Hope and hopelessness in carers of a relative with schizophrenia.

In her editorial, Rebecca McGuire-Snieckus warns clinicians against promoting optimism in their clients, since this can lead to unmet expectations and negative reactions when such expectations are not realised.1 In his commentary on the editorial, Femi Oyebode criticises Martin Seligman for exaggerating the importance of happiness at all costs as a goal of existence, and quotes Aristotle as stating that it is the mark of a courageous man to face things that are terrible to a human being.2 I wish to illustrate this in the context of family carers of relatives with schizophrenia. In particular, I focus on the overinvolved carer who is unable to relinquish her/his hopes and expectations for the affected relative. They are readily recognised by habitually referring to their relative in the past tense, for example, ‘she was such a beautiful girl’ or ‘he was such a good student’. This form of speech reveals the fact that the carer is living in the past and has not come to terms with the reality of their relative’s illness. This is particularly hard on the patient, who then feels driven to attempt to satisfy the carer’s need for their success, and fails again and again. The remedy is to offer the carer grief work to mourn their losses and to accept the reality of their relative’s disability and release both parties from this impasse, enabling them to develop a more realistic view. The patient will also benefit from grief work, administered separately from the carer.