The uses of hopelessness.

If most emotional problems, like most medical problems, are caused by bad luck as well as by f actors over which man has control, then those who suffer from such problems must accept a burden of helplessness. When patients and their families overuse theories of causality to avoid accepting their helplessness and to create an illusory sense of human control, unjust assignment of responsibility and excessive expectations for change may erode selfesteem and make change more difficult. The authors present examples of interventions that challenge the overuse of theories of causality. Although these interventions aroused hopelessness, they also fostered realistic hope and change. (AmJ Psychiatry 141:559-562, 1984)