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July 21, 1978

On Encountering Hopelessness

Author Affiliations

Manteno, III

JAMA. 1978;240(3):211. doi:10.1001/jama.1978.03290030029003

To the Editor.—  The commentary on hopelessness (238:2149, 1977) by Lisa Shulman, MD, illustrates the total frustration of the staff—their reaction to a patient labeled "hopeless." The history is not pertinent except for a clue concerning the negative, non-caring attitude of a stepdaughter and stepson. The question by Dr Shulman as to what caused the patient to begin "suddenly" to act like a rational adult after many weeks of fruitless extensive ministrations was unanswered.The patient who does not respond to therapy, does not give us a reasonable diagnostic niche, and acts helpless is almost always labeled as being hopeless. How aptly this describes those in nursing homes—even the many elderly as described in Dr Shulman's case report. Studies have shown that the locales of examinations as well as education and the varying attitudes of examiners produce diverse diagnoses and management decisions.1-3A study was initiated a few years