December THE AMERICAN JOURNAL OF PSYCHIATRY 1959 THE ACADEMIC LECTURE HOPE KARL MENNINGER, M.D.2 INTRODUCTORY REMARKS research or a discovery, and it is no dark President Gerty’s invitation to address hour, calling for exhortation or comfort. this assembly of the future leaders of I speak, rather, to the point of focussing our Association was one of the great attention upon a basic but elusive ingredi- pleasures and honors of my life. ent in our daily work-our teaching, our I can well remember my excitement healing, our diagnosing. I speak of hope. when, in company with my father and my Long before love became medically re- teacher Ernest Southard, I attended my spectable, long before Sigmund Freud first annual meeting-the 75th anniversary. demonstrated it to be a basic consideration This was 40 years ago, here in Philadel- in psychiatry, philosophers and poets and phia. I think I have missed only one meet- the common people of the world knew that ing since then. In those days we were a it was essential to our mental health. Per- small, intimate, informal group of a few haps the most beautiful essay ever written hundred; everyone knew everyone. The was about love and its manifestations in program was simple, the entertainment lav- personality. ish and the whole meeting a kind of family To that essay is appended a footnote reunion. Southard and father and many which is often quoted as if it were a others are gone now-but there are new summation. True, observed the writer, elements of a family affair for my brother there are other permanent goods in the Will and myself of which we are proud. world beside love: there is faith, and there In the years since then there has been is hope. But, he added, “the greatest of a vast development in the numbers and these is love.” With this concluding phrase complexity of our organization. I am glad most psychiatrists, I presume, would agree. to have had a part in the planning for its Most of us, I think, would also agree to re-structuring, even though the immediate include faith-the faith that sustains our impact of the suggestions made by the conviction that what we are doing is worth Committee on Reorganization was a shock doing, the faith that our existence has reaction. That 14 of our 18 recommenda- meaning and the faith that our concern for tions have been put into effect is gratify- one another reflects the concern of a ing. But I find the greatest satisfaction in Creator. the emphasis which the program commit- Our shelves hold many books now on tees and officers have placed on our contin- the place of faith in science and psychi- ued self-improvement, on psychiatric edu- atry, and on the vicissitudes of man’s ef- cation, on, for example, academic lectures! forts to love and to be loved. But when it it is from a background of teaching that comes to hope, our shelves are bare. The the topic which I propose to discuss journals are silent. The Encyclopaedia emerged. I would like to warn you not to Britannica devotes many columns to the expect a scientific analysis of it along topic of love, and many more to faith. But conventional lines. The subject does not hope, poor little hope! She is not even permit of that; we don’t yet know enough listed. about it, and it would be presumptuous to I confess I was astonished to discover make the attempt. I am not reporting a this. And yet, I realized that this avoidance of the theme reflected my own attitude. 1Read at the 115th annual meeting of The Time was when for this occasion I should American Psychiatric Association, Philadelphia, Pa., Apr. 27-May 1, 19)9. have chosen as my subject “Love” or 2 Menninger Foundation, Topeka, Kan. “Hate” or “Conflict” or “Instinct” or “Sub- This One 481 IHill11111111111UIliUiliilliliIUIU NX7R-Z43- RY6Q 482 THE ACADEMIC LECIVRE [December limation” or “Symptom Formation”-but far, they presume, they expect or promise never such a thing as “Hope.” It seems al- too much. More often frustration, sad ex- most to be a tabooed topic, a personal mat- perience, or self-depreciation erodes the ter, scarcely appropriate for public dis- confidence required for persistent effort, cussion. And yet-since when has psychiatry and the little candle of hope, which for eschewed examination of our innermost awhile burned so brightly, weakens, sput- thoughts and feelings? Should we not ad- ters and goes out. We see the beginning of here to our professional habit of self-ex- a repetition of scenes so common 25 years amination and contemplation? If we dare ago-hopeless physicians presiding, passive- to hope, should we not dare to look at ly, over hopeless patients. “Psychiatry,” we ourselves hoping? will hear, “has been oversold. The enthusi- This is not the way I began to think asm of inexperience only awaits the dis- about the topic. Nor did I come to it illusionment of time. It is enough if we fresh from struggles with Kierkegaardian bestow kindness and wait for the inevitable. logic, or from brooding over Greek pessi- Hope is for the hopeless, and for fools.” mism, or from apprehensiveness concerning We would like to think that the young the muddled management of unsettled men who pass through our training pro- world affairs. It was all in the day’s work, grams mostly emerge with certain limits so to speak, some preoccupations with the put upon their expectations and certain motivations of the young doctors I teach. guards upon their implied promises, but The miracle of growth has long intrigued with the flame of their hope unextinguished me: the growth of the child, the growth and unextinguishable. We like them to be- of plants, the growth of cultures and the lieve that there is no patient for whom growth of young psychiatrists. I have seen something helpful cannot be done. But we one after another young doctor step for- also like them to realize that the changes ward, fresh from his internship or from the patient desires in himself, or the physi- his military duty, to enter the mysteries of #{149}cian desires in his patient, may not be the psychiatric training. I have seen these ones which come about, may not even be, young men approach the abstruse and in the long run, the changes that it were puzzling material of our field of medicine best to have sought for. It is a responsibility with resolute courage-let us say, rather, of the teacher to the student, just as it is of with hope. the young doctor to his patient, to inspire But behind the fa#{231}adepresented by these the right amount of hope-some, but not acolytes there are often tumults of con- too much. Excess of hope is presumption flicting voices, fearful insecurity and bold and leads to disaster. Deficiency of hope is over-self-confidence. The dramatic picture despair and leads to decay. Our delicate of psychiatry fascinates them, the reputed and precious duty as teachers is to properly resistance to treatment challenges them, tend this flame. the multiplicity of method appalls them. I propose, therefore, that we examine this They are assigned to wards filled with essential constituent of both treatment and vacant or frantic faces, turned now upon teaching. How shall we think of it? Is it “the new doctor.” It is usually long after something which deserves our concern as their initiation into the uncanny world of scientists? Or only as philosophers and mental illness that they can distinguish poets? Is it only an epiphenomenon of life the moving process, or would have the and the healing art? Do we, perhaps, tacit- personal experience of interaction with a ly ascribe hope to temperament, a sort of recovering patient. fringe benefit deriving from certain fortui- Nevertheless, the novitiates assail their tous congenital arrangements of glands and tasks headlong, sometimes with a furor neurons? This is slight improvement upon therapeuticus. There is nothing mercenary the humoral theories of sanguinity and or aggressive about this. They are not melancholy treasured by our forebears. If working for money. They are struggling to we ascribe hope, as some psychoanalytic become effective in a new kind of relation- writers have done, to recollections of ma- ship with patients. Sometimes they go too ternal infallibility and recurrent oral grati- 1959 1 KARL MENNINGER 483 fications, what combination of these experi- indeed of St. Paul, writing to Greek friends, ences shall we regard as optimum? Others to declare that hope should stand along have seen in hope a prevailing note of fear, with love. In this Paul was loyal to his a counter-phobic denial of the horror and Hebrew heritage (Psalms 42, Isaiah 40) as despair born of self-destructive trends or of well as his Christian convictions. For while the immanence of existential doom. the Jews were, to be sure, people of faith, More congenial to my thinking is the they were also at all times a people of ascription of hope to the mysterious work- hope who, despite tribulation, clung to the ings of the repetition compulsion, the very expectation that the Messiah would come essence of which is a kind of relentless and and the world get better. Hence, with the indefatigable pursuit of resolution and spread of Christianity and the dispersion freedom. I would see in hope another as- of the Jews, hope had its missionaries, and pect of the life instinct, the creative drive Paul was one of them.