I was diagnosed with major depressive disorder and anorexia nervosa purging type a few years ago. Both of these issues had pretty much consumed my life during the years leading up to that diagnosis and have continued to be impairing ever since. I started cutting myself two years ago (it has become more frequent this past year), and I’ve had several panic attacks in the past several months. Fortunately, my overwhelming desire to commit suicide has subsided, although I still think of suicide and my death in general fairly often. In addition to my own issues, I have watched my mom slip into a state of psychosis during the past two years, triggered by the death of her father. She has become so depressed, delusional, and violent that my parents separated and sometimes I don’t even feel safe staying in the house with her—a few weeks ago my dad and I had to stop her from going through with a suicide attempt. The police were called, and I had to hold her arms down while she was clearly in a psychotic rage. At one point, she tried to stab my hand to make me let go. She was taken to a mental health facility where she stayed for a week, and now she’s furious at us for making her go there and hasn’t been much better since then. I feel like I never get anywhere with therapists because they just prescribe medicines that make me feel numb to any emotions or focus on my eating disorder so much that I never get to work through these other issues. I feel like my life is unraveling and it’s gotten so bad that, honestly, I don’t feel like I even want to fix it. My goal in telling you this is to figure out a way to help my mom and how to get through school while I’m dealing with this.

It may seem strange to hear this, for someone who suffers as much as you do from depression, anorexia, and the burdens of taking care of a very sick mother, but I think you’re doing an amazing job.

Yes, you’re chin-deep in shit, but you haven’t drowned, and that’s a remarkable accomplishment.

Your depression hasn’t made you hate people or blame them, and your anorexia hasn’t caused you to pretend you’re not sick, so you must have a solid hold on reality. There you are, with all your pain, finding the love to help your mother and the energy to go on with your studies. You’ve got good values and a big soul.

So you feel hopeless because treatment hasn’t done you much good, or, I should say, hasn’t done your symptoms much good. It sucks, but that’s the way it usually is when symptoms are as severe as yours. That doesn’t mean they won’t get better by themselves, or that a better treatment won’t come along. It does mean that, at least for the time being, you’re stuck with heavy-duty pain.

That’s not important, however, or at least not nearly as important as what you’re doing with that pain, which is, as I said, amazing, and there’s treatment that can help you distinguish between you and your symptoms. Any good cognitive treatment will help, whether it comes from a cognitive therapist, a good coach, or a friend with a positive attitude. One treatment that is aimed specifically at helping people with this much pain keep a positive attitude is Dialectic Behavioral Therapy, or DBT.

The inventor of this treatment, Marsha Linehan [link: https://www.nytimes.com/2011/06/23/health/23lives.html], suffered similar symptoms and, like you, managed to stay focused on the value of helping people and improving her own skills. She wound up inventing a kind of treatment that helps others do what she did for herself, and, like you, she found that helping others was a great way to keep her own demons in check.

It’s normal for you to feel that your life is unraveling, but trust me, it isn’t; your pain is a mess, but you’re doing a good job of bearing it and doing good things with it.

You are not your pain; you’re dealing with a lot of shit, but you are anything but. You’re the person who’s managing it while leading a good and meaningful life, and that’s not someone you should give up on.

STATEMENT:
“I may feel like a hopeless, deteriorating mess, but I love my mother and care about my education and I’m doing good things about both. I may not be able to stop my symptoms or save my mother, but life sucks and that’s not a personal failure. I haven’t let my symptoms stop me, however, and that’s why I’m doing well, even if my pain and my mother are doing badly.”

I have a great life and there’s nothing I care about more than my family, so I became really worried when, out of nowhere, I started to have horrible thoughts about murdering my children. I’m too ashamed to tell my husband. I’m not an angry person, and I love my kids and get along well with them, and I’ve never needed a shrink, but the thoughts keep me up at night. If there’s the slightest chance I could hurt my kids, I’ve got to do something about it, but I don’t know what to do. Please help.

Before you get crazy about having crazy, murderous thoughts, check out the risk factors for crazy murders. It’s not hard to do. What you’ll find out is that crazy murderers don’t just have intrusive murderous thoughts; they’re crazy as well.

By that, I mean they’re very detached, or they have strange ideas about their kids that they actually believe in, or they’re hearing voices, or going through extreme mood swings.

Ask yourself whether you fit the picture of people who really run amok. While I don’t know you, of course, my guess is that you don’t fit the picture at all, which means you run the same finite-but-small risk as your average Joe.

Trouble is, everyone who has intrusive, horrible thoughts without other symptoms of craziness is nevertheless terrified of losing control, so reassuring yourself is hard to do. What you want, of course, is total reassurance that the horrible thoughts will go away and that you’ll never, ever lose control; as you say, if there’s the slightest chance that you might hurt your family, you feel obliged to take definitive action. Unfortunately, you can’t. No one controls such thoughts, and trying to control them will just add to your helplessness.

Your goal then isn’t total reassurance or freedom from fear, but reasonable self-control and an ability to go ahead with your life in spite of fear. Assess the real risk you pose to your family and take steps to protect them if you think it’s necessary. Having done that (and realizing that your family is better off with you just the way you are, crazy thoughts and all), learn to bear your fear and go about your business, which isn’t easy to do.

If you want to tell your family about your symptoms, that’s the story you’d tell. You’ve got these crazy thoughts, but you’ve checked on the internet, and probably seen a shrink, and discovered you’re at no particular risk of doing harm, you’re just at risk of suffering from creepy thoughts. Reassure them that you have no intention of letting the crazy thoughts interfere with your normal activities and that, if you thought you were dangerous, you’d do whatever’s necessary to protect them.

As with the woman above, you are not your symptoms; a good mom can have crazy thoughts, and a great mom can carry on despite them.

STATEMENT:
“I feel like I’ve got crazy thoughts and might lose my mind but the truth is that I’ve checked out my symptoms and the part of my mind I’m losing is pretty small and insubstantial (although the process is scary and painful). Whether or not I can make my symptoms go away, I’m competent to manage them, keep everyone safe, and go on with my life, and that’s all I need to do.”

I discovered this site after reading Emma Forrest’s book, “Your Voice In My Head” [fxckfeelings.com was cited in the acknowledgments –Dr. Lastname]. I am very young (in high school) and have suffered from anorexia/bulimia for 3 years. I never had a calm childhood, and after being obese I lost half of my body weight through anorexia within half a year, but I gained all of it back by bingeing in not even a few months. I feel like I was not even strong enough to ”stay anorexic’,’ so I became bulimic. Everyday I wake up thinking about how I should die or how long I can keep living with myself, because I despise who I am, and it is becoming unbearable. I truly believe I will never see the light at the end of the tunnel, I will never get out of this and will spend the rest of my life with an eating disorder which has ruined my life. I have no more strength to keep fighting, I have had enough, enough of life. Please help, I am ready to hear anything.

As mental illnesses go, eating disorders are the most parasitic; they literally consume their host in order to thrive, but instead of demanding more food, they feed upon your body and self-worth.

Instead of having a moderate, healthy awareness of your own attractiveness, you’re dealing with a leech that is rarely satisfied with how you look and more often intensely disgusted with the ways you fall short. It would rather wipe you out than live with you ugly (and it always thinks you’re ugly).

If you’re lucky, you’ve got parents who understand your obsessions but have gained an ability to value themselves for who they are, not how they look, that allows them to live with the pain of body-hate or out-of-control eating and/or starving. They then work patiently with you (and likely outside help) to help you regain that perspective.

If you’re unlucky, depressive thoughts and/or out-of control behaviors, driven by genes or childhood experiences that are similar to yours, have pushed your parents into big trouble or divorce, or they’ve pushed you to the point that you can’t accept help from anyone. I hope that’s not your problem, but you’re sure not lucky.

Since you found out about fxckfeelings.com from Ms. Forrest’s book, you know then that the hero of the book is the psychiatrist she found who, in addition to helping her feel better, also gave her perspective about her mood swings and out-of-control behavior. He made it clear that, while there was no cure, it wasn’t her fault, and there were lots of good people who learn to live with these problems and lead good lives. He gave her realistic hope that she’s carried with her, even after his death.

While there’s no guarantee that psychotherapy or medication could help you feel better, at least not immediately, there’s a chance it might. What you can expect, however, if you spend time with someone who has perspective on your problems, is help in fighting your negative thinking and developing a sense of self-worth that doesn’t depend on size, weight, beauty, or being totally in control of your eating behavior.

Don’t get discouraged if counseling hasn’t helped you so far. Look for a good, positive coach with a vision of your value and your future. Don’t settle for less.

If you check out of life because you can’t stand yourself, you’re surrendering to that parasite who both hates you for and thrives on your perceived ugliness. Stand up to it and protect the nice kid who deserves respect, if only for her good literary choices.

STATEMENT:
“I can’t stop the endless self-hate, but I believe that everyone, including me, has a value that doesn’t depend on looks, size, or mouth-control and that, if I select the right friends, supporters, and therapists, I will get stronger.”

I don’t see the point in therapy. I was depressed and suicidal throughout my teenage years, and was often sent to therapists. I was hospitalized several times, once after an overdose and a couple times because I threatened to kill myself if I had to return home. Treatment did absolutely no good. Now I get by, but I don’t trust people and I wouldn’t be surprised if I wind up killing myself, and I don’t really care. What’s your advice?

People who don’t care whether they live or die are often disappointed (it comes with the full depression package). Usually, that disappointment comes from things they can’t help or control, but care a lot about. It can be that they hate their looks or personality (see above), or just want something they can’t have, but either way, that loss and anger become more important than their promises, ideals, or commitments.

Under the right circumstances, disappointed rage can give people courage and scare away opposition; when you have nothing to lose, you’re truly dangerous, to yourself and everyone else. People will often back off and give you what you want, unless they get just as mad or put you in jail. Either way, it’s a lose/lose (either you lose what you want or you lose your dignity/composure/mind).

Right now, your main issue isn’t your depression, but that nobody’s been able to help you do anything about it; I won’t tell you to get help because there’s no help for your disappointment, and you know it. You know that therapy can’t make you feel better, and any promise to the contrary gives you a target for your disappointment (and it’s dangerous to become a target for the kind of rage you’re packing).

The worst thing about your rage is that it makes you right; you attack people who disappoint you and they act more like jerks, which confirms your disappointment, so you feel justified in giving them more, and they give you back more to hate and despite. It’s a vicious cycle that feeds your self-righteousness while destroying your chances for improvement.

Ask yourself, though, if there’s anything more important to you than your disappointment and the confidence that it brings. Ask if there is anything worth doing or anyone worth caring for, or if you value helping people, being independent or making the world better. If so, ask if pursuing your values is worth keeping your disappointment, and rage, to yourself.

If there is something more important to you than disappointment, then you may want to learn how to keep it from turning you into a monster who loves to stomp on small cities, friends, and yourself. Restraint hurts, but it can be learned, if you want to learn it. First, though, you must decide whether it’s worth it.

I doubt that anyone can help you feel better if you continue to draw strength from your rage at their perceived incompetence. If you decide that life is worth living anyway, there are lots of people, including some therapists, who can help you be decent to yourself and others.

For now, start at square one and accept that life is unfair, dealing with mental illness is hard work, and you’re not big on luck. Don’t get mad, get over it, and then get on with the slow process of feeling a little better.

STATEMENT:
“I feel stronger when I’m attacking my enemies, and I’ve got good reason to attack them, but I won’t allow my enemies to become more important to me than my beliefs in what I should do to be a good person. However much I fear or hate them, I’ll try to focus on ignoring them and giving my own life meaning.”

Although I’m usually a big fan and praise your blog endlessly, this recent post [“Helping Head,” 6/17/11] isn’t a “like.” Eating disorders are treatable to full remission. In fact, the pervasive idea out there that people just struggle endlessly and that treatment doesn’t really work is self-fulfilling and even dangerous. Please consider re-considering. There’s new science on this!

Without irony, I can say that treatment for eating disorders is effective. In other words, I agree with you, except that the word “effective” has a hook in it.

“Effective” is the word most favored by drug companies because it implies no guarantees, solutions or cures, just that the treatment in question produces results that are better than no treatment at all.

Unfortunately, it does not mean completely effective, or effective for everyone, all the time. (And it also may cause dry mouth, constipation, etc., etc.).

The result is that people who commit their resources to such treatment (which is usually very costly) must work hard to monitor its effectiveness and know enough to stop it if and when it doesn’t help.

Here’s a common scenario—imagine you’re an uninsured parent of 3 kids, one of them has a dangerous eating disorder, and tens of thousands of dollars have gone into her second residential treatment. Under observation, she’s gained weight to the point of medical stability, but the moment she goes home on a pass she binges and purges and there’s been no progress in the past 3 weeks.

If you keep her in the program, you won’t have enough money to send your other kids to college or pay for another course of residential treatment if/when it’s necessary. The staff tries to be helpful by telling you that treatment works, it’s what they recommend, and when it doesn’t work quickly, they recommend more because they believe in what they’re doing.

What they don’t do, and have never been trained to do, is look for and identify the signs of an impasse, accept the fact that treatment sometimes stalls, and help you conserve your resources.

Emotionally, your daughter’s (partial) treatment failure may have you wondering what she, you, your wife, or the program did wrong. The answer may well be…nothing. Treatment works, but not always, and it’s no one’s fault. After all, it was effective, just not enough, and the possible side effects include bankruptcy.

If you begin any treatment with the strong belief that what ails you is curable and everything’s going to be OK once you accept “scientifically effective” treatment recommended by trained professionals, you face the possibility of draining yourself, your bank account, and your resolve in order to achieve something that, while possible, is not guaranteed.

While eating disorders can be treatable, it’s better to approach any course of treatment with the attitude that it might not take right away (if ever), it will be a struggle, you’re the one who needs to decide whether and when it’s working, and that, even if it doesn’t produce the desired results, you should always be proud of making the most of whatever treatment’s available, even if that includes shutting it down.

People should never give up hope in their ability to overcome illness by getting treatment and living their lives in spite of whatever disability remains. However, they should never make their hope dependent on the good ol’ effectiveness of treatment, particularly if it comes up short in the long run.

STATEMENT:
“I’ll try any treatment that has a reasonable chance of working and I’ll spend anything if I believe it’s necessary, but I must always do my own assessment of whether it’s working and conserve resources if it isn’t.”

When my daughter got dangerously thin, I knew she had an eating disorder and forced her to see a therapist, but she didn’t get better and I couldn’t get her to follow a meal plan or stop running 5 miles a day. Now, however, she knows she can’t return to college until she gains 20 pounds and gets permission from her doctor, so she’s willing to accept more help. I wonder how treatment can help her if she’s being forced into it. My goal is to find a way to get her to see the need for treatment.

Fortunately, as described above, treatment for eating disorders and other problems involving destructive behaviors don’t depend on a patient’s having insight and motivation. Unlike the old joke about the number of psychiatrists required to change a light bulb, it’s not necessary for the light bulb to want to change. That’s because, once people are exposed to a new routine and strong incentives to form better habits, their attitudes often follow.

With eating disorders, the effect of malnutrition on the brain makes it extra hard for patients to reason clearly. Once their weight normalizes, their thinking improves, at least partially, and the vicious circle reverses.

So don’t waste time persuading your daughter to see things more reasonably; you’ll get frustrated, she’ll dig in her heels, and you’ll have a harder time getting her to attend a residential or day program.

Instead, keep your mouth shut, open the car door, and convey your willingness to help her do what she needs to do to get back to college and her running. It’s very likely that she can get healthy again, but she doesn’t need to be reminded of that since she refuses to admit she’s sick in the first place.

Later, if she slips up on her meal plan when she gets home, you may well want to adopt whatever incentives seemed to work in the hospital to keep her going on her healthy behaviors. Again, less talk and less emotion are usually better. There are eating goals that you impose, there are consequences, and there’s your belief that they’re for the best and don’t need to be talked about.

In the long run, you hope that negative behaviors will lose their grip on her health and her values, but in the short run, you do whatever you think works. You’re the parent, and it’s your job to do what you think is best and create a customized treatment plan so effective that she’ll eventually be as willing to change as that light bulb.

STATEMENT:
“It’s agony to see my daughter starving herself and then insisting that she’s doing what’s best for her health. I can’t stand the lying and cheating. My job, if I’m going to be effective, is to do what seems to work and keep my feelings out of it.”

So you say “fxck feelings” and act on what I can change. How do I sit through a feeling and get to the other side of it without resorting to destructive habits (eating/not getting out of bed/no proper sleep because if I go to bed I will think and feel and remember as I’m falling asleep of all those things that I don’t want to keep remembering and that make me sad) that compound those feelings instead of dull/diffuse them? My goal is to live (emphasis on the word “live”) through a feeling until it goes away or at least becomes akin to white noise, instead of distracting myself away from a feeling with destructive behavior/habits to avoid it until I’ve made it ten times worse.

In one of her short stories, author Lorrie Moore describes two explorers captured by an angry tribe of natives in the jungle. The explorers are offered the chose of “death or Roo Roo,” and the first man choses Roo Roo, which turns out to be lethal torture. The second man then opts for death, so he is killed…by Roo Roo.

What you’re dealing with is a death-or-Roo Roo situation.

You either let depressive sleep impulses drive you to destructive habits that feel better in the short run and hurt you more in the end, or you suck it up until it’s not so bad (or you get distracted by something worse) and even then it’s not great. Alas, it’s a jungle out there.

The good news is that you’re seldom as screwed as you think. Depression will tell you that you’ve messed up, there’s no point in getting up, you’re falling behind, you won’t be able to explain your absences, and you’re bound to get fired. Those are thoughts that feel like truth, but, despite what depression tells you, aren’t.

If you accept those thoughts as truth, they have the power to make you feel, not just screwed, but damned and cursed. Those are the feelings that should go get fucked, because bad feelings cause bad thoughts that will fuck you if you don’t oppose them with your own wisdom and self-respect.

The depressive sleep habits you describe can destroy your confidence. It’s hard to get up, your sleep schedule makes it hard to work, you’re tired all the time, and you get colds. Your sleeping pills don’t work for long, you can’t give anything enough effort, and it’s easy to feel that your life is falling apart and that your health won’t survive the stress. Before long, you’re sick and tired of being sick and tired.

If you accept your powerlessness over a depressive sleep disorder, however, you’re no longer responsible for either causing or curing it, just coping with it. You can’t help feeling like shit every morning, but you’re a hero if you nevertheless drag yourself out of bed and out the door. You can’t help dreading bedtime, but you’ve got to respect yourself for trying to sleep while managing the painful thoughts.

So try to get up on time, regardless, and not nap during the day. Avoid alcohol and caffeine, keep to your evening routine and bedtime, and try what medications you can. Remind yourself that this will pass and that your basic health is OK, even if you have no vitality or ability to resist common viruses. Above all, respect yourself for the tremendous effort it takes for you to live your regular life.

Getting through painful feelings takes more than perseverance—it also requires an active respect for the good things you’re doing with a bad situation. Life is full of “Death or Roo Roo”-esque situations; the best you can do is respect your choice and bring the same values to the next one.

STATEMENT”
“I feel like I’m barely holding on and I can’t stay awake or think clearly, but I’m still trying to live my life my way, even if I’m forced to do it in slow motion and with tooth-picks propping up my eye-lids. I never thought it would be this rough, but I never realized how tough I can be.”

I love my girlfriend but I can’t stand watching her starve herself to death, which is what she’s doing without being able to admit it. She’s told me she had treatment once for an eating disorder, but she won’t talk about the details and she denies that it’s a problem now. I wish she was seeing a therapist, but I can’t be sure she’d be honest with a therapist if she saw one. My goal is to see her get healthy.

It’s no accident that all the problems we hear about at fxckfeelings.com are not solvable; after all, if they were solvable, we wouldn’t be hearing about them. A woman who can’t stop starving herself is one of the classic incurables.

As far as your goal goes, you’re screwed, and it would be easy, given your love and frustration, to see your relationship as a failure because you just can’t get through. You can’t get her to talk about the problem, you can’t be sure she would be honest with a therapist if she had a therapist, and you can’t get her to agree on an approach.

If you don’t see her problem as your failure, however, there’s stuff you can try. As clinicians who treat eating disorders will tell you, you can be quite direct in a positive way if you aren’t angry.

Tell her that, as much as you love her, and as good a companion as she is in other ways, her inability to control her eating behavior is dangerous and unacceptable and that, if she wants to continue dating you, there will be rules to follow. That’s just a positive re-statement of the fact that, if she doesn’t gain weight, your relationship won’t last.

Impose conditions that use your relationship as the reward but minimize your control and responsibility. They might include her seeing a therapist who’s mandated to speak with you, developing a meal plan, and including you in strategy meetings about what to do if she isn’t making progress.

Your goal isn’t to make sure she’s compliant with a plan so much as it is to make sure she’s trying. If you can’t cure, be helpful, but only if she’s willing to help herself.

STATEMENT:
“I can’t control my girlfriend’s anorexia or the pain of watching her starve, but I use what little power I have to push her into treatment, knowing I have no better alternative. What counts is doing what I can, knowing that my feelings about this are probably not going to be great, no matter what I do.”

I am a divorced 26-year-old (I have been divorced for almost 5 years). My marriage was a toxic abusive relationship. Regardless of that, I feel “happy,” I have realistic career goals, a loving family and boyfriend. Everything adds up, but I feel as though my happiness is a mirage. I’m happy with everything and everyone but myself. I just never add up to what I feel I should be or can be, especially when it comes to the number on my bathroom scale. I feel as though I will never be thin enough. I know it is unnatural to feel this way, being that I’m thin for my height, but I worry I am spinning on the edge most days looking at nutrition labels and focusing on the number of the day. How can I over come this mind game? Why did it bloom so late after my divorce? Is it even from my divorce or was this monster seeded a long time ago?

Most people aren’t happy with the way they look or how much they weigh, and all people spend at least a little time each day being unhappy, but many still manage to live normal, albeit slight chubby/grumpy lives.

As to the source of your insecurities, your guess is as good as mine and the many other scientists, clinicians, and desperate-for-a-topic writers who explain this phenomenon. It could be your ex, or it could reading too much Cosmo.

These experts assume, for the most part, that you wouldn’t be so self-critical if you didn’t listen to magazines, celebrities, or your critical-yet-well-meaning grandmother, and just believed in your self. They tell you that self-esteem will conquer all. Of course, they’re wrong.

There’s lots of evidence that self-hating body thoughts can happen to people with perfectly good self-esteem, nice families, and normal bodies. Instead of obsessing about why you feel this way the same way you obsess over calorie counts, stop and ask yourself, first, whether these thoughts are doing you much harm.

I know they’re causing you pain, but ask yourself whether they’re affecting your health or relationships. Right or wrong, you can think you need to lose a few without hiding major parts of your personalities and or being a bad friend or parent.

If you think your body-hate isn’t doing too much harm, try ignoring it. Certain kinds of psychotherapy may help, but watch out if you find yourself becoming more self-obsessed and blaming yourself for not getting better. The mark of good psychotherapy, like good coaching, is that it gives you ideas and motivation for managing a problem without increasing your expectations of control.

If body-hate is hurting your health or relationships—if you purge, have become anemic, or acquired any number of the dire symptoms that come with an eating disorder—assemble a treatment team, including a primary care physician, a psychiatrist and dietitian, and don’t hesitate to put yourself into an around-the-clock “eat-your-food” camp if it’s necessary. It can save your life.

In any case, don’t pin your hopes and self-esteem on self-control, or self-hating thoughts will just get worse. If you make it your job to keep trying and regard the illness as you would the weather, it can’t touch your sense of who you are.

You need never see yourself as a food nut or anorectic; you’re simply a person with eating issues, which puts you in the same camp as 90% of the population. You might feel like shit, but you are truly not alone.

STATEMENT:
“There’s nothing wrong with my values or approach to life, and I’ve managed to build a good life, except for one problem. I have an obsession about food and weight that sometimes drives me crazy. I don’t know that I can stop it, but I will always do whatever is necessary to keep it from ruining my health and relationships.”

I feel horrible about this, but ever since my husband gained weight, I find myself feeling much less attracted to him. Neither one of us has ever been super-models, but after 10 years of marriage, I’ve managed to keep my weight from getting out of control and he hasn’t. I tell him he should eat less because of his health, and he makes a half-assed effort, but the truth is, I also just hate his body like this. I’d never tell him that though because he’d be heartbroken and I’d feel like such a jerk. I’d never leave him over this (we have a family), but not having sex is putting a strain on our relationship, which makes being together so much harder. How can I want to be with him if he keeps letting himself go?

The fact that we spend billions of dollars improving and preserving our sexual attractiveness should be a clear indicator that we have absolutely no control over it.

Specifically, we don’t control what aging does to our bodies or how we respond to those changes, in ourselves and others. That’s probably one of the best reasons for not making a big deal out of it; the more we try to control it, the more it tortures us when we can’t.

Many think over-eating should be more controllable than aging, but to those people I say, try keeping your weight down while making a living, raising a family, and living in the golden age of Oreo Cakesters.

Even if you achieve your ideal body weight, you know how easily stress, sorrow and even inattention can open the door on your bad old habits. As Bush II discovered, there’s nothing more demoralising than declaring victory when you’ve temporarily got the upper hand on a problem that is never going to go away.

Even if weight control is easy for you, you know that it’s not easy for most people, like your husband, regardless of how much they worry about it. Worrying makes us hungry, as does reading about one more diet that does no better than old diets if you measure progress after a year or two. So, as much as you miss the old sexual attraction and worry about your husband’s health, don’t get obsessed with the “would-have, should have” of weight control. Blaming him isn’t fair, and will make the problem much more personal.

We’ve had lots of laughs at the expense of those idiot Victorians who advised women who didn’t like sex to “lie back and do it for England.” Sadly, it seems like there was great wisdom in that advice, particularly when you care about your partner and you’ve run out of other options.

First, though, don’t let guilt over your own negative sexual response—or anger at his “letting himself go”—prevent you from exploring those other options. Your husband probably wants to lose weight, if for no other reason than to improve his health. With his agreement, explore all the ways you can create “structure”—incentives and habits— in your daily home routine that will encourage exercise and caloric restraint.

Without letting yourself become a calorie Nazi, (which, for most of us, would be a worse sex-killer than growing a lady-beard), see if you can shape your menu, pantry contents, and exercise schedule.

If nothing works, fall back on your marriage vows. The reason you make vows is not because you’re fickle and likely to change your mind about your partner, but because life is hard and will eventually take the things that are fun now and make them difficult. You can try to help him lose weight (and help yourself), but if that doesn’t work, you need to help your marriage.

The test of a good marriage is not whether it’s fun, but whether two people continue to like and respect one another when it’s not. Through sickness and health, slim and flabby.

STATEMENT:
“It hurts to have a sexually repulsive husband, particularly after I’ve tried to help him slim down, but the purpose of our partnership was always to create a family and look out for one another, and was never about being young and sexually attractive forever, so I respect myself for putting up with this loss for the sake of a marriage that I value.”

I’ve been getting increasingly nervous about my aging parents, particularly because my mother, who’s a very vigorous near-90, likes to ignore the real risks of continuing to vacation in their old, 2 story, roughing-it country home. She loves to garden, take vigorous walks, build fires, and keep to the same routine she had when she was 40. I know I’m a nervous person—I’m a nurse, and I’ve had to deal with an injured leg since childhood—but I’m haunted about what could happen to her if she fell down and it’s no place for my dad, who’s very frail after a stroke. When I said something to her yesterday about how she should hold onto my father’s arm when he walks, she told me to mind my own business. I’m the only one of the kids who lives nearby, so their safety is my business. How do I get her to understand she needs to be more careful?

It’s understandable that you worry about your parents, but even if they were both freakishly healthy and lived in a hermetically sealed bubble, the sad fact is, they’re both going to die.

[Moment to process.]

Yes, your aging parents are lucky to have a caring child nearby, particularly someone who’s medically educated, as you are. You also know, however, as someone who’s lived with a crippled leg, how necessary it is to take risks if you want to live a full life and how important it is to make those risk-management decisions yourself.

Your goal isn’t to breathe easy, knowing that your parents are safe as can be, or make yourself responsible for their safety. As much as you’d like them to be safe, they can’t be, so those goals would drive you and them crazy (and provide me with a steady income).

Now that you know you can’t make them safe or ease your own fears, you’re ready to think creatively about realistic risk management, knowing that bad things (like death, but lesser things, too) will happen.

Your goal isn’t to prevent those bad things from happening, but to help your parents do whatever they’re willing to do to prevent them, then forget about them, and live their lives (and let you live yours).

Instead of nagging them to be more careful, offer to get them professional advice on how to manage risks from slips, falls, fainting spells, medication mistakes, and assorted worst-case scenarios.

If that doesn’t work, leave their doctor a message encouraging him/her to do the same and if that doesn’t work, take a course yourself and do what you can. Then, you’re finished and enjoy the veggies from the garden.

STATEMENT:
Here’s a statement for keeping your responsibilities in check. “As much as it would hurt to see my parents injured and as much as it scares me to think about it, I respect their determination to live independently as long as possible, despite the risks. I can do more for them by offering good advice than by inducing guilt. I will take pride in doing this job well, regardless of whether they accept my advice. Indeed, the less I can do and the more helpless I feel, the more pride I’ll take in not letting my management interfere with their choices.”

Two years ago, my wife was diagnosed with Type 2 diabetes. We’re both overweight, but she also used to be a smoker, so her health’s always been more of an issue than mine. We were both warned that if we didn’t get better eating and exercise habits, we’d be in trouble, and now she knows her diabetes puts her at much higher risk of heart disease, hypertension, infections, and kidney disease. Well, two years later, and I’ve started taking the dogs on long walks, stopped eating from the vending machine at work, and lost some weight. My wife, on the other hand, hasn’t really changed her habits at all. She says she’s eating less crap at work, but at night she’s making the same unhealthy (delicious) stuff we’ve always eaten, and she always says she’s too tired to walk with me. I don’t know what I can do aside from nagging her, and that’s not working, so I’m really worried that she’s going to go downhill fast and that I’ll lose her. My goal is to get save my wife from herself.

As much as you’d like to keep your wife around as long as possible, you know that your influence over her health habits is limited, and trying to control her health will cause you more conflict and probably drive both of you to an earlier grave…which contradicts your purpose.

Unlike the concerned daughter above, you don’t have the luxury of ignoring the inevitable; she can’t make her parents immortal, but theoretically, you can help your wife to change her habits. If you’ve ever tried to change any of your own habits, however, you know it’s never really that easy.

Weight control, for example, should be easy because putting food in your mouth and swallowing are supposedly voluntary actions. In reality, people don’t have that much control over their habits or their health. Ask anyone who’s eaten at Cinnabon.

It takes great effort, not everyone can do it, and other legitimate priorities, like raising kids and making a living, get in the way. Biology is powerful, and our bodies are designed to survive famine, not taste-bud seduction.

Accept that she has a chronic, incurable illness and you’ll start to be more helpful. Instead of nagging, offer advice on impulse management and eating better (but don’t force that advice, because then you’re back to square one).

If that doesn’t work, ask her doctor to do the same, and if that doesn’t work, learn CPR, read up on living with a diabetic, and enjoy your time together. After all, you don’t want to ruin the quality of your relationship for the sake of a little more quantity.

STATEMENT:
Here’s a nagging-restraint statement. “It’s hard to watch my wife’s unhealthy habits, but I’ll do more for her by keeping my feelings to myself, offering advice if she wants it, and enjoying her while I’ve got her. A good marriage always requires tolerating the pain of traits you can’t change, and this is more of the same.”

When I broke up with my girlfriend, I felt like I didn’t have a choice; she was smothering me, she made me feel guilty and like a bad person all the time, and I just couldn’t take care of her anymore. We’d been together for a relatively long time and I had reached the end of my rope (she’d even started hitting me and breaking things in our apartment). The problem is now that I feel even worse because, in the months since I ended it and she moved out, she’s started getting high a lot and has threatened to kill herself more than once. If she goes through with it, I don’t know what I’ll do with myself. My goal is to feel less awful about breaking up with her (which I did to feel less awful).

As a not-sociopath, you can’t feel less than awful about your ex-girlfriend’s drugging, depression, and self-destruction.

It’s the feeling responsible, as well as awful, that will not only do nothing to help her recovery, but will also turn your sorrow into well-entrenched, call-the-doctor depression. So…Dr. Lastname here, how can I help you?

You might think it’s good to take responsibility for the feelings of those you love; it’s a necessity if there’s something you really need to do for someone who’s helpless, like a kid or an invalid, or if you’ve done something wrong to cause those feelings.

On the other hand, life is hard for everyone, and most of the pain you’ll cause others is not something you or they control. Assuming responsibility for that pain is a way of pretending you could control it and make it right, which is a false hope that will prevent you and her from moving on.

Also, if you take responsibility for pain you can’t help, you’ll wind up blaming others and getting nasty, which will cause pain that you actually are responsible for, and then things get truly impossible.

The bad things she’s done and is doing (for love of you) are not your fault, but they’re not her fault, either. What they are are her problem, and, sad fact, your love seems to make it worse.

So don’t let guilty feelings affect your beliefs and don’t express them when you communicate with her, assuming that you do communicate, even if it’s with a look or through friends. You can’t stop feeling guilt, but you can stop guilt from controlling your actions. Stop feeling responsible, so you can stop calling on people like me.

STATEMENT:
Here’s a statement that pushes both of you to make the best of a sad situation while killing any hope that guilt will ever bring you back together. “We’ve both tried everything to make our love work and it can’t and now it’s time for us to move on. We’re both sad and it’s too easy to think about what either of us could have or should have done but that’s a dangerous, negative direction to go in. We both need support and nurturing, from ourselves and our friends, while we pick up the pieces, learn valuable lessons, and start a new life.”

My daughter is just starting high school. She’s had emotional problems since she was a toddler, and her current diagnosis is OCD (eating disorder, cutting, wild mood swings…it’s a mess). My wife is very easy-going with her, but also doesn’t really set any rules or limits, and I end up being the bad cop all the time. Having a teenage daughter is supposed to be hard for anyone, but as the only enforcer trying to take care of a girl with a bunch of problems I can’t understand, I’m in hell. At this point, as much as I hate to admit it, I hate my daughter—she’s impossible, angry, and just mean—and I’m jealous of how easily my wife gets along with her, and angry that she makes it my job to do all the discipline, and my feelings are an ugly mess. My goal is to love my daughter, like any normal dad.

While it may make you feel like shit, it’s not a sin to hate your daughter; it’s hard to feel warm and fuzzy all the time for an adolescent who’s probably rather verbal (and maybe physical) about how much she hates you—but it is a sin to be mean to her, and your feelings sure make it painful to be her dad.

Parenting under these circumstances is about as hard as it gets—it’s extreme parenting. You don’t need to bungee off any cliffs to encounter a day full of high suspense and drama, not knowing whether you’ll keep your behavior under control (hers, of course, you won’t).

This bad chemistry problem happens a lot to adoptive parents who have less familial experience with the kind of temperaments their kids present to them (no good deed goes unpunished). You’re one of the lucky biological parents to get stuck in this situation.

The pain of having no warm feelings and being angry much of the time is horrible, but feeling responsible for those feelings is much worse, so don’t.

You don’t hate her because you like to hate, but because of many factors over which you have zero control, including your daughter’s temperament, your wife’s personality, and your own reflexes. This isn’t your kind of kid, so you’re responsible only for making the best of it, and keeping her alive and safe.

Put your guilt aside, and you can applaud yourself for the hard job you’re doing and be more inventive about it. Nope, your goal isn’t to have positive feelings for your daughter (although you can still hope it will happen someday, and, honestly, I’ve seen it work out that way). It’s to do a good job of parenting someone you don’t like—that’s what defines a true professional—and respect yourself for doing a hard job under beyond-Mountain-Dew-level “extreme” circumstances.

STATEMENT:
Here’s a statement to draw the line on guilt-provoking accusations, whether emanating from you, a therapist or, after intensive psychotherapy, your daughter. “There’s nothing I value more than being a good, warm parent, but we have to play the cards we’re dealt, our personalities are not a great match, and it causes both of us lots of pain. I don’t apologize and neither should you, because I think we both do a good job of keeping that pain under control. I do lots of good parenting, in spite of those negative feelings, and they haven’t stopped you from having a good relationship with your mom and doing many good things, so I think we’re doing well, all things considered.”

I just started at college, and I like my roommate, but she’s bulimic and hard to be around. Not just because she’s sick (and everybody on the floor knows about her problem, it’s hard not to), but because when she binges, it’s on my food because that’s what’s closest, and she always feels really bad about it and cries that she wishes she could stop, but then she doesn’t offer to pay for it and it’s costing me a lot of money. Part of me just feels bad for her, because she’s clearly really messed up, but another part of me is pissed because I’ve lost a lot of money this year on food that she’s eaten and thrown up, and that just makes me feel guilty like I’m a bad person for putting my lost money above her health. I want to move after the break, but I don’t want her to feel abandoned. My goal is to help her and myself.

Welcome to that other part of college, Hard Knocks University, where the class Helplessness 101—what to do when you can’t help both someone and yourself, and sometimes you can’t help at all—is a frosh requirement.

The tough part is not the decision, but accepting the shitty nature of your options. Bulimia, like any chronic condition (depression, addiction, etc.) is not completely curable, not by you or certainly the patient herself.

If you buy into the psychobabble about body image and low self-esteem, you might think you could help her by praising her strengths, noticing her attractive qualities, or getting her to think about the superficiality and limitations of attractiveness. Ha!

Whether it’s coming from you or the Mormon Tabernacle Choir of Therapists, your therapeutic support is not going to change those mysterious urges to binge and puke. Buying into that notion will waste you even more time and money than all the cash you’ve already flushed away at the supermarket.

Bulimia, like all addictions, can turn people into assholes. Don’t get me wrong, they don’t choose to be assholes, but when you’re more interested in binging and purging than in anything else, including other people’s feelings and squaring your debts, you’re an asshole. Or really, you’re a normal, possibly good person suffering from a bad case of asshole-itis.

It’s a humiliating thing to say about ourselves, but what helps most in controlling dangerous behavior, when all else fails, is to be treated like a soldier or dog-in-training in a program where our every movement is controlled. That’s the kind of treatment that saves lives when bulimia gets dangerous.

Obviously, it doesn’t cure it, but it stops us from going over the cliff until we can get enough control back to keep it down to a barf or two a day.

So the most you can do is let her and others know if you think her life’s in danger. Otherwise, you’ve got little influence over her for good or ill, and you’re living with an asshole you can’t cure who’s costing you a bundle.

You may wish you could help her, ease her pain, and not make yourself feel guilty by locking the refrigerator if you don’t get a check. Well, I hate to say this, but fuck you. That’s a goal of feeling good, which is much like her goal.

If, however, your goal is to make the best of this situation, it’s not to feel good but to do what’s right by helping her if you can and otherwise preserving your resources for worthwhile causes.

That means bearing the pain of watching her in pain, feeling helpless, and ignoring the guilt of receiving a look that accuses you of adding to her misery. It also means letting her know you’re there if she wants to get real help, establishing your refrigerator perimeter, and getting to eat your own damned ice cream.

STATEMENT:
Prepare a mission statement that protects yourself from false guilt. “I can’t help my roommate feel better or control her eating behavior, but I can watch out for her if her life is in danger and I can encourage her to be a stronger obsession manager by requiring her to pay for what she eats. In doing so, I may temporarily make us both feel unhappy; but that’s an unavoidable part of her recovery and my self-protection. It’s the work we both must do to pass this course in making the best of a bad situation.”

Since there’s no easy way to say it, I’ll just put it out there that I have a problem with my anal sphincter (a botched surgery when I was a kid that left me with very little control). Like everyone since then, my co-workers notice that I sometimes smell bad and like to joke about it, usually but not always behind my back. I do my best to control it, and I’ve seen specialists about it, but what it comes down to is that everyone is happier when I keep my distance and I just wish I could find a job I could do from home. I even avoid attending family events and leave early when I go because I don’t want to embarrass my parents (and I obviously avoid women and people in general). I just transfered to another branch, and now I’m terrified about the reaction of my new co-workers. I know this sounds like a joke, but it isn’t. My goal is to find a treatment that can control this problem or a lifestyle that is less full of humiliation.

By now you should know that you can’t have what you want, either a sweet-smelling body or a solitary, well-stocked bat cave to retreat to. Forgive the pun, but tough shit.

You’re fucked, and if you keep trying to eliminate the problem you’ll never live your life and your parents will die and you’ll regret the things you didn’t do with them or the other things you want to do with yourself like make more money.

Now that that’s cleared up, ask yourself what your goal is when the goals you’ve been chasing are unattainable and there’s no way to avoid a shit-load of pain (last sly double-entendre, I swear).

The obvious answer is to try to reduce your sensitivity to humiliation so that you can live life as fully as possible. It would be nice if you were a natural-born comedian who could deflect nasty jokes, or an insensitive clod who never understood them in the first place; but you’re not. Now that you’re an adult, however, and no longer a school-kid, there are lots of other things you can do.

First, confront the Madison Avenue notion that your self-esteem depends on attractiveness. Your goal isn’t to be attractive, but to make people feel as comfortable as possible with your ugly side while you pursue your other goals.

So pretend you’ve got a colostomy and that’s the way it is and learn how to be shameless. Wear a diaper if it will help, just learn how to not take shit personally and put together a list of what you want to do with yourself and do it. That’s your goal.

Make people more comfortable by telling them, frankly, that you have a GI problem that sometimes causes bad smells and you can’t stop it but that you’re pretty good at managing it. That’s why you, for instance, use incense and deodorizers, and sometimes have to leave meetings unexpectedly. If your smell is a problem and you don’t notice it, you don’t mind having it pointed out to you.

Keep a candle burning on your desk. Be the first to let them know when you’re having a bad day. Read a book of bathroom jokes beginning with “What died in here?”

Your goal isn’t to control your colleagues; that’s impossible with heaps of cash or hypnosis, so accept that they’ll be nice or nasty, as they are. Instead, create a wall between you and your problem and invite them to see your problem as something apart from you. Lots won’t, but a few will.

After all, you’re not a bad smell, just a guy who’s trying to do a good job despite a tough, humiliating handicap. That’s something to be proud of, a much bigger accomplishment than being sweet-smelling and attractive. Fuck advertising.

Give your parents similar directions, letting them know that you’re happy to attend family events, but you’ll let them know if you’re having a bad day and you won’t take it personally if they’re planning a big event in a poorly ventilated space and don’t want you to come.

You can’t control your problem or how people react to it, but you can’t let those factors take over your life completely. After all, even for those of us with cooperative anuses, life often stinks. You just arm yourself with Fabreze and carry onward.

STATEMENT:
Prepare a manifesto that keeps you focused on your own priorities rather than the reactions of idiots. “My job is to lead my life and try to make a living and find friends, and I’m not responsible for my bad smell. I manage it well by protecting others and making it easy for them to protect themselves. My bad smell may humiliate me; but it can never outweigh my pride in not letting it stop me.”