I decided recently to listen to my friends and family and see a psychiatrist about my depression, but I don’t know whether I’ve made the wrong decision, or whether I’ve just chosen the wrong doctor. Basically, I decided to get help because I feel helpless, but my doctor wants me to do a lot of the work myself and doesn’t really help that much. It’s not just he wants me to ask myself a lot of questions (and answer them—if I had the answers, would I really be paying him?—but also deal with my insurance company and read up on the medication he suggests (he tells me about them, sure, but he says I owe it to myself to read up on them on my own, and that doesn’t make sense to me since he’s a doctor, knows everything about the pills, and he could just tell me himself). My goal is to figure out whether therapy is worth it, or whether I’m just getting help from the wrong source.

I hate to sound like your psychiatrist, but ask yourself what you have a right to expect from treatment, given what you know about its limits and your resources for paying for it.

If you want, you can spin things positively by saying that you’ve heard about good new treatments that can really help and that you’ve got great insurance that you pay a ton of money for. Of course, you’d probably be full of shit.

You don’t need to do months of research to know that no treatment has yet been acclaimed as a cure for mental illness or any other life- or personality-related problem.

Plus nothing you’ve read (or probably haven’t bothered to read) about the effectiveness of any current treatment implies that it works 100 percent of the time or that the treatment, if medical, is safe from possible side effects.

In addition, every method of “screening” for depression that you’ve heard about involves a questionnaire, right, rather than a blood test or scanning machine, which means that the burden for enduring, measuring and tracking the results of a trial of treatment falls, inevitably, on you the patient. And those are unfortunate facts of life whether you’re rich or poor, smart or stupid, board certified or not.

That’s the next problem: you’re not rich. And while you bristle at having to deal with insurance limits, you can’t afford insurance that would give you unlimited mental health treatment because it doesn’t exist. All insurance puts a limit of some kind on the amount of treatment you get and, unless you know what that limit is, you’ll use up your resources too quickly and have no idea about what, if anything, entitles you to more.

In addition, insurance limits your doctor’s fees and the amount of time s/he can afford to spend on a visit, so don’t fall for the professional who is ultra-amiable until your money runs out. Instead, look for someone who gives you what you most need in as little time as possible. In other words, beware smiles and frills because they may drain your limited resources.

Depressed people like yourself also tend to get negative and helpless ideas, which make them act negatively and passively, which makes them yet more depressed. That’s why mental health clinicians will push you to challenge your negative assumptions, learn more positive ways of thinking about your problems, and put the breaks on the depressive cycle.

It’s a cognitive kind of psychotherapy and is very helpful, although it’s often unpleasant in the beginning because you need to clamp down on your natural instincts. It’s a mental workout to make your non-depressive muscles stronger. No pain, no gain.

So yes, therapy of all kinds can be worth it, but you’ll be the one doing much of the work, not because someone else is slacking, but because mental illness sucks and both treatment and the resources to pay for it require careful management—by you.

Now you just have to decide what’s harder—doing the work or doing nothing. It might not be what you want to hear, but there’s no psychiatrist out there with a better offer.

STATEMENT:
Here’s a statement to keep you positive about a negative treatment process. “It’s hard having an incurable illness and knowing that the treatments are iffy, take a long time, and can easily use up my insurance before helping me, but I owe it to myself to give every reasonable treatment a try and become and good resource manager because that’s what I have to do.”

I’ve been in therapy for five years, and while I like my therapist a lot, I’m moving soon (my girlfriend got into grad school on the west coast), so I’m ending my treatment with her. She asked me recently though whether I was going to continue my treatment in my new town or whether I thought I’d taken it far enough, and I realized I honestly don’t know. She had some suggestions in terms of determining when and why to end therapy, but to be honest, they didn’t really help. I’ve been in therapy long enough that I don’t really remember how I coped beforehand, and while I feel much less tormented than I did when I began therapy, I’m not sure if my state of mind will crumble once I’m no longer getting help. How do you think one can determine when therapy has run its course, or whether there’s more to be done?

There’s a simple way to figure out how much talking psychotherapy you need: imagine paying full fee for it.

Before you crunch the numbers, ask yourself why you started therapy in the first place. Forget self-improvement, introspection, or generally pondering your bellybutton. Figure out what’s so bad about the way you feel and/or handle your life that you need to continue to spend lots of time and money on changing it.

Having failed to solve your problems over the past 5 years, you should wonder whether you can realistically expect a cure in the next year (no way) or whether you need maintenance treatment to keep you from slipping backwards (which is what you’ve been wondering all along).

At the same time, go back to the original question and ask yourself how much you can afford to spend on treatment each year and whether you should hold a few sessions in reserve for use in emergencies.

Unless you’re rich, don’t waste time worrying about how stopping treatment will make you feel. Instead, try stopping and see what happens. Even if you miss your therapist’s support, lose confidence, and re-experience your nervous stammer, suck it up, give it time, and the earth will continue to turn.

Next, think of therapy as a course that’s supposed to give you a specific marketable skill in exchange for your hard-earned debt. Don’t think like a college kid; you’re not there to party, please your parents, or become cool. If the first few sessions don’t deliver what you need, drop the class.

If you do have ample insurance coverage for therapy, don’t let it make you forget basic resource management skills. For one thing, many insurance policies are stiffening the limits on outpatient psychotherapies and are about to force you to do the above.

For another, being an active manager protects you from unnecessary dependence and time-wasting. Give your therapy specific goals, then examine how close to those goals you’ve come.

If therapy is more about discussion, then save the insurance hassle and start a search for a fun hairdresser. You can get your hour of talk and never have a bad hair day.

STATEMENT:
Here’s a statement that keeps you focused on making the best of limited resources instead of going for all-you-can-eat and then feeling deprived and abandoned. “I like psychotherapy and feel it’s been good for me, but it’s time, before it eats up more time and/or money, to think hard about how badly I need it, how well it’s working, how much is necessary, and how much I can afford to pay for it. The more I answer these questions for myself, the less likely I am to depend on experts to tell me what I need.”

I recently started going to a doctor for my depression. She thinks I should take pills, I’ve seen lots of articles about how antidepressants don’t work and the main reason they’re prescribed is because of the huge investment that big pharmaceutical companies have made in producing and marketing them. It makes sense to me that there are better natural, holistic solutions that get played down by the medical establishment because they can’t make money for anyone and threaten the profits made by those companies. My goal is to find treatments that work best, not the treatments that server the corporate interests.

The problem with most criticism of current drug treatments is its hopefulness; it implies that there are good, effective, cheap and low-side-effect treatments for depression (that are being suppressed). If only principal clause of that statement were true.

Sure, a magic bullet, holistic or otherwise, would be great (there are lots of other unsolved and incurable problems I can work on, so I’m not worried by the hit my business will take).

The truth is, however, that current treatments are time-consuming, weak, often costly, sometimes risky, and not guaranteed to work

Please resist the temptation to change the subject to tell me why current treatments are costly and often ineffective. You’re entitled to be angry about that sad fact, as about any other of the tragic, unfair and irritating facts of life, like tailgaters, the fact they cancelled “Firefly,” and almost anything having to do with hospitals and health insurance.

As much as I agree with you, I don’t want to hear it; you’ve got a job to do, and anger is a distracting escape from facing what you need to deal with if you’re going to manage treatment decisions for depressive illness. Instead of getting mad at your hand, play the cards you’re dealt.

Your treatment choices for depression aren’t that complicated…once you accept the fact that there’s no way to tell in advance which treatments are going to work or what side effects you’ll encounter. If you’re not in a hurry (i.e., if your depression isn’t about to push you out a window or immediately end your relationship with wife and family), you begin with non-medical treatments, like cognitive behavioral therapy, exercise, and diet and life-style changes.

If the symptoms are severe or longstanding or coming back after previous bouts, then you also experiment with antidepressant medications. This isn’t because Pfizer decrees it so, but because non-medical treatments are unlikely to perform miracles and an antidepressant medication improves your chance of recovery, even though it also has possible side effects.

If you want to try holistic remedies first, by all means, go ahead, but approach those treatments with the same care you would conventional ones; do your research to see what the data show in terms of results and what the side effects might be. Most data are inconclusive, but if you believe the treatment is working, then take that placebo to the bank.

Either way, you know the major principle of risk management: the more desperate your condition, the greater risk (pain, side-effects, cost, etc.) you should be prepared to bear in your effort to manage it. Draw on your own experience of your symptoms, their severity, and their impact on your life, as well as what the experts tell you about them, to decide how desperate you are.

It’s not a big pharma conspiracy against your health; your options just aren’t that great, and you have to figure out which one will work out, if not perfectly, then best.

STATEMENT:
Include your doubts about medication in a statement that focuses on management, not resentment or silly hopes for hidden cures stashed away in a cave with Sasquatch. “If I ever decide to use medication, it will be because I’m desperate and other methods haven’t worked. At that point, I’ll try to figure out their benefits and risks by looking at scientific, controlled studies, not emotional statements based on single cases or uncontrolled, badly selected patient populations. I will consult specialists and authorities to explain why they place faith in particular data or don’t like someone else’s data; but I will then make up my own mind, shutting out my emotional response to charisma or sincerity or a desire to include everyone’s opinion. When it comes to decisions about my health, I deserve a good, objective risk manager—me.”

I know the tranquilizer I take is addictive and interferes with my memory, but it’s the only thing that works when I get really anxious, and the other drugs I’ve been given for anxiety made me sick and didn’t work. I’m anxious because I’m stressed by some unusual recent events, which I’m sure I’ll get over in time, and then I won’t need to take medication. So my goal is to get the medication that works for me and avoid the stuff I know is going to make me sick.

It’s wonderful to get relief from severe anxiety, which is a terribly painful and frightening sensation. So I hate to make you more anxious by telling you that, unfortunately, there’s no good, safe medication that provides rapid relief.

The medications that provide rapid relief pose high risks of addiction and impair memory and balance, and the medications that are safer don’t provide rapid relief. That’s not very reassuring, but if you don’t cowboy up and face that fact, you’re in for trouble.

Remember, anxiety isn’t the worst thing that can happen. Much worse is what anxiety can make you do, like avoiding whatever stirs it up, medicating with alcohol, and making it your goal to feel less anxious. Given these dangers, your real goal is to do what you can to reduce anxiety while not letting it change what matters to you.

Don’t stop trying alternatives to addictive drugs because previous trials failed—that’s anxiety whispering its lies. It tries to tell you that everything that caused you pain in the past should be avoided now and in the future.

If you find yourself listening to that shit, you desperately need some cognitive therapy to help you straighten out your thinking. You can get it from books or a therapist or hanging out with anxious people who have learned how to manage their fears. There isn’t an actual Anxiety Anonymous, but there are groups like it.

If you stay with your current plan, you’ll not only lead a restrictive life, but you’ll tend to choose immediate relief over long-term advantages, whether it’s in treatment, jobs, or relationships. At that point, your anxiety is managing you, and that’s a real cause for worry.

STATEMENT:
Here’s a statement to keep you strong. “I need to develop new methods for dealing with anxiety because, as much as I wish it weren’t true, anxiety will always come back, eventually, and the tranquilizers that give me great relief in the short run will cause problems if I take them for too long. There are lots of non-medical techniques I should learn; and, if they aren’t sufficient, there are lots of non-addictive medications I should try that have a very low risk of causing serious harm. I need the courage to do what makes most sense to me, not what my anxiety would prefer.

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.”

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.”

My husband and I have two kids, we both work hard, and he always used to find time to play with the kids and spend time with me, but in the last few months, he’s buried himself in online poker in the evenings, and the kids see a lot less of him (I do, too, and it’s been a long time since we had sex). He tells me there’s nothing wrong and that he’s not betting with real cash, but I know what I see, so I’ve told him we need to talk, and that’s what’s really infuriating, because then he won’t talk at all. My goal is to figure out why he’s stopped caring about me and find a way to get through to him.

You’re assuming there’s something bothering your husband that you can figure out and communicate about, because that’s what would allow you to fix things; that it’s not the poker that’s really the problem (or the not being poked).

Before you sit him down and try to take him away from the e-poker table, ask yourself what happens if it doesn’t work, which it often doesn’t, and clearly, in your case, hasn’t.

Remember, there are lots of reasons for him to shut down other than his having something on his mind. He could be depressed and/or stuck in some kind of bad habit that he can’t shake. Even on-line poker can become addictive, whether or not the money’s fake.

If you push him to talk when he can’t think of anything to say or can’t own up to the bad habit or isn’t ready to fight it, he’ll get quiet and sullen. Then you’ll feel more certain that he’s angry about something he won’t tell you about and angry at you, and you’ll be angry at him, and upset that you’re angry, and worried about the kids’ reacting to your anger, and it’s a mess.

The issue will feel more and more personal. You’ll wind up water-boarding him, which won’t get you useful information and/or do the marriage any good. You will bet the house, and you’ll lose.

Remember, he’s withdrawn from the kids, too, and probably from the dog. Your own behavior was OK before and it hasn’t changed; something just happened to your husband that you can’t control. Withdrawal always feels personal, but it isn’t. If he had a tell to reveal his true feelings, you’d know it, and it ain’t there.

Your goal shouldn’t be to fix your marriage, because that’s not in your power. It’s to protect yourself and the kids from feeling responsible for what he’s doing, make the best of it, and not let anger make things worse (though Lord knows you have reason to feel angry).

If his little habit starts cutting into his other obligations, or if he starts gambling in earnest, then you’ve got a bigger problem. For now, he’s holding the line, and if you can’t make the best of it, you can always bluff in the meantime.

STATEMENT:
“You’ve always been a great husband and father, and we’ve been a great family together, but the huge amount of time you now spend playing poker has made you unavailable, which has all of us hurting. I don’t think anyone, including you, has done anything wrong, but I wonder if you’re depressed or have got stuck in some kind of bad habit. It happens to good people. I wish you could see what’s happening and try to change it, but that’s your call. Meanwhile, I’ll assume you can’t be available and the rest of us will need to adjust. I’m sorry, because you’ll lose chances to share things with us and I’ll have to rely more on my friends when I’d rather talk to you. If I can help, let me know.”

After my kids went off to college, I dealt with it by drinking too much. My husband’s always worked long hours, so he didn’t notice at first, but I managed to get his attention by totaling our car (with our daughter in the passenger seat). We were both fine and I haven’t had a drink since that day two years ago, and, while my kids have been very understanding, I can’t seem to win back my husband’s trust, no matter what I do. I’ve done rehab, attended daily AA meetings, done my best to be a model wife by anyone’s standards, and it doesn’t seem to make a difference. My goal is to get my husband to trust me again.

Though there’s nothing you’d like more than to regain your husband’s trust, it’s a terrible goal because it focuses on someone else’s feelings about you, rather than on your own priorities and values.

Surely AA has taught you to respect the things you can’t control, and surely, after raising kids with him, you know your husband is one of those things.

You know, mothers who love to nurture and are particularly responsive to their kids’ needs often have a harder time coping with an empty nest. You are simply gifted at putting other people first and it’s both strength and weakness.

If emptiness starts you drinking, you feel terrible about letting down your family and the shame drives you to drink more. Thinking about your husband is unavoidable—second nature, even—but, as you’ve already learned, it’s dangerous.

If you haven’t relapsed by now, it’s probably because you’ve found your own reasons to stay sober. Perhaps the AA meetings have given you support that’s separate from your family and also, perhaps, a perspective your husband doesn’t have.

In AA meetings, alcoholics don’t have to feel ashamed of being alcoholic; they try to be proud of what they’re doing about it. They build a wall between their alcoholism and how they manage it and between the past and what they’re doing now. Every day, shame and sensitivity threaten to make them believe that they’re failures and their job is to protect and accept themselves.

When you and your alcoholism were outed, you were probably mortified before you discovered big advantages. Yes, you lost friends who couldn’t accept you, but then you didn’t need to worry any longer about their acceptance, and could feel much more secure about those who stuck with you and respected your efforts to get sober.

Your husband may not be able to accept and respect you as much as you deserve. If so, it means he loved the glossy version of you more than the real woman. You can’t control his feelings, no matter how painful they may be to both of you.

You must, however, protect yourself from trying to get respect from someone who may not have it to give. Better be sad and get it over with than pine over something or someone that’s lost, and best do all of it sober.

STATEMENT:
“My dear husband, you may well feel you can’t get back to the way you used to feel about me. I was always afraid of losing your respect and that’s one reason I covered up my drinking. Now that I’m sober, I’m proud of what I do. I take no responsibility for sometimes wanting to drink and never knowing whether I’ll drink again. I can’t take responsibility for your feelings. I can only take responsibility for what I’ve done with the problem, and I’m much prouder of that than I’ve ever been. If you can accept me the way I am, our relationship can be better than ever. If that’s not possible, then there’s nothing either one of us can do.”

For years, I’ve talked to a friend of mine about my problems who’s also a counselor, and during that time, he’s urged me to seek professional help. I used to brush off that advice, mostly because this friend lives in another city and only ever really talks to me on the phone when I have problems, but in the last few months, I’ve begun to consider taking his advice. I don’t know what to say when I call to make the appointment, however, because I haven’t the faintest how to explain the unknown in my head (which is the main issue that frustrates me). I want to scream, but don’t know why or what. Do you have any advice as far as how to ask for help when I’m not sure what I’m really asking help for?

Remember, funny feelings in your head cause fear, which causes funny feelings, which cause fear, which create a spiral that will flush you down the toilet of needless worry. The first thing to do then is shut up and think about whether you need help.

If you’ve had funny feelings in your head for years, they’re not about to kill you; they’re not telling you to kill yourself or anyone else, and they’re not annoying you to death. Plus, they’re obviously not getting in the way of at least one long-term friendship.

So, taking all that into account, you have time to use your usual problem-solving methods to determine whether or not your weird head sensations are a big deal. You can try exercising and going on vacation, to see if you get better.

The big question isn’t what you say when you ask the shrink for help, but what you say after forming your own decision about why help is necessary. After all, you can’t shut up your worrying friends until you know your own mind.

There are several criteria for deciding when to seek help that apply to most situations, like if your problem gets in the way of making a living or being a good guy, or if your problem causes too much pain.

Assume, of course, that you haven’t been able to solve the problem without help, and throw in one special-knowledge exception: get help if the problem might be a sign of an illness that you might cure and/or prevent if you had expert advice. Then come to your own conclusion about whether you need help and then stand by it.

If you don’t need help, don’t bother to tell your friend to shut up. Let him/her know, if you need to talk about the problem, that you’re satisfied with your own way of managing it, and he’ll probably shut up on his/her own.

On the other hand, if you decide you do need help, shut up about your helplessness. Tell your doctor what the matter is and why you think it’s necessary to talk about it. Then the advice you get will be more focused and less patronizing, so you’ll actualy want to shut and listen to it.

STATEMENT:
“My symptoms are subjective and I don’t know anyone else who has them, but they hurt and distract me a great deal, so I want expert advice on what I can do about them that I haven’t already tried. I don’t care if the experts explain them away or tell me they’re in my head. That just means no one has an answer, and I have the answer I need (though the answer I want would include a cure). Then I know it’s not cancer, I’ve done my best, and it’s time to accept pain and move on with my life.”

After graduating from college last spring, my son moved to a new city for graduate school. The problem is that his psychiatrist, the one he credits with saving him from severe depression and turning his life around, did not make the move with him, and my son doesn’t want to talk to anyone else. The fix so far has been phone sessions, but this doctor is not covered by my son’s meager student insurance, so his father and I have been footing the bill, and that bill is staggeringly enormous. We love our son and want him to be well, but between our own expenses and the money we’re putting towards his graduate education, our goal is to get him to look for a new, local doctor without making him relapse.

Severe depression is scary and hard to control, so it’s not unusual that recovering survivors cling tightly to whatever may have made the bad symptoms go away, including anything from the lucky underwear they had on when the cloud lifted to, of course, their shrink, particularly if he or she is nice to talk to.

On the other hand, it’s also hard for parents to stress a kid who’s gone through depression, because it’s not just the kid that fears a relapse. That’s why you don’t want to tell your son and the therapist that it’s time for them to shut up.

Your goal, however, isn’t to protect him from stress or make him feel good, but to teach him how to deal with depression effectively, and superstitiously clinging to good luck charms isn’t the way to do it.

Instead, encourage him to make the most of his resources by bravely figuring out what he really needs, and what he can do without. Treat him as the agent of his recovery, the expert of his own experience, and the client who seeks useful ideas from many sources, including new therapists, all while debunking the therapeutic impact of nurturing/”special” relationships.

Yes, suggesting change will raise his fears and your own, but it’s your job to do that while offering him reasons for beating the fear and methods for managing it. Also, of course, don’t act frightened; sure, you can admit to fear and talk about fear, but not show fear, or else everyone will be so afraid as to soil their lucky underwear.

You’re there to convince him that facing fear will pay off; it’s for his own benefit in the long wrong, not just so you can make it easier to pay off your bills.

STATEMENT:
“Of course you need a doctor to help you manage depression, but our resources are needed for your education, so we can’t waste a cent. Find a doctor who is covered by your insurance. Don’t use that person for comfort and understanding unless it’s necessary; remember, we’re your friends and you have a dog and we’re all free. Ask yourself what you learned from your old doctor that helped you manage your negative thoughts and/or symptoms more effectively and look for someone who has similar ideas. Also, if you want to learn more about coping with depression, join a group of strong depression survivors. If you want to learn how to correct negative thinking, read a book and take a course. Use your doctor to get what you can’t get elsewhere. Whether we’re managing depression or diabetes, that’s how we can keep the costs of treatment under control.”

I’m a 58-year-old gay man and it’s a long time since life has been any fun. I’ve been single for some time (with no real prospects of a relationship), my friends don’t seem to have time for me, and at the end of a hard day’s work running my own business, I’ve barely broken even and have nothing to look forward to but spending the evening alone. That’s when the depression closes in and I can’t stand living. I write all this because I know that I’m a miserable failure, and that facts, not depression or any other mental illness, are behind my reasoning. I mean, when I tell my few close friends how I feel, they tell me I’m being too hard on myself, but if you’re almost 60, alone, and a financial mess, doesn’t that mean you’re a loser? My goal is to be real about myself.

Sounds like your goal isn’t to be real about yourself, it’s to be mean to yourself because you’re in a bad mood. If you were to reread the above paragraph when your mood wasn’t so shitty, you’d see your treating “facts” with the same care as Bill O’Reilly.

So, to quote Bill, Shut up, I don’t want to hear it. You wouldn’t talk like that to a friend, or even probably your worst enemy, so don’t do it to yourself.

Sure, the pain in your life is real, but there’s a monster in most of us that speaks up when we’re hungry or poor or lonely and says, “Look what a mess you got yourself into, you worthless piece of shit.”

If you’re smart and have high standards and a well-developed sense of style, the monster will comment on the bad clothes, dull conversation, and depressing colors; it’s very specific and discerning, because it’s the meanest side of yourself. It will give meaning to your pain, alright, by telling you that it means a lot and it’s your fault.

It’s your job to keep that monster from influencing your values. I assume you’re working hard on your own business, because you care about being independent and self-supporting.

I also assume you have old friends, because you care about friendship and maintaining relationships, regardless of whether someone is wealthy, clever, or stylish. You haven’t mentioned doing anything wrong; you’ve just described the kind of bad luck that often happens to everyone at one time or another, with or without depression, or a partner, or a great job.

If you have good values, be prepared to use them. If you want to talk “facts,” remind yourself how hard you work at your job and your friendships. Your goal isn’t to get me or anyone else to confirm that you deserve to feel bad; it’s to keep your perspective and not let the negative thinking of loneliness and bad luck undermine your sense of pride.

STATEMENT:
“My life sucks right now, but I respect what I’m doing. I work hard and stand by my friends when all my efforts are relatively unrewarding and, on top of that, I’m fuckin’ depressed. I can’t wait for my luck to turn but, until it does, I wouldn’t want to do anything differently, and that’s what counts.”

I have struggled with bipolar disorder for almost ten years now, but sometimes I can’t see the point. The last time I was admitted to a hospital, I was actually raped by another patient, and the whole experience left me with fears and nightmares I just can’t get over. I’ll never let my family or a psychiatrist put me in a hospital again. My goal is to find a psychiatrist who will give me the support I need so that I will never, ever have to go into a hospital.

If you had diabetes and got the best possible supportive care from the best physician in the world—you could even marry her—you might still need hospital treatment if you got an infection, overdosed on peeps, or just fell into a manhole.

So, while you have every right to feel traumatized by your assault, don’t paint yourself into a corner because of it. When it comes to this anti-hospital stance, (or pro I-need-to-be-nurtured-very-carefully-or-else), you have to shut yourself up.

Thinking about the risks logically, it becomes clear that you probably wouldn’t get raped a second time, and there would be steps you could take to make it more unlikely. So, in reality, you aren’t facing a choice of rape vs. death, but rather terror vs. death.

Terror or death is a decision most of us face every morning before we get on the subway; that’s life. There would be no other choice.

Unfortunately, you can’t change the way rape gave you nightmares, and you can’t avoid the possibility that you’ll find yourself in the same neighborhood. What you can do, however, is bear the terror—the fear of fear—so that you can promise yourself the best possible care and manage yourself as carefully and respectfully as possible.

Your goal shouldn’t depend on finding the kindest or most available psychiatrist, or extracting promises about what he or she would never allow to happen. Your goal should depend instead on your own ability to ignore fear while benefiting from your bad experiences to make good treatment decisions.

Yes, bad things might still happen, but you can be sure you will have done everything to protect yourself while taking the risks necessary to manage a bad illness. If you go to the hospital, something bad might happen, but if you need care and you don’t go, something bad is guaranteed.

STATEMENT:
I may never be able to shake the rape nightmares or promise myself that a mood swing won’t become catastrophic and push me into a loony bin. I can swear, however, that I’ll take reasonable care of myself and that, when I’m well, I’ll try to focus on living life, caring about friends, and ignoring pain, regardless of whether I can get it to go away.

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.”

I’m in my mid-30s, about to have my first child with my husband of about a year. My husband is a solid guy—he’s steady, and very caring—but deep down, I know a big reason I married him is because I wasn’t getting any younger and wanted to start a family. I dated a guy in law school that I was really in love with, but he was a lot older, made it clear he never wanted kids, and was your basic passionate, unavailable nightmare. I admit, I’m hormonal, which means my husband’s been getting on my nerves a lot lately, which just makes me obsess more and more about how I’ve settled for a life without love. My goal is to figure out how to get through the next stage of my life and live with my decision.

Don’t get superficial and compare the Valentine’s Day smiles at the next bistro table to your current mood and nostalgic memories of past lovers. In my experience, finding the love of your life isn’t too difficult, but finding a good partner is a real pain in the ass.

By “good partner,” I don’t mean someone you’re crazy about, under any and all circumstances, forever and ever, amen. I mean someone who is strong, easy to live and work with, accepts you during your weaker and less likeable moments, communicates on your wavelength, and picks up the load when you can’t. As well as someone whom you can put up with most of the time.

If you think two Harvard degrees have made me too selective (or obnoxious) to encounter lots of likely candidates, my patients tell me the same thing, including those with friendly, engaging personalities and dazzling beauty (they still have to see a shrink, after all).

As I’ve said before to other people seeking romantic advice, don’t yearn for someone you can talk to or someone who makes you feel special; those needs can be met by a good hairdresser. You describe your husband as “steady” and “caring,” which is worth more than the best of hair days.

Just as positive feelings can make you lose sight of what’s important in a relationship, negative feelings become dangerous when they cause you to devalue an otherwise good partnership. You can get negative because you’re a grump, or hormonal, or irritated by your partner’s less-than-perfect behavior, or because you ate too many turnips. Having those feelings, however, doesn’t mean you have to take them seriously.

If you think your relationship has become empty and meaningless because you can’t find a twinge of love, then negative feelings have made you forget what’s important. What’s important is not romantic advice, because romance is not what partnership is about. As you begin this next stage of life, that will become abundantly clear.

STATEMENT:
Here’s a reminder to help you fight the love-sick, sick love, Valentine’s Day blues. “As much as I love love, my goal is a family that has emotional and financial security. I’ve chosen carefully and we’re off to a good start. I wish there was more positive feeling and less bickering today, but I think we’ll be good at working and living together and managing the challenges of raising kids and dealing with setbacks, so we’re on the right course.”

I know my girlfriend’s a little unstable, believe me—I’m the one she stabbed twice with a steak knife (seriously). We broke up for a while, but after she came to me a few weeks after the incident full of remorse and apology, I had to take her back, because, even though she can be a freak, I have more fun with her than any other person alive. She’s the most exciting, dynamic woman, so, even though she sometimes flips out, I put up with it for all the times she’s just being a blast and making me stupid happy. I told my mom I was thinking of asking her to marry me, and my mom almost had a heart attack. I know we’re young (I’m 19) and that she really went overboard that one time, but I love the crazy bitch. My goal is to get the girl of my dreams, even if she sort of tried to kill me.

I’m not going to tell you that you’re crazy, or make waking-up-with-missing-anatomy jokes, because that’s what all your friends are doing, and maybe it’s not the way love feels to you.

Love can feel unselfish, like the joy of giving and helping and making a better world and having sex all mixed together, so it may feel meaningful to you, rather than just one big thrill.

On the other hand, I may be overestimating you. You may be the sort of guy who just wants to be stupid happy. That common expression is a most apt term in this case, and boy, will you be both (although more “stupid” than “happy” in the long run.

Maybe you think love will cure her problems. Unfortunately, love’s power is in what it makes people feel, not in changing their characters. It won’t make your girlfriend’s temper go away, at least not for long.

If anything, love makes needy people worse. It’s like heroin; the more they get, the more they need, the more they’re convinced you’ll never give them enough, the more they hate you for controlling them.

Maybe you want to believe that she wouldn’t get crazy if you could be more available, find the right words, and demonstrate your true love. That might be the plot of at least a couple of Drew Barrymore’s mid-career films, but it’s not what’s going to happen to you or any poor sucker in real life.

The good news is that love will make you very happy. The bad news is that you’ll be lucky to get away without third degree burns.

The other good news, while you may not take comfort in it, is that young men like you have been drawn to unstable women for centuries (a few of whom have written in the past). These unions aren’t totally without worth; after all, if it weren’t for gullible male/temperamental female pairings, we wouldn’t have tattoo removal technology, reality television stars, or so many girls named Amber.

Listen to your mom, however, and avoid being a part of that breeding statistic and put aside your wishful thinking. If love makes her crazy, ask yourself whether your love is really doing her a favor, and if this is a favor you want to commit to for the rest of your life.

STATEMENT:
Here’s a statement you’d be wise to deliver. “Our love feels wonderful and there are times when it brings out the best in both of us, but I think it also stirs up feelings that can’t be controlled and that could ruin our lives. What’s most important to me is not how good it feels to be with you, but what will do you and me the most good in the long run, and that’s why we need to walk away.”

I don’t know where I failed as a parent, but my daughter announced over Christmas that she’s leaving her perfectly nice husband after cheating on him, and it’s the last straw in terms of me wanting to just ask her why her behavior is and always has been so self-destructive. These aren’t the values I taught her—for one thing, I’m still married to her father after 30 years—and I’ve always pushed her to follow through in life and work, but she seems incapable of doing anything but sabotaging herself. My goal is to get my daughter to tell me why she feels she has to mess up her own life.

If your greatest joy as a parent is to see your kid happily married off, then it makes sense that one of your greatest sorrows is to see her unhappily divorced, particularly if she’s messed up and there’s nothing you can do to stop her.

If it hasn’t already occurred to you many times about parenting your daughter, this is certainly a good time to realize that you have no control, and that parents with good values and solid self-control can, and often do, have fucked-up kids and lose sons-in-law they’ve learned to love.

The gene for fuck-up-edness can skip a generation, or lay dormant until fed with alcohol, or it can wave a bright red flag in the form of the names “Randi” or “Amber.” Or it can just come out of nowhere and make parenting really hard, which is what it’s done to you for years.

Giving her a good, solid, come-to-Mohammad talking-to (Dr. Lastname knows that it’s dangerous to be flip about certain deities, but heck, there are no pictures), is likely to drive her away and make her act more crazy (like it would to someone deeply offended by the mention of Mohammad).

As you probably already know, most fucked-up kids can’t stop themselves from fucking up and get used to ignoring chidings or responding with true consistency, by fucking up more. Her guess as to why she messes up her life is probably as good as yours; all you both know is that it’s something she’s good at, and will continue to do for some time.

Your goal then isn’t to vent righteous wrath, but to help if you can. As a parent, that’s your job description. Don’t complain, because, while you haven’t been lucky so far in the daughter department, you knew there were no guarantees, and complaints can make this bad daughter worse.

Be supportive without taking sides, embracing infidelity or divorce, or welcoming her back to reside in what is now your office. The key to your support is, as usual, not caring too much about her happiness or lack of it, but more about her ability to do what will work best for her in the long run. Don’t press her as to why she’s a mess, but as to the best way (this time) to clean it up.

STATEMENT:
Prepare a statement to guide your tongue. “I liked your husband and I’m sorry about your divorce, but what’s most important in the long run is that you find a relationship that really makes your life better and, until such a relationship comes along, you need to be independent enough to avoid bad compromises. Right now, misery and loneliness may make you feel less capable and more needy. Hang tough, wait it out, and build up your own life. In the end, you can learn a lot from this divorce that will help you find something that will work better.”

My sister-in-law has never been one of my favorite people; I admit I’m always hard on my brother’s girlfriends, but she was always rude to me and the rest of our family, and aside from her job (in the entertainment industry), I really have no idea what my brother finds appealing about her. In the past, I’ve kept my mouth shut around her because it really upsets my mother when I react to this woman’s rudeness in kind, but this past Christmas my sister-in-law was so rude that she actually made my mother cry. I love my brother, but my mom and I are especially close, so this really feels like the last straw. My goal is to figure out whether I can just cut this awful shithead (who brings my mom to tears!) out of my life, or whether/why I have to keep tolerating her awfulness.

Add obnoxious in-laws to the long list of insoluble problems that makes life the pain it is. The more you love your brother, the bigger the shit omelet you must eat to keep your love for him alive after he marries a bitchmonster.

You might be tempted to free him, and the rest of your family, from the conjugal beastess who took him captive, but you know which side he’s likely to wind up on, so shut up. Like the fuck-up who will do worse when confronted on her behavior, somebody who loves a meanie will, upon being confronted about those feelings, be driven further into the meanie’s tentacles.

Your job isn’t then to free him, because it can’t be done, but to make the most of what you’ve got and not make it worse.

Here are the standard operating procedures; first, say farewell to the old, happy get-togethers, because since she hit the scene, they’ve stopped being happy, and she appears to be on the scene for good.

Invite him and his dear spouse only if the party is relatively large and public, so misbehavior will be less likely and easier to escape. For one-on-one, use modern technologies, like email, cellphone, and video-chatting. Never takes sides against, or exclude, his spouse, lest he be suffocated in her tentacles’ grasp.

Of course, you can count on your mother, or some other sweet, vulnerable family member, trying too hard to be nice and get close, and thus stirring up the unwinnable nuclear shit-storm you’ve been working so hard to prevent.

The more the hurt and humiliation, the harder for other family members to see the value of what you’re trying to do, and the greater their temptation to gang up on the horrible intruder; but sooner or later, they’ll find there’s no way to solve this problem, save hypnosis or murder, and that diplomatic distance is the best compromise.

No matter how bad things get, avoid the temptation to band together with the ones you love. Instead, do what you think is right and encourage them to join you. Hold your ground, hold your nose, and keep your brother and your beast-in-law in your life.

STATEMENT:
Prepare a statement to protect you and yours from the discouragement of loss and humiliation. “I treasure the lucky fact that our family is warm and close, but what I value even more, because it’s so difficult, is our ability to include obnoxious people when it’s necessary and stay relatively pleasant. We’re good at accepting change, however painful, and managing relationships that aren’t meant to be.”