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.”

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 need to face the fact that I have trouble getting close to people. I recently had a close relationship with a guy I was crazy about, but I often get depressed and, when it happens, I get quiet, and he couldn’t stand it. I’m good at functioning when I’m depressed, it’s never stopped me from getting my work done, and I push myself to hang out with friends, but I can’t help the fact that I don’t have much to say and that I don’t really feel like laughing. I kept telling him it wasn’t personal, but he didn’t really believe me. My goal is to figure out how I can find a partner if I can’t really interact very well.

The biggest negative thought you can have when you break up with someone is to believe it’s because there’s something wrong with you, either because your boyfriend said it or because that’s what your brain is telling you.

Nobody says, “it isn’t you, it’s me,” and means it, so you shouldn’t, either.

Remember, it’s deep human nature to blame ourselves for crap that happens, be it a failed relationship or a failed baseball season. It’s your job, however, as your one and only chief protector, to put this assumption to a logical test.

You can blame yourself for making a bad choice, but not if there weren’t any clues that badness was happening; you have to look closely for the red flags that might have given you warning, like evidence that he was needy or had broken up prior relationships when the feedback tapered off. If none of that was obvious, then neither was your error in judgment.

If this is a type of guy you choose over and over again, however, then you’ve got a bad habit that needs fixing and you should see a shrink/coach with that purpose in mind. On the other hand, as seems the case here, if you didn’t have the experience or data to warn you, then you’ve had a valuable/miserable learning experience.

You took a course in the college of hard knocks where tuition is paid in pain. That said, you should give yourself a good grade.

So before assuming you’re no good at relationships, name your standards. I’m sure you know lots of good relationships where one partner or the other gets withdrawn at times, and unless you’re an unusually outgoing person living an unusually lucky life, it’s only a matter of time before you or your significant other gets hit with an illness, loss or trauma that causes a shutdown. The test of a good relationship isn’t its connectedness (or, at least, not connectedness alone), but its ability to tolerate periods of unavoidable disconnectedness that life will inevitably bring.

You might also blame yourself if your depression made you do negative things, like drinking or turning into a blob. Even then, you wouldn’t have good reason to blame yourself unless you could have done better, and sometimes depression leaves you no choice. In any case, you’re successful at keeping yourself going when you’re depressed, and that deserves credit, not blame.

What you’re left with is the sad realization that, from now on, you must choose boyfriends who aren’t too needy or overly sensitive to your mood. Unfortunately, they might not understand you as well as a needy, moody guy would, particularly if they’ve never been depressed.

On the other hand, they won’t get upset when you fall silent, other than to be sorry you’re hurting, and they might not notice unless you tell hem. Ultimately, it’s not you or them that’s to blame, it’s just that some relationships aren’t strong enough to survive bad circumstances. Luckily, you are.

STATEMENT:
“I feel like my depression killed the happiest relationship I’ve ever had, but my experience tells me I can be a good friend, whether I’m depressed or not, and that’s the only standard that matters. So I’ve learned that love requires more than mutual passion and I will never go out again with anyone who requires happy feedback and shows no ability to tolerate pain in the ones they love.”

I’ve become very uncomfortable with a friend who has been very good to me. He’s the one who, when I was depressed, took me to the hospital, even though I didn’t want to go. He was right, I was suicidal and I needed help, but now I feel like he’s so good and reasonable and I’m the idiot-child whose diapers he had to change. I imposed my problems on him when I was totally out of control, so seeing him makes me very uncomfortable and ashamed. How can I get past this feeling of inferiority and embarrassment?

If you’re one of those people who has to learn to live with depression—and you are—one of your most important tasks is to get over your shame. I mean, shame is probably an unavoidable feeling when you’re disabled and have nothing to offer anyone but trouble, or at least that’s the way it feels. Still, you know on a logical level that you can’t be blamed for something you can’t help, and you’d protect anyone else from blame if you knew they had such a problem.

So at some point when you’re thinking clearly, you have a moral obligation to yourself to stand up to the negative thoughts and feel proud of yourself for surviving a very painful time—with a little bit of help, or more, from a friend.

Don’t give power to the side of you that values control at all costs and blames you for losing it. We all have those feelings, but they turn nasty and mean whenever we fail to meet their performance standards. Unfortunately, their standards lie in performance alone, when other values are what are important.

Ask yourself then how you expect other people to behave when they’re super-depressed. You got over your pride and allowed a friend to save you. Give yourself respect, and give that friend the credit he deserves; if he didn’t judge you then, he won’t do it now. Your friend did what a good friend should do and what you would have done for someone else. Don’t let shame deprive you of that friendship or reward his kindness with distance and discomfort.

You can’t help feeling ashamed, but what you can do is give attention to what you and he did with the depression and give respect where it’s due. Don’t apologize or act on your shame; let him know you’re grateful, that he did exactly what you needed him to do, and that you’re proud you survived with his help.

Then talk about other things, be friendly, and give the old friendship chemistry a chance to reassert itself. You went through trauma together, and now you can help each other with the recovery.

STATEMENT:
“Depression always has a way of making me feel humiliated, but it can never really humiliate me as long as I fight it as hard as I can. I will take pride in my survival and in the good friendships I’ve nurtured that have helped me survive.”

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.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I still can’t understand why my 15-year-old daughter would purposely overdose. I understand she’s always been an emotional kid and that she hasn’t been happy lately, but my husband and I love her. We’ve always told her we want to hear about any problem she wants to share with us, and she knows it would kill us to lose her. Still, she seems to have no remorse for what her suicide might have done to herself or the rest of the family. My goal is to understand how she could do it and teach her a sense of responsibility so it won’t happen again.

In many ways, a suicide attempt is like a natural disaster; you shouldn’t bother asking why it happened, or what if you had done things differently. Whether you blame global warming or God’s wrath, it won’t change the fact that it happened or that there is at least some chance that it will happen again.

The moment you think you understand the reason, you’ll think you know what she did wrong, or, at least, what she should have done better, and that will just make her feel more like a loser, and more like doing it again. Or you’ll think you know what you or your husband did wrong, which will make you feel like losers and blame one another, and make her feel like doing it again.

The truth is, no one knows why some kids are prone to overdosing. There are contributing factors, of course, such as depression, impulsivity, a trauma history, and loss, but they’re not factors that you can necessarily change, even with lots of therapy and communication.

If you interpret the overdose as an expression of anger or self-centeredness, you’re implying that she’s irresponsible. That may be true, but only if you knew for sure that your daughter had a choice, and she probably didn’t. Most kids and adults who overdose experience terrible feelings of worthlessness and hopelessness that sweep away all positive thoughts and beliefs. If you had them, and I hope you don’t, you’d know that they’re as powerful as hurricane winds.

If you want to help your kid, get off the irresponsibility kick. You’re good parents and she is probably a good kid with the bad problem of getting assaulted by intense emotional pain. Once you admit your powerlessness over the storm, you’re ready to address the problem.

While neither you nor her doctors can cure her or even be sure of protecting her, you can let her know you respect the fact that she has a rough problem, and that you believe there are good tools that can help her cope. In addition, the problem will pass. It doesn’t sound like much, but to someone who feels hopeless, it can make a world of difference to know that the feeling isn’t that personal, can happen to others, and can be resisted.

Your daughter is the kid you know and love—she’s not her overdose—and you should treat her accordingly. Yes, she has a painful problem, but the problem is what she has, not who she is.

Though you have cause to be afraid for her future, try to project confidence and optimism. You’re entitled to have feelings of fear, but not communicate them.

If she can’t be strong, you need to be. You can’t control the weather of her moods, but you can ready the sandbags and supplies and teach her how to fortify herself against the storm.

STATEMENT:
“Knowing my daughter could kill herself has almost destroyed my life and my confidence, but I still believe I’ve got a good family and that we will find ways to help her with her burden. We have lots to learn about the tools that could help her. We will help her most by showing respect for who she is and hope for her recovery.”

I’m going broke supporting my daughter in her apartment, but, if I don’t help her out, I’m afraid she’ll slip back into the depression she had last year, when she couldn’t get out of bed for 3 months, and then where will she be? I think her apartment is much more expensive than it should be, but she claims that, if she loses it, she’ll have to move someplace much smaller and less nice, which will just give her ex-husband ammunition in his custody case against her. Meanwhile, she doesn’t spend enough time looking for work, let alone for a place that costs less money. My wife and I are going to run out of money but I’m afraid to say no. My goal is to figure out what to do that won’t jeopardize her mental health and visitation rights.

You and your daughter may have good reason to be afraid of her losing custody, or her sanity, if she doesn’t have a nice apartment, but you have more reason to be afraid of her, and your, eventual insolvency.

That’s what blackmail is; not her blackmailing you, but fear blackmailing both of you into doing something that relieves your immediate terror while guaranteeing eventual chaos.

Being the father doesn’t mean you’re supposed to find the money to protect your daughter, just that you’re the wise elder who is supposed to recognize the dangers of letting fear make your decisions. Instead of sharing your wisdom, you’re allowing yourself to be infected by her fear.

Yes, bad things may happen if she loses the apartment; she may get depressed and paralyzed and lose custody of your grandchildren. On the other hand, you will make sure that she has food and shelter. Remind her that, even in the worst-case-scenario, once she starts working again, she can build herself a foundation that will be stronger than anything she has now.

Assure her that you are committed to helping her out, but only if it will really do some good, and giving her money now won’t. Saving it, on the other hand, will make it available later, when it could have more impact.

Remind her than many good people are hard up right now, given the sorry state of our economy. There’s no longer any disgrace (if there ever was) in living in a trailer down by the river.

Learn to support her, not her finances or her fear. You can’t promise her things will turn out alright, but you can assure her that she will have your respect as long as she’s trying to get on her feet, and that you don’t see her as a loser because she’s broke and depressed.

Give her money when you think it will actually help, but don’t support both of you into a dead end.

STATEMENT:
“I feel my kid is falling into an economic apocalypse, and I can’t prevent her from feeling overwhelmed and losing hope. I will, however, remind her that I see hope where she doesn’t, and help her respect the difficulties of basic survival in these hard times. I am sure she has the right values in looking for work and caring for her kids, and I see no reason why she can’t put a good life together if she keeps trying.”

You’ve probably had a disgusting amount of questions like the ones I’m about to put towards you, and that’s another thing that annoys me—I’m a cliché. 17 months ago my boyfriend broke up with me, explaining that he was too young to be in a serious relationship. I know this is perfectly logical but I have never been able to get over it, even though I do understand his point of view. I am still very much in love with him. I know perfectly well that realistically no one really marries their first love, that realistically it wasn’t even a proper adult relationship but I feel as raw today as I did the day it happened. I’ve been diagnosed with severe depression and anxiety. I have regular nightmares about him. Last Easter I attempted suicide yet it failed. I’ve been sent to counseling, but I didn’t like it. I dropped out of university as I was too distracted and there is nothing I can throw myself into to make me forget it. The idea of him with someone else would kill me. I keep thinking to myself, I’m only 21 and I shouldn’t take this so personally and seriously but I do and I have no idea why. I know I need to wise up but I can’t.

Some say love’s like a drug, but we think it’s more like a (sometimes) innocuous mental illness; it doesn’t make you “crazy”—at least not necessarily—but it does give you weird thoughts, sometimes long after the relationship is over.

While those thoughts are hard to stop and easy to believe in, at least they’re not true. Like anxiety and depression, love has a weird way of keeping itself alive by changing the way you think and act, until it changes your beliefs. That’s when you’re in trouble.

You think there’s no value to life once love goes from bliss to bad, so you try to remember and revisit and talk about everything that hurts the most, even though that keeps it hurting longer. Each time you think the thought, visit the memory, and talk about your feelings, you grind the loss in deeper, and the pain makes you do it again. You can set a Guinness record for miserable pining (i.e., a lifetime) if love-thinking goes unchecked.

Love has got you treating yourself like shit, and there’s nothing noble or beautiful about that. You feel worthless, treat yourself as worthless by trying to kill yourself, and then feel more worthless for failing and still feeling miserable.

Remember, there’s nothing wrong with being needy. OK, you’ve got a sensitivity to love, and in the right situation, that makes you open to certain kinds of joy and poetic feelings that others miss. Like some traits associated with mental illness, it has its good side (if there was no such thing as depression, most of the good art in the world would not exist).

Besides, the most likely reason you have this trait of sensitivity is that you were born with it, so don’t waste time wondering why you’re suffering, what you did wrong, or what you need to do to change. You are who you are, and you happen to be vulnerable to lost love. You need to manage that part of yourself better instead of focusing on it and feeding its destructiveness.

Big Pharma has yet to release an anti-love potion, so take treatment into your own hands by challenging the thoughts and memories that keep the disease going; keep busy while accepting the sad fact that you’re miserable, you can’t control it, and you can’t stop it. Almost everything you want to do about it will make it worse, so force yourself to do the opposite.

Find a recovery coach, or a recovery support group, that can remind you that you have a self that’s independent of your sadness and loss and that you deserve to respect yourself for carrying on with your life, in spite of your pain, one day at a time.

If you ruminate, visit old haunts, or try to share your sad story, they can tell you to shut up and do whatever you’re supposed to do when you “slip.” Prepare to fight negative thoughts and feelings every day for as long as it takes.

You will recover, learn from your experience, and do better next time, but only if you accept the unfair burden of your disease. There’s no cure for love, but if you work hard enough, you can manage your mind again, and then maybe one day find a truly healthy relationship.

STATEMENT:
“Right now I don’t care about living, but I’ve never believed that the meaning of my life is much related to how I feel. I respect myself for doing what I think is right and being a good woman and that hasn’t changed. I’ll stand by that view for as long as it takes.”

My husband and I have been married two years. Before we were married, we had been living separately and co-parenting our then 4-year-old son (we had split up when he was 18-months-old because I suspected he was cheating on me). He became involved with the woman I suspected, moved in with her and got engaged all within a year of us breaking up. Then, she cheated on him and they broke up. We began hanging out with each other and “dating.” I broke it off with him when he admitted he did not consider our relationship “exclusive.” I moved on again with my life. Then eight months later he proposed marriage stating that he knew he had made mistakes but was now certain he wanted nothing more than to be with me exclusively for life. I have trouble getting our past out of my head and trusting that he will not abandon me for someone else again. We have trouble getting along sometimes and his passive-aggressive behavior bothers me. My goals are to get over my feelings of mistrust and to be able to communicate better with my husband.

Being abandoned feels terrible—the word suggests the helplessness of a newborn left alone on a wet rock—so don’t apply the word to yourself if you’re an adult unless you intend to abandon yourself, which I’m sure you won’t do unless you’re thinking too much about your husband.

Besides, you did fine without him before and you’ll do fine without him again, if necessary. Meanwhile, ask yourself whether life is better with him around, assuming that you can’t get rid of your suspicions. Put aside, for the time being, whether your suspicions are true or not; assume you’ll find out someday and, if you do, you’ll deal with it then.

One thing you don’t want to do is to get rid of your suspicions by asking him for reassurance or watching him closely. That’s a good way to kill your relationship, drive you both crazy, and improve my business.

It’s unfair you should have to live with painful suspicion, but as long as you decide he’s a worthwhile partner, it’s part of your job description. That’s what you get when you re-cycle a flip-flop guy, which is why deciding his worthiness is so important—otherwise, it’s a lot of suffering in vain.

Don’t blame yourself for your suspicions, and don’t blame him; you can’t help having your feelings and he can’t help stirring them up. All you can do is not make things worse (see above) by keeping your feelings to yourself and not being overt about checking his email.

Remind yourself that you’re independent and not a fool. If he strays, you’ll find out sooner or later. At that point, you’ll know it’s not because he’s “too young for commitment,” but because he’s too self-absorbed to be faithful. Luckily, you seem self-reliant enough to “abandon” his sorry self and move on.

STATEMENT:
“It’s hard to live with suspicion, but I can do it if I think it’s necessary for a good partnership, and not because I’m too needy to say good-bye to a jerk. I can live alone again if I have to. Whether my husband proves true or not, I respect myself for taking risks in a good cause.”

My partner cheated on me while I was pregnant with our baby, and kept ME the secret. He told lies about me and told people that we were no longer together so that he could openly date the other woman. I’m struggling to stop thinking about it all, and the whole ordeal has triggered a particularly intense bout of depression and self-harm. I have hundreds of questions I feel I need answers to, but my partner is 100% unwilling to discuss the matter, seeing it as “dragging up the past”. My goal is to be able to get through the day without memories of the betrayal and the gossip that surrounded it intruding on my life.

When a guy hides his relationship with you when you’re pregnant, you don’t have hundreds of questions that need answers; you’ve got a few simple, sad, unpleasant answers that need to be accepted.

After all, you’re not doing a PhD in trying to understand him. That’s a waste of time and, like most inquiries into the sad “whys” of this universe, a sneaky way of avoiding acceptance.

You could see it as him not being that into you, but the reality is that he’s not into anyone, at all, except for himself. At this point, the only important question is one you have to ask yourself, and it’s figuring out what’s the right thing for you to do, regardless of what your should-be-ex might think.

First, stop calling him your partner, because, as he made perfectly clear by his actions, he was a partner in sex, not life. Partnership means you work together and have each other’s backs. If you turn your back on this guy, he’ll move on to some other woman’s front before your shadow hits the ground.

There’s probably no way you can avoid some intense depression if you care about him a lot and expected more of him, but don’t make it worse by trying to figure out what went wrong, or where you failed, or why he doesn’t care any more. The only thing you did wrong was fool yourself about your relationship and his character and let yourself care too much. No big crime, but unfortunately, you can suffer horribly from such mistakes without ever really having done anything wrong.

So don’t make things worse than they have to be. It’s too bad you’re feeling depressed and suicidal, but the pain will pass. Nothing has happened that should lower your respect for yourself or change your priorities, and now that you know he’s not good for much more, you’re free to stop worrying about his ability to remain faithful and look elsewhere for someone who has that ability, period.

You’re now free to plan a better future; a lawyer can tell you how to secure financial support, friends and family can provide emotional support, as could a therapist or therapy group to address the issue of self-harm.

When a guy rejects you and acts like a total jerk, it may hurt more in the short run because you feel humiliated; the fact, again, is that you’ve done nothing wrong and he has. You’ve done nothing to be ashamed of, other than to trust someone who doesn’t know enough to know when he should be ashamed. The answer might hurt, but the truth will set you free.

STATEMENT:
“It’s scary to find out that you’ve let yourself trust someone who’s basically untrustworthy, but love is blind. Recovery is going to hurt like hell, but better now than later. I’d much rather be gullible and hurt than nasty and cold, so my goal now is to be a good mother and take care of me and my baby in a way that he can’t and never will.”

If you were to have a casual chat with her, my wife would seem sane and reasonable; she’s a fine accountant and mother, but ever since she flipped out 7 years ago and spent 2 weeks in the hospital hearing voices tell her the FBI was after her, she’s had paranoid ideas about my having affairs behind her back. Sometimes, she knows it isn’t true, or I can joke her out of it, or she’ll talk about it as a symptom of illness. Other times, I see her giving me an uneasy look and pulling away, and I wonder whether I’ll ever have her trust. I wish I could persuade her to try new medications and get her paranoia under control, but she resents taking or being told to take medication, so I don’t try. My goal is to get her paranoia under control and save our marriage.

It’s sad to see weird, intrusive thoughts that come from nothing but mental illness tear a love apart, but it happens. Love can’t conquer all, and one of the worst things it can’t conquer is a paranoid delusion.

Your partner looks and sounds like the person you always knew, loved, and counted on, but a sudden flare-up of suspicion where there used to be comfort and love means you may not really have a partner any more. It’s hard to imagine anything other than a fairy tale curse that could drive someone away from the one they love, but the weird neurologic disturbances of mental illness can do it; it’s a real life evil spell.

Unfortunately, you can make it worse by trying to make it better. If you express your love, sadness, fears, concerns, sincerity, anger, you name it—you can’t change how she feels, except to make her feel discredited and blocked, which leads to more paranoia.

If medication hasn’t stopped it by now, it probably won’t. Theoretically, it’s possible she might be helped by some medication not yet tried, but not likely. For one thing, medications don’t always stop paranoid thinking, and, for another, paranoid thinkers don’t always take their medication (because, surprise, they’re paranoid about what it may actually do). So pushing her to take it may do nothing other than to make her feel annoyed, controlled—and paranoid. You see the pattern.

Your best bet is to accept her paranoia, and your loss. Don’t push her to be different, just see instead whether life together can be bearable for her, or not.

Don’t let sadness make you, or the kids, feel like failures. Success isn’t staying together; it’s finding the best compromise that eases her symptoms while allowing you to work together, if possible. What makes this task heroically difficult is that it leaves little room for your own needs, but you have no choice.

In the end, you need independence and other sources of support. You welcome what she can give you, but you dare not ask. Learn to roll with the punches of her paranoia, and if you can’t and they knock you out, defeat is never disgrace.

STATEMENT:
“My marriage is dead and what I have is weirdly similar, but basically different and subject to change without notice. For any number of reasons, particularly the kids, I’ll accept what I must and take pride in doing so, but I do so knowing these circumstances are hard, possibly impossible, and nobody’s fault.”

Please Note: In responding to suicidal goals, as in the case below, we do not presume to offer emotional support. If you’re at risk of hurting yourself, you should, of course, go to an emergency room, discuss your state of mind with a professional, and decide how much support you need in order to remain safe. In most of the cases we encounter, however, our correspondents are not simply suicidal; they are familiar with treatment and have come to believe that it won’t help. Often, we must agree that their feelings are unlikely to change in the near future. What we try to demonstrate, however, is that negative feelings create falsely negative and hopeless beliefs and that there are ways to recover your strength and perspective, even when the pain won’t let up.

I’m considering suicide. My life is a joke. I am in my late 30s and female and I have never had a relationship with a man. Several men have used me for sex and at least 2 of them begged me not to tell any of their friends they’d had sex with me. I’ve never been loved, been held, been listened to, been cherished. I’ve just been used like a toilet. On the outside I’m pretty. I can hold a conversation and I have a reasonable number of friends. But I hate myself and I don’t feel good enough. I was abandoned by both parents and I was raped for the first time when I was about 2-years-old. It’s like men I meet can smell the self-hate on me and they treat me accordingly. I do not have even one person in my life who cares about me or who I could trust. My friends are there to go for drinks or dinner with me if they can find nothing better to do but they are not there to be supportive ever, in any way. What is the point of me continuing to live?

It’s horrible to feel that you don’t belong to the human race, except for your ability to satisfy the needs and cravings of jerks.

Remember, however, that those feelings almost always beget more falsely negative beliefs, particularly about relationships. Whether or not you’ve done anything wrong, you feel infinitely rejectable, comfortable in the company of jerks, and anxious around people you respect, since you know they will reject you for your anxiety and fundamental worthlessness.

You distrust other people, but it’s your feelings and instincts that are far more suspect. In turn, you can’t trust your feelings to guide you in relationships (even more so than the rest of us).

If you do, you will seek out jerks and excoriate yourself after real or imagined rejection, and of course, life will appear meaningless and full of relationships that always end badly. Being needy strips away the friendship filters that would otherwise keep jerks away and it makes non-jerks look like jerks or, even worse, like people whose rejection would be devastating.

For instance, after starting to trust a potential friend, you might be so hurt after noticing that she was slow to answer your calls, even if that dearth of calls was due to a busy work week or broken phone, that you would feel you could never trust her again and would feel like hurting yourself. It’s hard to make real friends when your own sensitivity is such an enemy.

Don’t give up, because there are other ways to build a more rational, positive set of beliefs that can protect you from dark feelings, even if they can’t ease the pain. They don’t require you to risk a relationship; all you need do is assess your own response to the hardships of your life, using reasonable criteria for judging your effort and the difficulty of your accomplishment.

If, while bearing the scars of neglect and abuse, you’ve picked up skills, earned a living, and treated people decently, you’ve accomplished something you have good reason to admire. Forget whether anyone else knows, understands, or respects what you’ve done. Then forget the fact that you continue to hurt like hell, (when you’re not feeling numb). You know what you know, and it’s your opinion that matters most.

If only therapy could help you make better choices and avoid negative distortions, or at least give you a sense of being respected and valued; but it often doesn’t work that way. Instead, relationships with therapists often fall victim to the same false beliefs that ruin potential friendships.

Because of your age, I’m assuming you’ve tried therapy and it hasn’t worked. You aren’t alone in having that experience, but it is possible to see beyond it. Don’t be surprised if a relationship- or emotion-focused therapy or support group hasn’t helped. Don’t give up hope, because there are other approaches that can help you grow stronger.

DBT (dialectic behavioral therapy) is a kind of cognitive-behavior therapy that can help you maintain your perspective and fight negative thoughts and actions. It’s taught as a course, and discourages participants from sharing strong feelings or engaging in intense relationships. As such, it doesn’t offer relief from loneliness, but it does provide ideas and mental exercises to root your self-worth in your own values and actions and thus protect your beliefs from distortions caused by fear, sensitivity, and loneliness.

When emptiness consumes you, it’s almost impossible not to feel like a disposable loser. If, however, you can make an honest assessment of your accomplishments, and acknowledge that there has also been triumph and survival despite tragedy, you will get stronger and find reasons to live and respect yourself.

If you review the things that you’ve done without the approval or involvement of others, jerks and not, you’ll see that you’re not just a member of the human race, but an exceptional one.

STATEMENT:
“I’ve never found a friend and often feel that life has no meaning; but abuse left me determined to be independent, treat people with respect, and be a good person, and I value what I’ve accomplished, regardless of self-hate or loneliness. I will build self-respect on my own actions, and hope that someday I will have the strength and luck to find a friend.”

My mother only has one sibling, but I’ve never met my uncle because he’s had severe agoraphobia for the past 30 years. My mother says that it started right before he graduated high school (he stopped talking to his friends, stayed in his room more, washed his hands compulsively, etc.), and it’s been going on since then. The only person he regularly communicates with is my grandmother, who also supports him, and while he sometimes talks to my mother, he doesn’t let her see him, and, like I said, I’ve never met him because if I’m in the house he won’t talk to anyone or leave his room (this is how he treats anyone who isn’t my mother or grandmother). My mother says that my uncle’s too macho to admit he has a problem, and “too Italian” to ever leave his mother’s house. I guess my problem is that my grandmother isn’t in the best health, and I know that nobody else in the family has the resources to take care of my uncle when she’s gone. Plus, I mean, he’s sick, so my goal is to get my uncle some help.

If almost every chronic illness is a test of character, agoraphobia is one of the most challenging. The fear goes far beyond anything you’ve experienced; think of it as a migraine headache where, instead of pain, you’re flooded with fear and the only relief is to hide out.

Yes, there are treatments that can dull the fear and help people recover their lives, but they take effort, they’re not a cure, and, somewhere along the line, they require people to leave their caves and endure some additional anxiety. It’s no wonder many people with severe agoraphobia will accept tranquilizers or use alcohol, but will not stick with any other kind of treatment, particularly if they have to leave home to get it.

So don’t blame your grandma or your uncle or put responsibility on anyone, including yourself, to get help. That bird has flown, leaving much pain and helplessness behind. Respect your grandma for carrying an extra load and your mother for bearing the sorrow of losing her brother.

Now that you’ve given up on helping your uncle directly, however, consider an alternative. Ask yourself whether he would accept behavioral treatment if he had no place to stay. Consult with experts and find out what would be available to him if he were flushed out of his hideout.

Obviously, eviction would make him more anxious in the short run, and might make your grandmother and mother guilty and anxious as well. If you believe there’s a positive alternative, however, encourage them to consider offering it to him. Urge them to trust their idea of what would benefit him in the long run and to ignore their gut response to seeing him in pain.

If they’re ready to push him out, good for him. If not, your mother will encounter this option further down the line, after your grandmother dies and the family can no longer afford to keep her house/his prison.

You’re right to fear for your uncle’s health and your family’s future, but as long as fear imprisons your uncle, you are all, to some degree, stuck.

STATEMENT:
“I’m sorry my uncle has a painful mental illness and I don’t want to add to his pain, but his current dependence on the family can’t last forever and he might do more for himself if he had less support and more encouragement to man up and get treatment. There are 2 generations ahead of me with responsibility for his care; but if, after learning more, I think they’re overprotecting him, I’ll let them know I respect them for caring for him, I’m concerned about what will become of him when grandma is dead, and I have a plan that might allow him to get stronger, regardless of his fears or urges to disappear.”

I’ve been so depressed I can barely get out of bed, so at this point, I’m willing to try medication. The problem is, none of the pills I try seem to work for me, and some of them make me feel worse. One antidepressant made me dizzy, and another one my doctor recommended is said to cause weight gain, and another sometimes causes a severe rash. I’m desperate, but there’s got to be a way to feel better without a fucking rash. I need something that will work without doing me serious harm.

If you’re looking for an antidepressant that’s sure to help and has never caused harm, stop your search now. Like cold fusion, unicorns, and a good Joel Schumacher movie, such a pill doesn’t exist.

Refusing a medication because it makes you gain weight is like skipping chemotherapy because of possible hair loss. Expecting too much from antidepressants, or any medication, can paralyze you and prevent you from getting the actual help they might be able to provide.

Meanwhile, depression is endangering your job, relationships, and even your life, while at the same time damaging your brain; there’s evidence now that, the longer depression goes on, the greater the chance it can make permanent structural changes.

So forgive me if we fight fear with fear, but you’ve got more to fear from depression than from any antidepressant, regardless of its possible ineffectiveness and/or side effects.

That’s why it’s worth trying one antidepressant after another, even though each trial can last a month and has a 30% chance of doing squat. When they say antidepressants are effective, they mean “better than nothing,” not “always” or “completely,” and certainly not “permanently.”

The good news is that side effects are rarely serious and that, when one antidepressant doesn’t work, there’s still a good chance the next one will, because they’re not identical. It’s just a long process towards finding the right one.

You have good reason to be frightened, but don’t seek comfort in false reassurance from the biggest doctor in town (unless you’re determined to believe whatever he/she says and stay off the internet). Stand up to your fear, figure the odds, and make your play.

Life isn’t just unfair, but hard, and only a fool (or someone without broadband access) can ever believe that things will turn out perfectly. There’s no cure (or unicorns), but there are treatments that can help and you will gain courage and comfort from knowing that you’ve made the most of them.

STATEMENT:
“Depression is frightening and its symptoms include fear. It will try to paralyze me with helplessness. I will do what I have always done: figure out my chances based on the best information I can get, make a choice, and take pride in the fact that I’m managing pain, fear, and uncertainty with every tool I have.”

I recently discovered a great deal of support, and sobriety, from AA, and the people I’ve met are remarkably nice and compassionate, but I’m worried about over-depending on meetings for my social life, and yet I’m not sure I have any alternative. Like a lot of recovering drunks, I don’t know how to go out and have fun, or really meet someone, if I’m not high. Then I talked to some people after last night’s meeting and this woman was complaining about how her boyfriend just left her, and how “damaged addicts like us are fucked” when it comes to relationships, and I began to feel depressed about identifying with a group of damaged, lonely people. My goal is to find someone, and I wonder if AA will require me to face the fact that it’s impossible.

Remember that sobriety comes with lots of negative thinking; when you’re sober, you’re more aware of what you don’t like about yourself and what you did when drunk (especially without the cushion of being sauced).

You may also be depressed, particularly if your sobriety is recent, and depression sparks its own negative thoughts about what you should have and could have done and the bleak future ahead of you.

That’s why AA gives you lots of positive truths to tell yourself. It may sound silly and like (Senator) Stuart Smalley, but these positive aphorisms are necessary tools for fighting negative thoughts that will otherwise have you believing all the equally silly shit about yourself and your future that depression is telling you.

For instance, you and your friends see no social future for damaged, recovering alcoholics. Sure, identifying yourself as a recovering alcoholic is an acknowledgement of damage and might seem like a turn-off, and if “recovering” weren’t part of your description, you might be right.

Yes, on a superficial level, we’re all attracted by strength, youth, and beauty, which is why no one whose wedding is reported in the Style section of the Times is ugly, poor, or in rehab.

Think, however, about what you really respect. It’s the ability to deal with pain and loss and remain true to your values, which is what you and the other folk in your AA meeting are helping one another do.

There’s no crime in being lonely or damaged, but there is in pretending you aren’t or trying to escape the pain. Your AA friends may feel like unlovable losers, but with every day of sobriety they come closer to being people you respect and would like to spend time with. You’re good enough, you’re strong enough, and if you’re sober enough, people will like you (except for the ones you don’t want to have anything to do with).

STATEMENT:
“Sobriety has certainly not brought me a feeling of attractiveness or social confidence. I believe, however, in the value of what I’m doing and that true friends will be the ones who accept my weaknesses and appreciate what I’m trying to accomplish; others need not apply.”