The dilemma of being caught between idealised rescue of a cure and a denigrated rejection of the role of carer evokes misery in professionals who struggle to find a balanced place in which to reflect on being pulled in one direction or the other. The professional ethical dilemma becomes a more hidden personal moral dilemma of resenting if not hating the patient who evokes helplessness and a sense of profound inadequacy.

Therapeutic impotence is the other side of the coin of therapeutic omnipotence and both carry a harsh sentence in the professional world. Pride comes before a fall and the borderline tightrope is strung between hubris and nemesis. There are many judges to witness the fall from grace; the patient, the institution, the profession and perhaps worst of all, the mind of the professional who contrasts their failure with their shameful secret expectation of cure. These are the narcissistic wounds of real or perceived negligence, the professional echo of early neglect.

The narrative unfolds: the patient appeals to the professional sharing their terror.