I hate life. What is the most reliable and painless way to commit suicide?

You hate life, and I hate the kind of dangerous, self-lacerating whining that makes a painful life seem meaningless, when it isn’t.

Hating life is an understandable feeling, whether the problem is a hateful life or your own, reflexive intolerance of life’s general hatefulness. There’s no doubt that life is sometimes hateful, some people’s lives are more hateful than most, and some good people are more sensitive to its hatefulness.

There’s more than enough hate to go around, and you can’t help how you feel.

Any time you let hateful feelings shape your goals, however, you’ll make life more hateful (after a brief burst of genuine satisfaction) and destroy what’s left of your self-esteem.

Yes, taking your hate out on yourself may give you the satisfaction of protesting life’s unfairness and heaping guilt and contempt on your so-called friends. What it also does, if you think about it or survive to see what happens next, is define your life as a reaction to your hurts and the people you value least. It both fuels and destroys, hateful little fucker that it is.

What you really want (and what your survivors will try to do) is to remember the times you did better things and followed your own values. It’s not as exhilarating as being a nihilist, but exhilaration is, by its nature, short-lived. You shouldn’t be.

During its short run, hate is a lot more attractive and satisfying than reminding yourself about what you stand for and thinking about values and consequences. That’s why you need to work on building a philosophy and preparing for hate before it arrives, instead of boarding the hate train and then finding the will to get off.

You can do that by going to the right church or temple (one that doesn’t waste too much time on holy this or ecstatic that), hanging out or reading about people who’ve made the same journey, or getting the right kind of therapy. DBT (dialectic behavioral therapy), which borrows heavily from Jewish, Christian, Buddhist and 12-step ideas about living with anger, can be particularly helpful.

Therapy or no, you can find ways to keep your hate (and my hate for your hate) under control.

STATEMENT:
Here’s a statement for taking pride in good hate management. “I know what it’s like to hate life, but I won’t let myself forget what I value about life and my own ability to make it better. I can’t escape hate; but I will make myself strong enough to protect myself from its destructiveness and use its energy for my own goals.”

I feel like it’s finally time to confront a serious problem I’ve had for years; when I drive, I become filled with rage. My mother was the same way, and it was scary. She was never violent and neither am I, but the amount of anger I feel can’t be healthy, and I don’t want my daughter to do the same thing. I want to feel less furious.

I hope you’re not expecting therapy, a pill, or some Tibetan meditative experience to take away your anger, because it probably won’t.

Whatever causes anger—mommy’s genes, bullying by your older brother, or one rotation too many around a Boston-style rotary—it’s usually yours for life by the time you’re old enough to write me a letter.

Sure, psychotherapy may help, but my rule of therapy thumb is, if it hasn’t helped in a few months, move on. Therapy just isn’t that powerful (not even in my Harvard hands), and sticking with it when you’ve got anger to control delays your acceptance of the red-hazed reality you need to start managing.

What I’m really advocating isn’t to give up on therapy, but to give up on the idea that it will make you feel better by taking your anger away. Instead, use therapy (like DBT, see above) to help you manage anger.

I know you’ve probably seen kung fu monks master their anger by thinking pacifist thoughts while smashing bricks, and maybe you think channeling your rage into big muscles and loud thuds will improve your control while intimidating your tormentors into not cutting you off you in the first place.

Wrong, young grasshopper. The only reason martial monks don’t get sued for everything they own by everyone they lay a finger on is that they’re monks and own nothing. For the rest of us, the slightest adult physical altercation, combined with martial training, is as bad as a car-crash without insurance or witnesses: an endless goldmine for lawyers (and shrinks) at your expense.

So now that you’ve abandoned all hope of ever getting rid of your anger, you’re ready to improve your ability to manage it. Instead of tailgating those who dare offend your road-warrior sensibilities, learn to shut up and back off until you have a chance to think and decide whether a battle is worth fighting (almost never) and, if so, how to do it most effectively (by never appearing angry).

Feeling angry is unhealthy because it raises your blood pressure, but expressing it is even more unhealthy because it causes you endless misery that raises your blood pressure higher for longer.

You can’t control the former, but you can learn to get a handle on the latter (even if you can’t break a brick with your fist).

STATEMENT:
Here’s a statement for taking pride in frustrated rage. “I hate the way other drivers ignore the road rules, put my life in danger, and never get punished. Teaching them a lesson would make them think twice about driving like assholes. My goal in driving, however, is to get from one place to another as safely as possible, without being endangered or diverted by people whom I least respect. I’m proud of my ability to eat my anger and never, ever fight.”

I don’t know what I did to drive my husband away. I guess I’m a pushy type of person—I’ve got an executive job—and he’s an easygoing carpenter who spends every spare moment rehabbing old houses, and he gradually got sick of my nagging him to spend more time with me on the weekends, until one day he just moved out. Now, when I reach him on his phone, he tells me he loves me, and agrees to meet with me to talk things over and work things out, but then he doesn’t show up. I wish I hadn’t given him such a hard time, but now I want to know how to get him to come to couples therapy and put our marriage back together.

Some girls prefer being married to someone who’s never around but pays the bills. Those girls and your husband have something in common, whether you like it or not.

Before figuring out how to save your marriage, ask yourself what you want your marriage for (and don’t say love—you should know better).

You’re an executive, so be as specific about the amount of availability you would write into the partnership as you would for a job description: hours per week, time of day, degree of alertness, freedom from inebriation, etc.

Keep sitting on that save-your-marriage urge long enough to ask yourself, regardless of how much you nagged him and/or how much he loves you, what the likelihood is of his doing the amount of necessary face time with a non-shack-rehabbing marital partner.

The way you describe him, not fuckin’ likely; he’s not into hanging out with a girl who’s not into holding a hammer (unless maybe she’s handing over a credit card).

If that’s true, you’re in luck and out-of-luck. Out of luck because there was never much chance he’d meet your marital requirements, and the chances aren’t going to improve, no matter how sweetly you try to entice him into marital therapy and how persuasive the therapist is.

You’re in luck, however, because your nagging isn’t at fault, and you have nothing to blame yourself for, so we’re not going to talk about how your nagging drove him away or how a therapist can glue him back on.

Now that we’ve killed off false hope, think about ways to make the best of things. Ask yourself how to avoid making the same mistake twice, given the fact that you probably knew his habits from the beginning and then talked yourself into believing he’d change.

If you still think guys change, slap yourself. People don’t change, but that doesn’t mean you change your approach towards relationships. Be an executive at work and in your personal life, and be glad your husband quit.

STATEMENT:
Here’s a statement to point you forward. “I hate losing this marriage, but my goal is to find a good partner, not create one from someone who doesn’t have the right material. Partners aren’t made, they’re found. My job is to use my experience with this marriage to choose better next time.”

When we were in training, I used to depend on my wife completely—she was a year ahead, and I couldn’t stand it when she was on call and would leave me alone overnight. I wasn’t jealous, I just needed her. But then we got married, and I graduated and started my own specialty training, and suddenly—it was like a switch clicked—I stopped needing her and didn’t really want to be around her. Now it’s 4 years later and we’ve got a couple kids and the trapped feelings just keeps getting stronger. It’s tough, because she’s a very nice person, she doesn’t do anything wrong, and she wants to make our marriage work, and I feel totally guilty, because I just don’t want to be with her. How can I get our old chemistry back?

Some people believe the measure of a good partnership is an equally balanced feeling of need for one another—wanting her as much as she wants you—and you’re the living, breathing example of why that’s not so.

You didn’t want your neediness to blind you into thinking your then-girlfriend had strong feelings about you, if she didn’t. Congratulations, she did and does really love you. Unfortunately, what you were blind to was the depth of your own feelings.

The trouble is, needy feelings come and go depending on your confidence, mood, loneliness, horniness, whatever. Neediness makes you blind, which is why satisfying your needy feelings shouldn’t be in the partnership job description.

Instead, consider your actual needs as you would if you were looking for a partner in your practice. You need someone you like to spend time with and can rely on, whether you’re needy or not.

So here’s the standard procedure: the more you’re crazy about someone, the more you should take it slow. Clean out a basement together, travel long distances and sleep in crummy motels together, foster a diabetic cat together, whatever, just put your relationship to the test to see if it’s a shared partnership or a personal fix.

Meanwhile, the old chemistry can’t be retrieved and wasn’t the real thing, in any case, so give up that goal and stop wallowing in guilt. You might not need her anymore, but your kids do, so you’ve got to figure out how to make the best of it.

STATEMENT:
Here’s a statement to address her and your own conscience. “I would do anything to make this partnership work but I made a mistake in thinking my need for you was the same as good, solid attraction and acceptance. Now that I’m feeling less needy, I can’t find the necessary chemistry and I can’t help not loving you. You haven’t changed. It’s no one’s fault. Meanwhile, we have a good family, and I need to keep it strong while managing the bad chemistry that makes it impossible for me to give you what you deserve.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I have a dedicated husband, three teenagers, a nice house, a well-behaved dog—it’s not a bad life—but I’ve had a nagging sadness my entire life, and I still do, despite all the good things I’ve got. I deal with it, admittedly, by drinking a bit. I wouldn’t say I’m a drunk, and my drinking doesn’t interfere with my parenting or my marriage anymore than my mood does, but I know that what I’m doing is self-medicating. My husband wants me to see a shrink because he thinks I should take real medication for depression, but if my drinking doesn’t mess up my life, and if, despite all I have, I can’t be happy, anyway, then I don’t understand what makes one medication better than the other. My goal isn’t to be happy, just to withstand my misery, my way, right or wrong.

I understand that chronic depression, which is what we call “nagging sadness” in the biz, isn’t fun. It can make you grumpy, negative, unmotivated, scattered, and lousy at whatever you’re trying to accomplish.

All that’s excluding the pain, so no wonder it can demoralize you into seeing a negative future for yourself. It’s enough to make you want to turn “what the fuck” into words to live by.

If there was some way to relieve your pain that was risk-free and didn’t affect your other life priorities, that would be wonderful (for you—the aforementioned biz would probably dry up).

Sadly, said riskless, perfect painkiller, psychic or otherwise, hasn’t been invented yet, which is why depression relief requires hard choices and can’t be your only goal.

Clearly, you’ve got other goals than depression relief, or you wouldn’t have the good family you do. Good families take lots of work, so I suspect you’re good at putting the goals of work and family-raising first. Being strong about these goals can’t make your depression go away, but it can keep depression from affecting what’s important, and that’s an accomplishment to be proud of.

Drinking hasn’t done you any apparent harm, but your decision-making method is dangerous. You didn’t weigh risks and benefits, and you didn’t mention the fact that drinking, in the long run, tends to make depression and anxiety worse, and doesn’t protect your brain from the risk of long term damage that depression is now known to cause.

Don’t tell yourself there’s no point in giving up your only source of happiness for the sake of a future that will never be happy. You don’t make most of your decisions that way, and it’s a bad example for your kids.

Do what’s right in the long run, even when there’s no light at the end of the tunnel, or at least consider doing what’s right, even when the long run doesn’t feel worth it, but you know it is.

You might feel like you’re damned if you do, damned if you don’t, but that’s your damned feelings talking, not your values.

STATEMENT:
Here’s a statement to guide your drinking decisions. “Alcohol gives me relief from depression and hasn’t done me any harm. But I know the risks from using alcohol increase over time and my future matters, (even if I don’t feel like it does), so I will keep looking for and considering lower-risk alternatives and try to make whatever decision is best for me and my family.”

I’m conscientious and hard-working and I don’t need a lot of praise from the boss—I’ve been in my line of work for a long time—but the thing that’s gotten me in trouble in the past, and what’s threatening my position at my current office, is that I hate it when someone acts like they’re doing more work than I do and the boss agrees. I need this job and I’m good at it, but I don’t want to lie down and roll over when someone says I’m a slacker and deprives me of respect I deserve. My goal is to keep my job and that means not letting anyone ruin my good reputation.

In a fair world, we’d all get respected for the hard work we do. The need to get respected is basic: most large companies do elaborate reviews, wasting tons of time, to make sure it happens; it gets most married couples fighting, sooner or later; it got Rodney Dangerfield to stretch his collar for decades.

So of course you know that the right to get the respect you deserve…doesn’t actually exist. That’s a fact of life, and it really hurts, but the best thing you can do is do what you think is right and hope that someone notices. That, and maybe hire someone good at PR (and acquire a taste for shit, since, sooner or later, at some point in your career, you’re going to be eating it, buffet-style).

I know, your friends tell you to stand up for yourself, and your company assures you that their HR department is there to help anyone who has been treated unfairly.

As your e-doctor, however, I’m telling you, bullshit. If you’re complaining to me, chances are that you’ve tried to speak up and it hasn’t worked. Worse, it’s drawing fire.

Yup, that’s what often happens, and it’s not because bosses and HR staff are insincere and evil, or at least not usually. People aren’t evil, they’re stupid; they speak different languages, then look at the same thing and come to opposite conclusions neither side can understand.

If you’re really good at describing someone else’s evil abuse of power and your abuser can’t see the abuse, but understands how you see him, you know what will happen—it’s the law of conservation of victimhood—it will come right back at you.

He’ll work harder to compile new instances of your slacking and you’ll have new fodder for outrage, less job security, and more reason to see a lawyer, thus making worker-boss divorce almost inevitable.

You want justice, you’ll get unemployment. The real injustice is that conscientious people often hurt the most over this issue, while a real slacker wouldn’t care.

Your goal should never be justice, but making the best of a shitty situation and keeping your job, if you have to, for as long as necessary. That means eating shit, smiling, and not letting moral outrage and helplessness stop you from searching for better work (or gathering evidence of mistreatment in case you can use it some day).

See a lawyer, by all means, to see what it takes to make a good case. Your goal, though, is to maintain your steady diet of shit and smile until the legal case is in place, if it ever is. In the meantime, stay strong, quiet, and well-stocked with tic-tacs.

STATEMENT:
Here’s a statement for quittin’ time. “I do a good day’s work for no respect and it hurts. I can’t change it and I can’t find another job. But the reason I work isn’t to get respect, but to make a living, and if I do that under difficult circumstances, I deserve more respect from the person who knows what’s going on, and that’s me.”

My daughter is turning into a petty criminal. She’s getting kicked out of school again, she won’t stop messing around with drinking and drugs, she has unprotected sex, and her boyfriend is probably the guy who broke into our house and stole our TV, though she refuses to believe it. My husband and I have tried so many times to get her to see what she’s doing wrong and steer her in a better direction—we’re our own private “scared straight” program at this point—but every time we confront her about where she’s headed, she says she feels terrible, that she’s sorry, that she never wants it to happen again…and then she gets wasted and everything repeats itself. If only we could get her to understand the harm she’s doing, maybe we could get through to her and turn her around. Meanwhile, it’s killing us. We try to forgive her, but it’s hard. My goal is to forgive her and get her to see what she’s doing to herself and everyone who loves her.

There’s no point in getting your daughter to see what she’s doing wrong if she can’t really stop herself from doing it, and she really, really can’t. You can’t scare straightness into a boomerang.

Regret and remorse will make her feel bad, and you might think that will stop her from fucking up next time. Well, au contraire, my dear unHarvard-educated sap. It’s not fair, but that’s the way it works. You should know that since you’re the one missing a TV.

According to Christmas movies and sentimental parts of the Bible, repentance leads to redemption, but I say, goddammit, that’s just wishful bullshit.

Repentance leads your daughter to hating herself more for the shit she does when she loses control, and self-hate makes it that much easier to lose control again. Your goal isn’t to get her to repent. It’s to get her to accept that she’s fucked and should nevertheless try for better self-control.

Fuck forgiveness, too, while you’re at it. You wouldn’t forgive a snake for doing its thing with your foot and its fangs, because it does what it does, and your daughter’s lack of self-control is probably the same kind of thing. If you weren’t around, she’d still be having the same problems. She’s just steal someone else’s TV.

No one knows why some kids have so little self-control over anger and neediness, or sometimes we know but knowing does no good. Acceptance means you aren’t entitled to judge or forgive; just to make the best of things.

Making the best of things means trying all the standard tricks for keeping a kid of any age away from over-stimulation and temptation. Keep her busy, move her away from the bad kids if you can, and find good activities you can schedule regularly. Above all, stay calm and positive, and don’t show how scared and upset you are about her fuck-ups.

Don’t expect treatment to change her. Sometimes a 24 hour control-your-every-activity residential school will break bad habits and build new ones, but it’s expensive and often doesn’t work.

As for the oft-derided “Good Will Hunting” one-on-one psychotherapy, it’s less expensive and similarly unlikely to lead to a basic transformation. More realistically, therapy can do the same thing as you’re doing: positive coaching towards better behavior. As for achieving that better behavior by getting her to take responsibility, own her actions, and feel bad…you’d have better luck with a snake charmer.

STATEMENT:
Compose a statement of purpose that will keep you positive. “I think you want to be a good kid and that you regret at least some of the things that happen when you mess up. But it’s hard for you not to mess up because your brain pushes you so hard to act before you think, that’s just the way you are. So we’ll keep on trying to keep you away from risky situations and slow you down, so you have more time to think about what you really want to do. There are some troubles we can’t protect you from. You may get HIV or go to jail. But nothing will change our determination to help you get the control that you need, sooner or later.”

My sister and I have had issues over the years, but we’ve always managed to stay cordial despite our differences, at least until she got married. Just after she got married five or so years ago, she did something to my parents that really pissed me off—she was basically stealing from them, as far as I can tell—and while, in the past, she and I would have eventually gotten over it, her husband got into the crossfire (I chewed both of them out, not just her), and now he won’t let me anywhere near my sister to even try to move past this. I still think what she did was awful, and I still think her husband is an asshole, but she’s my sister, and she’s family, and I need her in my life. My goal is to figure out how and whether I should make amends to my brother-in-law, even though I’m not really sorry, so I can put my family back together.

You’re right to start thinking about what’s best for your family relationships and forget about who’s a conniving criminal, because you’re never going to stamp out family crime or protect its willing victims. You’re not God, or even Judge Judy.

On the other hand, you may benefit in the long run by avoiding unnecessary conflict, retaining your family membership card, and participating in events that allow you to make the best of the family you have, crooks, liars et al.

If forgiveness is important to you, you’re fucked, because whatever you forgive your sister for, she’s likely to do again, which will destroy your faith and make you nasty. Fuck forgiveness. Again.

If she’s a criminal, she is, so your goal is to accept her the way she is and decide what you want to do with her and the family relationships that you will always unavoidably share.

Figure out if the fight with her is worth it, and if it’s not, and you decide that peace will give you a better chance of enjoying family events, then mend fences, declare the war over, and let all hostilities from this point on be for her and her husband to sustain, or not.

You can’t stop her and her husband from continuing to hate you or freeze you out, but by refusing to hate them back, you just may lull them into giving it up, shutting up, and making nice.

STATEMENT:
Prepare a statement that stays positive, doesn’t lie, and lays out the advantages of peace. It may sound like an apology, but it’s not. An apology would be dishonest. “I know we’ve had our differences, but there were tensions in the past that no longer seem important, at least not to me. I believe you and your husband are an important part of my family and I think we’ll all be happier if we can share some friendly time together. I think it’s better to put the past behind us and remember that we share lots of good childhood memories, a love for our parents, and responsibility for their welfare as they grow older. I think we’ll all gain from resuming a positive relationship.”

My big sister, whom I live with, is always on my case about my spending habits—I’m no good at budgets, and she knows I’ve always been that way—but the more she nags me , the more I want to spend. I’ve been feeling really down for the past year or so, which also doesn’t really help me get motivated to do much of anything, including taking care of my kids, which just makes her even angrier, because she says that I basically spend money and she does all the work, including cleaning and childcare. So when I told her I needed money to visit a sick friend, she said she’d give it to me, but then there’d be no money for Christmas presents. So now it’s a few days from Christmas and she’s blaming me for spending the Christmas money and I’m tired of listening to her lecturing. My goal is to get her to find the money, which I’m sure she can, and get her off my case.

You’re pushing for money you don’t control from a sister who may not have it, and you want her to change feelings that aren’t going to change in a living situation that you can’t afford to escape. While you’re at it, you should attempt to eat a mouthful of pure cinnamon and cure cancer.

As you might have gathered, you can’t have what you want, any of it, and going after it will make your happy home into a hellhole that will make your kids yearn for the day they can escape for their lives and sanity.

You’ve got a right to your wishes—they’re human and understandable—but watch what trouble you create by making it your goal to express them. You’re not just farting into a phone booth, but laying down a shit as well.

Making it your goal to guilt your sister into giving you cash means you’re always the helpless kid who’s dependent on and mad at her, and she’s the mean skinflint who will always be mad at you. You’ll get much more power and freedom in the long run, and create a more peaceful home, if you manage your money as if you’re the boss and you’ve got to make the tough decisions about what you can’t buy.

Ignore what your sister says and how you feel about it. Yes, those feelings may hurt, but they’re not important compared to the survival issues you face and the need to improve your relationship with her. Shut up about her, and think about what you need to do to survive, because that’s what you’ll need to do if your sister can’t take care of you.

As controlling as she seems, your sister really doesn’t make the decisions now, because there’s never enough money and no one knows where it goes. Her priority is as bad as yours: making the squeaky wheel shut the fuck up.

Right now, no one is steering your family finances and the sooner you step forward, the better for everyone. Your goal then is long-term survival with less conflict.

What you have now is an opportunity. There’s no shame in sacrificing Christmas presents to support a sick friend, so you can take this opportunity to give the kids a good lesson in the meaning of Christmas. Instead of blaming your sister for not giving you more, tell her that you stand by your priorities, you appreciate her support, and you’re going to think harder about your other spending priorities and get back to her with your ideas.

Then sit down with a friend, add up your monthly expenses, and make your own decisions about where the money should go. Yes, tough decisions may give you a headache, but they’re the source of what little power you’ll have in your sister’s house, and what most of us have in this world in general.

STATEMENT:
Prepare a statement to enlist your sister’s cooperation and protect both of your from the destructive whining and grudging giving of the past. “Your hard work is keeping us afloat and I wish I could do my share, but depression has made that impossible. But I’m going to put together a budget that reflects our priorities so that, when it comes time to spend money, you’ll be happy where it’s going and we’ll be pleased to remember how hard you worked to make it.”

My boyfriend tells me that I’m too closed-off and in my own head. I know that I shut down sometimes, but it’s not like I’m really holding anything back. I think I do my share, but I’ve never been one of those flamboyant stereotypes (we’re gay). Anyway, an old friend of mine got very sick recently, and he came with me when I went home to visit. We’re sitting in the hospital, waiting to see my friend, when my boyfriend whispers that he really needs a kiss, right then. I didn’t know what to say, but I didn’t want to kiss him, because it didn’t seem appropriate, plus I wanted to pay attention to my friend, so I just quietly brushed him off, and later he exploded at me for not sharing and being connected. I love my boyfriend, and I hate seeing him unhappy, and now I wonder if I’m doing something wrong. My goal is to make our relationship work.

Trying to make a bad relationship work can suck you dry and make you an accessory to bad deeds. There’s no harm in wishing it could work, and nothing more dangerous than assuming you should make it work.

If you give up on the idea that you can make this relationship work—want a hankie?—you’re free to ask yourself what’s getting in the way and whether there’s anything you can do about it.

Judge your own behavior. Get input from people you trust. Ask yourself if you do your share of relating and responding, and if the answer is yes, then congratulations, you’re innocent of wrong-doing, and condolences, you have no control over your boyfriend’s unhappiness.

Now, let’s talk about his neediness. There’s nothing wrong with feeling needy, but when he makes it your responsibility, you’ve both got trouble. Between his neediness and your guilt, you’ve got the makings of some long-term, intractable conflict.

You can have a nice relationship if he sometimes suffers from frustrated neediness but accepts the fact that you’re not responsible for kissing it and making it feel better. Otherwise, he wants you to change, and that never works. It’s a deal-breaker.

So the bonus round question is whether or not he can accept you. If he can’t, the prize is, you’re fucked.

Never, ever choose to live with someone who doesn’t accept you, no matter how much you love him. Sure, it’s ungrateful of me to make this statement, given the amount of business I get from the strong attraction people have to partners who don’t accept them, but as a not needy person, I’m putting your health first.

STATEMENT:
Here’s a statement that responds to his complaint and gives you a chance to see if he can manage his neediness and accept you the way you are. “I love to make you happy and I understand that you think I sometimes withdraw too much to satisfy your needs. I’ve been asking myself and others whether I withdraw too much to do my share in a relationship and I’ve decided three things: I do my share, I can’t change my style, and our relationship to work if you can’t accept me for the way I am, including the way I sometimes leave your needs unmet. I hope you can manage those unmet needs without attacking me; because otherwise, this relationship can’t work.”

My father, a Holocaust survivor, is dying of cancer. I’m his only child, and while my mother is doing the best she can, I feel overwhelmed with responsibility and grief. I don’t know how to stop feeling so helpless, not just because I love him and can’t save him, but because he overcame so much to make life possible for me, and now all I can do is watch him die. My goal is to figure out what I can do for him since he’s done so much for me.

Don’t fall for the common misconception that you fulfill your duty to your parents by taking care of them and keeping them safe when they’re old. As a genuine geezer, Dr. Lastname can tell you with authority: you can’t, and it’s not your duty anyway.

No, I’m not telling you to push your dad out on an ice flow or forget about him, not for a moment. I am telling you to think about two things: what your goal will be for your kids when you get old and need their help, and how little you can do for anyone when they’re suffering from old age.

If you’ve made sacrifices for your kids, it’s for the future of your family, and you want your kids to do the same for their kids. The last thing you want is to deplete their resources, disrupt the stability of their marriages, or take them away from your grandkids.

My guess is that your father didn’t have a child after surviving the Holocaust simply because he wanted care during old age or revenge on the enemies of the Jews. If he’s like most survivors, his main goal was to do what he started out doing before the earthquake happened, which was to give love to the next generation, pass on good moral values, and not let unavoidable sorrow or anger interfere.

Perhaps the intensity of your sorrow is part of your inheritance as the only child of a survivor. Your goal is not to make it go away by holding on to him, but to bear it, as your parents did, while living a full life.

So your goal isn’t to devote yourself to your father’s care; it’s to help him if there’s something you can do that will make a substantial difference and meanwhile continue with your normal life priorities.

No, it’s not a process that will make you feel good; tearing yourself away from his care, even though you know you can’t do more, never feels good and you’ll be tempted to keep on doing more and more and more.

If you let your loving, protective feelings take over, however, you’ll wear yourself out, do him no good, and damage the life your father wants you to build for yourself and others. Your father survived impossible hardship; honor him by surviving his illness with your sanity and priorities intact.

STATEMENT:
Prepare a statement to protect yourself from irrational guilt and responsibility. “In my family, we are committed to caring for one another, but we are also committed to carrying on with life and we know there is only so much we can do when faced with life’s worst problems, like aging, death, and loss. I will do anything for my father that will really help. And I will try to bear the pain of losing him without faltering in my other responsibilities, as he did with his losses throughout his life.”

I know it’s a cliché, but I am a gay man with a cat I love more than anything in the world. The problem is that she’s 15, she’s having serious problems with arthritis (and general old age), and the vet has made it clear that there are ways to prolong her life but not without some suffering on her part. The last thing I want is for my girl to suffer, but when I think about living without her, it’s like my heart stops. My goal is to make a responsible decision even though just thinking about making the decision tears me up inside.

Responsible decisions about unhappy dilemmas will almost always make you feel worse, because the only choice you have is between less-pain-now-and-feeling-like-a-shit-later and gagging-on-the-bitten-shit-bullet-now-but-knowing-you’ve-done-the-right-thing-later. Be a shit, or eat shit. Viva life.

So if your goal is to feel happy about your beloved cat’s death, forget it. On the other hand, if your goal is to do right by your old friend, then prepare to suck it up and bear your sorrow proudly.

It’s dangerous to want to feel less pain, because in order to do that, you’ll need to stop being a sensitive gay guy. You’ll need to get tough, brag about your sports injuries, and trade in your cat for an iguana.

Furthermore, you’ll need sign up for my cut-rate lobotomy service. Don’t worry, I promise to keep my charges down until I’ve completed 5 and gained the experience necessary to put myself in the upper ranks of brain surgeons. It’s all in the wrist.

If you insist on being gay and staying true to yourself, however, you must accept your pain. In all fairness, you wouldn’t want to get over the loss of a close friend in 2 weeks. Feeling pain is part of honoring her importance. There’s no shame in that, or the cliche.

STATEMENT:
So give yourself a pep talk to remember that pain can have positive meaning if you make it so. “I’ve been lucky to share my life with a wonderful cat, who gave me the kind of conditional non-acceptance that only a cat can provide. She saw me through tough times and taught me that the only thing of real importance was seeing to her needs. I’ll do right by her and cherish her memory.”