I’ve done some research, and I think my girlfriend is bipolar. She gets into these very good moods for no particular reason, and when she’s in this mood she can’t stop talking and seems high and silly (and that’s when she sometimes drinks too much). When she’s like that, she’s more obnoxious-funny than really funny, but she thinks she’s a riot. I’m not crazy about her up times, but what I really dread is the crash that follows; it’s hell for her and everyone around her. I know she sees a shrink, so I told her what I was worried about, but she acted like I was insulting her and then she said she was sorry, maybe I was right, but she likes feeling happy and doesn’t see anything wrong with it and why should it bother me. My goal isn’t to take away her joy, but I wonder if it’s bad for her to be bipolar and, if so, what she should do about it.

You’re right to worry about your girlfriend’s highs, but getting through to her may not be easy. Manic people aren’t exactly perceptive, unless by perceptive, you mean frighteningly giddy and overwhelming obnoxious.

Meanwhile, she sees her mania as the time when she’s fun and funniest, so she may resent you for criticizing her behavior when, from her point of view, she’s at her best, wittiest, and happiest.

Being manic also comes with the certainty that you can do no wrong. Between that and the ecstatic feelings, judgment is lost in a heavy, happy mist.

That’s why, if you have bipolar disorder, you should ask trusted friends to tell you if you seem over the top—it’s an “advance directive,” like the one you would use to tell them whether to authorize CPR if you pass out—because mania makes it hard for you to judge for yourself, especially when you’re too busy dancing on cars in a bikini to notice.

Of course, your girlfriend has a milder form of the problem, but it makes her focus on how she feels, rather than on what’s happening now or on consequences. That’s why she’s heard what you have to say and doesn’t appear to give a shit.

So, instead of expressing worry and doom, encourage her to consider the risks while expressing confidence in her abilities, and respect for her right to make her own choices. If she can’t or won’t understand your warning, accept that fact and do your best with it.

You want her to heed your warning and save herself and your relationship, but if she can’t, it’s better for you to know now than to spend months and years in a negative struggle, trapped in an unhappy mist that will drive you crazy yourself.

STATEMENT:
Compose a statement that makes your best case in a non-coercive way. “You’re usually very responsible and good with people, but I worry about your high moods because you seem to get carried away more than you realize, lose touch with how other people react, and drink too much, and afterwards you’re always depressed and very unhappy. Don’t trust my view if you think I’m prejudiced; ask others who know you and ask a professional whether the mood swings might get worse. Then, whatever you decide, I know you’ll be thinking about what’s good for you, rather than what feels good.

I like my brother’s girlfriend—she seems like an all-around good person—but I really worry about the two of them together. They fight constantly, and from what I can tell, the things they fight about are things that are never going to change. Like, she hates that he works so late, but she knew he was a chef when they met and that the hours are long, and he loves his work and isn’t leaving it for anyone. Then he hates how stingy she is about money when it means going without things they don’t need, even when they can actually afford it. I hate to see them fight, but they seem absolutely determined to stay together even though neither one of them wants to, or is able to, change his or her lifestyle. I see that they love one another, and my brother wants to marry her, but I worry that they’re locking themselves into a lifetime of unhappiness.

You’re right not to criticize a relationship that is obviously important and meaningful to your brother, for obvious reasons. What feels like worry to you will feel like criticism to him, with no good results to your relationship or his.

You can help him think rationally, however, (or at least satisfy yourself that you’ve done your best on that score), if you first show obvious respect for him, his girlfriend, and their effort to make things work. Keep your fear to yourself, because it always implies disrespect for his choices. Think like a hostage negotiator, with your brother’s future in bondage.

When he brings up an issue in their marriage, don’t talk about solutions; you’ve already decided there aren’t any, and trying to find one will just make you impatient. Instead, ask him about what will happen to him and her if they are who they are and life does what it does.

The key component you describe as possibly missing is acceptance—she can’t accept the hours dictated by his profession, and he can’t accept her money management–so it’s reasonable for you to wonder what’s likely to happen as their jobs become more complicated, they have kids, one of them gets sick, i.e., if life happens.

If you believe, as you do, that the things they can’t accept aren’t likely to change, then ask him whether, given the worst case scenario for his schedule and her spending, he thinks he can accept her as is and vice versa. You can share the notion that you think acceptance is a more important predictor than love of whether a relationship is likely to work.

Remember, you’re not asking him whether he thinks they’ll be happy together, because marriage is often painful and unhappy for everyone. Non-acceptance, not unhappiness, however, is what blows marriages apart.

You’re asking him whether they’re likely to be able to continue to do business together and, if not, what impact that will have on their lives. If he hears you out and still goes forward with marriage, then at least you can accept that you did your best.

STATEMENT:
Here’s a statement of your mission. “You’ve got three good things going for you: you love one another, you really want to make things work, and you’re actively trying to find out whether you can live together. You can’t necessarily control your own work and money habits, let alone someone else’s, so you never know whether you can make things work, no matter how much you love one another; but doing what you’re doing is the way to find out and, as long as you have the courage to accept what you find, you can’t go wrong.”

My husband worries a lot about my drinking and depression but, to my mind, I don’t think my drinking is a problem and I don’t think I’d be depressed if I wasn’t worried that he’d leave me. For the sake of our marriage, I’ve agreed to stop drinking for a while and go to AA, but I really feel that my drinking wasn’t causing me any problems and that I’m doing this to make him happy, which makes me feel weak and angry. I want to get him to accept me the way I am before I can’t take it anymore.

You’re in a tough spot, because partnership really can’t work without acceptance, and acceptance is not something you can control. The more you force acceptance, the harder it is to achieve. Accept that, buddy.

If you try too hard to get his acceptance, you’ll hide whatever you think he won’t accept, which means putting your drinking in the closet and going to the mall instead of AA meetings.

On his end, if he tries too hard to make the relationship work, he’ll pretend you’re not really drinking or that you’re going to change, which also means no real acceptance.

The sad fact of life is that you are never going to change who you really are, which, at the very least, is a girl who enjoys drinking, and he’s going to have to take it or leave it. On the other hand, if you present the issue positively and he considers it realistically, maybe acceptance will occur, now that you’re not forcing it.

That’s why your goal shouldn’t be to win acceptance from your love; it’s to find out if your love can be accepting. He doesn’t need to like your drinking, but you need to know whether he can accept that it’s part of your package and accept the whole deal.

Instead of getting him to accept you the way you are, begin by accepting yourself. Forget how much you like to drink and ask yourself, on the basis of your own experience and what you’ve read, whether drinking gets in the way of anything you hold dear, like your health or making a living or being a good woman and a good friend. If in doubt, stop drinking for a while and see if there’s any difference.

Once you know your own mind, lay things on the line with your husband in a positive way. Of course, if you’ve come to agree that you’re a lush, let him know that you want to stop drinking because you believe you need to, and not to please him.

Otherwise, state your differences positively while letting him know how much you’d like him to accept you, if he can. If he can’t, then that’s a sad reality you both have to accept on your own.

STATEMENT:
Prepare a statement of your own views that is not overly reactive to his. “I respect your concern for my drinking and regret that it worries you. I’ve looked hard at how much it affects my health, work, and friendships. In the end, I don’t see it as causing me problems and, as much as I love you, it won’t help our relationship to appease unfounded fears. I hope you’ll accept my decision. Meanwhile, I think we should drop the topic of my drinking and, hopefully, move on to other things.”

My daughter is severely bipolar and lives with us so my wife and I can try to make sure she takes her meds and doesn’t hurt herself. We aren’t always successful—she’s practically an adult now and hates when we parent her—so she stopped taking her meds because she thought she didn’t need them anymore. Now she’s extremely manic, maybe using hard drugs, and extremely irritable. We’re absolutely helpless and there’s nothing we can do because she won’t talk to us. Our goal is to get her to listen to us, stop drugging, and get back on her meds.

Mental illness makes all families helpless; after all, it’s hard to have a dialogue with someone whose brain is diseased, irritable, inattentive and unresponsive. You’d have better luck reasoning with a rabid wolverine.

If you believe that your only power derives from your ability to have a heart-to-heart talk with her, then you are, indeed, helpless. The good news is, you’re wrong. After all, you can help wild horses improve their self-control without first teaching them English. Thus, you, too, can become a bipolar whisperer.

As parents and landlords, you control a number of powerful incentives, like access to money, car, refrigerator, shelter, and, oh yeah, money. That doesn’t mean you can control her or her illness, but it does mean you can create some pretty strong reasons for her to do the good things she needs to do.

Set rehabilitation goals for your daughter that you believe are truly essential, which will probably include sobriety, doing enough household chores in order to live independently, controlling violent behavior, and stopping sudden impulses from affecting her safety or treatment. Add or subtract from these core goals, based on your own experience and other parents’ war stories.

Once you know your priorities, announce them and back them up with rules and incentives for following them. I said announce, not converse. If you’re too worried about her anger or hurt or lack of understanding, you’ll be ineffective.

Don’t pick a fight, but don’t hold back on saying what you think with friendliness, conviction, and optimism. Tone of voice is as important as content. Don’t end sentences with a rising, Valley Girl inflection that asks for approval. Use the same calm, assertive energy praised by Cesar Millan.

Yes, there’s a risk that she’ll do something dangerous or force you to ask her to leave, but a bipolar-veteran parent knows how to manage crises without appearing to panic. It’s a risk you need to take, and be prepared for, because the alternative is way worse than facing an angry four-legged beast.

STATEMENT:
You need a statement that says, “This is what we believe, here are the rules that are required for self-control and independence and this, very simply, is what will happen if you don’t follow them. There are no punishments and we do not believe you are being stubborn or childish; but we will withhold privileges and, if necessary, ask you to live elsewhere for a while if we think it’s necessary, either because your behavior makes it impossible for us to live with you, endangers your safety, or blocks you from making progress.”

Most people thing my mom is really fun, if a little flaky and emo, but they don’t see how crazy and mean she gets when there’s no one around but my brother and me (my parents are divorced). When she’s in a bad mood, she tells us we’ve been mean to her, and reminds us of things we’ve said that hurt her, and tells us how bad we are until we’ve apologized, and then she forgets it ever happened. There’s one cousin who’s seen what she gets like and I rely on him to remind me that it’s OK, she’s crazy, but the other day he seemed charmed by her and then, when I complained, he told me I had to get over her and not be so angry, and now I feel totally unsupported. My goal is to get someone to understand what’s going on.

Nothing gets people more stirred up than dramatically pitched false accusations and punishments by a powerful, inescapable, totally two-faced authority, like your mama.

The good news is that, while you’ve got the makings of a perfect soap opera, it sounds like you’re not getting swept away by it.

The trouble with soap operas, of course, is that they trap the good guys into endless rounds of angry, hurt reactions to crazy bad guys. In the process, they take up huge amounts of time and energy for tears and talk, talk, talk before, finally, there’s a glimmer of comfort and validation…before the cycle starts all over again.

The process leaves no time for any other (boring, make-a-living) activities or relationships, positive or negative, and the good guys’ angry responses and efforts to expose the villain usually make them more vulnerable to slander in an endless vicious circle.

So enjoy validation if it comes your way, but don’t seek it out too intensely or your life will become ready for daytime. Besides, even if somebody sees what your mother’s really like, her behavior is not going to change. Sadly, you drew her number in the mother lottery and won a nut job.

Not to be indelicate, but, as you might have guessed, your mama sounds a little crazy. On the positive side, that basically means, while her behavior is erratic and sometimes cruel, it’s not personal, just like your cousin says.

She’s not motivated by anything except a blip in her brain, so keep that in mind when you’re tempted to “fight back,” because you can’t win against crazy, no matter who acknowledges how crazy she is.

Your goal then isn’t to out your mother as a witch from hell, but to keep doing whatever you think is positive, good for you, and likely to spring you free, like getting your schoolwork done, keeping busy with out-of-house activities, and keeping these goals in mind when she does blow up and accuse you of untold (and likely fictitious) evils.

There’s more good news in that it sounds like that’s what you’re doing; you’re not describing angry, “cry-for-help” drug-downing or cop-defying behavior that will accelerate the soap opera cycle at the expense of your health and future independence.

You’re moving ahead, regardless of anger and turmoil, and that’s what you need to do. Forget exposing her two faces, because nobody will be happy if the soap hits the fan.

STATEMENT:
Here’s a standard business plan for growing up with a closeted witch. “I’ve got good reason to believe I don’t do bad things unless she gets me mad, and I can’t stop her from getting me mad, even if the world knows it’s her fault, so I’ve got to believe in myself and pursue my regular goals, like schoolwork and building a life. I can’t expect to be happy when she gets going, but if I can keep my mouth shut and fight the temptation to join her in big, dramatic scenes, I’ll be doing a good job and acquiring an excellent training in how to be a therapist.”

I’m a psychotherapist with a small but thriving practice. I’m also recovering from an addiction to pain meds (please note: I cannot prescribe medication, nor can anybody in my practice, so there’s no ethics violation there, I got my pills like any other druggie would). I’ve been completely sober for three years now, but I’m afraid to be open about my problem with almost anyone, including my family, because I can’t see how people would respect or want to get help from someone who was as messed up as I was (and I know most drug counselors are addicts, but I think this is different). The problem is, I feel more stressed than ever. I’m burning out on my practice because I’m always staying late and trying hard to make sure everyone is settled before I let them out of my office. And I feel terrible about not spending enough time with my family, and I never have time for myself. I feel I’m in danger of slipping, but there’s no escape.

Your drug use might be under control, but right now, your life isn’t.

Your life is being managed by your need to do a perfect job and keep your patients safe and happy. Meanwhile, you’re running out of gas, losing credibility with friends and family, and slipping closer to the pit of pain pills.

You’re not at the wheel, your desires are, and we know where that road leads. Caring too much about how people feel and doing a perfect job are what got you into this mess in the first place.

You can’t make people happy, particularly if you’re a shrink. Patients are unhappy; that’s why they’re patients. So far, there’s no cure to life sucking, so, like a good physical therapist, your job is to use your time efficiently to offer coping tools. After that, it’s quitting time.

Sometimes people are helped; but sometimes they’re disappointed. Your job is to do a good professional job and then move on to other responsibilities.

Then there are patients who want to hold someone responsible for their unhappiness, and their therapist is target number one. They know you haven’t done enough, or you’ve done the wrong thing, or you need to do more. If you react too much to their beliefs, you’ll never leave the office.

Of course, you can’t stop being sensitive, because that’s your nature; I might as well ask you to start writing with your other hand or grow a foot overnight. Instead, accept your sensitivity and learn to manage it.

You need to take pride in how you manage your weaknesses and, to do that, you must first acknowledge them, not disown them. Out yourself and lay claim to the management credit you deserve.

STATEMENT:
Here’s a management directive. “I always feel better if people respect me and are happy with my work; but I will not let that need interfere with my building better self-control, limiting workaholism, and doing what I think is right to balance my life. The greater my weaknesses, the more right I have to be proud of what I’ve done with them and intend to do.”

My psychiatrist thinks I should increase my medication, but it already makes me sleepy and has caused me to gain 10 lbs. If anything, I’d really feel better getting off it entirely, because I hate being dependent on it. For the time being, I know I need it, because I’ve barely recovered from my last depression, but even thinking about increasing the dose makes me feel depressed. I’ve seen this doctor throughout my entire illness and she’s been very good with me up to this point, but now that I don’t agree with her I don’t know what to do. I don’t want to have to take more medication.

It’s much easier to have an agreeable disagreement if you’re not pushing someone with your emotions; after all, lawyers use evidence, not tantrums, to win a case.

Still, it’s hard not to push with your emotions when the issue is personal and scary. Unfortunately, you don’t have a choice.

If you don’t put your emotions, you’ll sound (even to yourself) like a kid who hates needles. Your doctor will then feel like you need protection against your fears and impulses, and so will become even more insistent and condescending (and afraid of a liability lawsuit when your fear turns to anger).

That attitude will make you feel more like a helpless kid who isn’t being heard, and long story short, it’s a vicious circle we’re all familiar with, and it requires you to shift approaches, not give in.

Besides, if you’re pushing someone with your emotions, you’ve got to wonder whether you’ve conned yourself into doing what you want, rather than what’s best for you.

Switch your language (and maybe your way of thinking), list risks and benefits, and prepare a list of the questions you need answered to make a good decision. Put your feelings aside, put facts first.

No one likes medication, but it’s your job to know enough about the possible course of your long-term, incurable mental illness to judge whether the beneficial promise of a given medication outweighs its costs and sluggish, chubby side effects.

Becoming educated about your illness and its treatment is the only way to avoid being a medical victim who feels helplessly reliant on a doctor’s judgment.

If you want to have a discussion with your doctor that doesn’t sound like you’re trying to escape the ouch of your camp shots, learn what your odds are for relapsing and whether resuming meds at the beginning of a relapse can be counted on to stop your symptoms before they damage your life and/or your brain. Also, find out what the chances are that a higher dose will make a positive difference in the short or long run.

Don’t forget to ask what evidence the doctor is drawing on for his answers. Then you’re prepared to announce your verdict as a responsible adult.

STATEMENT:
Here’s a formula for a worst case, high risk disagreement. It alludes to your fears but sticks with a managerial point of view. “I know that rejecting your recommendation carries a 10 percent higher chance of relapse, that there’s no guarantee that we can stop a relapse once it’s started, and that relapse can cause a little brain damage. But I’ve weighed these odds against the risk and side-effects of the medication and my own conviction that I’m less vulnerable to relapse now and I’ve chosen to keep the dose where it is and wean off in the not-too-distant future.”

Admittedly, I’m a neurotic, depressive guy—I’m a New Yorker, I’m normal here—but when I had a shitstorm a year ago when my girlfriend left me and my job changed/became horrible, I started going to a therapist. It was helpful to rant and get some perspective, but now I really think I’ve come through the other side of the situation and don’t need therapy anymore. My therapist, on the other hand, thinks I still have a lot of work to do, because we never really talked about my relationship with my father (not great) or why I had trouble with my ex-girlfriend. Thing is, I don’t really think my dad has anything to do with anything, and I know what my problem is with my ex-: I chose badly. How do I convince my therapist I’m ready to leave and that there’s nowhere deeper to dig?

There are always therapists out there who, when it comes to accepting the fact that people are the way they are and treatment is a limited tool, need more therapy than their patients do.

What your therapist may have trouble facing—more so than you—is that your treatment has produced all the change and relief that it’s going to, despite the fact that you still have pain and other problems.

Many therapists can’t accept imperfect results. They feel they’ve failed if they can’t help you and, so as long as you’re suffering, they’ll look for a deeper level of change.

If they could bring themselves to accept you the way you are and let go, they could also become more creative about teaching you methods for minimizing the harm your behavior can cause. Obviously, this is not the case here.

So prepare for your decision by gathering data about whether or not it’s really time to stop. See your therapist less often, or take a designated break, and see what happens.

If you slip back into that shitstorm feeling, your goal is to figure out what the treatment was doing to help you, whether you can get that help for free from any other source and, if not, how often you need to see your therapist to sustain the benefit.

If, after running that test, you decide to stop treatment but don’t want to get drawn into a fight with your therapist in which you sound like you’re trying to avoid your homework and your therapist sounds like a concerned adult, there are 2 options.

You can lie, and tell your therapist you’re feeling better and last night you had a dream about a happy bird flying high above the clouds and missing its nest down below but confidently soaring towards the mountains in the distance where your dad and ex-girlfriends were waiting to give you a hug.

Or.

You can be straightforward and truthful, telling your therapist exactly what you told me, backed by the results of your experiments with withdrawal, and stick to it.

After all, you’re an adult who can make your own decisions, and your therapist will have to accept your decision. And if s/he can’t seem to cope, s/he’s the one who needs time on the couch.

STATEMENT:
“I know I’ve still got problems but I think I’ve got what I’m going to get from this treatment and I’m managing things well enough. I wish I were less grouchy but I don’t think that’s going to happen and, meanwhile, it’s not doing me any harm. I’ll always look for new ideas about how to manage my problems but, for now, I don’t think I need more psychotherapy.”

I love my work, my kids, and my wife, but I have bipolar mood swings (and I’ve taken medication for years) that lead me to do things that get me into trouble. Recently, in spite of the medication, I felt a surge of energy and started to stay up late, sneak into my studio and paint. I’ve also started to drink again. I don’t want to change meds or let people know what’s happening because I want to keep my options open. I love the highs and the freedom, and I hate being told what to do, but I’ve got a demanding day job that doesn’t involve painting, and a wife who doesn’t like it, to say the least, when I’m not honest. So my goal is to get myself under control before people catch on to what’s really happening.

There are few fathers and husbands who can’t identify with the goal of wanting to feel special, have time to themselves, and avoid humiliating comments about eating, drinking, toileting or sleeping habits from their next of kin.

The fraction of these fathers who are dealing with mental illness and addiction to alcohol don’t want to be asked if they’ve been taking their medication or started drinking.

So, if your goal is to avoid immediate disrespect and hang on to your secret Van Gogh identity a little longer, then keep doing just what you’re doing.

On the other hand, if you want to avoid the long term chaos of going nuts, listening while your doctors try to find a mental hospital that also does alcohol detoxification and having your wife tell you that you’re not welcome home until you straighten out and maybe not then either…then you’ve got to give up on secrecy and come out of the out-of-control closet.

That’s because it takes a powerful part of your personality to make a good guy risk his health and marriage for the joy of a very, very good but relatively brief mood and paintings that will never reach Sotheby’s. It takes a demon.

Lots of people have demons—they pay my bills—and it’s a waste of time to figure him out instead of looking for ways to manage him better, all of which require you to face and ‘fess up to your (or should I say his) possession.

Sorry, but it’s almost impossible to gain control of a demon without acknowledging that he’s A, there, and B, can’t be extirpated or exorcised (except through lobotomy). That’s because he gains strength from being hidden.

So tell your wife and trusted friends about your problem, share your story with similarly possessed people, discard false shame, and do your best to keep the demon under control.

In recovery, they say you’re only as sick as your secrets; admit your secrets, and you can keep your demon at bay.

STATEMENT:
Here’s what you need to say to yourself (and others). “I’m living a good life, but it isn’t easy. My priorities are to make a living and raise a family, but there’s a part of me that wants to drink and paint and stay up late and enjoy the bipolar highs, and sometimes that part takes control, particularly when I think I’ve beaten him for good. Making my problem public is the best way to strengthen my self-control. I respect my willingness to humiliate myself for a good cause.”

My girlfriend and I keep breaking up without ever really getting together. She’s obviously interested in me, or she wouldn’t keep calling, and I can sense her sincerity. We have a good time together when we get a chance to go out. Whenever we’re at the stage of taking things to a new level, however, like we’ve been talking every day for a couple weeks, she’ll suddenly drop out of contact for a few days and then act like nothing’s happened and I shouldn’t expect her to be that available. A couple times when she dropped out, it was because she couldn’t decide whether to get back together with an old boyfriend. That’s no longer the issue, so I thought we were clear to go, but we can’t seem to take off. I’d like to know if I’m doing something wrong or if there’s a way she could get help.

Don’t trust your feelings to tell you whether someone is really interested. Feelings are easily fooled and love is blind; watch her feet and see what they have to say.

This girl’s feet are doing the cha-cha-cha, one step forward, one back, quick shuffle, one more back, one forward, another shuffle, and repeat. She likes to dance with you, but that doesn’t mean she’ll ever move forward or make you her number one partner.

If you trust your feelings, then you must ask yourself what you’re doing wrong, which keeps you stuck with her and introduces you to doubt, depression, and me. It costs you time and money to stay at the mindfuck disco.

Ask yourself what you’re dancing for. It’s not because you need to dance (though you do), but because you’re looking for a partner, which requires you to know what you’re looking for and keep your feelings out of it until you’re sure you’ve got a likely candidate.

One of the requirements—I know, it’s amazing that I can read your mind, but remember, I went to Harvard—is that someone has a good track record with relationships. No one who does the cha-cha-cha need apply, ever.

Don’t tell me that’s easier said than done. First, I’ll tell you it’s harder if you don’t do it, so you don’t have a choice. Second, given today’s theme, I’ll tell you you’re possessed by a demon who loves attention and wants to dance and you have a hard time keeping him in check.

Your goal is to make a solid, independent choice, regardless of your short-term needs. Cowboy up, be a grown-up and give yourself the benefit of solid, caring protection and a nice, sturdy, one-on-one waltz.

STATEMENT:
Here’s a statement, in case your demon (or sometime dance partner) asks why you can’t, at least, enjoy a nice, friendly talk. “I don’t think our chemistry is right for what I’m looking for, though we certainly have a good connection. Spending time with one another right now doesn’t take either one of us in the right direction.”

I have a 30-year-old patient whom I’ve been seeing in weekly psychotherapy for 6 months and he had a terrible history of sexual and physical abuse and years in state care. Amazingly, despite all his trauma and several prior failed treatments, he settled into a trusting relationship with me. He tells me I’m the first person he’s bonded with, and he’s been able to stop using cocaine, and, for the first time, sees some hope for himself. The problem is that he just got a new job, and I’m not covered by his new insurance plan. He wrote me a letter telling me how much he feels his recovery depends on continuing the treatment we’ve started and I feel professionally obliged to put his welfare ahead of my financial needs, but I’d like to get paid. My goal is to do right by my patient, and not trigger the feelings of abandonment that underlie much of his negative behavior, but I’m not sure how long I can afford to see him for nothing.

There are many therapists who believe the best thing you can do for a troubled patient like this is to “be there,” providing the steady acceptance and secure relationship that they need for healing. I’m not one of them.

The sad fact is that the healing power of currently available treatments is vastly over-rated and a good example of false hope and the harm it can cause.

What’s wrong is that our treatments, in terms of demonstrated effectiveness, are all rather weak, and it shouldn’t be surprising; we do our best, but life, such as it is, is a bitchmonster from hell. You can’t undo the past, change personality, stop drug cravings, or even guarantee that you’ll be available next week.

Look where you’re going with this treatment and “mind the gap,” as they say on the London Underground, because, as ideal a healer as you seem right now, there are many ways this dynamic could get tripped up.

For example, unexpectedly, you and/or your treatment rub the patient the wrong way. It may be that you fail to live up to an impossibly high ideal or that you have a bad day and say the wrong thing. When that happens, trust disappears and with it, your patient’s rationale for healing.

You try to stay calm, remain empathetic, and ride out the storm while resenting having your personality dissected for an unpaid hour. If your anger shows, it gives your patient more reason to feel victimized and find a therapist who can help him recover from his latest trauma/treatment.

Another common outcome is the “Bill Murray Morass,” whereby he continues to feel strongly that treatment is beneficial and can’t imagine living without it, and you, and this continues for many years, while you continue to feel responsible and indispensable. “What About Bob?”, indeed.

You and “Bob” could argue that treatment has benefited his control over negative impulses, but it has also fostered a sense of dependency and fragility that will surface if, God forbid, you should die first, or, more likely, he just changes his mind.

So don’t buy into his idea of your precious relationship. If he liked you, it proves he has the capacity to like another therapist. There are many fish in the sea, many therapists in his insurance directory. If he depends on that positive feeling to stay sober or maintain a positive idea of the future, he’s in trouble, and so are you.

Your goal is for him to build up ideas for staying sober and fighting off despair that are not dependent on a single relationship or good feeling, and that can stand up to rejection and depression. In other words, you want to “be there” for your patient, but you don’t want to be the only thing between him and oblivion. Don’t beget a Bob.

STATEMENT:
Our relationship has been positive, but it’s important for you to manage negative beliefs, despair, and anger when you’re not feeling closely supported, and our stopping treatment gives you just such an opportunity. You have the capacity to form a positive relationship, so I’m confident you’ll do well in shopping around for a new therapist. Meanwhile, it’s good for you to focus more on the ideas than on the individual, because it’s your own ideas and the way you use them that will give you strength to manage yourself. I’m confident that this will work out well.”

I have a new patient who’s a young woman, college freshman, who was sent to therapy by her parents after her roommate turned her in for cutting her arms and drinking too much. After a fair amount of discussion, I started her on a medication trial and explained to her that these pills take a while to work (if they work at all), but it didn’t sink in, because after a week she’d had enough with feeling tired and hungry, especially because she still felt depressed and anxious. Not long after that, she declared that therapy in general was a waste of her time and she could stop drinking and self-mutilating on her own. Part of me thinks that it’s not my job, or anyone’s job, to sell her on treatment if she’s not ready, but I admit, there’s a softy side of me that doesn’t want to let her off the hook just so that she can really hurt herself or get kicked out of school. My goal is to get this kid to give treatment one more chance.

It’s tempting to tell a young woman with obvious problems that she should stay in treatment, but don’t. This is not the time to listen to your softer side. Of course you wish she would feel better and stay positive, but first, you and she must accept your lack of control.

If psychiatric treatment—medication or psychotherapy—were more reliable and effective, maybe it would be worthwhile to give such advice. More often than not, however, the first trial of treatment doesn’t work or causes side effects and patients who are already angry and disappointed about their life expectations are then quick to feel that their negative beliefs have been redeemed.

Your goal isn’t to get her to stay in treatment; it’s to give her tools to make rational and positive decisions about treatment. You don’t want her treatment decisions to depend on her positive relationship with you (see: above Bob) or an initial positive result. You want them to depend on her own ability to weigh risks and benefits and do what’s right.

It’s easier to help her think realistically about treatment if you crush false hope up front. You are obviously well aware that treatments of any kind rarely bring about a “cure.” I’m often reminded, when patients cite a pharmaceutical add touting a particular medication as “effective,” that the scientific meaning of the word is the opposite of its meaning in plain English.

In the language of science, effective means “better than nothing,” not “helpful most of the time.” Life is tough and so are most psychiatric problems. Unfortunately, so is your patient’s attitude.

Ultimately, you want her to know that, while you don’t care which decision she makes, you do care a great deal that you make she makes that decision rationally. Being soft won’t work, so be hard, or really, be honest, not emotional or sentimental.

STATEMENT:
Here’s a speech for encouraging her to take good care of herself and use treatment appropriately. “I wish I could tell you that treatment will ease your pain, but it often doesn’t. Given the fact that depressive feelings often come from genes and that we don’t have a cure, it’s not surprising that they tend to come and go and then return, even when a medication or other treatment has been very helpful. So the main goal of treatment isn’t to make you feel better, but to make you stronger and better able to tolerate your condition, much as if it were diabetes. You can get stronger by choosing the right psychotherapist or therapy or 12 step group and also appropriate friends and readings, because the right choice can make you stronger, and the wrong choice won’t. Medication is worth trying if your symptoms are hurting or threatening to get you canned. There’s a risk that each medication will cause side effects or won’t work, but you don’t want to make a choice about meds because you love or hate them. You want to weigh the risks of not taking them and the possible benefit of their working. If I were in your position, I’d definitely be trying them, but it’s your call.”

I know that my depression is one of the main obstacles keeping me from getting a new job; I got laid off three months ago, and even though my meds had stopped working way before that, I had enough discipline to push through. Now I don’t have a workplace to go to, I have trouble getting motivated enough to do anything, so between my inability to get out of bed and the fact I look like a mess, interviews aren’t happening. My wife is pissed because I’m not motivated to get new work and I won’t go back to see the psychiatrist, but I don’t see the point in trying this new prescription, because it’s my fourth medication so far, and I don’t understand why the first medication I took, which worked the best, stopped working, and why none of the others since has done the job. I don’t see why I should waste my time getting treatment if it isn’t going to work, but my wife thinks I’m being complacent and lazy. My goal is to find some way to get better or at least get her off my back.

You’re reinforcing something I’ve been telling my children their whole lives; life is unfair.

It was unfair for them when I wouldn’t by them a Happy Meal or the latest Nintendo game, even when they deserved it, and it’s unfair for you now that you’ve lost your job and can’t find the right meds. Unfair is unfair, as they say (or at least as I say).

The trouble is, it isn’t a fair world for anyone, young or old, and you won’t survive if you can’t take your lumps and keep on going.

The less you do, the more you scare and burden your wife, who gives you an earful, which makes you more depressed (as does doing nothing), and so on down the pit that leads to self-pity and divorce, all of which you can blame on your wife, who will be happy not to hear it.

Let’s get your expectations about depression straight. If anyone told you that antidepressants were effective, they were using the medical meaning of the word, not the English meaning.

The English meaning is, “usually works,” but the medical meaning is, “better than nothing.” You might get helped by antidepressants, but never count on it. Meanwhile, you’ve got to take care of yourself, so ask yourself how you’re going to manage, not why you can’t get a cure or stop your wife from being critical.

Consider the job description for a depressed survivor in an unfair world. If treatments don’t work, your job is to suck up the pain and ask others to give you the prompts, reminders, and coaching you need to keep going. If a treatment might help, pursue it.

Remember, when you had a job to get up for in the morning, you found the strength to keep moving and work all day, regardless of how bad you felt. Now that you don’t have a job, create a schedule of activities and meetings with people who are expecting to see you.

It isn’t easy when you’re unmotivated and unemployed, but you still have a job, assigned by you, and that’s to prevent your disease, unfair as it is, from taking over.

If you’re angry, disappointed, discouraged, or resentful, it’s also your job to shut up and not let your negative feelings become nasty words. Don’t expect your wife to be positive; after all, you’re not, and it’s an infectious venereal disease, bouncing back and forth.

You want your wife to help you recover, so put your negative feelings aside, reassure her that you continue to care about her and finding a job, and enlist her help in fighting an illness that can’t be helped.

After all, life provides us all with hard times, whether or not we deserve them, all the time. Don’t add to the unfairness quotient with your own behavior; if life pushes you down and hands you an unHappy Meal, there’s always something you can do, even as a depressed person, to push back.

STATEMENT:
Hit yourself upside the head. “Depression is sapping my natural motivation and ability at a critical time, but my goals haven’t changed. I believe in work and independence. I won’t let false pride, resentment, or negative thinking stop me from doing my best and asking others to help me.”

My husband and I are at the stage where we should start thinking seriously about starting a family. The problem is that his father and that entire side of the family have a history of severe mental illness, so he’s not just afraid of having kids, but of even adopting, because he’s afraid he might get sick down the line and ruin our future child’s life. When we got married, it didn’t seem to be a problem, but as his own father has gotten more and more nutty, he’s become convinced that having kids is a bad idea. I want to stay with my husband, but when we got married, he knew that I wanted a family, as well. And I’m OK with adoption, but it’s a long, expensive process, so if we want to go that way, we have to start now. Basically, my goal is to get him to come to his senses, or at least be willing to take a risk.

Life is tough, and having a child—creating a life—is risky. In fact, it is never not risky, even at the best of times, regardless of all that crap on TV about the power of eating right and giving birth in a bathtub, so don’t reassure him that things will turn out OK, because then he’ll have truth on his side.

After all, while modern medicine greatly reduced the rate at which pregnancy killed mothers, it hasn’t changed the way genes sort out randomly and often badly. So, whether you’ve got mental illness in the family or not, there are always tons of bad genes floating around and having a kid is a dangerous lottery.

The question isn’t whether having kids is dangerous (it is, always and forever), but whether your husband has the balls to take on the usual, scary, risky human lottery that is, for the time being, the only way to begin a family.

Once you accept that the risks are real and the results sometimes devastating, you can take pride in the good qualities that you bring to parenting.

You’ve got a good team; you seem open-minded, and he has lots of experience handling mental illness, which he’ll need for those many problems over which good parents have no control.

Remind him that many of those dangerous genes are also beneficial and it will be your job, as parent, to help your kids to manage traits that may be both a gift and liability, be it depressive sensitivity or athletic hyperactivity.

If your husband can see that there is no such thing as risk-free child-rearing, then you can calmly assess which parenting option—standard conception, adoption, foster care, whatever—would work best for you both.

Then, in the most educated way possible, take the risk of your life and take pride in your work, regardless of the (inevitable) helpless times. Just don’t let fear make you throw out the baby plans with the (birthing) bathwater.

STATEMENT:
Your message is: “Absolutely right, having kids is scarier than hell, but that’s the way it is. Don’t panic. We’ve got some good stuff going for us and, regardless of what happens, we’ll do a good job.”

My son was diagnosed with severe depression when he was a freshman in high school. I know it’s supposed to be a hereditary disease, but neither I nor my husband have any history of it; we both come from stiff-upper-lip backgrounds, and when our son attempted suicide, we were completely taken by surprise. He was also doing drugs, and we didn’t know it. He’s doing much better now, seeing a therapist weekly, but I still worry about his going off to college next year. He doesn’t share much with us, but I know he wants to do what’s “normal.” I don’t want to intrude on his relationship with his therapist or undermine his confidence or make him feel pressured, but we need to decide whether he’s ready to go. My goal is to make the right decision without hurting him in the process.

You can’t protect your son from of having an illness and all the trauma that goes with it, so for your own sake, and against all your instincts, don’t try.

On the other hand, if you try too hard to avoid all potentially painful issues with your son and stick to being stoic and reserved, you’ll be helping him avoid the hard choices he has to make, instead of doing your job.

Life is hard, precisely because it includes illness and drug abuse on top of the usual high stresses of being adolescent and finding a way to be independent. It’s a clusterfuck, and you’re the motherclusterfucker; you’re all in this together.

You’re right, you need to make decisions about whether he’s ready to go to college, but if you guess wrong, he’ll get pushed into relapse and a worse sense of loserness. Then you’ll be out a big chunk of tuition that will have done him no good and won’t be there later, when it might help.

In other words, on no level can you afford to be squeamish about dealing with the issues of his illness and drug abuse just because you’re afraid of hurting his self-esteem. Life is responsible for hurting his self-esteem, and while you gave him life, the transference of responsibility doesn’t work that way.

Instead of trying to make things right, try to prevent further damage. You’ve got painful topics to discuss, but that’s why you became parents: to experience a new level of pain. Starts from childbirth and it’s only downhill from there.

You don’t have to be critical or grim or sad to discuss this issue. Yes, you have to push the sad fact that he has not one but two chronic conditions—depression and a weakness for drugs—but, having accepted that, you’re free to celebrate the good work he’s done and talk about realistic options.

It’s possible to push your son towards making good decisions without shoving him into a wall. Don’t be afraid of doing the heavy lifting parenting can require; time to forget your upper lip and, instead, stiffen your resolve.

STATEMENT:
Here’s a formula. “You’re recovering nicely from a bad bout of depression, but we know that the brain can take a long time to recover fully and that you’ll always be vulnerable to relapse and, probably, drug abuse. Life is hard, and that’s the way it is. Now, you’re doing your job perfectly; you’re sober, you work as hard as you can at school, and you use therapy to get stronger. Let’s look at how you’re doing with your current course-load, get input from your teachers and therapist, and consider how much structure you’re likely to need next year and whether it’s time yet for you to live away from home while continuing your work.”

I love my parents, and we have a good relationship, but if the issue of my sexuality ever comes up (I’m a gay man), all hell breaks lose; my mother sobs about how the family name is going to die, my father pleads for me to try and find the right woman, your typical Jewish soap opera. I know they’re not really bigots and all the hubbub comes from a place of concern, but enough already, you know? None of us is getting any younger, I’m not getting any less gay, and yet they refuse to tone it down. My goal is to get my parents to calm down about the issue before it drives me away completely.

The tough part about having loudly protective parents, as opposed to quietly protective ones like the mother above, is that loud is harder for parents to control, once they’ve gotten into the habit.

People always say that telling the truth is important, but in reality, telling the truth is more gratifying than important; unbottling all of your feelings and unbottling all of your hard liquor have a similar emotional result (and similarly damaging long-term effects).

This truth urge is especially strong for some people when they become parents; it feels right, somehow, to smite the person they’re trying to protect. It expresses all feelings at once, love and hate, protection and punishment. It’s a lost weekend of honesty.

If they were too restrained, instead of too verbal, you’d have an easier time. Then again, Jews wouldn’t be Jews and the Mediterranean would be a basin of peaceful civilization, instead of a crusade magnet for the entire world. [Full disclosure: if you missed it before, Dr. Lastname is of the tribe.]

As such, don’t make it your job to stop an honesty drunk; you can just try, and be ready to get out of his/her way if you can’t get through. If you try too hard, you’ll prolong the juicy, emotional battle all crusaders are itching for, and everyone gets hurt.

Instead, try diplomacy. Show them there’s a better way to be protective, and that they don’t need to worry because you’re pretty good at protecting yourself. In other words, honor their parental functions without addressing their negative feelings.

Think of it as an endless process that may not succeed until your parents are too old, tired, or senile to keep up the war—you (I-srael) versus your family (Parents-stine). L’Chaim.

STATEMENT:
A business-like and formulaic manner can help you keep your emotions under control and provide you with a ready exit. “I know you worry that being gay will prevent me from having a normal life and expose me to lots of pain and trouble that I wouldn’t otherwise have, but the same could be said about being a Jew; it’s not for those who wish to lie low and play it safe. I can’t say there isn’t pain, but thanks to you, I’m ready to manage the problems and pursue what’s important, which is still work and friendships and being a Mensch. So genug, enough has been said, things are going well, and fear is not helpful.”

My roommate calls me the Ritalin vampire, because once my meds run out around 5, I become a different person (or really just a depressed, anxious mess). My mood drops so low so fast, and my nerves become so raw, that I have to drink just to get through the evening and get some sleep. It’s obviously driving my roommate crazy, but more than that, it’s messing up my life—I wake up hung-over, my boss is pissed, I feel sick all the time, so even when I’m not anxious and wired when I’m on my meds, I still feel like shit. My goal is to figure out how to get my ADD under control when the sun is down.

Most Ritalin users don’t have a terrible comedown with severe anxiety every time their meds wear off—what you have isn’t normal ADD, but ADD plus anxiety, plus, probably, alcohol dependence.

The medical term for your three-pronged disorder is a trifuckedta. Surprise, the prognosis ain’t so hot.

You might say, yes, that’s what I mean, I’m really, really, really fucked and that’s why I need three times as much help.

Here’s the hard part, though; there’s no good treatment, and nothing, but nothing, is likely to solve these problems to your satisfaction. Now that we have that out of the way, however, you know your goal is not to be fulfilled, so we can discuss how to make the best of things (starting with getting off the bottle).

Yes, I know you can’t stand the anxiety, but there are alternatives to booze. By learning some relaxation techniques and trying out some non-addictive meds, you too can get used to the idea that people often have to, and do, live with chronic pain.

Alcohol will make your anxiety worse in the long run, regardless of how much fast relief it provides, and letting alcohol and/or anxiety control your decisions will toilet your life in short order, causing more anxiety, more drinking, and more business for me (no, of course, I won’t waste your time, but everyone who loves you will be looking for help and running into my ever-loving arms).

Second, ask yourself whether you can reduce your weekly Ritalin consumption by changing your job and/or learning some organizational tricks that will help you keep it together even when your mind is flying apart.

Yes, there are a few medication strategies that might reduce your distress—trying another stimulant or adding a low dose in the late afternoon may help—but don’t expect a cure, or you’ll feel just as entitled to your medicinal alcohol as ever, and we’re back at square one.

Third, you need a philosophy for dealing with impulses and chronic pain. You can get it from the right parts of the Bible and other religious texts, the right friends/relatives/therapists, AA or similar groups, Neil Diamond records, whatever speaks to you. You’ll find it when you’re looking for strength, not relief.

I know, easier said than done, but don’t think for a moment you have a choice. Living with the trifuckeda isn’t easy, but your current choices are actually making life harder. Get sober, get your meds in order, get some good support, and get out of vampire mode for good.

STATEMENT:
Here’s a statement to keep you on track. “Because of my ADD and anxiety, I expect most of my decisions will be painful trade-offs between getting things done, tolerating pain, and controlling dangerous habits. On any day that I hit a healthy balance, I deserve great respect, regardless of how I feel at the end of the day, which will seldom be happy.”

My boyfriend and I are starting to get serious, but I’m not sure whether to move in together or break it off. On the one hand, he’s funny, caring, smart, and generally a good guy. On the other hand, he struggles with ADD, which is the reason he’s amassed massive credit card debt, and because he’s ashamed of his ADD, he didn’t tell me about it until we were dating for a year (that’s when he admitted to me that he had a problem and took medication). I don’t want to hold his disorder against him, because it’s not his fault and I don’t want to make his shame any worse, but I also don’t want to commit to a life with someone prone to major screw-ups. My goal is to make a decision based less on feelings (good, right?) and more on what’s smart.

Look at the positive: your boyfriend’s ADD may well be part of his most likeable qualities, including humor, spontaneity, and an ability to connect with others. In the right circumstances, it may help him make a living.

At its best, ADD is a style, not a disorder. I know, it’s called a disorder, but don’t believe it. It’s a disorder when you have to study in a classroom or do bookkeeping, but when you have to think of ideas or be at a party, it’s a huge help.

As for his sins, the cover-up is usually worse than the crime. If he lied about his credit card debt and spent more effort inventing reasons for his fuck-ups than correcting them, then he’s in trouble, as is anyone who depends on him.

The problem then isn’t his ADD, it’s the avoidant habits that have taken over his character and undermined his integrity. You’re saying he’s better than that; he ‘fessed up, and I assume he really wants to do better rather than slide by with a diagnostic excuse.

So here’s how you can check him out. See whether, with your help, he can set up a savings plan and retire the credit card debt (but by help, I don’t mean nagging). What you want to know is whether he can use you as a coach, friend, and provider of structure, not as a nag or mother.

Ask yourself whether you’re good at doing the things that are hard for him; (if you’re both hopeless with schedules and budgets, you won’t be good for one another). Work together and see if it works, and by work, I don’t mean feeling the joy of helping or taking care of him. I mean imagining the two of you getting the job done, whatever it is you want to do together, and with each doing his/her share.

Your boyfriend has problems, but, believe it or not, ADD might not be one of them. So assess his qualities as you would any other guy, without emotions (bravo!), or excuses.

STATEMENT:
Here’s a statement to guide the next phase of your partnership search. “I’ve found someone I love and respect, but I need to know whether he can manage his baggage and whether it will prevent us from being good partners. So, instead of avoiding the pain of going through stressful situations together, I’ll embrace them and see what they tell me.”

Do you think sex addiction is a real disease that needs therapy, or is it a way to make a big deal out of nothing that helps cheaters and the people they cheat on feel better while people in your business get paid? I love my wife—we’ve been together for almost 20 years—but I don’t think anyone would say I have an disease because I grab a little extra action if the opportunity comes along. I don’t think she knows I’m not faithful, it doesn’t happen that often, and I don’t think it hurts our marriage at all. It’s not like I have a steady mistress; I just end up going home with women I meet when I’m traveling sometimes, because it’s nice to feel young and like I haven’t lost it, whatever it is. As far as I can tell, everyone wins, because I feel better and my wife is less annoyed by my constant begging for sex. So my goal is to figure out if the way I live my life, which seems to be A-OK, is actually reason to go into rehab.

To rehab, or not to rehab. That is the question.

You’re raising the timeless question, and obviously, we’re not going to tell you to let your feelings be your guide, or, for that matter, your daddy, your minister, your rehab counselor, or your parakeet, Ray.

As to the validity of sex addiction, it either doesn’t matter, or it depends on your definition of illness. I define illness as something wrong with your body that’s personal, important, and out-of-control, and it doesn’t matter whether it’s cellular or behavioral, neurological or psychiatric. Or kinky.

Some people have lots of guilty feelings over nothing, others have no guilty feelings ever, and others are swayed by whomever they spoke to (or whatever website they read) last.

In reality, you can figure out the answer to the rehab riddle yourself if you’re willing to push aside false hope and wishful thinking, as well as unreasonable guilt.

Wishful thinking is believing there’s no risk of anyone’s getting hurt because, so far, no one has been hurt; that’s what it means to think with the little head. Unreasonable guilt is feeling so bad about having sinned that the only way of getting relief is to do it again.

That said, let’s look realistically at the risks and benefits of a sexual adventure. The benefit is a good (or even great) feeling, but the risk is that, despite your efforts to be discrete, your cover may get hit by an STD, a partner’s passionate clinginess or nastiness, or some other accident. You’re the one who knows best what happens after the great reveal in terms of your wife’s feeling hurt and/or deciding to end your partnership.

Whatever happens, it will involve lots of pain for you and your wife (and your kids if you have them), and lots of business for yours truly, never mind realtors, lawyers, jewelers, you name it.

For most people, that kind of marital apocalypse is an emotional and financial catastrophe. On the country music timeline, begin with “My Cheating Heart” and wind up “Sleeping Single in a Double Bed.”

You may think you’re in the clear if your partner subscribes to an “open marriage” and tells you she doesn’t believe in jealousy. Again, if that’s what you’d like to hear, don’t trust your ears until you ask yourself what she’s really likely to do, given all you know about her and her past relationships.

Remember, you’re not asking for permission from your mama; you’re the papa and a grown-ass man whose job is to figure out how things will really work out for the entire family.

So don’t wait until you’re scared by the evening news or local preacher or shrink to find whether or not to rehab. Look at the risks realistically and then do what you think is right.

If you decide to stop and can’t, then look for whatever help is simplest, cheapest, and most available and move on to costly treatments only if you absolutely have to. Remember, as much as you’d like to think that the costliest intervention—a month at Betty Ford—is more likely to give you the strongest, most permanent, temptation-resistant self-control, it’s not so.

If your sexual behavior is out-of-control and can do serious damage, and there’s a treatment that might work, then it’s worth a try. Start cheap, however, before you plunk down a college-tuition’s worth, and remember that treatment may not work. Or you can keep going, and pay the equivalent of my entire Harvard bill during your divorce.

Either way, the decision is ultimately yours, and hopefully things will work out better for you than they did for rehab Hamlet.

STATEMENT:
Write up a risk-reminder before the next time you leave town. “There’s nothing wrong with the pleasure of being attractive but there’s lots wrong with what can happen next. If I think the risks of causing harm are too great, I’ll do my best to avoid temptation. I may feel like a nervous wimp who’s afraid of what other people think. In reality, I’m doing what’s necessary to manage my life and do what’s right.”

When I was a teenager, I used to shoplift a lot, and I stopped, like a lot of kids, when I turned 18 and could get into real trouble with the law. That was a long time ago, and while I haven’t stolen anything from a store with a price tag on it since then, I do, and I’m not proud of this, grab any freebies I can get my hands on. For example, everything from the sugar packets to the toilet paper in my house is taken from local coffee shops. I want to stop doing it, because I’m really ashamed of the habit and I know it’s stupid, but I honestly feel like I can’t help myself. My goal is to stop taking things, whether or not they’re free.

Any behavior that doesn’t measure up to your standards of control will make you feel bad, but if control-of-everything was important, then those iron-willed guys who like to see how long they can hold their fingers in a flame (you notice they never hazard other body parts) or tolerate vigorous self-lashing would be the most virtuous, instead of the most insane.

Your goal then isn’t to feel in control (or put any vulnerable body parts at risk); it’s to have enough control over the controllable things that really matter.

You can judge the importance of any behavioral control problem by asking yourself how much harm the problem is likely to cause and how hard it is to control.

Don’t question whether it’s an addiction or not, or, at least, don’t do it more than once. Questions about whether or not you need withdrawal symptoms to define something as an addiction, or what the difference is between addictive and obsessive behaviors, help you dodge the tough question you don’t want to face, namely, how you’re going to deal with it.

Instead of debating the nature of addiction, ask yourself whether you have bigger behavior problems that are harder to notice, like, say, not doing enough with your life. Often a weakness for petty thievery is a sign that you don’t have other goals that are more important.

So add up the risk assessment of your out-of-control behavior. No, you’re not likely to get arrested, but you’re not going to like yourself for the fact that whoever sits down on the can after you’re finished, both with the toilet and taking the TP, is in for a nasty surprise. You need to ask yourself whether you’ve got better things to do with your time and, if not, what are you going to do about it.

Don’t ask yourself whether this sin will prevent you from getting into heaven, or even whether it will cause you embarrassment. Instead, imagine that your time is running out, and then wonder whether you’ve taken on enough meaningful tasks in life, like making a living and caring for others, to make you proud, with or without an iron-will.

STATEMENT:
Keep your smaller guilts from interfering with your bigger concerns. “I don’t always like my behavior or control it as well as I should, but I do my best with the bigger, harder responsibilities of life and that’s the source of my pride.”