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.”

I was sexually abused quite a bit by my dad (and am de-repressing memories right now, fun-fun). I am realizing that I am very fearful of the people I love, and avoid them. Honestly, if I didn’t need to bond to keep from going insane, I would never have a close relationship, because anyone I care about enough can destroy me. But I’m in a lot of pain from loneliness as it is.

Many people believe there are tons of benefits to confronting your past, namely that it will teach you something that will bring catharsis to your present. The common notion being that if you can figure out what went wrong then you can avoid being victimized again.

The problem here is that reviving memories of sexual abuse by your dad will also bring back the old feelings of helplessness and having no choice, which, of course, is the opposite of your situation as an adult, so the lessons are the opposite of useful to your life now.

You’re not examining the past to drown yourself in feelings of helplessness, but to assure yourself that you can protect yourself from abuse.

Also, as an adult, your love for your dad may leave you with a dangerous sense of comfort and familiarity with low-boundary, exploitative sleazebags. In other words, your dad may have given you a tendency to be drawn to people who aren’t trustworthy, and who are worth being fearful of. I’m sure there are people in your life who aren’t scumbags, but your history makes you especially vulnerable to them.

It’s hardly surprising then that your world, as you see it as an adult, will seem full of both loneliness and dangerous people who can’t be trusted. Don’t criticize yourself then for being fearful of relationships or lonely; fear is a good protector, until you get strong enough to protect yourself.

So, as you examine your past, a therapist’s support for your pain and trauma may not be enough to counterbalance an ingrained conviction of helplessness. You may need an additional shield against that conviction before awakening the sleeping dragon of your memories.

One way to get stronger is to approach your past with less feeling and more thought. Develop specific standards for screening potential friends and lovers and use them to override any instincts to get together with, or over-involved with, the wrong people. In other words, if you want to remember your father’s worst traits, look for those traits in people before you decide whether or not they’re worthy of your friendship. Once you convince yourself that you’re a reasonably good self-protector, you can approach your memories with less fear of being swept away.

Find a therapist who’s a good relationship coach, or a therapy group whose members have some wisdom with difficult or exploitative relationships. Don’t force yourself to re-experience memories of abuse until you know how you’d manage it as an adult.

Don’t assume, because you’re fearful of the ones you love, that you’re bad at relationships or that they’ll turn out badly. You’re right, relationships are potentially dangerous, but your awareness of that fact and willingness to get some coaching and training can protect you and eventually help you find friends and lovers who deserve your trust.

Learning from/dealing with the past can be helpful, but beware of the risks, particularly if you (and a therapist) focus exclusively on painful emotions for which you still haven’t developed defenses.

If you want to look back, don’t lose sight of your present ability to spot and avoid guys like dear old dad; then you can learn from and use your memories, instead of being haunted by them.

STATEMENT:
“Because of the past, I may never feel secure about relationships. Once I learn how to detect abuse and avoid abusers, however, I can find friends I can trust, even if my fears remain.”

My friends can’t stand my girlfriend because they say she steals from me to feed her habit, but we’ve been together for 3 years and I can’t help feeling she’s the best friend I have. It’s true, she has a drug habit that she can’t control, and money sometimes disappears from my wallet, but it’s an illness and it’s no good to blame her for it. It doesn’t change the fact that we love one another. Aside from her habit, I know I can trust her. I truly believe our love is a positive factor in helping keep her habit from getting worse. My goal is to help her, of course, while getting my friends to see that she’s a real person, not a drug addict.

Relationships can always be dangerous if you focus too much on the other person’s feelings, or your own, without stopping to think about your other priorities in life. She might make you feel like a hero, feel like you’re a healing saint, feel guilty if you can’t do what she asks, etc. If you focus on that instead of whether or not this relationship is ruining your life, you’re doing it wrong. The more sweet, sensitive and generous your temperament, the worse your peril.

The opposite of caring too much for someone isn’t, of course, to be selfish; it’s to be responsible for your other goals, the ones that arise from your values, interests, and other obligations, including your job to take good care of yourself. You need money for your own education or rainy day fund or, simply, survival during hard times. You deserve to be loved for more than your ability to give.

Go back to basics and think about your own standards for a good relationship, as if you were advising a friend. Yes, you’d say, you need love and good chemistry, but you also need someone who can cover your back, take care of things when you’re disabled, help you on your way, and work well with you in a crisis. You’d have to agree that, without those standards, you’ll team up with someone who can suck you dry and undermine your stability in a very unstable world.

Love is a drug and it can addict and ruin your life and other relationships in a way that puts meth to shame. That’s why, rather than getting into a discussion of how wonderful it feels, you’d urge your friend to think about what he wants a relationship for and how it will help him do what matters.

Forget about what your friends think and put aside your desire to help your girlfriend; instead, focus on what you want to make of your own life and trying to be a good person in a crazy world. Remember who you are and then see where this relationship fits. You’re not a saint, you’re a boyfriend, and if you want to do what’s best for both of you, you won’t even be that much longer.

STATEMENT:
“I love my girlfriend and want to save her from drug addiction and I don’t mind her faults, but what comes first are my own standards for being a strong and self-reliant person that are not dependent on any one person’s love or approval.”

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.”

I have struggled and do struggle with mental illness. I am 29-years-old and live in my parent’s house with my 2-year-old. Although I have been in school and have worked a few jobs, I can’t seem to stay on one path once I’ve made a decision. I have a very difficult time making decisions, whether they are big decisions or small ones, and once I do finally make a decision I often drive myself crazy changing my mind a billion times. I break up with my boyfriend every few weeks because I’m doubting my decision of being with him, then I turn around and try to mend it because I’m doubting my decision about breaking up. I booked a trip and spent the whole two weeks prior wondering whether I should go, worrying about something bad possibly happening. I struggled right up until the morning of my flight, almost cancelling and not going to the airport 15 minutes before boarding time. This problem has contributed to ruining relationships in my life and I’m very tired of dealing with it. Why am I constantly plagued with indecisiveness and how can I cope?

Your were right the first time; what’s bothering you isn’t indecisiveness, it’s mental illness. That’s one of the many conclusions you don’t have to second guess.

It’s mental illness that makes you unthink everything you think; if it were indecisiveness, it would arise more from a wish to avoid decisions or uncertainty about what you want. Your problem seems more like a mental tic that obsesses you with doubts and alternatives every time you make a plan.

What’s clear is that you’ve tried to lead a life. You’ve gone to school and tried jobs, in spite of the agony you experience about every decision. You break up with your boyfriend, but you also try to keep relationships going. Every day your head is abuzz with doubts, but you don’t seem to give up.

No one knows why you have such a curse, or why anyone has mental illness. Maybe you have an excessive amount of a gene that normally causes reasonable self-doubt and helps people survive. Enough of that gene, and you’re the tribal leader; too much of it, and you’re a nervous wreck.

No one knows what causes illnesses like these, and there’s probably no single cause, but one thing is sure, and that’s that you haven’t caused this and don’t control it. Despite that, you’re doing good things to manage it. You’re letting your parents help and you’re committed to raising a child. You’re living a full life, even if it’s a painful one.

Don’t let your doubts persuade you that you’re defective. You’re afflicted, but you’re moving ahead, and every day that you manage to do some chores, be a good friend and mother, and look for work if you can, you’re overcoming your affliction.

As you probably know, medications sometimes reduce self-doubtful ruminations. The only way you’ll know for sure is by trying them, if you haven’t already, and being patient during the process. Another major way of managing this kind of torment is to fight the negative thoughts of self-doubt by developing a positive perspective and philosophy. Your ruminations will characterize you as a failure, and you need to find ways to fight back.

For now, keep living your life and developing your management skills. Treatment can make you a stronger manager, but in the meantime, be proud of what you’re doing to keep the mental turmoil from ruining your day to day activities and relationships. You might doubt your choices, but you have no reason to doubt yourself.

STATEMENT:
“I feel paralyzed by indecision and guilty about my inability to commit, but I have little control over this mental flip-flop tic and there’s nothing wrong with my wish to hold a job, stick to a decision, and be a good friend. I’ll keep on fighting for my values, look for ways to manage my ruminations, and respect myself for living a full life in spite of the way they sometimes cripple me.”

I’d like to leave my last marriage behind, but my ex won’t let go. She was the one who was always unhappy with me, but when I finally left, she said I had abused and abandoned her. She quickly found a new boyfriend to move in with her, but if she heard I was dating (from my next-door neighbor, whom she quizzes), she’d tell me she wouldn’t send the kids over if there was any chance that my friend was sleeping over. She changes visitation at the last minute just to see if I’ll react and threatens to go to court if I don’t like it. What can I do to get her to stop?

Obsessive love is creepy and destructive, as anyone with a casual knowledge of Lifetime movies can tell you. Maybe all love can cause obsessive thoughts, but some people lack either the will power to control what they do or the perspective to see what they’re doing or both. Then you (and your pets, family, bunnies, etc.) are in trouble.

Fighting and arguing with an intense ex makes things worse. Showing intense emotion of any kind gives her that connection she craves. If you show her you’re upset, you’re showing her how to get you next time.

Of course it drives you crazy; she’s upsetting the kids and portraying you as a villain, not to mention distorting the facts, spreading lies, and breaking agreements. You have every reason to be worried, enraged, and fearful for the kids—and even more reason to keep your feelings to yourself.

Pull out your poker face and put it on. If you have experience dealing with unhappy customers or clients, now’s the time to use it. You must respond whenever necessary, of course, and that will usually involve threats to visitation or major intrusions on your privacy. Your response, however, must not show fear or anger. It must express confidence in your ability to stop her if and when you think that time has come.

Your goal, of course, is not to win a contest or humiliate your ex. Her obsession is like a demon that has devoured her, so even though she can’t help it, her demon-controlled mind will fight to the death. Your job is to avoid feeding it and build a protective wall around your emotions and activities that it can’t get through.

Yes, you were married to a demon and now you aren’t. That’s the good part. Unfortunately, exorcism and revenge fantasies are for movies. What you’ve got to do requires patience, time, restraint, and courage. And maybe better movie channels.

STATEMENT:
“Although my ex-wife often makes me feel helpless and unhappy, I know that she’s nuts and can’t help it. I used to think that divorce or mediation or time or reason would help, but they haven’t. Now I have to use the careful techniques of a demon-whisperer to disconnect her from my life and make sure that her bad behavior doesn’t pay off.”

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.”

My best friend and I got together after 9 years of friendship. A couple of years before we got together, I was with a guy that my best friend absolutely hates and also works quite closely with. My friend and I love each other immensely, but after only six months it was all over and done with; his trust and jealousy issues got the better of him in our relationship even though there was no basis for it, and he called it off as he knows that won’t change about himself. While he loves me, he wants us to be in each other’s lives forever so broke it off. I thought it was something we could work on so never really gave up hope that he would return. We finally had a proper talk about all of it, however, and now I get that he is never coming back to me, but I still don’t know how to reconcile that. How can he give up on himself and his chance of love, and how do I stop beating myself up over the guilt I feel for being with that previous guy, when all that goes through my head is that had I not done that, we could still be together? I feel like I ruined what could have been the best thing in my life and don’t really know how to move on, especially when all I want is for him to have a main role in my life. How do I separate my friendship and feelings? How do I stop hating myself for what I’ve done?

Many people hate themselves whenever something goes wrong, picking apart everything they might have done different, from bringing an umbrella to not swinging on a pitch that was down in the dirt.

As long as you don’t think too hard, there’s no difference between could have and should have, leaving you with heaps of regret (along with ruined shoes and/or play-off chances).

Trouble is, the only way to defend your self-respect when things go wrong is to ask yourself whether you did your best and then believe in the answer. Otherwise, you’ve given yourself total responsibility for all bad things, which is pretty unfair (as unfair as having your “best friend” be jealous of a guy you dated years ago).

If you accept total responsibility for all sorrows, you also have no way of judging anyone else’s contribution; by deciding that you’re the one who fucked up/the one guilty party, you give any offending assholes involved a clean record and lose your ability to defend against them.

If you look back at the situation with a clearer head, you’ll see that a lot of what went wrong wasn’t just someone else’s fault, but completely out of your control. After all, you can wish you’d brought an umbrella, but you can’t beat yourself up for making it rain in the first place.

So stop giving yourself grief for losing your “one true love” and apply your own standards of right and wrong. By your standards, there was nothing wrong with your brief relationship with the guy Mr. True-love happens to hate, and there was no reason you could think of why, two years later, he should still get jealous enough to throw away the good thing you had going.

Instead of giving yourself a hard time, ask yourself whether intense jealousy that appears for no reason is likely to go away, and what it’s like to live with someone who’s jealous and suspicious and feels entitled to make it your problem. In other words, consider not just the circumstances for what caused things to fall apart, or how painful it feels, but the actual value of what was lost.

Relationships don’t need love as much as trust; if he couldn’t bring it to the table from the get-go, you’re biggest mistake was letting feelings instead of thinking guide you forward. You’re doing the same now, but you can separate your friendship from your pain if you can see your ex as the flawed, less-than-ideal partner that he is and adjust your expectations of him accordingly. It’s not a painless process, but it’s necessary if you want to stop torturing yourself, which is more painful (and much more useless) in the long run.

You wouldn’t punish a kid for doing nothing wrong: don’t do it to yourself. Be a fair judge, and, while it’s true, you’ll never cure your ex-beloved’s jealousy or win him back, you’ll treat yourself fairly and protect yourself from taking responsibility for your ex’s dark side.

When you learn to see the red flags, you’ll stop blaming and start crediting yourself for the preparation it takes to avoid heartbreak, rain, a fastball, or anything else.

STATEMENT:
“I can’t help missing the love we had, but I know that, for some people, jealousy is a curse that can’t be controlled and it’s impossible to live with. Next time, no matter how nice he is, if a guy tells me that jealousy has destroyed his relationships, I’ll stay away.”

I don’t know how to keep my daughter out of trouble, particularly since she doesn’t want help. She’s always flown into rages whenever she’s frustrated, and it got worse as she got older. She has learning disabilities, so she was often frustrated, and I feel for her, but the worst part is that she blames everyone else and thinks she has a right to hit anyone who deserves it, meaning anyone who makes her angry or “disrespects her” or “causes drama.” Now, at age 21, she’s living with me and I’m afraid she’ll even hurt me if I make those mistakes. She sees a therapist because her parole officer insisted, but she says nothing and it’s doing no good. I’m afraid for both of us. What should I do?

During the early years of childhood, parents assume that when their child has a tantrum, it’s their responsibility to calm them down, deliver the desired relief, and accept an apology or contrite behavior afterwards. Every now and then, especially beyond puberty, however, that’s not a safe assumption.

Ask yourself whether your daughter feels sorry about hurting people, especially you, or whether she wants to avoid getting into trouble. If the answers are no, and they seem to be, you can’t keep on thinking of her as an unfortunate kid who needs something you haven’t yet been able to provide. Thinking that way gives you responsibility for something you don’t control and forces you to keep your door open when it may be dangerous for both of you.

You’re not responsible for her rages or for housing her if you’re afraid of her; you’re responsible for helping her control her rages if, and only if, she agrees to try and you and she are reasonably safe.

Give her information about where she can stay if you can’t let her stay with you, and don’t be ruled by fear or guilt if she refuses your recommendations and threatens to hurt herself if you send her out the door. Your safety and hers may depend on her believing that she leaves when you say so, with or without a police escort.

Then write a contract of basically acceptable behavior, making it clear than any basically unacceptable behavior will require here to leave your home, at least for a day or two. The basic no-no’s should include not backing off when you tell her it’s necessary, not contributing her share to the house, and not taking drugs if you think they’re dangerous for her.

As the parent, you know what’s necessary to keep your house safe and your daughter from doing anything destructive. Don’t expect her to understand; just to agree and follow through. The same argument you used when she was a toddler applies now; because you’re the mom, that’s why.

Her not getting better doesn’t make it your responsibility to do more, but rather to define the limits of acceptable behavior so that you don’t make an unsafe situation even more dangerous. Even if you can no longer soothe her, you can still give her a well-deserved time out.

STATEMENT:
“I feel for my daughter’s pain and anger and I know she has good reason for her feelings, but I can’t hold myself responsible for giving her self-control. I won’t let guilt or fear stop me from telling her that she can’t stay with me if that’s what I believe is necessary. In the end, I hope that will help her to straighten out.

I’m a quality inspector and recently had cause to turn in a worker after I caught him fudging his work in a way that made the workplace unsafe (I made a copy of his logbook before he could fake his report). Well, since then I’ve been getting the cold shoulder from his supervisor, who says I was mean to get him fired and trying to suck up to my boss, but the truth is, I think our quality has been slipping and this worker was cutting too many corners and needed to be fired (though it wasn’t my decision). It’s painful to be shunned by guys I’ve worked with for years, however, and I wonder, if they understood how upsetting and unfair it was, they might be persuaded to stop.

Despite the value put on employment by the current recession, a job is just a job. It might feel like a family, a career, a definition of your identity, a source for your self-esteem. In truth, it just keeps you in rent and car payments.

The real meaning of a job, then, is what you give to it. If you do what you think is a good day’s work, that’s where your pride and self-esteem should come from.

It shouldn’t come from what the boss or your co-workers say, or from any expectation that good work will be recognized or rewarded with approval, a raise, or security. You did the right thing, you’ve got reason to be proud, even if everyone else has a reason to give you shit.

If you try to change your co-workers’ feelings or explain your own, you’re accepting their definition of the problem and exposing yourself to more pain. Feelings are their idea of what’s important, particularly sympathy for the guy who got fired and fear for their own jobs.

Instead of worrying about how they think or what they feel, you’re more concerned about safety and quality and the bad things that will happen to everyone if those values are compromised. You’re right, they’re wrong, and their feelings, as ever, can go fuck themselves.

Of course it hurts to be shunned by people you’ve known a long time. Let them know, however, that you believe in the importance of doing a good, safe job and there’s no way of doing that job if you don’t face problems and fuck-ups when they occur. They’re free to think you were petty and mean; you think that, if their practices don’t change, everyone will be in trouble.

If they don’t respond positively and you see no sign of a change for the better, look for another job while respecting yourself for tolerating the pain of this one. You can’t change the economy, a bad boss, or corporate culture, but it takes a strong person to do a good job when the job sucks. At least it’s only a job.

STATEMENT:
“I value positive relationships at work but I believe that we can’t do good work unless we recognize bad work and do what’s necessary to improve it. I know when improvement is necessary, even if it causes pain and some of that pain is mine, and I’m proud to make it happen.”

I don’t know why I have the feeling I’m living a life meant for someone else. I love my wife, but she’s a normal person and totally unlike the people I grew up with, who were loony, unsettled, angry, and totally unreliable. Now we have a healthy baby, and the in-laws are available and supportive, and I feel like a visitor from another universe who has wound up in Ordinaryville. My wife knows how I feel and tells me it will pass, but I hate the feeling and think it’s telling me I’m leading an unreal life.

Sometimes, if you’ve had a troubled childhood, you feel authentic only when you’re dealing with shitheads and creeps that remind you of your dear ones. That’s a natural feeling, but you can never go home again, and maybe you shouldn’t if home was a shithole.

I assume it took a major effort and decisions based on sad experience for you to date a nice, normal girl, no matter how strange that made you feel. What’s remarkable is not that the relationship feels strange, but that you and she seem to be doing a good job of bridging the gap between your cultures.

You’ve found a way to let her know about your rocky background and the unexpected, undesirable feelings you contend with, and she accepts how you feel and doesn’t get hurt when she can’t make you happy and comfortable. That’s a big deal; a relationship like that has its own power to create a new world, gradually.

I also assume that you don’t feel your baby was forced on you or that your response to your in-laws is entirely phony and false. You can be you, it’s just not easy because your new world is unfamiliar and triggers sad comparisons that make you feel like a loser who perversely misses his old loser world filled with his lost loser tribe.

The good news is that you’re probably on the right track and your new life will eventually come to feel more solid and familiar. After all, it’s also the life you want for yourself and your family. The sad news is that the feeling of unfamiliarity and dislocation will probably not fade quickly and may always linger.

In effect, you’re an immigrant in a new country with a new language and you immigrated for good reason, but there’s a cost to being an immigrant that you never stop paying.

My guess is that you’ve done what’s necessary to put bad family relationships behind you and create a better life for you and your children. While the pain of your transition is long and unavoidable, you deserve great respect for what you’ve done; even though you were raised by a pack of losers, your current situation is a huge victory.

STATEMENT:
“I wish my new family relationships could feel easy, spontaneous, and natural and that I didn’t sometimes feel like a stranger in my own life, but I’m proud that they’re genuine and I can rely on them in a way I could never rely on my family as a kid. I may never feel like a natural in my new life, but that’s what makes it more of an achievement.”

I have a friend who has a history of being diagnosed with depression, self-mutilation and, recently, suicidal thoughts. She was forced to seek treatment with a counselor in HS (now 24-years-old) whom she said was no help, and now she says she won’t ever seek treatment again because it won’t help her. She acknowledges she has issues that need addressing, but she doesn’t believe in mental illness diagnoses, states she just needs to “deal” with it. However, all we talk about is how much she hates her life, hates feeling this way but isn’t willing to do anything about it. I’ve told her she’s an adult, and makes her own decisions and no one can force her to do anything, but I’ve been very honest with my concerns about her, and that she needs help. I don’t want to treat her with kid gloves or enable her but I also don’t know how much I can push her, since I know its her mental illness that’s clouding her view of the world/reality. How can I continue to be a good friend without beating my head into a wall and enabling her?

For many people, “help” and “cure” have become interchangeable words, as if good motivation and proper treatment will always make things better (tell that to the common cold).

Sadly, the help your friend needs, just like a cure for what ails her, may or may not exist, depending on her luck, the severity of her issues and whether she sees them as hers or just a reaction to other people.

Regardless of treatment, the normal course for severe problems like depression, eating disorder, and urges to hurt yourself are the same; off and on, for many years. There is certainly no cure, and very rarely can anyone provide the help to stop recurrence completely.

Don’t then assume that treatment would make your friend feel better if she were “willing to do something about it,” because, unfortunately, this might not be true. After all, she was willing to try something, and it simply failed to take.

Instead, find out what she knows about the various kinds of treatment available to her and what she thinks about their possible benefits and risks. If she lumps them all together as useless because the one didn’t work, you have good reason to warn her against the power of negative thinking when people are in pain and/or depressed.

If you can persuade her that depression-pumped negative thinking has clouded her judgment into fearing and avoiding options that are worth exploring, you’ve also provided her with some excellent cognitive therapy and shown her that she needs it—a beneficial trifecta. If not, you’ve shown yourself that she’s too negative to be logical, you’ve been as helpful as you can be, and you just can’t get penetrate her depressive pseudo-logic.

Never buy the idea, however, that you have to get better to get better. If she has, in actuality, exhausted all likely treatments and nevertheless keeps trying to work and be a good friend, respect what she’s doing, because that’s what beating an illness is all about.

It’s easy when treatment works, but the true heroes are the ones who keep on going when it doesn’t. If you’re there for her during that struggle, that’s the best kind of help there is.

STATEMENT:
“I hate to see my friend suffer and I’m worried that she could do herself serious harm, but I know that mental illness and negative thinking can brainwash good people and that help, from me or a professional, is not necessarily the answer. I will always insist that there is a hopeful way forward, but accept the fact that she may not agree and that argument is not helpful.”

I can’t stand the way I’ve become a disorganized idiot when I used to be incredibly good at juggling multiple responsibilities. I’m only 35-years-old and, while becoming a father has been stressful, it shouldn’t have destroyed my basic organizational abilities. Admittedly, I ‘ve been through a major depression or two, but I’m in a good mood now, I love my work, I’ve got a great wife, and my life isn’t a lot more complicated than it used to be. Nevertheless, I ruminate over tasks that go nowhere, get distracted before I get important things finished, forget my priorities and miss important meetings. I’m a mess, I’m an incompetent ditz, and I hate it. Medications haven’t helped so far, and neurological tests show nothing. There must be something that will give me back my competence.

If there was some way to restore your mojo, you probably would have found it by now, because you’ve had yourself evaluated and tested, and you’ve tried treatments and nothing has worked. In other words, here lies your mojo, may it rest in peace.

It’s sad, but I’ve seen this kind of acquired ditziness happen to people who’ve had a bad depression or two, as well as to people who’ve been concussed. Things may get better in the long run.

Meanwhile, a part of your brain has shut down, even though you feel normal in every other way and nothing shows up on an MRI. Only a voodoo doctor will notice the missing mojo, and your insurance won’t cover all the chicken blood that likely requires.

On the plus side, there’s lots you can do to help yourself if you stop trying to turn the clock back and substitute your old brain for the one you’ve now got. Yes, it’s humiliating, but so is a colonoscopy. Accept it, and you can keep yourself in the clear.

You can ask your wife and friends for help, take a course on organizational techniques, buy a to-do calendar book to write down priorities and create a schedule. You can also put alarms into your smartphone, and set up habits for checking your book, your messages, and your checkbook. Accept the need to learn simple, dumb-looking methods for doing things you used to accomplish intuitively, and you may be able to compensate 100% for your dysfunction.

Ambitious perfectionists fight this notion, because they want to control their lives in their heads. They get mad at themselves for losing control, then depressed, then more dysfunctional, and then more depressed. They also keep me from becoming unemployed.

Fighting your ambitious nature will not be easy, but remember, your goal isn’t to be who you were; it’s to be organized enough to make a living, run a family, and keep your life together, that’s all. The next step is to accept that what used to feel like “that’s all?” is now “that’s a lot.”

STATEMENT:
“I feel like a brain-damaged ex-whiz kid, but my real goals haven’t changed. If I can force myself to endure rehabilitation, and become competent enough to keep my major commitments, it will be the biggest achievement of my life so far.”

A year and a half ago, my ex-fiancé died suddenly from a heart attack. He was 38. We had broken up a year earlier, and it was a very messy break-up. He called my boss at work and told her I was trying to have her fired so I could steal her job, I walked away from most of my personal belongings when I moved out, and I walked away from my savings because we had a joint bank account. I went to the funeral and found out that while we were planning our wedding he was pursuing on-line long-distance relationships as well as inappropriate relationships with women in our city. A letter from one of the long-distance women was read out at the funeral. I can’t move past this. I have been dating a man for about 3 months now and he’s wonderful. I have a really hard time thinking positively, and every time we have an argument I think ‘worst case scenario’—that he will leave me. How can I think more positively?

First, begin with the idea that love is dangerous and some people are more vulnerable than others. We’ve called love a virus before, and sadly, your emotional immune system is impaired.

People love to say it’s important to “follow your heart,” but for people like you, that can be deadly; after all, those same people might say that “love is blind,” and when you’re helpless to love, following your blinded heart can lead you right off a cliff.

Maybe a vulnerability to love is a genetic trait that helps people stick together, like the way geese imprint on one another, and it’s a good survival trait under certain circumstances and in moderate doses. Without guidance from your common sense, however, love can overwhelm your ability to think positively, negatively, or at all.

To recover from a love that binds you so powerfully to someone who is nasty, unreliable, and destructive takes lots of time and it hurts. You’re already doing something helpful by dating someone who seems nice, so take it one step further by defining what you mean by nice and checking out whether he fits.

From now on, your definition should never depend on how strongly you love or feel close to someone, because you get love-sick so easily and so quickly that your instincts are shot.

So stop looking to your useless heart for directions and follow the facts. What you want to see is a good track record for reliability in relationships, work, and money management. Then you want to see good evidence that he accepts you when you’re down, prickly, and not terribly responsive. Finally, maybe, you can let yourself start to connect.

Keep working at it until you get it right, and don’t be afraid to ask your friends whether they agree with your findings. The more you practice, the better you’ll get, and the less reactive you’ll be to whether he makes you feel good or your fears make you feel bad.

Along the way, your pain may make you feel needy. Fortunately, however, it sounds like you’ve acquired a healthy sense of self-doubt and wariness and that’s the kind of negative thinking that, in moderation, can be healthy.

Being susceptible to love doesn’t mean there’s something wrong with you; just that the world contains bad people, that some are too easy to love, and you’re learning how to protect yourself.

If your heart’s judgment is going to fail you, then train your mind to pick up the slack. It’s not about becoming more positive; it’s about getting real.

STATEMENT:
“It’s hard to get over feelings of being broken, uncertain, and doomed after loving a psychopathic man, but I learned a lot, and my pain is there to warn me of danger. I will use my fear to think more logically about danger signs and how to spot them. I will remind myself that there are far worse things than being alone. I will become better at identifying people I can really trust.”

My sister keeps going out with the same kind of guy—attractive and sleazy—and, as you might expect, she gets her heart broken regularly. She’s a good kid and I try to tell her she needs to look for love in better places, but she insists that she sees good in these guys and knows what she’s doing. If I push too hard, she tells me I’m jealous of her happiness and unwilling to take the necessary risks to find a love of my own. I’ve learned to shut up, but my goal is to see her happy.

Sometimes love is 100% blinding, just like anger, sex, fear, etc., and getting in its way is useless. In your sister’s case, it isn’t love for a particular person, as in the case above; it’s love in general.

She wants to follow her heart and believes it’s a good thing, regardless of her bad experiences, which she probably rationalizes as something she did wrong. It’s hard to watch, but impossible to stop.

So don’t suffer and watch. Instead, wait until she recognizes that one of these guys is a jerk or that she’s lost something she values by spending time with them.

At that point, you can tell her you told her so, but not in terms of what she did wrong. As satisfying as that might be, sharing your frustration will make her feel bad and push her where you don’t want her to go: self-recrimination and the fantasy that things would go well if she did things right.

Instead, tell her that, as far as you can see, she’s been a great friend and partner to her boyfriends, but that you warned her that that particular jerky boyfriend was unworthy of her love. It’s not her you’re critical of, or her search for love, but the great number of attractive guys out there who can’t be good friends and partners.

Help her separate the idea of her performance from the pain of her loss. She’s not hurting because she fucked up, but because life is hard, her luck sucks (and so does her taste in men, but keep that to yourself).

Then, maybe, if she’s less defensive, she’ll buy into your procedures for screening out sleaze-buckets. Or maybe not, and you’ll just have to accept the fact that some people are fatally blind when it comes to love and the jerks that pretend to offer it.

STATEMENT:
“It’s no fun watching my sister fall for bad guys time and again, but good people sometimes have blind spots about love and blind spots about their blind spots, and I don’t know she’ll ever do better. If there’s a chance, I’ll help her. If not, I’ll try to have dinner with her when her guy isn’t around.”

My best friend drives me crazy and doesn’t give me room to breathe. She calls every night and wants to talk for at least half an hour, even when there’s nothing to talk about, but we’re adults, not high school kids. I work full-time and get home late, so she doesn’t expect us to get together during the week, but if I don’t want to see her on Saturday or Sunday she wants to know what I’m doing and acts hurt if I could have been doing it with her. We’re both over 40 and don’t get asked out much, but I’d like to develop a wider group of friends. Instead, I feel like I’m always on the defensive. The more irritated I get, the more careful I have to be about what I say, which just makes me sound more defensive. I’m trapped. My goal is to be myself with her.

Even though your friend sounds like the emotional Ike Turner, I’m sure she isn’t all bad; she might be good at offering support, or fun to hang out with, or talented with a guitar.

On the other hand, your friend is clingy by nature, over 21 and, if she hasn’t responded to comments about her clinginess so far, incapable of getting it. Remember, no matter how much she sounds like a jealous spouse, you and your friend aren’t married. It’s OK to ask yourself how much time you want to spend together, not just what’s best for Ike.

The point isn’t trying to be yourself, because that will just lead to a venting of poisonous feelings that will kill your friendship entirely. Instead, figure out what you want to do with her and how she fits in your life.

Don’t hold yourself responsible for feelings or expectations on her end that you haven’t encouraged or for debts you don’t owe, so regardless of what she feels or says, be OK with your own conscience when you put limits on your time together. Instead of defending your right to set limits or getting her to understand and approve, just set limits, and do it as if you have a right.

If she pushes, tell her you’re tired and get off the phone. Let her know you’re busy on Saturday and you don’t always like to talk about what you’re doing. If she pushes again, tell her it’s not a secret, you just don’t like to talk about it.

Don’t be blackmailed by guilt or fear; you can’t be guilty if you’re treating her as you would want to be treated, and you can’t be afraid of losing the relationship, because if she breaks it off, then you’re better off with loneliness than bondage, and you’re strong enough to suck it up.

What’s most likely is that, after huffing and puffing and looking for a reaction and seeing that it’s getting her nowhere, she’ll accept your terms and have a good time. If not, then you’ll have to accept the friendship divorce, but if Tina’s any indication, you’ll do better solo, anyway.

STATEMENT:
“I’m careful not to abuse my friendships so there’s no reason I should feel guilty about my best friend’s neediness or let it force me to be closer to her than I want to be. I’ll be firm and friendly about the way I want to do things and, if that doesn’t work for her, too bad. There are worse things than being lonely.”

My wife doesn’t interact all that much with me since her last stay in the loony bin. She doesn’t hear voices anymore and she can answer questions appropriately, but all she wants to do is read and watch television, and not interact with anyone. She tried a volunteer job but stopped going. She’s not interested in working and I can’t imagine that she would stick with it. She wants me around but also wants to stay in the other room and doesn’t enjoy interacting. Thank goodness we don’t have kids. I’m out every day working to support us. I married her for sickness and health and I take my vows seriously, but we’re in our early thirties and I see my whole life consumed by keeping her company while she watches TV. My goal is to figure out how to shake this feeling of being trapped.

If we lived in a world where total devotion to the people you love always did a lot of good, then it would always be a good thing. That would also be a world where no one got sick.

Unfortunately, illnesses happen that don’t get better in response to love and devotion—some people with psychiatric illness get worse—and that’s when love and devotion can do lots of harm, both to the would-be protector and his or her other dependents and relations.

The thoughtful wedding vow should bind you to stand by your spouse if it will substantially help his or her well-being or the success of what you’re trying to build together, which is usually a family. If, however, something happens that limits the amount of good you can do or that endangers your other obligations, then you have to make a decision.

That’s another way of saying it’s not right to stick with an out-of-control spouse if it endangers you or the kids, whether the problem is violent behavior, compulsive spending or hyper-sexuality. Your goal isn’t to be the very model of devotion, but to manage competing obligations, including one to yourself.

Ask yourself how much good you’re doing for your wife, given the damage her illness has done to her ability to have a relationship with you. If the main thing she gets from you is a benign presence in the next room, she may get as much from someone else, including a health aide.

You’re the one who must judge how much your partnership is costing you in terms of your other goals and relationships, then decide how much good it’s doing. If your roles were reversed and you were the one whose ability to relate were damaged by incurable illness, ask yourself what you would expect your wife to do.

Don’t do what looks right or feels good; do some moral heavy lifting by examining the competing obligations and prepare to feel bad no matter what you do. If you consider all your obligations and weigh your devotion to your wife in terms of necessity, i.e., how much good it does and how much it costs you, then whatever you decide will feel more like a choice and less like a trap.

Unlike the pair above, you did take vows, but the circumstances of those vows have changed. Now you have to decide whether being there for her in her sickness is actually healthy for either one of you.

STATEMENT:
“I will always honor my commitment to my wife, but I acknowledge that life can prevent that commitment from having a positive effect, and that it’s my job, if that happens, to give priority to what does the most good or prevents the most harm.”