et al (2011), “Hopelessness has been found to have a negative impact on the psychological well-being and physical health of individuals”.
When I relate this study with my patient, I analyzed that because of hopelessness, her physical and mental health declined and she got depressed and was admitted in the hospital along with other physical symptoms . Not only that but it also affected her cognitive ability and she showed lack of performance in her education and lack of interest and motivation in her social life, making her isolated and further stressed out.As Sarin and Abela (2005) have clearly explained, “Once hopelessness develops, hopelessness depression is inevitable”.
Literature review about the theory of hopelessness shows that it’s a continuum of negative and positive attribution. If a person develops negative attributional style in hopelessness and depression ,the person starts adopting maladaptive ways of coping like alcoholism, drug addiction and suicide attempts in order to get out of painful events.
Sokero et al (2006) also explain that “Hopelessness, severity of depression and anxiety are all identified risk factors for suicidal behavior”. Likewise my patient had also history of suicidal ideation. If we see this situation in south Asian context so the researchdone by Vikram and Rahul (2009) also shows that the South Asian region has amongst the highest suicide rates in the world and suicide is one of the leading causes of death in young people (18, 19). Mental disorder is overwhelmingly the most important preventable factor for suicide, and depression is by far the most important mental disorder.
Different strategies were used with my patient in order to develop and maintain a sense of hope in her personality. According to Darlington and Bland (2010) “Focusing on the client’s strengths, acknowledging small gains, making links to past gains, being genuine, helping clients to understand their illness, understanding the importance of achievement and holding on to hope when the client has none”.
At an individual level through therapeutic communication I developed a trusting relationship with the patients and plan strategies which benefit the patients. First I allow the patients to express their feeling by verbalizing and then I try to make my patient recall and focus on their strengths.I encourage patient to count their blessing when they feel hopelessness and divert thier mind in other activities like chatting with friends, going for outings ,reading books and also teach them coping strategies.
At group level we involve the family members in patient care and family counseling is done to overcome family conflicts which affect the health of patients. With the help of occupational therapies I plan to involve patients in different activities likes, music therapy ,painting and games. Such group therapies help the patient in expressing their feeling.
At an institutional levels interventional management rehabilitation sessions are planned and cognitive behaviour therapy is done. I encourage patients to attend this session because it is helpful for them to cope with stress .Patient and family counselling must be planned on a weekly basis.
Through this paper I have learnt that the concept of hopelessness is something thats not only related to the mentally ill patients but it can affect normal individuals as well. Before writing this paper Iused to think about hopelessness in a negative way but I learned through this experience that how we change hopelessness into hope is a very essential aspect of our lives which comes from within ourselves and it gives us the strength and courage to work hard and achieve our goals.
Darlington, Y., & Bland, R. (2010). Strategies for encouraging and maintaining hope. doi:10.1080/03124079908414131
Ebenuwa, E. E., & Obiunu, J. J. (2011). relationship between dimension of sibling abuse and personality development. pakistan journal of social sciences, 8, 90-93. doi:=pjssci.2011.90.93
Marsigila, F. F., Kulis, S., Perez, H. G., & Parsai, M. (2011). Hopelessness, Family Stress, and Depression among Mexicanheritage. 36(1), 7-18.Sokero, P., Eerola, M., Rystala, H., Melartin
Patel, V., & Shidhaye, R. (2009). Depression Retrieved from http://http://sancd.org/uploads/pdf/Depression_fact_sheet.pdf.
Sarin, S., & Abela, J. Z. (2005). The Development of Cognitive Vulnerability to Hopelessness Depression. Graduate Student Journal of Psychology, 7, 10-22. Retrieved from http://www.tc.colombia.edu
Sokero, P., Eerola, M., Rystala, H., Melartin, T., Leskela, U., Mielonen, P. L., & Isomesa, E. (2006). Decline in suicidal ideation among patients with MDD is preceded. journal of affective disorder, 95, 96=102. doi:10.1016/j.jad.2006.04.028 Retrieved from http://vpn.aku.edu/10.1016/Danainfo
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