Personal hopefulness, along with the perceived future, has been overlooked by psychiatry until relatively recently. There are cogent reasons why psychiatry should not ignore developments in relation to hope. Concepts related to hope are examined to delineate the components of the perceived future. Hope is defined in terms of its elements, its objects, its subject, its phenomenology and its relationship to despair and reality. The contribution of hope to our understanding of psychiatric and medical disorder and recovery from mental illness are also considered, with special reference to existing notions of depression and anxiety. Institutionalization is characterized as a disorder of personal hopefulness. Implications for potential shifts in current theoretical formulation and practice are anticipated. In particular, a critique of the learned helplessness/optimism formulation is outlined.