While most mental health clinicians would feel guilty admitting this, I’ve been in the biz for long enough that I don’t give a shit and I need to vent. Most of the crisis calls I get from my psychotherapy practice are senseless and irritating; they’re from patients who feel bad because they forgot to take their medications, or drank too much or when they shouldn’t, or allowed their demons to wreak vengeance on their enemies, the nearer the better, self best of all. A few call me because they’re feeling suicidal (but won’t go to the hospital) and just want me to make them feel better, which is hard when it’s late and I’m tired, and often impossible just because I don’t have that kind of power. I try to be civil, but their calls leave me feeling helpless and wondering whether I’m doing any good. Discussing their responsibility for their behavior is useless, because it usually makes them mad or apologetic. My goal is to figure out what to do with crisis calls that are really a useless pain in the ass.

Many crisis calls you receive as a shrink do a good job of showing off a patient’s worst behavior. It’s like having partial custody of a colicky child.

It’s not that their distress isn’t real and severe—it is, almost always—it’s that it causes self-defeating behavior, like drinking or mouthing off or retreating from the world, which creates a jam that is extra hard to get out of.

Bad feelings cause bad behavior, bad listening skills and bad regrets about going into the therapy business instead of owning a Toyota dealership.

You’re right to wonder whether your response to crisis calls is helpful. Whether you realize it or not—and you seem to realize it—your words sound moralistic and angry, though for good reason. The more you care about your patients’ welfare, the more upset you get about what they’re doing to themselves and how it undoes all those good talks (and/or medications) that seemed to help. As you say, their negative feelings become contagious as you wrestle with your own fatigue, doubts, and fears about more calls to come.

Unfortunately, a moralistic tone usually makes people who’ve messed up feel more messed up. You judge them as having made bad choices, whereas they experience a rush of emotions and habits that sweep all choice away. Your intentions are good, but labeling your bad-behaving patients as irresponsible bad-choosers will usually make them feel like losers talking to their dads.

The good side is that you’ve given them a focus for their anger and disappointment that isn’t themselves. The bad side is that you may get an honorable mention in a suicide note.

If you truly believe in your observations, however, assure yourself that you’re not responsible for making the crisis caller less destructive. The threat to you isn’t the intrusion on your time, it’s feeling responsible for the mess they’re in, which you’re not. Their mess is out of your control, and theirs. Your only responsibility is to give them good advice and do what you can if they’re not safe.

Tell them what you think they eventually need to be able to tell themselves; it will pass, there are good things to do meanwhile, and they’ll sort out the cleanup when they’re better rested. If they’re not safe, they should take themselves to an emergency room.

Assure them you’ll work with them on increasing their self-control over anything they think they’re doing wrong, but it can’t happen now. Good night and good luck to them, and I hope it felt good for you to vent.

STATEMENT:
“It’s hard to stay calm when I see my patients fucking up their lives and then wanting me to make them feel better during my spare time, but my feelings are just a reflection of their feelings, and don’t have to get in my way. When I can’t help them, it’s too bad, but it doesn’t help to blame them, and we can make good use of the experience later, when we talk during work hours.”

As a therapist, I assume that my strongest weapons are kindness and empathy, but sometimes the process is exhausting and my family does not appreciate the amount of time I spend fielding patient phone calls off-hours. When I get desperate calls at dinnertime or late at night, they interfere with my family life, but I don’t believe in hanging up until my patients feel better. Many have been traumatized and go through terrible periods of emptiness and they need to know that someone cares. My family jokes, somewhat bitterly, that my patients have more access to me than they do. I feel unappreciated, tired, and torn in many directions. At least my patients feel that I care. My goal is to help my family see that I also care about them.

If empathy and kindness were as powerful as some therapists and Christians believe, the world would be a lot better than it is. As your family correctly observes, however, the calls keep coming, there are no cures, and What About Bob is coming down the road.

Ask yourself whether your patients are actually getting better, or just feel better because they’ve found someone nice to take their calls. If they are feeling better, figure out if it’s because they’re better at managing their own crises, or because you’ve confirmed their right to have a nice response whenever they need it. If it’s the latter, heaven help them when you’re not there (and help your family when you are).

It’s good that you’re kind and empathic; that’s why your family and patients like to spend time with you. What’s wrong, however, is that, in over-valuing the therapeutic impact of those qualities, you’re putting too much responsibility on yourself for your patients’ problems (see above). Realistic experience should tell you that kindness doesn’t cure. Neither (see above) does moralistic confrontation.

That is sad, and limits your powers considerably, but it also means you should keep calls short and treat them as evidence of your patients’ need for better self-management. If a patient is willing to try improving his/her self-management, that’s a great focus for treatment and the calls are grist for the mill.

If, on the other hand, a patient can’t see any possibilities for better self-regulation and wants nothing other than better treatment from others, your therapy won’t do any good other than providing him/her with a short-term fix and your family with an empty seat at the table. In that case, Forget Bob and return to the family fold.

STATEMENT:
“It feels right to soothe those who are in despair, and to help them carry their load, but I know that I can’t really carry anyone else’s load and that responding to repeated off-hours calls doesn’t help patients appreciate and make best use of their own resources. Without sacrificing my kindness, I will offer them ideas about how to manage their moments of disorganization and despair, and I will do that most effectively during treatment hours and not at other times.”

Like a lot of artists, I don’t think I’m good at anything else. I’ve been “the arty one” since I can remember, I went to art school on a scholarship, and I’ve gotten illustration work pretty steadily since then. Ever since my last job, however, I’ve started to wonder if I’ve lost it somehow. I got a steady gig in a graphic design department, and at first, I totally got along with my co-workers and we seemed to share a sensibility. Then, for some reason—maybe it’s my age (I was the youngest one), the new department head, an off-the-mark project I completed, I don’t know—the group consensus turned on me and I was treated like an untalented hack for the first time in my life. I’ve never dealt with this before, and I still don’t get it, because the higher-ups were still pleased with my work even if my peers decided it sucked, and I was always nice to everyone. The only thing that did happen was that I started to doubt my ideas more, because every time I’d come up with something I’d immediately think of all the reasons my co-workers would hate it. After a few months of this, I couldn’t take it anymore, so when a college friend told me there was an opening at his work, I jumped on it. The problem is that I still can’t get that negativity and doubt out of my head—maybe I am a hack, after all—and I’m terrified of starting this new job and either not coming up with anything good or not coming up with anything period until eventually I can’t get a job at all. I’m not good at anything else, but what if I’m not good at design anymore, either? My goal is to get my mojo back (or at least get these assholes out of my brain).

One of the curses of being talented, in arts or sports, is that talent becomes the heart of your self-esteem. Talent and ego have a flawed-yet-symbiotic relationship.

It’s particularly true if, like many talented people, you’re actually not so hot at doing other things. It’s as if your talent takes up extra brain-space, crowding out room for the basics and leaving you both gifted and klutzy, brilliant and ADD, hyper-capable and totally incompetent.

Other people might tell you that you’re good at other things, but those other people are wrong; they don’t have or understand an artistic mind. They had to decide on a career, whereas you probably felt like you didn’t have a choice. They also probably have health insurance.

What you’re “good at” is what you and others respect until you come to believe that nothing but hard work stands between you, success, and being a somebody. That’s when ego starts to assume you’ve got control over your artistic career when, in truth, no one controls art.

Even with all the hard work in the world, art is outside of your control. Sooner or later, you’ll perform poorly, perform well but meet an unresponsive audience, and/or get ill, injured, or misunderstood. And that’s when, if you rate yourself by performance, you’ll start to fear failure, and then fear the fear of failure, which is the fear of losing your mojo.

The feelings are awful and there’s no avoiding them. You can sense the rejection and feel your creative juices drying up, like you’ve lost your gift and can’t get it back. Meanwhile, you feel like there’s nothing good you’re good at. Without talent, ego feels like a total failure.

So here’s the hard part for people who want to do well at what they’re good at (and everyone else): develop a deeper set of values. You’ve already got the hard-work ethic for managing the controllable part of your gift—no need for improvement there. Now, learn to respect yourself for dealing with shit, which is just a technical term for that part of life that you don’t control.

Counter those fucked-up feelings with your beliefs; that you’ve done your best, and if you can’t do what you’re good at, you’ll do your best with other things. You’ll try to make a living and be a good friend. You’ll do what matters with what you’ve got.

Remember, what you admire most in others is not their ability to do great things, but to eat shit and still be a good person (unless, of course, you’re one of those shallow people who admire nothing but good performance, and then you don’t really have any friends and you’re probably an entertainment executive). Suck up the pain and remember who you are.

That’s the antidote to losing your mojo: redefining what you value. When you decide that mojo doesn’t matter, it comes back. When you care more about trying and less about results, results improve.

No one can stop the agony of unfulfilled talents, but the real challenge is to bear that pain, remember what you’re here for, and do what you can with what you’ve got until your ego’s healthy enough for talent to return.

That’s not easy to do—it’s a lot harder than being lucky and performing well—but it’s an art in itself, and a much higher achievement.

STATEMENT:
“I’m stuck with excruciating feelings of failure and self-doubt, but I have no doubts about my hard work or my ability to do whatever is necessary when I think it’s worth doing. I have no doubts about my ability to be a good friend. I will not let my feelings touch my self-respect.”

I can’t deny that I’ve had success as a musician—I’m well known in the area—but fashions have changed over the last few years and now gigs are far from plentiful. Financially, though I have a day job, I’m just getting by. I do my best to schmooze and talk up producers, but I’m basically a shy person who’s happiest to be alone, practicing. I know the economy is bad and every performing artist is having a hard time, but I can name at least 3 other musicians of my generation who are doing much better than I am because they’re more energetic and sociable and maybe more talented. I feel like a failure who’s wasted his life and watched his professional reputation ebb away and now I’m facing a sad end in a lonely rooming house. My goal is to turn this situation around.

As noted above, it doesn’t matter whether you’ve proven yourself as an artist; sooner or later, the pursuit of an artistic career exposes you to an unusual amount of shit you don’t control and, when that happens, it feels personal.

Fortunately, you’re too old and well-established to worry about the negative impact of your feelings on your music, and thus on your career, and thus on your music, etc. It’s good not to worry about the losing-your-mojo whirlpool.

It’s not much better, however, to fear that no one cares about your mojo, you’re facing a sad and lonely decline, and you’re sure it’s your own fault, as proven by the fact that your peers are doing better.

That kind of proof, however, is one of the nastier tricks the human mind plays on itself in the name of so-called reason. You know you’ve managed a good career for many years, in spite of a shy temperament, and you’ve never neglected the business side of music-making. You also know that other people’s gifts, both musical and non-, are different than yours. So real logic tells you that the only thing that deserves criticism is your luck.

If you believe in making music, you also know it’s a meaningful thing to do with your life, whether or not it pays. Remind yourself that no artist in his or her right mind expects to get rich and that living with poverty is part of your job description (though one you hope to escape).

Be proud of your choices and the good music that resulted. Keep with your successful formula, playing when you can and paying your bills when you’re able. Don’t doubt that you chose a tough life…and did well with it.

STATEMENT:
“When I’m poor, old, and gig-less, it’s hard not to feel miserable; but music is important, I worked hard at it, and I will not regret past or future sacrifices. Life is hard, but good music is forever.”

I have suffered from anxiety and depression much of my life. My most recent (and most devastating) bout was a couple of years ago, when I worked with a therapist and managed to heave myself out of it without the use of antidepressants (which I had been on in the past and want to learn to live without.) Now I find myself slipping back in. My biggest issue seems to be that I put too much stock in what others think of me or might think of me (I’m really good at fabricating things people might be saying about me.) I also had a baby last year, which has prevented me from pursuing my career fully, so when I hear of the successes of others (or see them on Facebook) I get very anxious and feel that the universe is unjust. I want to be a good mom, and I want to be good at my job, but I feel I am failing at both and resenting others who are great at either. I was made fun of a lot when I was a kid and I think I still carry some of this baggage around, like whatever decision I make is the wrong one because I’m basically a loser. How can I focus on myself and my own life without worrying about what everyone else is up to or what they may think about me?

While you already have a good idea of what to do about your negative thinking, you still need to protect yourself from two bad ideas that you express here. Unfortunately, those two ideas are also your “goals.”

First, disavow yourself of the notions that you should be able to stop depression without using medication and that you should find a way to be less, for lack of a better word, insecure. In doing so, you won’t be giving up—you’ll be giving yourself some relief.

The good idea, and better goal, is to train yourself to fight negative thinking, and there are lots of ways to do that. A therapist can help, but so can the right kind of friends, readings, church, and/or spouse. Though you can’t make the negative thoughts go away, you can assemble a strategy (and maybe team) to help you handle them.

Develop a routine for reminding yourself that you’re the one who’s managing your life and working with your unique gifts and disabilities, and that you’re the only one who can judge whether you’re doing your best. Then, when you start to compare yourself to the better gifted, give yourself a dose of positive reality. Nobody else can judge you, not even Facebook.

The sad truth is that depression could sweep you away, regardless of what treatment you use and how motivated you are in pursuing it. It’s scary, but it’s also liberating; you’re responsible for doing your best with depression, not making it go away. Cancer patients don’t set performance goals, and neither should you.

Instead, set your goals in terms of the process of managing, rather than the outcome, of recovery, using non-medical and other minimal risk treatments whenever possible. Then go ahead and choose riskier treatments if and only if you think they’re necessary. Don’t let fear or guilt prevent you from choosing what’s best for you.

Don’t always listen to your doctor, because your doctor doesn’t know how much pain your depression is causing or how much it has disrupted your work and relationships, so it’s your tough decision. All the doctor can do is tell you the relative risk of the treatment, compared to your symptoms, and what he or she would do in your place.

Embrace the fact that every parent with a career has to contend with bad feelings about difficult compromises. The challenge for you is to accept those bad feelings and the fact that there’s always someone out there who can do things better than you, then learn how to manage yourself positively and tell Facebook to go fuck itself.

STATEMENT:
“I don’t often feel good about my performance at home or at work, but that’s my nature. I’m proud I’ve taken on parenthood and that I’m doing OK, whatever my insecurities tell me. I know I try hard and that I’ve made good decisions and I will use those facts to lift myself up when depression tries to tear me down.”

I shouldn’t be writing you about my depression because I have no reason to be depressed. I’m a lucky person with a good job and great boyfriend. I eat a healthy diet, exercise every day, and work hard to stay healthy, mentally as much as physically. I had a severe depression as a teenager but I worked hard in therapy (and still do all I can to keep those negative thoughts at bay), took my medications as directed, and have been much better since. So now, 10 years later, there’s no reason I should be unhappy, tearful, and unmotivated to do anything but go back to bed, but no matter how much I exercise or try to stay positive, I can’t get ahead of this thing. I must have missed something. My goal is to figure out what.

The one big thing you’ve failed to understand is that depression, like most illnesses, can’t be controlled. You can be careful, do everything right, avoid giving into negative thoughts and actions, but still feel like shit. It’s not fair, but it’s the nature of the beast.

Just in case this sad fact depresses you, think about how, just like the person above, you’re depressing yourself even more by holding yourself responsible for staying healthy. Maybe you want to assume that awesome responsibility because you wish you had the power to stay healthy, but you don’t, because nobody does. Even those people who follow all the rules and work their butts off.

Luckily, staying healthy is not part of your job description; coping with illness is, so stop telling yourself you shouldn’t be depressed. What you should be doing is reviewing what you need to do to cope with depression, and realizing that you’re probably doing most of those things.

You sound like the kind of person who tries hard to keep working, relating, and parenting regardless of how you feel. If that’s true, you’re doing most of what you need to do already. You’ve probably talked things over and tried to figure out whether something’s getting you down that you don’t know about, which takes care of another basic self-management task.

Decide whether to try any new medications (see above case), using the same procedure you would use for weighing the risks and management of any treatment. Don’t be a sissy about your dislike for treatment—no one likes treatment—so just add up the risks and benefits, and don’t let fear make your decision for you.

Finally, keep working on how to think positively, beginning with the most positive statement of all: you aren’t responsible for your illness, and despite bad results, you’re doing your best. You’ll quickly discover you’re doing a much better job of coping with depression than you realize, and while the situation may still seem unfair, your efforts are all that matter.

STATEMENT:
“I never expected to get depressed again, but I realize now that I didn’t fail to prevent depression, I failed to give myself reasonable expectations and responsibilities. Now that I know what to do, I have little to fault myself for and I can be legitimately hopeful about finding new tools for managing depression.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So I’m a 20-something girl who has been faced with a couple big problems in a short period of time, the first being that I am in my last semester of nursing school and I failed. This has been a very long hard stressful experience, and being faced with failure is devastating. I have to wait till September to try to get back into the program and that’s my last chance, so I’m having a hard time accepting that my very laid-out plan for my life is now in jeopardy. Also I am being faced with health issues, with myself and with my family, and finally, I have been in a mind-fuck of a relationship for three years with a person that shows me five different faces. I know all the ways he’s done me wrong but I cannot walk away because I have yet to conquer him, even tough I’m trying to accept the fact I cannot change him and need to stop being a doormat. In summary, I have obvious control issues, over-analyze everything, have anger that is uncontrollable if I don’t get what I want, and really need help to fix it.

Priorities are like dominos, and if you put the wrong one first, you lose your goals one by one. So, while this may look like a chaotic clusterfuck of issues, you probably already know that it’s actually a chain reaction caused by putting school behind this five-faced jerk.

After all, the main source of your strength is your desire to get stronger, pick up skills, and make a living, while the main source of weakness is, as usual for most people, your need for something/someone you can’t have.

Fortunately, you’re smart enough to recognize your effort to change your boyfriend is a compulsion that you just can’t stop, and you have the willpower and determination in your character to take on and pursue difficult goals.

Unfortunately, you’ve focused this strength on changing your boyfriend, thus throwing said smarts and willpower down the shitter.

In addition, you expect to control your school performance and your relationship without bowing to the fact that you don’t have the time or energy for everything, but your school performance won’t improve unless you have more time for it, and your boyfriend, well, we covered that.

Besides, you can’t “conquer” someone; even actual conquerors like Napoleon don’t die happy (or even with their genitals intact).

When you give yourself a reasonable assignment, your control demon helps you do a great job. If you don’t put a limit on your self-assignment, your demon will eat you alive. It’s a tough reality to accept, but if you can—not just admit that you can’t change your boyfriend, but find the strength to stop trying—you can give yourself an assignment you can do, and do well.

You’ll probably do better in school if you stop blaming and scaring yourself, because that can’t do wonders for your ability to focus. Instead, don’t be ashamed to look for help, either from a nice, positive tutor or a study group, and prepare a new study plan that helps you with your weaknesses.

No problem, you’ll have the time, because there’s no reason to continue wasting it with your boyfriend. This is probably not the answer that you want, but it’s the only acceptable one since succeeding in school means more to you (and is more tenable) than putting up with quintface.

Inside, it may feel like a defeat to let him go, but once you do, all the other, better goals in your life will have room to grow. You just need to stay vigilant about your priorities, because it’s amazing how easily a compulsive person can make them all fall down again.

STATEMENT:
“I feel like a total, helpless loser, but my priority is to put my energy into getting ahead, and not into relationships that don’t work. I can’t conquer my boyfriend, but my compulsion can’t conquer me. I’ve learned a valuable, painful lesson that can help me move forward if I stop criticizing myself and start doing what I need to do.”

I had a terrific boyfriend, whom my parents loved, but I just couldn’t see us staying together all our lives, and my feelings for him weren’t as positive as what I see my parents’ having for one another (they have a wonderful marriage). So I left him and broke his heart, and now I’m dating someone I feel closer to, because I think he understands me better. We’re going very slowly, however, because I’m afraid of making the same mistake, and I want to see if I still feel the same way about him in another year. He’s getting impatient, and I wonder if you think I’m right to go slow.

I suppose the traditional reason for going slow in a relationship is to see how you really feel about someone as time goes by. Still, that won’t do you much good if you happen to really love him a lot, and he’s a useless jerk.

Yes, it would be nice if you could find someone you love as much as your mom and dad love one another; but many good partnerships are not totally lovey-dovey, and good partners are hard to find. Begin then with the important stuff and consider perfect harmony as the icing on the cake, rather than the filling.

So, instead of hooking yourself up to a love-meter and graphing your progress as time goes by, tthink about the basic qualities you’re looking for. Again, priorities are key, but if a relationship is your main goal, then looking for the right things in a relationship is what you need to be mindful of.

The important stuff that makes a prospective partner eligible for consideration, as you know, begins with a solid character, reliability, common values, and mutual acceptance. He’s got to be able to do his share and share your mission, without your having to change or persuade him. Otherwise, it’s a no-go.

Yes, positive chemistry is necessary, but it can also be dangerous; the guy who connects with you most is not necessarily a solid character, and often the exact opposite. So take your eyes off the love meter long enough to do your due diligence.

If your guy checks out as a good prospect, but the emotional fit is not quite as perfect as your parents’, think carefully about how many good guys you’ve run across and how much mileage you have left on your dating tires before deciding whether he’s worth the compromise.

Don’t wait for the love-meter to make your decision for you while you pick mental daisy petals to see whether you love him or love him not. Add up the reasons you trust him to be good company in hard times, and prepare for a possible compromise.

Yes, you may cry a tear for the loss of romantic dreams; but you’ll have far fewer tears in the future, when the stakes are much higher. As we always say, if you want unconditional love, get a pet. If you want a partner, get your priorities straight.

STATEMENT:
“I don’t want to break another guy’s heart because I don’t love him enough, but t won’t let my worries stop me from checking out his basic strengths and deciding whether we have the makings of a good partnership. When it’s time to decide, I’ll use my wisdom and experience rather than measuring my love against my parents’ romance.”

I trust that my sister will be a fair executrix for my father’s will, but I often feel out of the communication loop because she’s closer to my other sister, and I’m often the last to know about her decisions. When I’ve shared my feelings about this in the past, she’s just gotten testy. Recently, I wondered why his will had not put in a special bequest for my daughter, because he’d once expressed that intention, so I asked my sister whether she could get hold of an earlier will and see whether the bequest had been there before and then taken out. She blew up at me about how I didn’t trust her, and couldn’t see why it was such a big deal. My goal is to get her to see that my request was legitimate and to keep me informed.

Nothing has more potential to damage a family dynamic—not a long car trip, adultery, a coming out here or there—like a dispute over a will.

If somebody feels screwed, cheated, or in any way shortchanged, blood ties will get bloody.

Luckily, you trust your sister, so that eliminates the most common source of conflict. Unfortunately, you’re now creating conflict in an extremely fragile situation where it doesn’t need to exist.

When it comes to wills, you have broader goals than getting inside the loop or having your feelings understood. For one thing, you can’t get inside the loop; it’s an old loop, and if you’re not inside by now, just trying to get into it will turn it into a noose.

For another, you haven’t stopped to ask yourself whether there’s any point in being inside the loop. If your sisters are closer with one another than with you, then so be it. Even if you don’t have a loop of your own, theirs doesn’t seem so inviting.

Ultimately, it’s more important for you to consider what your goals should be at the time of your father’s death. It’s natural for the pain of his loss, or impending loss, to make both you and your sisters testy. Given how the situation is an emotional landmine, choose your priorities carefully.

Unless you’re mercenary, which I assume you’re not, a few dollars doesn’t matter. And, however much you were deprived of love by one family member or another, your bigger interest now is in keeping things peaceful. If you need love, get a dog, and if you’re still desperate for that loop, take up crochet. If you want to keep your life free from sib-wars that will enrich lawyers and therapists and cause years of pain, however, your goal is to keep the peace (and keep your mouth shut) while helping your sister settle the estate.

Accept the fact that your father’s death may leave you with feelings of emptiness and perhaps resentment at decisions that should have been made differently. Death forces acceptance, or else, and acceptance is necessary if you’re going to pick up the mantle of leadership and help your family survive this trial intact.

STATEMENT:
“In addition to mourning my father, I can’t get over the feeling that I’ve been unfairly pushed aside in my family. I’m confident, however, that I haven’t deserved such treatment and my job, therefore, is not to react to family feelings, but to take pride in my own identity and make the best of a transition that passes leadership and responsibility to me and my sisters.”

I love my husband and he’s a great father, but I can’t stand the way he wants to mess with our house. It’s an architectural masterpiece that got left to me by my parents, along with their collection of old American antiques, and I want to pass them on intact to the next generation. My husband doesn’t have the same reverence for the place that I do, and wants to put in some of his own furniture and repaint rooms that really don’t need it. I want him to be comfortable but I’m not going to get rid of beautiful antiques or waste money on repainting rooms that were recently painted. My goal is to get him to understand how I feel about the place and to back off of unreasonable demands.

It’s hard to accommodate two loves, your home and your family, without someone taking it personally. It’s like a strange love triangle between you, your husband, and interior design.

So long before you get to talk about specific compromises, your husband is going to resent playing second fiddle to a sofa and you’re going to feel he doesn’t care enough about you to support your love of architecture and your family’s traditions.

Try to fight those feelings by presenting the problem less personally. Sure, it’s normal to feel under-loved and misunderstood, but that discussion will go nowhere, as you already know, and communication on that theme is a bad idea.

Instead, ask your husband for a list of specific changes that would allow him to feel at home. If you can’t stand listening to his ideas, and are too likely to blurt out your opposition, then ask a decorator to serve as your intermediary/mediator. As any decorator would tell you, their real job is often family therapy.

If you like, make a list of what is most important for you to preserve, and then sit down when you’re not feeling too tired or stressed and take a look at your husband’s ideas. Don’t think of them as demands or impositions or threats to the family legacy, just ideas. And while you’re at it, cost out the alternative of living separately. Some people can afford such arrangements, and the exercise gives you a concrete Plan B instead of an unthinkable insult.

Or you can pass your priorities, together with your husband’s, to the designated decorator/family therapist and charge him/her with the job of preparing compromises that might allow both of you to feel at home. At least, if that doesn’t work, you would both hate the decorator.

Remember, people can love one another very much and still not find a way to be at home with one another. In retrospect, that would become a key criteria for you in any future partner search, as it should be for everyone. One reason you move in together is to find out whether you can both feel at home in the same (historic) house.

STATEMENT:
“I can’t help feeling my love for my husband threatens my tie to the old family home, but I’ll try to keep my fears and needs in check, and my mouth closed, while I try to find a compromise. Then I’ll know I’ve done my best.”

Please Note: The next new post will be 11/28, after American Thanksgiving.

My husband and I get along better since I left with our daughter to start a new job in a nearby town, and he is usually polite when he comes for his weekend visits (he sleeps on the couch). He’s a devoted father, but sometimes, when he’s in a bad mood, he gets as nasty as ever and calls me a loser and a wimp who can’t keep things clean or make much money, and I’m back with the old feeling of not being able to do anything right. I suppose I should shut the fuck up, because anything I say just sets him off and gets our daughter upset. My goal is to keep my feelings to myself and keep the peace.

It’s hard to tell nasty criticism from the valid kind if you already tend to get down on yourself for not getting much done. Then again, it’s hard to get much done when you have a kid and an ex-husband who’s always criticizing you.

What you seem to be taking issue with is how unfair your ex’s judgments are, as if you’re agreeing with him that you’re a loser, but you wish he’d be less harsh. The real problem, however, is that, without carefully applying your own standards, you’re allowing yourself to take his judgments seriously in the first place.

If you’re afraid of his reaction to your disagreement, you could say that staying quiet is a way of keeping the peace, and that peacemakers are blessed. It doesn’t seem blessed, however, to absorb nastiness indefinitely unless you can explain to yourself and your daughter why it’s necessary.

Otherwise, it actually make you a wimp, and it encourages him to be a bully, and while you can’t get double divorced, you can shut his criticism down without absorbing it.

After all, you’re no longer stuck with him and with doing nothing. You’re working during the weekdays and being a single parent, so you may be tired and have little to show for it at the end of the week. Still, you’re independent and accomplishing difficult and important goals, and you’d be foolish not to respect yourself, regardless of what your inner voice, or your husband, has to say about it.

Without getting mad, you can tell your ex-husband that you’re satisfied with how you run your life and don’t want his comments; if he insists on sharing, you insist on his leaving. It’s not hard to do if you believe you have a right (and he doesn’t), and it’s easier to feel you have a right if you’ve thought it through and don’t get into a fight.

You may never feel great about what you’re doing, given that you’re poor, tired, and have a critical ex who gives you a regular earful. Look objectively at the good things you’re doing, however, and you can stand up to those self-critical feelings and challenge anyone who echoes them. It’s time to recognize who the real loser is in this scenario.

STATEMENT:
“I may never feel like a winner, but I’m doing two tough and worthwhile jobs in working and raising a child, and I now have the right and opportunity to veto negative topics my husband would like to share. I will let him know that, if he escalates, he goes.”

I get enough done when I have a full-time job to go to—I’m motivated, show up on time, and keep up with my work—but since I’ve been unemployed I can’t seem to keep moving. I get up late, scan the internet, play some games, and go back to bed. It’s depressing, and the more depressed I get, the less I do. I’m turning into a total loser. How do I kick myself into action?

Lots of people need structure to keep moving; at school, you’ve got bells, attendance, and homework. At work you got a time-clock and a boss who will notice if you no-show or don’t get your work done. As such, structure’s basically a fancy word for having other people force good habits upon you so you don’t have to worry about them yourself.

When people don’t have structure, they have trouble getting things done. Some people, of course, are very good at staying energetic and knocking off their priorities in a disciplined way. And then there’s the rest of us.

Of course, when people don’t get much done they see themselves as lazy; with all that time on one’s hands, there doesn’t seem to be an excuse for accomplishing nothing. It’s the same tone we use to chide ourselves for making a careless mistake or eating too much pie. The negative criticism usually makes escape more attractive/leads to yet more pie.

If you’re ashamed of your low productivity, you may hide it by diverting energy into appearing busy and inventing a cover-up to explain what you haven’t done. The less you do, the more it becomes a secret. When the secret comes out, you’re more likely to be chided for laziness, the more you’ll want to hide again.

Don’t sink into that rut. Instead, treat your problem as important and respectable, and become your own boss or principal. Wage a campaign to be structured, whether you like it or not, to the degree to which you can get your employee/self to go along with you.

Start with a job description that keeps you busy and attends to priorities, i.e., what work you need to accomplish everyday until real work comes along. It should have enough time for hygiene, exercise, work, and friends. Not perfect, but good enough.

Look for help wherever you can get it. You may need help in putting together a schedule, or appreciate a call or a visit from a friend to watch you do something you said you’d do but wouldn’t do if there wasn’t somebody watching.

If you ask friends to help out, they’ll appreciate the chance to be helpful and will respect your struggle to bring your inner sludge under control. You’ll find lots of them have the same problem, so you can create a structure for each other until you’re back in a cubicle without so much cursed free time.

STATEMENT:
“I feel lazy and incompetent when I realize I can’t get much done when no one is watching but I realize that good people are often unable to control bad habits, so I’m determined to bear the shame and take advantage of every trick I can to get where I need to go.”

When my wife is feeling fine, she’s a reasonable, hard-working, dedicated woman who believes in helping others, but then she gets into this grim, obsessed mood and knocks herself out and then gets mad about how people don’t respect or appreciate her and she just doesn’t care any more. Yesterday, she told the boss she didn’t care if he fired her, because she didn’t care. If he fired her, it would damage a career she really cares about and, besides, we need the money, but when I tried to tell her she needed to shut up, she told me she didn’t care about our marriage or about living any longer, particularly if I didn’t support her. What do I do to stop her from hurting herself?

As we’ve said before, there are a lot of people out there who either don’t believe in mental illness, or do believe it exists but don’t really understand what it is. The former usually believe in Xenu, the latter are baffled by “Hoarders.”

Either way, the easiest way to explain mental illness to those types is to describe the disease as a demon, and yes, it’s a sad fact that people are quicker to understand satanic possession over an actual illness, but such is the biz.

As for your wife, some good people get into very black, destructive moods that are hard to describe, even though most of us have felt it at some time in our lives. It’s the kind of mood when you’re ready to cut off your nose to spite your face (and then turn to a loved one, telling them they made you do it and you hope they’re satisfied).

Those good people have the demon, and, if it’s bad enough, it’s a kind of mental illness that can be sudden, random, and completely out of their hands.

Some people are more vulnerable to those moods because they’re particularly sensitive or perfectionistic; they forget their own priorities and lose themselves in doing a good job or caring for others or making someone else happy. If they can’t succeed, they get exhausted and flip out. It’s worse in the afternoon, or when they’re tired and haven’t eaten.

If you send them to their room, they’ll trash it, beginning with whatever they value most, to show you how little they care and how bad they feel—this is the cutting-off-your-nose business described above. There’s not much you can do to help someone who’s sick/possessed in this way except to try not to not make it worse.

Start with not trying to confront her; otherwise you’ll just become a target and foil for her negative emotions. Instead, let her know you appreciate her hard work, know how upset she is and share the feeling that life can suck. Offer her some hot chocolate and/or a foot massage.

Then tell her you support her quitting, but you want her to do it when she’s feeling better and can do it properly. If she hates you for saying that, tell her you’re happy to give her some alone time and take a walk. Then hope you come home to an intact living room.

Later is when you’ll discover whether she’s the kind of relatively normal demon-possessed person who has perspective most of the time and wants to work with you and/or a therapist to gain better self-control, or whether she’s a permanent victim who can’t get past her anger and is sure you’re responsible for it.

In the shrink trade, we call that kind of person a “bad borderline” or “severe character disorder.” We can’t help them, because that demon/disorder problem started when they were young, took over, and convinced them it’s always someone else’s fault.

From what you said, however, she’s got values and priorities that aren’t totally reactive to her anger, most of the time, and she doesn’t always blame it on you or the boss, so there are lots of things she can do to strengthen her rage-management. Medication sometimes helps, but in my experience, what always helps is “DBT”, a behavioral treatment that is a lot like AA, as explained in the book Skills Training Manual for Treating Borderline Personality Disorder, by Marsha Linehan.

Read what you can, talk to experts, whatever it takes to help you understand what’s going on. If you can see her illness as something she can’t help instead of Biblically evil or self-indulgent, you will feel less obliged to stop her attacks and better able to suggest management tools for keeping her demon/disease under control.

STATEMENT:
“I hate watching my wife self-destruct when she’s tired and enraged, but there’s only so much I can do without making it worse. I know the problem isn’t me and I’m sure it’s here to stay, so I’ll encourage her to work on managing it, particularly when she’s feeling better.”

My wife gets paranoid sometimes, in spite of the fact that, after every episode, she agrees she won’t let it happen again. She promises she’ll see her therapist and take her medication but then, for some reason, she decides the side-effects are unbearable and stops them without telling anyone. A couple weeks later, she tells me she can’t stand living with me and moves out. She also tells me they’re plotting against her at work and planting microphones in her desk and she’s going to go to her boss and, by the way, she thinks her psychiatrist has been talking with him about her so she won’t see him any more. She gets loony, and she sort-of knows it when she’s her usual self, but not when the madness is on her. My goal is to get through to her and prevent her from losing her job or leaving me for good.

Paranoia is hard to prepare for or prevent; it’s one of those disorders that makes you wish that it came with a rash or ache, because some very sane-looking people have paranoid ideas that are very plausible until you realize they’re talking about the aliens, FBI and/or Virgin Mary.

It sounds like your wife keeps her paranoia buried well enough for her to be a good partner most of the time, so treat her that way, despite the weird fears lurking behind her eyeballs. She’s a regular person whose “possessed” brain is whispering bad things in the background which you and she know aren’t real and aren’t her.

Of course, your feelings about the matter are strong–her relapses put you through hell—but if you push or infantilize her, you may trigger the paranoia, and you’ll be the target. So keep your intense feelings to yourself while making it easy for her to take her medications and see her shrink.

Have a plan B for the times when she loses it, so that you don’t lose it yourself; the calmer you are, the better you’ll be able to help her. Prepare yourself for the bad times when you have to go against all your spousal instincts and back off.

As you know from the times when she’s taking her meds, they’re not a cure and, so far, nothing prevents relapses. There’s no reason, however, to think that the relapses will get worse; and at some point, treatments will get better.

When relapses occur, however, don’t blame her or yourself. Treasure the times you have together when she’s herself and hope that her crazy spells will be brief and leave her career and relationships relatively undamaged.

Being a borderline and being paranoid are two very different things, but the rules for caring bystanders is the same; if you can’t avoid the illness, just do your best not to be a target.

STATEMENT:
“It’s awful to have my wife’s personality taken over by someone who fundamentally mistrusts me, but I know it’s not personal and we’re a good team when she’s herself. I can’t protect her, but I know the difference between her and her paranoia and maybe that knowledge will help her find her way home.”

Is the habit of procrastination a reality that cannot be changed, or not? I often find myself procrastinating so long that something I feel I want to do or should be doing is no longer possible to do. Then I feel terrible about myself and berate myself. Should I give up those dreams/things I want to do or should I plug on and do the best I can, hoping that I can overcome procrastination enough to actually accomplish a few things?

Berating yourself whenever any bad habit gets the better of you can make you feel weak, angry, hopeless, etc. The one thing it can’t do is make that habit go away.

On the plus side, your frustration shows that you care about doing better, but self-blame leaves you feeling weak, angry, hopeless, etc., which makes it harder for you to get out of your chair and start catching up.

While logic dictates that finding the source of a problem will lead you to the solution, trying to find out why you procrastinate doesn’t usually help. For one (deliciously ironic) thing, it gives you a reason to avoid doing what you need to do.

Sure, you can tell yourself you’re working on the problem and that you’ll get going when you finally feel more energetic. Unfortunately, figuring things out doesn’t usually give you that energy, just insight, and insight won’t get your ass in gear.

It could be that many people procrastinate because their brains aren’t very good at self-starting, even when they’re quite motivated; look at how many people run out of gas after they retire, with no schedule or manager to tell them what to do and when to do it. Most of us rely on our families, financial pressures, and work obligations to give us structure.

So you can try to find where your bad habits started, or you can accept that procrastination is like over-eating, over-drinking, or any number of guilt-inducing behaviors; it’s remarkably common, you assume you should be able to control it, and yet it’s remarkably hard to control. Then again, if it was so easy to control, there wouldn’t be such a remarkable number of people with the same problem.

Admitting that you’ve got the problem and accepting the fact that you’re stuck with it is probably the first step (as in AA) to recovery. Once you’ve stopped waiting until you feel better and realize you’ve got to work with what you’ve got, you’re sufficiently desperate to shove aside your shame and ask for help. At that point, you will discover lots of other nice people with the same problem, some of whom are willing to offer you help and guidance. They’ll help you get over insight and get practical.

Otherwise, there are a few simple things you can do to work around your problem, like asking a friend to come over and watch you get a specific job done. S/he doesn’t have to nag or provide direct help; just by standing around, expecting you to start working, and not being distracting, s/he may have given you the necessary structure.

If you think procrastination is a big enough problem, ‘fess up and go to work on it. It won’t be easy, and you won’t always get the better of it, but you will gain the confidence that comes with knowing you’re doing the best with what you’ve got. So, first and foremost, don’t blame yourself and don’t give up. And don’t keep putting off following this advice.

STATEMENT:
“I hate myself for not keeping my commitments, but there’s no point in kicking myself for a weakness I can’t control. I may not have the strength to overcome it without losing my pride, but I will take pride in shaming myself if that’s what’s necessary to get stronger.”

I don’t see why my wife doesn’t try harder to recover from her stroke. It’s been 3 years since she was paralyzed and she made an almost perfect recovery. She’s got back all her old intelligence, wit and charm. Her balance is off, but, with the help of a good physiotherapist, she’s recovered the strength in her legs. What bugs me is that she likes to stay in her room and do very little. She’s not depressed, but she won’t do her exercises and her legs are starting to lose their strength. She’s happy as a clam as long as she doesn’t have to leave her room except to go to the bathroom. She’s nasty with me, because I keep on pushing her to get up and come down stairs. I don’t know what’s happened to her motivation or why she’s irritable. My goal is to help her recover and get our old life back.

We all know the way recovery from a debilitating injury is supposed to work, at least according to stage and screen; a strong, determined physiotherapist or friend or partner imposes a positive regimen of activity and exercise, refuses to take no for an answer, demonstrates results, and restores a patient’s hope and confidence. Everyone walks away with their lives feeling affirmed, roll credits.

This expectation can cause a shitload of trouble, however, if a patient’s brain injury damages their ability to motivate and organize themselves. Yes, it can happen, and often does, and when it does the patient gets blamed for being a quitter. Family relationships turn ugly and everyone feels like a loser. That’s the dangerous, feel-bad side effect of physiotherapy.

Yes, it’s possible that your wife is depressed or phobic, and that a structured behavioral program, and maybe some medication, could help her get over the hump. You describe her, however, as happy to veg in her room and untroubled by her limited mobility, so I suspect that, after 3 years, she’s not going to budge or agree to a tougher rehabilitative program with a psychiatric evaluation. She is who she is, and it’s not who she used to be.

If you want to improve your relationship and restore the old camaraderie, give up on your other dreams. You can’t have them, and you can’t blame her for not living up to them. You can still encourage her to walk, but don’t expect a hike. Enjoy the part of her personality that returned, mourn the part that didn’t, and keep your sorrow to yourself.

Strokes are horrible–you lose a precious part of someone you love–but you can’t show your sadness, because you’re trying to make them feel good about what they’ve recovered. Recovery is a two-way street; she’s got to try to get back to her old self, and you have to learn to accept her new self.

As a good and loyal husband, accept your loss, turn in your certificate as a rehab trainer, and enjoy spending time with the person she’s become. In real life, an outcome that’s less-than-miraculous can still be a happy ending.

STATEMENT:
“I miss the part of my wife, and life, that I lost to her stroke, and I hate giving up, but I’m proud of what I’ve done to help her recover and I think she’s done her best, given the changes in her brain that hold her back. I will show that pride when we’re together, while becoming more independent about the parts of my life she can no longer share.”