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.”

Please Note: Monday is also a fxckfeelings.com holiday. Happy New Year (and again, if/when it’s unhappy, you know the drill).

I’m a current student and I’ve sort of self-diagnosed myself as having an unusual kind of OCD. It started out four years ago when I was studying for an upcoming major exam. I had always been one of the few top students, but at one point in time in the midst of hours of straight studying, I couldn’t absorb any more info, and in a fit of frustration, a ball of emotions welled up and I actually said harshly in my mind to myself, “you shall FAIL!”, even though I’ve always tried to avoid such negative thinking. What came next was an unshakable, unexplainable, and annoying-yet-scary series of feelings, thoughts and emotions for the next few days and weeks. After that episode, I developed an irrational apprehension about me having “ruined” myself and my academic ability. To get myself back to my normal, anxiety-free mind when studying or doing anything related to studies, I imagined “transferring” the whole chunk of this mental mess on other stuff, whether it is the faces of people who did badly in academics in my field, to those I don’t like, etc. Still, my mind would automatically be inclined to have these random obsessions appear in my mind while studying, and it’s really prevented me from fully unleashing my full academic ability in subsequent grades. I really felt restrained and trapped by this, and my goal is to eliminate this strong-rooted (it’s been 4 years) mental condition that happens whenever I study and then makes it almost impossible.

Some OCD thoughts are crippling but come out of nowhere, like fear of contamination or making a mistake. While they often lead to compulsive rituals, like repeated hand-washing and fact-checking, you manage to keep studying. So, while you’re suffering, you’re still lucky.

The fact that your obsessive fears are tied to school may make them easier to deal with, because, unlike germs, school (usually) doesn’t go on forever.

School is built on mental constructs that attract obsessions like lint to a dryer vent; it’s got grades, grade-points, and exams that hinge on a word or the instructor’s interpretation of same. It invites obsession and obsessive argument, which can be torture, but at least it has an end date.

After school is over, you can find branches of almost every major profession that thrive on obsessional thinking, but you can also avoid them if you want; you’ll have choices beyond what courses you can take and how much to put on your meal card.

Also, the mental activity that sticks words in your mind as if they’re big, significant boulders is probably good for certain kinds of learning, and it’s not uncommon. Respected psychiatrist John Nemiah liked to point out that Martin Luther had a similar problem, and went on to start Protestantism (although his Catholic colleagues might not see this as a success).

The bad news, I guess, is that you’ll probably never “eliminate” your fear of certain intrusive thoughts. What you can do, however, apart from putting school behind you, is develop techniques for breaking into the vicious circle that enhances the power of whatever you’re afraid of.

In other words, if you’re afraid to think about something, you’ll think about it, and your fear will probably have a small negative effect on your performance, which will prove you’re right to fear the intrusive thoughts, which scares you even more. What a good cognitive therapist can offer you is a bunch of mental and physical exercises that either distract you from the vicious circle or remind you of your ability to deal with fearful events as they occur.

Get used to the idea that, like many people for whom ideas and words have a life of their own, you can be troubled by obsessive thoughts. You can’t get rid of them, or always prevent them from distracting you, but you can always stop them from changing your goals or failing to try your best and reach the finish line of graduation.

STATEMENT:
“I’m afraid that intrusive thoughts will prevent me from ever living up to my potential, but, if I have to live with them, I can do it. I will regard them as just one more weakness that I can learn to deal with as I go about pursuing my interests and trying to graduate and make a living.”

I do pretty well as project director at work, but I’ve always been troubled by thoughts that get in my head and just won’t quit. During the last year, I’d get haunted over and over again by the thought that I’d said the wrong thing to one of my colleagues and offended them. What I’d want to do was ask them if I had in fact offended them, but if they said no, I’d probably worry that my asking them had offended them, and I’d want reassurance about that, thus making it worse. Instead, I ask my wife, who listens carefully and reassures me…but then I think of something I left out of the story and ask her again, and make it worse at home instead of at the job. She’s a kind woman and understands I can’t help it, but, after a while, her patience wears thin, and then I worry about my marriage. My goal is to figure a way out of this trap.

A couple good things about your obsessive thoughts are that you’re used to them and they haven’t stopped you from succeeding at a tough, challenging job. The bad thing is that your technique for diminishing painful self-doubts has gained a hold on you and, if unchecked, could trap you in a dangerous vicious circle. Instead of washing your hands, you’re using the Purell of reassurance to wash your mind of guilt.

If you read up on obsessive compulsive disorder, you’ll learn that the behaviors for reducing painful thoughts (like your reassurance technique) are called “rituals” and they can get out of hand. The treatments for controlling them are a lot like the one invented by Mel Brooks’ comic alter ego, Dr. Haldanish, who cured a young boy of a paper-tearing habit by yelling at him not to tear paper. Which is to say, an absurd-seeming disorder has a similar therapeutic approach.

The goal of these treatments is, simply, to help you stop the ritual, even if this causes more short-term pain and doubt. The therapist may give you reassuring thoughts to repeat or exercises you can use to distract or calm yourself. In extreme cases, the therapist may actually accompany you and directly encourage you to refrain from the ritual (alas, Mr. Brooks doesn’t do house calls).

If you think there’s an element of truth in your concerns and that your speech with colleagues is too negative when you’re stressed or find yourself worried, angry, or unhappy, coaching would also be helpful. You may discover new ways to keep your statements positive, while being direct about tasks and responsibilities.

If you were really offensive, however, you’d be getting more criticism at work and at home, and you aren’t. On a professional level, that’s really your standard and it’s one you want to think about and reinforce as much as possible.

Your goal isn’t to make your doubts go away, though that would be nice; it’s to have respectful conversations at work, even when you’re stressed, and feel confident about your ability to have those conversations. And to keep all paper intact.

STATEMENT:
“It’s hard not to ask for reassurance when I’m haunted by doubts, but I have my own good standards for professional behavior and, so far, I know I’m meeting them. My job is to make them stronger while I tolerate the doubt that seems to be part of my brain chemistry.”

Helping my daughter pay the rent on a bigger apartment seems to have lifted her out of her depression and she’s much more active at her job, but she’s still not making enough money and I’m running out of cash. If I tell her that she has to take a roommate, I’m afraid she’ll just crawl under the covers again and we’ll be back where we started. It shouldn’t be that hard for her to make enough money, but it is. I’m mad and I’m stuck. My goal is to get her to make more money and/or understand that I can’t keep supporting her like this.

While you may think you’re giving your daughter money out of love, you’re actually doing it out of fear. That’s trouble, because when you give money out of fear, you’re usually being mugged.

Fear makes you forget long-term risks, like what you’ll do after you run out of money and the consequences for you, her, and other people who depend on you. Your love is infinite, but your finances aren’t.

You’ll also forget that your daughter may be able to do more for herself now than she could before. She may be able to tolerate more stress and access other resources if yours are less available.

Finally, your fear amplifies her fear and vice versa, until you both doubt that she’ll be able to survive without your current level of support, without there being any evidence of that, other than fear itself.

If you want to manage her disability, rather than be managed by it, you must continually test out what she’s capable of. If she’s stressed by looking for a roommate, coach her on how to do it or how to find a coach. If the roommate is hard to live with, advise her on ways to protect herself. If you protect her more than absolutely necessary, you’re just stifling her growth in the long run.

After all, you’re not responsible for relieving her stress, but for teaching her how to live with it. You’re trying to ensure her basic safety and security, and while you wish she could be happy, that’s not something you or she control.

If she’s afraid of slipping back into depression, point out the constructive things she’s doing to prevent it. Stress may make her feel overwhelmed, but that doesn’t necessarily cause depression or mean that she’s slipping back. It just that means life is hard.

Don’t let her panic incite yours. Instead, think up an emergency, affordable bail-out plan in case she has a bad relapse. Don’t share it with her, just remind yourself that you know what to do for her safety and that the pain she may experience as you cut her funding is an unavoidable part of her recovery and your solvency.

By giving no more than you think is necessary, you become a strong fear-manager and learn self-defense against an emotional hostage situation. Ultimately, that’s the skill you want to give her.

STATEMENT:
“I’m terrified of the stress my daughter will experience if I cut back on the money I’m giving her, but I’ve thought carefully about what she needs and I’m sure she’ll be stronger if she can cope with the stress and do more with less.”

My 22-year-old daughter is mildly retarded, but she’s pretty well taken care of. She’s not unhappy—she worries about things much less than I do—but I’m unhappy, because I’ve never felt comfortable with her. Most people think she’s sweet and docile, but my daughter very much has a will of her own; she doesn’t like to shower, she doesn’t care about other people’s feelings, and she has no idea of how people are reacting to her, or anyone else. I’ve tried hard to find a point of positive connection, and failed. Other people think I’m a great father, but I can’t get over the feeling that I never met this challenge and that there’s unfinished business between my daughter and me.

Regardless of whether your daughter is retarded, super-powered or “normal,” you can never be sure that you’ll like her. It’s so much easier to be her father if you do, but that’s never a guarantee.

It may be that no one would like her if they really knew her, but that doesn’t matter. It sounds like you’ve tried hard to like her, but you don’t, and it’s not in your control.

Given the lack of good chemistry, however, you should appreciate your achievement all the more. You haven’t punished your daughter or told her she’s a failure; on the contrary, you’ve taken good care of her. You’ve done your job under much tougher conditions than most parents have to deal with, and I don’t mean because she’s retarded, but because of your negative feelings for her.

The test of a good teacher isn’t how well she teaches the kids she likes, but how well she does with the kids she doesn’t like and how well she hides that fact.

If this were the movies, your business wouldn’t be finished until the two of you have a good hug. Since this is real life, it’s never finished, so every day, do your best to treat her with respect and friendliness. If you slip and get nasty, apologize. It’s one day at a time.

It’s certainly sad that you couldn’t like her more, but it’s not a failure. It’s a success that, in spite of that, you treat her right, and one that only a great father could achieve.

STATEMENT:
“I will never feel comfortable with my daughter and I will always suspect that, if I were a better person, I would; but I am who I am and she is who she is and I’ve done the best job possible given that simple fact of life.”

I have been struggling with performance anxiety for years. It was particularly difficult during university, where I saw three psychologists, including a campus counselor, who, while supportive, weren’t helpful. It got much better though when I was able to take control of a treatment group I was facilitating, where I could design the program and run it the way I wanted to. I enjoyed being the therapist who helps others, and the experience gave me confidence. Still, the anxiety has not been extinguished in all situations—when teaching and presenting at conferences, the anxiety in these two areas is just as high as it was previously. I have been managing this for a long time and I do not feel motivated to continue to place myself in situations where my anxiety is raised again so high that I experience nausea, stomach pains, dry mouth, etc., not to mention the exhaustion I feel after the anxious-provoking event has finished. I do have some mild/moderate social anxiety—I don’t like socializing in big groups unless I know the people, and this prevents me from making new social contacts and networking for my profession. I am well versed in exposure therapies and ACT and have used these to get me to the point I am at now, and I continue to use them. However, I don’t think my anxiety will ever improve beyond where it is now and I am too exhausted to continue to try. I guess I’m stuck and don’t know if I should try to find a specialist to help me to continue to force myself to network, push myself to present at conferences, and become an academic psychologist or move into working as a clinical psychologist in a private practice, where I would work more on my own and I would be happier and more relaxed but also know that I am avoiding the events that are anxiety-provoking.

Maybe being in the mental health business makes you feel more responsible for controlling symptoms of anxiety and becoming a role model for good mental health. It’s ironic, given that most people in our field are the worst role models for mental health. If we were totally sane, we’d just go into dermatology and rake it in.

If you are driven to perfection, it’s causing you to forget that certain symptoms, like anxiety, tend to be incurable, and that, if you’ve reached the point where you can’t make them better, it’s because you’ve done an amazing job of managing them and pushing yourself to the limit of what you can bear.

That you’ve pushed yourself so hard during a long educational process may have caused you to become academically institutionalized, i.e., to rate your progress by where you stand in the institution (not the other, less fun kind).

You’ve become the very model of an up and coming academic psychologist, but now that the institutional phase of your life is no longer a requirement, you have a wider array of options and no easy reference points. You don’t have to present papers or schmooze colleagues if you don’t want to; that’s not avoidance, unless presenting papers and schmoozing colleagues are part of the life you want to lead going forward.

You know what they call the PhD who came in last in his class? Doctor. Sure, it’s a nasty MD joke, but the fact remains that your degree sets you free, offering you many different career options and you’re now familiar with most of them. Ask yourself how much money you need and then rate your options according to how well they pay, and how much you might enjoy them. Then, when you consider the amount of anxiety each will require you to bear, you’ll know whether it’s worth it.

Remember, like its first cousin, depression, anxiety causes your brain to focus on helplessness and failure rather than achievement and courage. It will tell you that treatment has failed and that you’re a failure if you don’t act normal, but wisdom tells you that you’ve already accomplished your biggest academic goals, in spite of great obstacles, and reached the point where you can finally put your own spin on life.

Be proud of what you’ve done, and don’t mistake anxiety and fatigue for discouragement; they’re challenging you to recognize what you don’t enjoy doing, and there’s no shame in choosing the career path of least (torturous) resistance.

It’s up to you, however, to decide what’s meaningful enough to be worth the pain. If you can maintain a practice despite your own struggles, you’ll be a role model, with or without symptoms (or an MD).

STATEMENT:
“I feel like I’ve failed to conquer my anxiety, but in reality I’ve done everything I set out to do, other than get rid of my symptoms. Now I’m in good position to decide what I want to do next and confident that I can bear whatever unavoidable anxiety goes with that choice.”

Whenever I screw up at work, it causes a chain reaction of even more fuck-ups until fate mercifully intervenes. The most recent incident started when I miscalculated the logistics of a project and ended up forcing another department to work overtime to make up for it. The department head was understanding, but I was so pissed off at myself that I actually couldn’t sleep at night, and that made me late enough for work to miss at least one really important meeting, so now I’m of course thinking that this time I won’t get lucky and will actually lose my job. There’s got to be a way to fix this myself.

It’s certainly unpleasant to make mistakes (that make mistakes that make mistakes), but don’t lynch yourself before you conduct a proper trial. It’s possible that your pain is torturing you to confess to crimes you didn’t commit, just because confession makes you feel better and provides a cheap sort of redemption.

You don’t need a judge and jury to conduct a proper trial on your own conduct, just rules that you believe in (i.e., that you’d apply to a friend) and an ability to review your behavior.

You’d expect a friend to take reasonable precautions to avoid making the same mistake twice; your standards, after all, are for his conduct to be good enough, not perfect. So you wouldn’t assume his miscalculation, the overtime, or his missed meeting were easily avoidable unless he hadn’t followed procedures that he should have known about. At least, those are the rules I think you’d use, but you be the judge. It’s your trial.

Then ask yourself what you should do if the verdict from your trial is “not so bad” but your heart still proclaims you a loser who should embroider a scarlet L in your shirts. That’s when you have to give yourself some good coaching and dismiss your heart’s request for an appeal.

Remind yourself that challenging projects always expose you to the unforeseen and congratulate yourself for taking responsibility and working hard, and give credit to your boss and co-workers. Apologize, but only once.

Be aware that frustration and humiliation, like anxiety (see above), make you think of the should-haves and could-haves without regard to actual, reasonable responsibility. They trigger a lynch mob in your head, but you’re not just the law, but order, and justice will overcome.

STATEMENT:
“I feel frantic when things go wrong and I’m sure I could have or should have prevented it, but I’m also capable of deciding what my real responsibilities should be and standing by that decision.”

My wife suffers from non-medication responsive depression (we’ve done ECT’s, every med in the book, and she has a psychiatrist). She’s bitter and short to family; she goes off on the kids and then can turn around and be nice. I do all the work around the house, get the kids to activities, etc., and I’m wearing out. She comes home from work and just logs on her lap top and sits in front of the TV while I get dinner and clean up. She shows no affection towards me and I feel like a servant. When I complain or push her, she talks about killing herself and putting herself out of our misery (she’s been hospitalized several times) or just hurting herself (sometimes she cuts on her arms and legs). I’m getting to the point where I don’t like her anymore. She just seems to have given up. Nothing interests her, nothing tastes good…she gets no enjoyment from anything. What can I do? She’s in her forties, now, but she struggled with depression in her twenties and this current bout has been going on for 5 years. Her doctor and therapist are really committed to her, but it seems like she doesn’t care, like she enjoys being miserable. Sometimes I feel like I’m spiraling down with her, but I’m not going to give up. If I just stand by, she seems to just sink lower, but I can’t leave, because she’s said that the kids and I are the only reason she’s still alive.

If you’re like most married people, you become dependent on your spouse for a positive response, no matter how independent you are as an individual. You married her because you respect her opinion and take pleasure in her approval. You make her happy, everyone feels good. You see the problem here.

So it’s normal to feel bitterly disappointed and deflated when depression turns her into a grouchy, nasty, unappreciative, unaffectionate black hole who threatens suicide if you criticize her and never does her share.

It’s not just the lack of approval from her that’s bothering you, it’s the overabundance of disapproval, of you and everything else.

Unfortunately, the bitterness you feel in response to your unmet needs adds to her self-hate, creating a vicious circle of negative emotion that demoralizes everyone. Controlling that bitterness is the one thing you can do to improve what is an otherwise impossible situation.

First, pretend that she’s had a stroke that zapped the part of her personality that was warm, active, and responsive; your loss isn’t personal or preventable, and your needs are no longer plausible. Acknowledging these difficult truths now prepares you to assess, without hurt or a sense of failure, whether your family is better off with the two of you together or apart.

There are positive aspects to your marriage, like the fact that she contributes financially, and that, by staying alive, she helps the kids, and hopefully she does some parenting from time to time. She’s showing courage, whether she knows it or not. Maybe the advantages of staying together outweigh the many disadvantages you’ve listed above.

Whatever you decide is best, present it to her positively; tell her you know she’s trying and there’s probably love and affection in there somewhere, if the depression would only lighten up. Remember the person she was and talk to that person as if she’s still there but, like Sleeping Beauty, can’t wake up.

If you feel separation is for the best, let her know that you value and support her role with the kids and that what you are separating from is not her, but her illness. And if she threatens suicide, tell her that her threats are a factor in the separation.

When depression takes over your personality, it makes you do bad things, like putting your life in other people’s hands. If she could control that side of herself, she might improve her parenting and your partnership, even if her depression does not improve. Recommend DBT, a kind of therapy I often recommend, that helps people who feel terrible protect themselves from acting terribly.

Decide what’s for the best, don’t be a victim, and ignore blackmail. You may be a victim of her illness, but you’re also the man in charge who’s doing a wonderful job of soldiering on. If you do what’s best for you and your kids, then it doesn’t matter what she says now; the healthy part of her approves, even if it can’t be heard.

STATEMENT:
“I feel like I’m taking it from all sides and that all the love and nurturing I give my sick wife comes back as shit. I know, however, that her response is not her, but her illness. I have assumed a huge load as a single parent who must now go on alone without the love and support of a partner. I will make hard choices that she may see very negatively, as she sees everything. I will hold fast to my own vision of what’s best for the family.”

I’m writing because my husband wants me to. He thinks there’s something wrong with me, but I like being a little manic, so I haven’t taken my mood-stabilizer medication in 10 years. It’s true, I talk fast, I can’t hold a job, I’m irritable, and he’s had to put me in the hospital a couple times. On the other hand, I don’t hurt anyone and I like the way I feel, most of the time, except for one thing: he wants me to be the way I used to be and he’s always unhappy with me. I hate sleeping in the same bed, but he’ll give me a hard time if I move to another room. My goal is to get him off my back, so I agreed to write.

As noted above, when you’re married, you can’t help depending on your spouse’s approval, in some deep, hard-wired way, which means that, if you never seem to get it, you become a permanent rebel who cares too much to leave but feels better every time you do the opposite of what he wants. In the process, you lose track of your own priorities.

On the other hand, you know your priorities about your hypomanic mood. Keeping it natural and un-medicated is more important to you than holding a job, staying out of hospitals, and keeping your husband happy. That’s where you stand.

The problem is, you wish your husband would get used to the new (10-year-old) you, but that’s not going to happen. There’s no point in talking about whether he should accept you, just like there’s no point in talking about whether you should damp down your hypomania. He can’t help where he stands and neither can you.

So instead of writing to someone who’s supposed to persuade you to take your medication, face the sad fall-out from your decision. Don’t blame yourself; just ask whether the marriage is worth it, because clearly, your old marriage and the mania can’t co-exist.

On the one side, you’ve shared a lot of years together and your standard of living is probably better with him than without him, given that you’re on disability. On the other hand, there’s the mutual non-acceptance, which is hard for both of you to live with.

Whatever you decide, stop whining. You’re not to blame for a bad decision, and you aren’t a victim of bipolar disease, so don’t make yourself a victim of your husband’s non-acceptance.

If you want to continue to live with him, have the balls to stand by your decision. Tell him you’re sticking with the temperament you’ve got, you still want to live with him, you won’t talk to shrinks, and you’ll sleep where you sleep. If he wants to throw you out when he realizes, after 10 years, that you aren’t going to change, so be it. You don’t blame yourself for choosing to live with your hypomanic mood, and you don’t blame him if he wants to leave his life with you behind.

STATEMENT:
“I feel like I’ve ruined my marriage by deciding to do what’s right for me, but the decision has been costly in so many ways that I know I didn’t do it lightly or to spite my husband, so I respect my decision. Now I need to ignore feelings of guilt or wishes that he could accept me the way I am and instead accept him the way he is. Whatever I decide to do about our marriage, I’ll do what I think is best for us and never be a victim.”

I always suspected that I was attracted to women more than to men, but I liked my husband, and we’ve been good companions for the past 20 years. It hurt him deeply, however, that I wasn’t interested in him sexually and finally, when he pressured me to tell him what was wrong, I told him I thought I might be gay. Now he feels I lied to him, that our marriage has been meaningless, and he wants a divorce. Our life together is over and I feel totally to blame, like I’ve let down my husband and betrayed our marriage. What can I say to make amends?

There’s one important step people sometimes forget to take before making amends– asking yourself what you’ve done wrong.

Obviously, your husband is hurt and he thinks you’re to blame, but, as we’ve said many times, that’s the whole point of marriage—having someone to blame. Real sin requires knowing that you have something to hide, and that doesn’t seem to be the case.

With only 3 shopping days left until Yom Kippur, you might wish to remind yourself that the Day of Atonement, when Jews make a special effort to examine our sins, begins with a thrice-repeated statement claiming that no one should ever be responsible for vows they can’t keep.

In other words, life is often impossible and it’s not rationalizing to say you can’t be responsible for what you don’t control– it’s Old Testament.

So look what you’ve done with your (newly coined) homosexual feelings. You haven’t been unfaithful, or blamed your lack of attraction to your husband on his being fat. If you kept a secret from him, it was because you also kept it from yourself, and in spite of your uneasiness, you forged a 20 year relationship. That’s a major accomplishment for both of you.

So don’t let your sexual identity shock shake your confidence; you’ve taken a step forward that allows you to be more self-accepting and spontaneous. While it damages your husband’s matrimonial ideal, it shouldn’t diminish your pride in what both of you have done with the marriage so far, or your hope in what it might become in the future, if your husband calms down.

After all, this doesn’t need to be the end of your relationship; you maybe not have been a great sexual partner, but you’ve always been a great partner, and there’s no reason not to continue to be great friends.

STATEMENT:
“I wish our sexual chemistry and my sexual identity were less complicated, but I feel my husband and I have been good partners, not because of my lying, but in spite of it. I wish it didn’t hurt to face these sexual realities but I’m glad we did and think we can be better friends now that I no longer have to hide who I am.”

I would like to stay off pain pills and I attend AA meetings regularly, but I get the pills from an old friend of mine who also goes to the meetings. She’s been sick with HIV and needs all the support she can get, so we wind up hanging out and then getting high. I wish my husband gave me a little more credit for trying to stay clean, even if I haven’t been successful. It’s hard to say “no” to spending time with a dying friend.

Forget for a moment why other people think it’s bad for you to take pain pills; instead, do your own assessment, not just for whether the pills are bad, but for whether or not amends are in order.

Obviously, the good side is that they make you feel better and you enjoy passing time with a sick friend. Then again, pain pills have a magical ability to kill pain while also causing a ton of it.

Start with a checklist of possible negatives, so you won’t miss the big picture. Include the weekly cost and whether the pills interfere with your ability to work, either directly or by risking a positive drug screen. Ask friends and family whether they see a negative effect on your behavior, and ask yourself whether your focus on feeling better has pushed aside other priorities, like being a good friend or parent.

Finally, assess your friendship with this friend in the same way. Ask yourself whether this is a friend who, in addition to being fun to hang out with, is someone you can count on. Look carefully at whether the feel-good focus of the friendship excludes the more important priorities above.

You need to find your own reasons for being sober, and the strongest reasons will come, not from your need to please your husband or meeting-mates, but from your sense of what it takes to be a good person. As the AA saying goes, you are the reason for your own sobriety. If you’ve used drugs a long time, however, you tend to be super-aware of how other people feel about you and relatively insensitive to your own standards. Those standards give you the reasons to stay clean.

Remember, however, that standards aren’t the same as sentiments. You may feel like a good woman for supporting a sick friend—a nice sentiment—while failing to meet important commitments to manage your health, work, family and other friendships.

Be careful not to bullshit yourself, or your good deeds will, surprise, get you little appreciation or, more importantly, little self-respect. If keeping your friend company keeps you from doing the right thing, then, like the pills themselves, you’re causing more pain than you’re preventing.

STATEMENT:
I feel good when I can help out an appreciative pal and share some good times, but if I want to keep my relationships with people who really care about me, I need to put commitments ahead of good feelings.

I have been wrestling with depression for years now and my maternal side of the family has a history of depression and suicide. I don’t feel that I can do this on my own anymore and need help. I don’t want to just take a medical cocktail of antidepressants. My question to you is how do I go about finding a therapist and/or doctor that will be most helpful to me.

The first step for getting treatment for your depression seems simple– don’t get depressed about treatment for depression. After all, depression’s just another form of pain unless it twists your thoughts into thinking that not getting rid of it is a kind of failure that marks a meaningless life.

As long as you realize depression is a persistent ailment, just like persistent back pain or diabetes, you’ll have an easy time making treatment decisions because you won’t regard using treatment as evidence of weakness.

The fact that your family has had depression and suicides doesn’t indicate weakness or failure on the part of anything but your genes. Suicide is terrible, but it often happens to good people who’ve lived meaningful lives and been good friends in spite of lots of depression, which doesn’t make them failures—it makes them heroes.

If depression causes you a lot of pain or makes a noticeable difference at home or work, the very least you should do is get help in fighting the negative thinking. While using therapy to find the cause of your depression and get rid of it is usually useless when the depression is long-lasting and familial, using many therapies to protect yourself from feelings of weakness and failure is often a necessity.

A therapist is like a thesis adviser for an academic; you have a topic you want to explore, and you’re looking for someone who both understands that topic and supports your approach. If you start treatment with someone and it doesn’t gel, chalk it up to bad chemistry, not your own failures, and continue your search.

Whether a therapy helps you to keep a positive perspective is easy for you to evaluate; you can tell whether a particular therapist is a good coach or has good ideas, or when you’ve got little more to learn from someone and need a fresh point of view.

Yes, a sustaining therapeutic relationship helps, but not if you come to feel it’s necessary for fighting negative beliefs. Sometime that special therapist won’t be there, or your insurance will change and you won’t be able to afford to see him/her, and then you won’t have the tools to manage your depression on your own. Your goal in talking to a nice, warm therapist is to pick up positive ideas, practice using them, and report back on how you’ve done. Don’t cling to the warmth or the need for their approval.

Make sure you try behavioral treatments, including exercise, which at the very least can distract you from depressed thinking (but don’t punish yourself if your depression makes you too tired or listless to exercise regularly). If, as often happens, the non-medical treatments can only help so much, it’s time to consider medical options. Usually, medical options have a higher risk, but they should be considered if and only if you think the alternative is worse.

If you use a sound risk management methodology to make your decision, respect yourself. Never call antidepressant treatment a “medical cocktail” unless you would say the same about chemotherapy for cancer or pills for high blood pressure.

In addition to having a greater (although not terribly high) risk, antidepressants are a pain because they take weeks to work and often (30% of the time) don’t. So after becoming a risk-manager in order to make the decision to use or not use them, embrace your inner scientist and prepare to conduct an experiment—on yourself. It’s hard, risky work, but if you feel it’s necessary, it’s worth taking on.

In the end, do everything you think is reasonable and required. Use the low risk treatments first, the higher risk treatments when needed, and be prepared for mixed results at a slow pace (that in no way reflect on you or your effort). Needing help or medication doesn’t make you weak; it makes you sick, but strong enough to do something about it.

STATEMENT:
“If I found a medication that relieved my depressive pain, it would be hard not to feel that I’ve taken an illegitimate shortcut. I know from experience, however, that there’s nothing illegitimate about treatment that reduces depressive pain as long as it doesn’t create risks that are worse than the pain itself and that the only illegitimate way to treat depression is to regard it as a weakness.”

I’d like your advice in helping my sister, who is starting to act crazy again, but she won’t accept anyone’s help. She was in the hospital several years ago for hearing voices telling her she was a friend of the Virgin Mary. Now she’s starting to talk fast again and calling the company that I think she was fired from, saying she believes they’ve sent her on a special project and she needs to report back. She sometimes sounds ludicrous, and I can’t help laughing, but I’m afraid where this will end. How can I get her help?

It’s tough to respect an illness that makes people act silly and ridiculous, and tougher still to believe you can’t get through to someone who seems, in many ways, to be in control of herself and able to care about you in the way she usually does. If only mental illness came with a rash or flu that made it easier to recognize and accept.

You’re right, however. Your sister’s illness is serious, it could get her into big trouble, and, in spite of her apparent lucidity, it can be very, very hard to help her. Especially if she’s too sick to know she needs help in the first place.

As hard as it is to be depressed (see above) and to respect yourself when you have depressive symptoms, depressed people usually know they’re sick and are ready to accept help, even if it feels humiliating. With mania, however, people often can’t see themselves as being ill. If respect were measured in nothing but feelings, you could say they respect themselves too much.

If you push your sister too hard, you may provoke a fight, which does no one any good. Manic people are often irritable and ready to fight or flee (often on motorcycles, cars and airplanes, and in the middle of night, and often while underdressed). Don’t let your concern for her become an impassioned plea that triggers her great (naked) escape.

Persuade her, if you can, with calm reason, emphasizing the positive. You think she’ll feel better and calmer if she sees a doctor, and you’ll be happy to drive her to an emergency room and wait with her while she gets an evaluation. Don’t argue about what’s wrong with her, just express confidence in your belief that there’s good help available and that you can lead her there, if she’ll let you.

If persuasion fails, be aware that your ability to intervene depends entirely on her demonstrating dangerous behavior. The moment she says or does something that shows, in an obvious way, that she could hurt herself, put herself into danger, or hurt someone else, you have acquired the critical information that allows police to take her to an emergency room and emergency room clinicians to commit her. At that point, the hope is she becomes lucid enough to want treatment herself.

Until that day comes, it takes great patience and restraint to live with a manic person. Respect yourself for your kindness and tolerance, be patient, and remember, no matter how unreasonable or naked she becomes, you’re doing the right thing.

STATEMENT:
“It’s agonizing to watch my sister act crazy and feel like I’m doing nothing, but I’m really doing a great deal by waiting, caring for her, trying to steer her towards help, preparing to intervene if she gets worse, and tolerating the helplessness.”

People like to think that trusting an inner voice—their gut, their instincts, the force, etc.—will always lead in the right direction. In actuality, instincts and body parts are better known for causing instant urges (a.k.a. “feelings”) that ignore logic and implant convictions that the sky is falling, love occurs at first sight, and advertising never lies. When it comes to major decisions, don’t trust your gut (which, as we’ve pointed out before, is literally full of shit). Find out facts and figure out the odds before doing something that scares you, titillates you, or gives you an enormous Visa bill.
-Dr. Lastname

My brother is a good doctor, and an especially good one given that he’s struggled with depression his whole life. When his own illness needs attention, however, he becomes a terrible patient. He doesn’t get depressed often, but when he does he obsesses about the possible side effects of each medication and so doesn’t take what’s recommended, takes half the prescribed dose, or insists on his doctor giving him something less harmful (and much less effective). The result is that he drives his doctor (and me) crazy and takes a lot longer to get better. When I tell him he’s over-reacting to his fears, he tells me “I’ve learned to listen to my body.” I know he’s a doctor, but I think his body’s lying. What can I do to help him when he’s sick?

It’s a sad fact of mental illness that it often prolongs itself by disabling a person’s ability to seek and select appropriate treatment. Like any smart disease, it knows from self-preservation (in all the ways your brother does not).

That means you can’t necessarily get through to your brother by reasoning or addressing his fears. In your brother’s case, it’s unlikely, not just because you and his doctors have tried and nothing works, but also because he is a doctor, and the side-effect of trying to treat a doctor is a giant pain in the ass.

Recognizing his response as inherently unreasonable and illness-driven, however, can build your confidence in your own opinion to the point where you don’t have to persuade or argue. If he insists on listening to his body, you can serve some truth to his brain.

Yes, medications have potential side-effects and some of them can be dangerous or unbearable. On the other hand, that’s true of all medication, which means you don’t choose a medication because it’s known to be safe, but because it’s relatively safe compared to the condition it’s treating and less risky to try than doing nothing. He probably tells all of his patients that, even if his body isn’t giving him the same message.

Don’t then reassure him that medications are safe, things will turn out well, or his body will deliver good news, because you’ll just be burdening yourself with responsibility for easing his anxiety. Instead, acknowledge his anxiety without offering it respect.

You don’t need to be a doctor to know that he’s anxious, life is hard, medication uncertain, and anxiety is a symptom of his illness. In your opinion, however, he needs to man up, stop listening to his body or the many fears his illness is pushing through his body like a speaker, and start to follow through on the decisions the professional, reasonable side of his brain has already made (or that have been recommended by the doctor he chose to advise that side of his brain). Appeal to the part of his mind that is healthy, instead of negotiating with the part that’s sick, suffering, and nutty.

Patients of any profession have a right to trust their instincts, but when you’re suffering from a disease that pointedly impairs instincts and strengthens fears, it’s time to admit that your body’s voice is secondary and get a second opinion.

STATEMENT:
“It hurts to see my brother suffer and dither, but the best I can do is to refuse to listen to the dithering, remind him that he makes good decisions (when he’s himself) and urge him to follow through on his current treatment plan, which represents those decisions. If he can’t, I may feel helpless, but I’ll believe in my message, deliver it when I can, and take pride in having done my best.

I still don’t understand what went wrong with my marriage. He was my best friend, we got along well, he liked his work, and we had 3 wonderful kids. Then he decided I was boring and got a divorce. My heart always told me he was the right guy. If I can’t trust him, I’m not sure I can ever trust anyone. My goal is to figure out what went wrong and get my confidence back.

It’s not uncommon to hear someone describe their spouse (or, more likely, their ex) as their “best friend.” And if that someone had known their spouse for years, gone through hard times together, and seen evidence of loyalty, fidelity, and reasonable self-control, then “best friend” would be the right term. May they get matching necklaces and/or tattoos and live happily ever after.

The problem is that there’s a big, sad difference between that kind of best-friendship and feelings of closeness that can arise quickly from interpersonal chemistry, mutual interests, common enemies, and one or both parties trying very hard to be attractive.

Instant best-friendship can feel just as close and important as the real thing, but the major, crucial difference is that the person you feel extremely close to is someone you don’t really know from a hole in the ground.

So forget about how well you got along with him and what your heart told you; those are feelings, like the body messages above, to take under advisement. Ask yourself whether your husband was good at standing by his friends and not getting carried away by ambition or new attractions.

Chances are this is not the first time he’s gotten tired of the old and jumped to whatever made him feel better. You just didn’t want to think he would do it to you, because your heart was having such a good time and you didn’t want to spoil the party.

Nobody wants to hear it when their heart is broken, but the only way to get over being dumped is to suffer for a while and learn from what went wrong. Don’t learn to distrust people or your own sense of being loveable and acceptable to those who know you well, because that’s not the problem.

Instead, learn to distrust your heart when it insists on working solo, without the ol’ brain as a co-pilot. Learn to trust your experience, which tells you that people don’t change, and that you can trust people who have always been trustworthy, once you know them well enough. You can still listen to your heart, but insist on hard proof.

Your heart may now tell you that you and the kids are rejectable, but don’t listen. Anyone who knows and loves you will also disagree with that, especially your real best friends.

STATEMENT:
“Being dumped by my trusted partner has left me hurting and doubting, but I have no reason to doubt myself or my own ability to be a good wife and friend. The only thing I need to improve is my asshole radar.”

My friends tell me I’m too good to my ex-wife because I always take care of her when she’s in town by giving her a place to stay, feeding her, and tending to her medical needs. Even our kids say she uses everyone, promises everything, and gives back nothing, and, after many years of marriage and an equal number divorced, I know they’re right. I argue back that it’s not smart for me to antagonize her after she’s promised me half the estate she inherited from her dad, but they tell me that she never keeps her promises and she always figures out a way to blow her money on impressing new acquaintances and going on shopping sprees. My goal is to find ways to protect myself and maybe satisfy my friends’ concerns without fighting with my ex- and maybe losing her bequest.

God bless the giving people of the earth—kindergarten teachers, foster parents, 02% of psychiatrists—but I’ve said many times that, no matter how saintly their exterior, the givers’ biggest recipient of generosity is often their immediate feelings.

Let’s face it, giving feels good (partly because it offers peace of mind to the persistently guilty), and that means it’s bad, at least under some circumstances. Giving too much, like any source of good feelings, is dangerous to you and detrimental to the object of your charity.

When you experience the joy of giving, you may be ignoring other personal responsibilities. You may also be enslaving yourself to someone who senses your secret addiction and threatens you with guilt if you don’t do what s/he wants.

Admit it, you’re not taking care of your ex- for her inheritance—you’d probably kill yourself helping her without a cash reward—but now that it’s in the picture, it should be a strong motivator to help less, not more. After all, the big risk here is that you’ll feel bitter if/when she dies and leaves you nothing, either because there’s nothing left or she gave it to her new best friend. Now your bullshit excuse is bullshit in more ways than one.

Meanwhile, your current relationship with her makes her too important, interfering with your ability to find better friendships. Giving can make a compulsive giver very passive, like a waiter (or worse, a manservant).

The opposite of giving isn’t overindulging yourself or aggravating your ex; it’s giving sensibly while considering all your responsibilities. There’s nothing wrong with being kind to your ex, but there’s no need to give unless you think it’s necessary and can afford it, meaning that you’re mindful of your own needs as well.

Ask yourself whether there’s a big trade imbalance between your exports and imports with her. If, when she comes to visit, you think the relationship is unbalanced (meaning she doesn’t put in the time and attention you would expect from a friend), then it’s not good for you.

If your relationship is one-sided, offer a plan for balancing it. Tell her you believe your relationship will work better, in the long run, if you readjust what you and she contribute. She could do this by creating a trust fund to protect your bequest, or making some regular or hourly gift for your services. You’re not critical of her character or past actions, just trying to protect a valued relationship from being spoiled by a destructive imbalance.

If she tells you that she’s entitled to your services and that you’re the one who is ungrateful and un-giving, don’t argue. Simply express your belief in what you think is best for the two of you and insist on your right to agree to disagree.

Don’t throw your friends and other family under the bus to give everything to the one person who doesn’t deserve it. Generosity may give you a buzz, but the cost doesn’t justify any of the rewards, real or fabricated.

STATEMENT:
“I believe it will do nothing but good to equalize the give and take of my relationship with my ex-wife and that it does no good to let fear, guilt or worry about her feelings control what I do. If she refuses to accept what I believe is a reasonable proposal and blames me for destroying our relationship, I will bear the pain of her criticism knowing that we’re both better off putting the manservant into retirement.”

My brother drives me crazy in many ways, but nothing is more infuriating than when he decides to attempt to be generous. He remembers my birthdays and urges me to tell him what I’d like him to get me, but then he doesn’t get around to buying it until my birthday is long past, if at all. The problem is that he has money, I don’t, and if I ask him for something, it’s probably because I can’t afford it myself. Then again, if I really, really need it, I have to get it for myself somehow, which then offends him (and pisses me off). He tells me I’m overly sensitive and paranoid about delays he can’t really help. If I offer him reminders, he acts like I’m nagging him and moves even slower. He’s always been competitive—is he rubbing in his success or just totally oblivious? Should I just stop expecting things from him altogether and get some space?

Poverty and neediness have a way of inspiring resentment and injury. If someone denies you when you’re poor (particularly when you’re not used to being poor), it feels like a personal insult that you should have avoided and should never tolerate again. So it’s entirely possible to feel shafted and shat upon by someone who basically has more good to offer than bad and doesn’t mean to hurt you.

If your feelings take over, you may drive away your pain-in-the-ass brother (assuming he’s not a total jerk), leaving you poorer and madder. It’s like a poverty riot that burns down your own neighborhood.

So put aside your poor-guy feelings and do a business-like evaluation of what your brother has to offer, taking care to value the ways you can count on him (if any) and the things you enjoy about his company. Feeling insulted is not as important as what you think about his ability to be a good friend (sometimes) and to add meaning to your life, simply by being your brother.

While you’re at it, examine whether he does his bait-and-delay to other people. Poverty makes neglect feel personal, but he may be treating you the same way he treats everyone.

If he’s a jerk who usually takes more than he gives (see case above), then you’re right to pull away. It’s sad, but the best you can do.

If, however, he’s not all that bad, then learn to suck up the pain of being a downwardly mobile member of a lower economic class and make the best of your relationship. Not to please him or your family, but for yourself.

STATEMENT:
“I can’t help being poor and having a brother who’s late on delivering stuff I really need, but I won’t let a little pride and/or fury get in the way of a relationship that I value.”

My boyfriend went through hell from chemotherapy, but I don’t know what to do with his depression and irritability. We’d been dating about a year and planning to get married when he found out he had a nasty kind of cancer and, since then, he’s been brave about chemo and going on with his life, which has meant working when he’s feeling OK, and our moving in together and being partners. Usually, we get along well, but lately he’s been depressed and telling me he knows he’s a burden, he can’t get much done, and he just wants to be alone. I want him to get help for his depression and stop the negative thinking but I don’t want to attack him or make him feel I don’t respect the fact that he has cancer.

One of the things you always hear from people in pain is that you, the lucky one, “just don’t understand.” It’s the rallying cry of the suffering, whether they’re coping with cancer, or just being between the ages of 10 and 18.

What sick people often fail to realize, at least at first, is that people who aren’t in their position understand things that they can’t; after all, you might have the good luck not know what it’s like to have cancer, but you know what your boyfriend’s like when he’s not depressed, and you know this isn’t it.

If you want to get through to him, put aside your guilt about his bad luck and your fear about hurting him when he’s down. You believe his negative thinking is doing more damage right now than his cancer, and that he needs a better perspective. You’re right, so guilt-be-gone.

Then, remind him about the way he and you usually think of your life together. He’s had the worst kind of bad luck, but you admire the way he’s managed it and continued with his life and you’re happy to share his fight.

After all, you’re not with him because you pity him for having cancer, but because you love his courage and find it gives you strength, and because you hope for the best and are happy to share as much time as possible.

Maybe his cancer, chemo or pain tells him he’s a useless burden, but you don’t accept that and you know he wouldn’t if he were in his right mind, because those things are mean and disrespectful. What he should be saying is that he’s fighting a good fight, respects what he’s doing, and is proud of the way the two of you have created love and closeness in the midst of chaos.

Maybe he needs therapy or medication to put a lid on the negative thinking, but in any case, reminding him about what he values and challenging him to protect his self-respect is good therapy in itself, and you can do it. You don’t need to fully understand his experience with illness in order to help him through.

STATEMENT:
“I can’t rescue my boyfriend from attacks of hopelessness about his cancer, but we’re together because we share the belief that life is worth the pain he’s gone through and, so far, nothing has changed my mind. Sickness has made him forget his beliefs and accomplishments, so it’s my job to stand up for them until he’s ready to reclaim them.”

I don’t know how to tell my wife that we can’t afford for her to continue her present business because she’s losing too much money. She used to be good at it, but cancer and chemo had a bad effect on her brain 2 years ago, and now she gets too distracted and drops the ball. I admire her courage, and I owe her for supporting the family all these years while I raised the kids and taught painting. Now I’m making more money and have taken over the finances, but it’s not enough. I’ve tried to help her keep her business organized, but it just doesn’t work. I feel angry and guilty. I can’t get her to see that she needs to find a new job that doesn’t require her old attention span and can make us some money.

It’s hard to confront your wife about about a new, cancer-related, permanent disability without feeling you’re destroying her hope and confidence and adding to her pain. On the other hand, if she doesn’t accept her disability, you’re all sunk and she’ll never have a chance to make the best of what she has.

Remember, you’re not inflicting her pain—the real cause is life and cancer—and the only reason you think she needs to face her disability is that the alternative is worse. That’s your decision as her partner and someone who’s stepped up to assume a greater share of responsibility for the family’s welfare and survival.

After all, you’ve risen to the occasion. You’re not preparing to confront her because you’re angry about the way cancer has robbed you of her strength and old personality (although you may certainly have such a feeling). If you confront her, it’s because you’ve done your homework, weighed the alternatives, and decided it’s necessary.

Begin by accepting her disability yourself; don’t see it as a treatment failure, or as a problem the two of you have failed to solve, just as a wound imposed by the sucky side of life. Respect the way she’s tried hard to return to a normal life, and respect the way you’ve picked up the load, because you both did the right thing. You needed to know the limits of her abilities, and now you do, but you just got a bad result.

Once you accept her disability without shame, you’re prepared to put it in a positive context. Tell her, without guilt, how much you respect her efforts, and that, though most of her mental equipment is functioning beautifully, there’s something wrong with her attention span that won’t let her make money at her old job.

Don’t sound as if your mind isn’t made up or as if you’re waiting for her to agree; her ability to perceive a business plan realistically may be included in the brain damage, or she may not be emotionally ready to accept it. In either case, sound like someone who has made up his mind.

In your opinion, she shouldn’t continue her old job and, if it’s up to you, you won’t support her doing it. You will, on the other hand, support her in finding something new to fit her current limitations.

STATEMENT:
“I miss my wife’s old strengths, and so does she, (or she would if she was in her right mind), but our idea of partnership was that one of us would take over if the other was injured, and that’s what I’m doing. I will raise painful topics if I think it’s necessary and respect myself for doing so.”