The author presents a case study of a psychotic patient who lived for fifteen years in a psychiatric residency. The study describes, with a critical pen, incomplete or fragmented practices, nihilistic inertias and discouragements, all events that hampered the patient’s life. The author highlights, on the other hand, the patient’s unyielding resilience, in which hope never disappeared, not even during the hardest periods of her existence. Hope and appropriate tools, the author emphasizes, help to redirect a life considered without future. The reconstruction of Serena’s biography, the shared comprehension of her grief, the understanding of her language and hence of her inner world, are the ingredients of life-enforcing relationships. Such relationships, supported by concrete practices (i.e. case management), can become the tools of new life prospects. Finally, the author interweaves a comprehension of Serena’s delirium with a hypothesis on the meaning of delirium and madness as an endeavour to act in response to the anguish of nothingness.