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 diagnosed with major depressive disorder and anorexia nervosa purging type a few years ago. Both of these issues had pretty much consumed my life during the years leading up to that diagnosis and have continued to be impairing ever since. I started cutting myself two years ago (it has become more frequent this past year), and I’ve had several panic attacks in the past several months. Fortunately, my overwhelming desire to commit suicide has subsided, although I still think of suicide and my death in general fairly often. In addition to my own issues, I have watched my mom slip into a state of psychosis during the past two years, triggered by the death of her father. She has become so depressed, delusional, and violent that my parents separated and sometimes I don’t even feel safe staying in the house with her—a few weeks ago my dad and I had to stop her from going through with a suicide attempt. The police were called, and I had to hold her arms down while she was clearly in a psychotic rage. At one point, she tried to stab my hand to make me let go. She was taken to a mental health facility where she stayed for a week, and now she’s furious at us for making her go there and hasn’t been much better since then. I feel like I never get anywhere with therapists because they just prescribe medicines that make me feel numb to any emotions or focus on my eating disorder so much that I never get to work through these other issues. I feel like my life is unraveling and it’s gotten so bad that, honestly, I don’t feel like I even want to fix it. My goal in telling you this is to figure out a way to help my mom and how to get through school while I’m dealing with this.

It may seem strange to hear this, for someone who suffers as much as you do from depression, anorexia, and the burdens of taking care of a very sick mother, but I think you’re doing an amazing job.

Yes, you’re chin-deep in shit, but you haven’t drowned, and that’s a remarkable accomplishment.

Your depression hasn’t made you hate people or blame them, and your anorexia hasn’t caused you to pretend you’re not sick, so you must have a solid hold on reality. There you are, with all your pain, finding the love to help your mother and the energy to go on with your studies. You’ve got good values and a big soul.

So you feel hopeless because treatment hasn’t done you much good, or, I should say, hasn’t done your symptoms much good. It sucks, but that’s the way it usually is when symptoms are as severe as yours. That doesn’t mean they won’t get better by themselves, or that a better treatment won’t come along. It does mean that, at least for the time being, you’re stuck with heavy-duty pain.

That’s not important, however, or at least not nearly as important as what you’re doing with that pain, which is, as I said, amazing, and there’s treatment that can help you distinguish between you and your symptoms. Any good cognitive treatment will help, whether it comes from a cognitive therapist, a good coach, or a friend with a positive attitude. One treatment that is aimed specifically at helping people with this much pain keep a positive attitude is Dialectic Behavioral Therapy, or DBT.

The inventor of this treatment, Marsha Linehan [link: https://www.nytimes.com/2011/06/23/health/23lives.html], suffered similar symptoms and, like you, managed to stay focused on the value of helping people and improving her own skills. She wound up inventing a kind of treatment that helps others do what she did for herself, and, like you, she found that helping others was a great way to keep her own demons in check.

It’s normal for you to feel that your life is unraveling, but trust me, it isn’t; your pain is a mess, but you’re doing a good job of bearing it and doing good things with it.

You are not your pain; you’re dealing with a lot of shit, but you are anything but. You’re the person who’s managing it while leading a good and meaningful life, and that’s not someone you should give up on.

STATEMENT:
“I may feel like a hopeless, deteriorating mess, but I love my mother and care about my education and I’m doing good things about both. I may not be able to stop my symptoms or save my mother, but life sucks and that’s not a personal failure. I haven’t let my symptoms stop me, however, and that’s why I’m doing well, even if my pain and my mother are doing badly.”

I have a great life and there’s nothing I care about more than my family, so I became really worried when, out of nowhere, I started to have horrible thoughts about murdering my children. I’m too ashamed to tell my husband. I’m not an angry person, and I love my kids and get along well with them, and I’ve never needed a shrink, but the thoughts keep me up at night. If there’s the slightest chance I could hurt my kids, I’ve got to do something about it, but I don’t know what to do. Please help.

Before you get crazy about having crazy, murderous thoughts, check out the risk factors for crazy murders. It’s not hard to do. What you’ll find out is that crazy murderers don’t just have intrusive murderous thoughts; they’re crazy as well.

By that, I mean they’re very detached, or they have strange ideas about their kids that they actually believe in, or they’re hearing voices, or going through extreme mood swings.

Ask yourself whether you fit the picture of people who really run amok. While I don’t know you, of course, my guess is that you don’t fit the picture at all, which means you run the same finite-but-small risk as your average Joe.

Trouble is, everyone who has intrusive, horrible thoughts without other symptoms of craziness is nevertheless terrified of losing control, so reassuring yourself is hard to do. What you want, of course, is total reassurance that the horrible thoughts will go away and that you’ll never, ever lose control; as you say, if there’s the slightest chance that you might hurt your family, you feel obliged to take definitive action. Unfortunately, you can’t. No one controls such thoughts, and trying to control them will just add to your helplessness.

Your goal then isn’t total reassurance or freedom from fear, but reasonable self-control and an ability to go ahead with your life in spite of fear. Assess the real risk you pose to your family and take steps to protect them if you think it’s necessary. Having done that (and realizing that your family is better off with you just the way you are, crazy thoughts and all), learn to bear your fear and go about your business, which isn’t easy to do.

If you want to tell your family about your symptoms, that’s the story you’d tell. You’ve got these crazy thoughts, but you’ve checked on the internet, and probably seen a shrink, and discovered you’re at no particular risk of doing harm, you’re just at risk of suffering from creepy thoughts. Reassure them that you have no intention of letting the crazy thoughts interfere with your normal activities and that, if you thought you were dangerous, you’d do whatever’s necessary to protect them.

As with the woman above, you are not your symptoms; a good mom can have crazy thoughts, and a great mom can carry on despite them.

STATEMENT:
“I feel like I’ve got crazy thoughts and might lose my mind but the truth is that I’ve checked out my symptoms and the part of my mind I’m losing is pretty small and insubstantial (although the process is scary and painful). Whether or not I can make my symptoms go away, I’m competent to manage them, keep everyone safe, and go on with my life, and that’s all I need to do.”

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.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I’m a 22-year-old who is coming out of a pretty rough emotional patch. I got into a bad habit of leaning on a male friend, being a complete needy, co-dependent mess with a guy who is a pretty heavy drinker and, you guessed it, a needy, co-dependent mess. Well. Now I’ve sobered up and tried to develop some space between us, and he’s not taking it well. He drunk-dials me at least once a week, and leaves these crazy, rambling, needy voicemails. (I moved away a while back, and he keeps pushing me to make plans to meet up.) I basically want to cut him out of my life altogether, because I really think he’s bad for me. But he was there for me—albeit in a f*cked up way—when I was a mess. Does dropping him make me a bitch?

There are two sides to every sin; for example, murder is evil while manslaughter is just really unfortunate. The same is true for good deeds, and fidelity, while less deadly (hopefully), works much the same way.

There’s a bad kind of fidelity based on feelings and a good one based on what you think is right. The bad one is a gut-level sense of obligation you feel towards anyone you’ve shared a bed or bread or booze with, who cries out to you in need and expects you to respond.

It’s some kind of basic nervous system bonding that disregards whether you’ve already done your share, whether the other guy can actually make use of your help (or will just need more and more), or whether you have a right to weigh his needs against other priorities, like finding a relationship with a guy who can occasionally walk in a straight line.

Now, if you were judging the conduct of a friend, you’d probably say that you’ve done all you can, but until he stops drinking, you can’t offer much more. He may see you as dumping him, but what you’re dumping is not him, but his alcoholism. You might like him better if he got a grip and got sober, but you won’t know unless he does.

However, since you’re not using the rational side of your mind, leaving him makes you feel like a bitch and you need someone to tell you you’re not. Instead, you’re getting someone who will tell you to think for yourself.

Don’t ask anyone else for that kind of reassurance, not even (or especially) over the internet. Learn to give it to yourself, because your values are fine. You could confidently advise a friend, so stand by what you know and give yourself the same advice you would give anyone else.

Yes, you’ll still feel like a bitch because feelings are feelings. If your goal is not to feel guilty, have a drink (which will eventually make you feel even more guilty, so you see our point).

On the other hand, if your goal is to be your own woman and give yourself the right to weigh moral priorities without having to please or appease, then suck it up and do what you think is right. Until he stops drinking, he’s dead weight to you, so drop away. If he picks himself up, then you can, too.

STATEMENT:
“I hate to feel like I’m causing pain to someone who has been good to me, but I’m tired of being manipulated by guilt and other people’s needs and I have a right to say “enough” when I’ve done my share and want to move on. I’ve learned how to stop drinking and I’m ready for the next level of sobriety, which is to tolerate the guilt of feeling responsible without giving into it.”

My mood is never great, but I’ve survived divorce (my wife decided she liked someone else) and been a responsible dad and I was looking forward to being a grandfather when my middle son, who’s never been too happy, told me our relationship sucked and he didn’t have much hope for it unless I went into therapy. He had some names of spiritual therapists and told me, if I was really serious about making our relationship better and becoming a good grandfather, I should see them. Of course, I’d do anything for our relationship, but this whole thing makes me feel depressed and paralyzed. What should I do if my goal is to hang on to my son?

Kids come first, but that doesn’t justify turning off your own judgment. Which is what you did the minute you heard the words “spiritual therapists” and didn’t giggle out loud.

You don’t have to read my advice (though it helps) to know that you’re not supposed to accept criticism uncritically; otherwise you’re handing out keys to your self-esteem to every overbearing and unhappy jackass you meet, whether or not they’re your spawn. You’re supposed to consider accusations carefully and decide for yourself whether there’s really something you could have and should have done better before deciding whether to apologize and take responsibility for doing better.

What may have hurt your son is something you don’t control, and that includes the personality that the good lord gave you. He may have grown up happier with another dad, but you may have been happier with another son, and we all might be happier with a prehensile tail. Too bad, life is hard, and the only question to ask yourself is whether you managed your faults as well as you could and took care of your son’s basic needs, including safety.

Let’s assume that, after considering his criticism, there’s something you want to improve. Then choose someone who you think can help you do the job; don’t accept your son’s recommendation because you want to please him or prove something, but because you think it’s a good idea.

Regardless of what you decide, there’s a lesson you can teach your son. It’s not just that you’re flexible or that, no matter what he thinks, you really love him; it’s that you have confidence in your love for him, regardless of what he thinks, and that you can have a positive relationship in spite of obvious and painful flaws that you would gladly remove if you could, but can’t. He can call it spiritual if he wants, but you’re calling it like it is.

STATEMENT:
“Nothing makes me feel more like a loser than having my kid tell me I was a bad dad, but I know I wasn’t that bad (I got better reviews from the other kids) and I’m not bad now. I’ll accept responsibility for mistakes I control; for the rest of it, I love him and think our lives will be better if we have a relationship, even if it requires us to bear some pain. The choice is his.”

Even in my 40s, I carry a lot of baggage/resentment from my upbringing. I was born in a foreign country and adopted by an older couple who had already raised two of their own kids before deciding to adopt. They were worn out, emotionally distant–my Mother suffered severe depression—so it was a quiet, lonely, and undirected childhood. I’ve since created what most days feels like a good life but working in a very competitive field, I feel like it can all be taken away from me in a flash (and, like most people since the economy collapsed, I’ve been laid off a number of times). I’ve always managed to find work, but I can’t help but think my shy and quiet demeanor has a lot to do with ending up on the chopping block; slipping through the cracks has been the recurring theme of my life. On some level I know I suffer from attachment disorder–connecting with others has always been a challenge and making idle chit-chat with co-workers and “bragging” about my accomplishments takes extreme effort—but moving forward I’d like to feel more connected to people I work with and form stronger relationships and friendships in my life. I think it would be good for my career and my overall being. How do I make that happen?

Before plumbing your personal history for the cause of your isolation, examining its impact on your resume, or trying to increase your degree of connectedness to other people, there’s a much simpler first step—asking yourself why you’re doing all this in the first place.

You’re not saying you’re lonely or that you wish to be closer to a particular friend or family member, just that, if you were more connected to others in a general, categorical way, you would be less disposable and less easily fired. That may be true.

On the other hand, you’re also saying that your lack of connectedness, like your mother’s lack of connection with you, represents a kind of failure that makes life less meaningful. That’s just plain false.

Yes, connection and emotionality can give life meaning, but love often turns to meanness and shallow sentimentality if it isn’t based on shared purpose and strength of character, and those who allow neediness, love or lust to run their social life often feel that everything is less worthwhile when things fall apart. (If you need examples, this site’s archives have plenty.)

On the other hand, your mother, whom you describe as depressed, worn out, and distant, may have achieved something meaningful in adopting you. No, neither you nor she experienced a sense of happiness or intimacy and, if those are your main criteria for judging worth, then her parenting was a failure from which you haven’t been able to recover.

What she did do, however, in spite of depression, aloofness, and fatigue, was give you safety, stability, and a chance to grow, and you clearly did a lot of growing, acquired substantial skills, and developed a good work ethic.

I assume you could, in some way, count on her, and, given your background and start in life, that’s a big deal. As parenting goes, distant isn’t good, but unreliable is much worse, and that’s worth acknowledging. It’s also possible that there was love on both sides that neither of you was good at recognizing, either in yourself or the other. You both may have achieved more than you realize.

Don’t then assume then that the connectedness of small talk and easily flowing feelings is the only or best way to be. As Star Trek’s Spock demonstrated more than a few times (and in alternate realities), even the emotionally aloof can create meaningful bonds by spending more time with someone, gathering information necessary to translate feelings into their own terms, and learning to express whatever is important.

As far as work goes, you don’t need to feel obliged to joke around or share feelings at the water cooler. Find projects that will allow you to work with people you respect, become a good listener, and keep a database on what’s important to them and interesting to you. When Spock says “Fascinating!” he means it, even if he doesn’t get the joke or join in the camaraderie.

Don’t try to be chatty or regard yourself as a failure if you’re shy and like solitude. Give yourself the right to choose the importance of relationships in your life and then go about building them, using the strengths you have and not torturing yourself.

This is an instance where space, at least the one that exists between you and others, need not be the final frontier.

STATEMENT:
“I may feel marginal because I’m shy and don’t attach easily to others, but that hasn’t prevented me from achieving independence or doing good things with my life. If I respect my own strengths, and choose relationship goals that are meaningful to me, I can find my own ways of achieving them.”

When I got home from vacation recently, I felt guilty about fending off a dinner invitation with a nice but obnoxious cousin and wrote him an email suggesting I’d missed his calls because I’d been away, and I was now very busy catching up, was sorry to have missed him, but would phone when I had a chance. Alas, he has phoned daily since and has an unerring ability to call when I’m just going out the door or sitting down to dinner, etc. He is also an extremely difficult person to get off the phone, failing to grasp concepts like “I must go now.” I thought perhaps I could write him to tell him of my unfortunate agoraphobia and chronic laryngitis, but I’m sure Dr. Lastname can provide nicer advice about reaching my goal of avoiding contact with boring relatives. Honest to God, he phones at least once a day. And nothing gets rid of him. Except you?

It’s a sad truth that some people yearn for closeness (see above) while others crave distance, but that’s the fun nature of the human condition. It’s not clear what your cousin wants aside from a (boring, endless) dinner, but as much as you want to avoid that, you should first determine what’s best in the long run.

There’s no reason to feel guilty about disliking a friendly cousin who lacks social skills. Feelings are feelings, and just as they may draw you to someone who’s a charismatic asshole, they may also drive you away from a decent bore. Which is to say, sometimes your feelings have their upside, just not for your cousin.

It’s natural, too, to be amused by the oblivious blindness of the socially impaired, irritated when it pushes them to intrude into your territory, and perhaps guilty about your negative response to a friendly overture (complete with four symphonic movements and an encore before the first intermission). What you don’t want, however, is to let irritation or guilt control your response.

Decide how much contact you feel obliged to have with a cousin you don’t really like, thinking generically and in terms of policy, procedure, and consequences. Factor in any debts, moral or otherwise, that you owe him or his parents.

Remember that, apart from the displeasure of his company, you may gain satisfaction and meaning from meeting occasionally, sharing memories about old times, and swapping information about relatives you seldom see. Decide for yourself whether this activity gives you a broader sense of where you come from, who you are, and the community you belong to—even when it’s boring.

Don’t feel obliged to hurt feelings in order to make him go away; patience and inventiveness, which you obviously possess, can do the job. Without lying, you can tell him you’re engaged in a number of solitary projects, often don’t answer the phone or respond to friends for long periods of time, and refuse to give details (which, given your cousin’s lack of perception, probably won’t be asked for anyway).

Assure yourself that you can control the duration of any conversation, as long as you give yourself the right to do so, and that you need never fear drowning in his persistent attention.

Don’t expect him to get the message—he just doesn’t get that kind of message. That means, however, that he’s also unlikely to be offended by your unending excuses for not responding to his calls, or your methods for shortening their duration when you allow them to happen. You can keep your distance without being cruel, even if he can’t take a hint.

STATEMENT:
“I may feel guilty and irritated by my cousin’s calls and wish I could get a restraining order, but I make my own decisions about sustaining family connections and I will stick to my own rules, regardless.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I can’t seem to recover from my wife’s infidelity. Six months ago, when I found out, it nearly destroyed me. I stopped sleeping, and started eating compulsively, and felt depressed and anxious all day. I have a demanding job and we have a 2-year-old son and I simply had to keep going. Now, after months of couples therapy and my wife’s promising to stop drinking and then starting up again, I’ve gotten strangely detached. I don’t think our marriage is going to make it and, on some level, I don’t care. I can’t lose the 20 pounds I gained, I don’t exercise the way I used to, and I can’t seem to get my confidence or happiness back. What more should I be doing?

I want to take this opportunity to congratulate you, not for losing a horrible spouse (that seems both insensitive and obvious), but for becoming a fat, lazy mope. Most people consider “letting themselves go” to be a bad thing, but in this instance, it’s a positive side-effect of recovery at work.

After all, the best measurement of how well you’ve recovered from trauma is not how good you feel. This Sunday marks a rather grim anniversary for many Americans, and after 10 years, some of those people still hurt, and some of those in pain are also in shape. Trauma doesn’t factor into it.

Depending on the trauma and what it means to you, there may be no way to feel good for aa long, long time, no matter what you say or do. What counts is how well you cope with it, and coping well doesn’t necessarily make you feel good or hit the treadmill.

For instance, you’re telling me that you’ve continued to co-manage a growing business and parent a 2-year-old boy despite a severe emotional shock. At any size, that’s amazing. You’ve also accepted the fact that your wife has resumed drinking and is unlikely to get control of other behavior. It’s sad, but you’re not obsessing about what you did wrong or what you should do to change her.

This is the kind of pain you need to have. Not that you deserve it, but life sucks, and it’s far better than the pain that would come with denial, holding on to what you can’t have, or assuming responsibility for things you don’t control.

Indeed, the fact that your weight and appearance come last is also a strength. You’re absolutely right in acting like what comes first is parenting your son, making a living, and accepting what happened. Dieting should never be your top priority.

Exercising would help if you have time for it, but there are times when you don’t, and shouldn’t, have time for it. When the chaos subsides a bit, you can renew your gym membership. For now, be proud that you’ve got your priorities straight, even if you feel rotten and sluggish and look large.

You’ve done the right thing under difficult circumstances for both yourself and your son, so stop mourning how far you’ve let yourself go and instead admire how far you’ve come.

STATEMENT:
“My heart remains broken and I don’t have the energy I used to have, but I’m doing what really needs to be done and I’m realistic about my options, so I know I’m doing the right thing, even if I feel far from confident about myself and life in general.”

I’ve think I’ve gotten over my last boyfriend, but my friends tell me I still need help. They know that my ex had a fidelity problem and a way of borrowing money from me and not paying it back, but I didn’t tell them about how worried I was that the loan sharks would hurt him (and I knew he wanted to pay me back), so it was more complicated than my friends realized. In any case, I eventually realized he was getting money from someone else and, when I confronted him, he said he couldn’t stand my nagging and that he needed someone who would give him more respect. I was shattered, but I’m OK now, and I don’t know why my friends don’t believe in my recovery.

Once again, the point of getting over a bad relationship isn’t to feel better; as nice as it would be, your top priority in “getting over” something isn’t to land in the sweet valley of bliss (and weight loss). Instead, you get through it in order to learn what went wrong so you can do better next time or, at least, figure out whether there was any way you could have seen the bad stuff coming.

If you feel better without learning something, you won’t feel better for long; there’s always more trouble coming, and no valley in sight.

Don’t try to forget him before first trying to remember what went wrong and searching for warning signs. No matter how shocking a boyfriend’s bad behavior can seem, most guys who have fidelity problems don’t develop them the moment they meet you. They’ve had them for a long time and the behavior problem isn’t invisible if you know where to look (and aren’t blinded entirely by the good feelings that come with a budding romance).

Usually, it’s just a matter of asking straightforward questions about past relationships and getting corroboration from friends and family—the same methods a dumb cop would use. Ask yourself whether your love of romance caused you to turn off not just your inner detective, but your brain entirely.

Trying to protect loved ones from behavior they show no signs of stopping is another red flag, announcing that you have a weakness for your own nurturing instincts. It’s a good thing to protect babies and children, and a terrible idea to protect grown babies from behavior that can take you both down. I suppose he doesn’t see himself as having a problem, and that’s his cross to bear. That you also don’t see it is a big problem for you, and that’s what worries your friends.

Of course, there are smooth-talking-but-bad boyfriends whom no one can see coming—those polished psychopaths who fool everyone because they believe in their own lies and are good at hiding their pasts. If your inquest doesn’t uncover that kind of nutjob, then you have less to worry about, because you didn’t make any mistake other than to have bad luck.

So before you insist he’s in the rearview and you’re feeling great, figure out exactly what you’re putting behind you; do your homework, figure out what went wrong, and then it’s OK to forget about him. As the old saying goes, you don’t know where you’re going until you know where you’ve been. If you push through the pain and figure out what your last relationship was really about, you’ll be able to go forward without getting over quite so much.

STATEMENT:
“I’d prefer to put the past behind me, particularly because I’m much more attractive and fun to be with when I’m feeling happy, but I’ve learned more from my mistakes than from the relationships that went well, and I take pride in being a good learner.”