By | September 23, 2011 7 Comments

Where there is life, there is hope … or is there?

By Joyce Alexander, RNP (Retired)

One of the things I was raised to believe was, “where there is life, there is hope.” It was one of the precepts I was taught to believe to always keep “hope” alive.

In the last few decades, there have been many advances in the medical profession’s ability to save people that not long ago have surely would have died. My grandfather was one of the early members of my family who was “saved” from a sure death from pneumonia by the first “sulfa drugs,” antibiotics. It was a miracle, as he was already thought by the doctors to be “sure to die,” but he returned from the very brink of death and survived.

With cardiopulmonary resuscitation (CPR) and advanced CPR and defibrillation equipment, people have been saved from death by choking and the occasional heart attack, from being unable to breathe for themselves for a time, etc. The media, however, have led the general public to think that there is “always” hope of someone, even when they are comatose, reviving, waking up and hanging on to life.

The truth, however, is that even with these many advancements, there is still only limited hope of someone who is in a deep coma waking up and walking out of the hospital and living a full life. The truth is that there is not always a realistic hope.

Trying to resuscitate

Having been a member of my local volunteer fire department for many years, I was one of the first responders to many car wrecks, strokes, heart attacks and traumatic injuries of all kinds. Even if the person was non-responsive and I could look at them and know for a certainty that there was no “realistic hope,” I would do CPR on the person, unless there was a do not resuscitate order. In working in hospitals, I followed the same protocol, “doing my best” to keep the person alive.

In working in intensive care units, I have seen futile resuscitation attempts made on very old and very sick people that there was absolutely no chance in Hades that they would ever wake up, much less live any kind of quality life. I have seen children kept on respirators for decades because their parents could not give up the hope that their child would one day wake up and go home with them.

In our personal lives as well as in medical care, there are people who cling to unrealistic hope to the point that they sacrifice so much to hang on to that hope. In psychology, we call that unrealistic hope “denial.” But I have also coined the term “malignant hope” to, I think, better describe the results of continual, long-term denial.

Denying cancer

A patient came to me once with a large infected abscess on her breast. It was obviously infected, so I gave her some antibiotics to treat the infection, but I asked her, “Have you had a mammogram?” She said to me, “No, I don’t get mammograms because if I have breast cancer, I don’t want to know about it.” My consulting physician then spoke to the woman and insisted that she get a mammogram immediately, which she reluctantly did, and yes, she had advanced breast cancer. The lesion that had become infected had not arisen “over night.” It had been there and easily visible for some time. I am sure that this woman had seen the many public service announcements on television about women needing to be screened for breast cancer by regular examinations and by mammograms and self examinations to feel for “lumps.” Yet, she was afraid to find out the truth.

This woman had known for months that there was “something wrong” with her breast, that there was a lump there, but she clung to “malignant hope” in her denial, because the thought of having cancer was so painful to her that she could not accept that there might be something there she should do something about. She continued to endure the anxiety and pain from the lump, but she could not do anything about it as long as she maintained the “malignant hope” of denial. Denial keeps us from taking action.

In this woman’s case, she did not (the last I knew) die from her cancer, but she had a much harder treatment regimen than she would have had if she had done something about the lump when she first noticed it. Her denial, her “malignant hope” that she might not have cancer, was counter productive to her healing. To her very survival.

Malignant hope for change

When we are dealing with psychopaths in our lives, we want to have “hope” that the person we love will somehow turn out to be a better person than we are seeing evidence of. We want to hold on to that hope, rather than admitting that there might be no hope that they will reform, repent, or become whole. We cling to the denial, the malignant hope, that if we just wait, or if we just treat them better, or do more to show them that we love them, that what we dread and fear will not come to pass.

Just as people who are “brain dead” can sometimes be “maintained” on “life support” (I prefer to call it “death support”) for extended periods of time, we maintain our relationship with the personality disordered at great cost to ourselves and our lives in the malignant hope that will never be realized.

There comes a time in medicine when we must admit that we cannot prolong life, only prolong the dying process, and there comes a time in our personal lives when we must accept that we cannot improve or prolong a relationship with someone who is disordered.

Cutting the disordered, the malignant personality, out of our lives is likely to be a painful process, just as surgery to cut out a malignant tumor is sometimes painful and disfiguring, but it is essential to our health and sometimes our very survival. If we remain in our state of denial and malignant hope, our resources will be used in a vain attempts for cures that can never benefit either us or the personality disordered person we love.

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Oxy and All,

As a nurse, practicing, I love the medical analogies you use, Oxy. I so relate to them! This is another excellent article and got me thinking about how I came to the idea of malignant hope, and subsequently malignant ‘helping’ (which I think Skylar has recently been blogging about).

Pema Chodron, a Buddhist monk, says to ‘abandon hope’, as a way of coming to terms with ‘what is’ and not what we would hope for it to be. The Buddhists’ are always pushing man to face what is real and present in each moment. And, if I am understanding even a little, ‘hope’ is something that happens outside of the reality of ‘now’ and can only exist in the future. Persistently living in the future, through hope, means we are not managing the reality of the present. This can have disastrous effects.

Pema went on to talk about the neurotic ego, not the healthy ego, being the source of this kind of hope, and the closely tied belief that hoping will affect the outcome. And that this is one way our unhealthy egos cause us to act in ways that are self-destructive, and prolong our involvement in destructive/drama-driven/’hopeless’ situations.

I think no place is that more evident than our hope that a personality disordered individual will respond and change. That is, as you say, a malignant (neurotic) kind of hope.

Years ago when I talked with my therapist about this idea of abandoning hope and how I had hoped, and striven, and did everything I could to ‘fix/change’ the spath, she also pointed out to me how my own narcissistic tendencies were driving this malignant form of hope/help. We spent many sessions looking at ways that my young self had been ‘ego wounded’, and how this had lead to inaccurate beliefs and ways of relating to my world. One of which was that my hope and helping were kind of ‘all powerful’ and that I could actually change people through the power of my hope and love and helping.

These were ideas that formed when I was very little, and were the fantasy response of a helpless child who was suffering all sorts of abuses.

When I read about abandoning hope I felt a real feeling of relief. But it also, to one part of me, seemed WRONG to not hope. That I would be a bad person if I let go of hoping, and plunge into despair and have nothing to live for.

I sort of related to hope like a religious practice. It went along with always turning the other cheek, never saying anything negative, trying only to think ‘good’ thoughts about people, every problem is 50/50, and we always have to meet folks halfway, and everyone is deep-down good and just.

None of these things are true.

It is hard, hard, hard to let go of what I think of as our personal religions. And it takes some serious digging to unearth these buried lies.

May we all dig till we find our real selves……

Ox Drover

Dear Slimone,

THANK YOU VERY MUCH!!!! Your comments added so much to my article.

That NARCISSISTIC STREAK in us all that we have the “power” to HOPE THINGS INTO EXISTENCE…when of course we dont’ have, is a sort of “magical thinking” that we engage in. That idea that if I just work hard enough I can fix whatever is wrong…LOL Yea, I’ve seen it so often in medical practice, and with physicians as well as family members not “giving up hope” like ti is some sort of (as you said) “personal RELIGION”–that’s a very good analogy, I think!

Thanks for your contrabution!


Excellent analogy. When we think that finding out we have cancer is worse than dying from it, there is definitely a disconnect from reality. Caused by fear.

The same goes for fear of admitting that your family members are evil. Only education can change that. Education forces us to look at reality and see that there is no denying it. Once we’ve passed that hurdle, it isn’t as difficult to know the truth. The truth won’t kill you, but a lie might.

For 2 years, I’ve not been able to see my parents for what they are. I was sickened by the idea and would panic whenever I even contemplated it. 2 years I spent studying spaths – DAILY. I had to understand the profile, the reality of what they are and how to recognize them. With a solid understanding, I was ready to “look” at my parents and really “see” them. This summer, it came slowly into focus. It was scary. But it’s becoming more and more “real” for me. There is less Cog/Dis.

Ox Drover


Darling, I can totally relate to that….same way with realizing and recognizing what my son C was/is and my egg donor…you “know” and yet you “deny” and hold on to the “malignant hope” that what you know is true is not true…and your own narcissistic “belief” in yourself that you can FIX IT. LOL

The person in our lives that is TOXIC to us doesn’t even have to be a full-fledged psychopath, just a toxic arse is plenty of reason to say NO MORE!!!!

It is painful, just like cutting out a cancer, but if we don’t get that “cancer” of “false hope” out of our lives, it will spread to every organ in our bodies, minds, souls and lives. As long as we allow cancerous cells to remain in our bodies, or our lives, they will ultimately destroy us.

I finally decided it was the same with my smoking and eating too much salt and too many calories. I stayed in denial about what they were doing to me…just like I stayed in denial about my family’s toxic and destructive behavior…my OWN toxic and self-destructive behavior, and So I ultimately CUT THEM OUT along with my OWN negative and toxic behaviors as well. Sometimes it was like cutting off an arm or a leg, but ultimately it saved my sanity and I think my very life.

Jesus said “if your eye offends thee, pluck it out” etc. and “it is better to have only one eye.” (Paraphrased) And I think basic common sense tells us that if have cancer in an eye, we are better off to cut it out than to die from the cancer, or an arm or a leg, or a loved one—relative, friend, spouse, child, etc. Whatever is the “cancer” in our lives, we need to CUT IT OUT. Much better to live than to die because we couldn’t bear to be without an eye, or a leg, etc.


Long time no TYPE!!!! Many changes, including “Mike” finally making the decision to come live with us after his spath brother was involved in a very serious motorcycle accident – the spath was found to be “at fault,” and there is some question as to whether or not it was intentional.

The article by Slimone is superb. And, I really identify with the “malignant hope,” or false hope. I had to come to realize that there is what SHOULD be, then there is what IS, and never shall the two meet.

Thanks to EVERYONE for sharing their experiences and their healing processes. I haven’t posted simply because I haven’t had a better tool than a stupid smart phone (yes, an oxymoron). But, I have been able to read. So, thank you all for helping me to remember that I’m not insane and that we can, and DO, get away from these people once we can peg them for what they are!


Ox Drover

Dear Truthspeak,

Well, I hope that mike coming to live with you all will be an improvement all the way around and that the brother will lose influence with mike.

Keep on reading even if you are not able to post! (((hugs)))


Thanks, OxD,

Mike has a long, long road to travel and Mike keeps in touch with the brother, not the other way around – I understand this and I don’t attempt to discourage it. I just don’t say ANYthing about the brother, at all.

I do read whenever I can – and, whenever I fail to visit LoveFraud, I get into trouble with spaths. I swear, this is a fact! This site helps me to keep centered and remind me of my boundaries.

Brightest blessings!!!!!!!

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