I decided recently to listen to my friends and family and see a psychiatrist about my depression, but I don’t know whether I’ve made the wrong decision, or whether I’ve just chosen the wrong doctor. Basically, I decided to get help because I feel helpless, but my doctor wants me to do a lot of the work myself and doesn’t really help that much. It’s not just he wants me to ask myself a lot of questions (and answer them—if I had the answers, would I really be paying him?—but also deal with my insurance company and read up on the medication he suggests (he tells me about them, sure, but he says I owe it to myself to read up on them on my own, and that doesn’t make sense to me since he’s a doctor, knows everything about the pills, and he could just tell me himself). My goal is to figure out whether therapy is worth it, or whether I’m just getting help from the wrong source.

I hate to sound like your psychiatrist, but ask yourself what you have a right to expect from treatment, given what you know about its limits and your resources for paying for it.

If you want, you can spin things positively by saying that you’ve heard about good new treatments that can really help and that you’ve got great insurance that you pay a ton of money for. Of course, you’d probably be full of shit.

You don’t need to do months of research to know that no treatment has yet been acclaimed as a cure for mental illness or any other life- or personality-related problem.

Plus nothing you’ve read (or probably haven’t bothered to read) about the effectiveness of any current treatment implies that it works 100 percent of the time or that the treatment, if medical, is safe from possible side effects.

In addition, every method of “screening” for depression that you’ve heard about involves a questionnaire, right, rather than a blood test or scanning machine, which means that the burden for enduring, measuring and tracking the results of a trial of treatment falls, inevitably, on you the patient. And those are unfortunate facts of life whether you’re rich or poor, smart or stupid, board certified or not.

That’s the next problem: you’re not rich. And while you bristle at having to deal with insurance limits, you can’t afford insurance that would give you unlimited mental health treatment because it doesn’t exist. All insurance puts a limit of some kind on the amount of treatment you get and, unless you know what that limit is, you’ll use up your resources too quickly and have no idea about what, if anything, entitles you to more.

In addition, insurance limits your doctor’s fees and the amount of time s/he can afford to spend on a visit, so don’t fall for the professional who is ultra-amiable until your money runs out. Instead, look for someone who gives you what you most need in as little time as possible. In other words, beware smiles and frills because they may drain your limited resources.

Depressed people like yourself also tend to get negative and helpless ideas, which make them act negatively and passively, which makes them yet more depressed. That’s why mental health clinicians will push you to challenge your negative assumptions, learn more positive ways of thinking about your problems, and put the breaks on the depressive cycle.

It’s a cognitive kind of psychotherapy and is very helpful, although it’s often unpleasant in the beginning because you need to clamp down on your natural instincts. It’s a mental workout to make your non-depressive muscles stronger. No pain, no gain.

So yes, therapy of all kinds can be worth it, but you’ll be the one doing much of the work, not because someone else is slacking, but because mental illness sucks and both treatment and the resources to pay for it require careful management—by you.

Now you just have to decide what’s harder—doing the work or doing nothing. It might not be what you want to hear, but there’s no psychiatrist out there with a better offer.

STATEMENT:
Here’s a statement to keep you positive about a negative treatment process. “It’s hard having an incurable illness and knowing that the treatments are iffy, take a long time, and can easily use up my insurance before helping me, but I owe it to myself to give every reasonable treatment a try and become and good resource manager because that’s what I have to do.”

I’ve been in therapy for five years, and while I like my therapist a lot, I’m moving soon (my girlfriend got into grad school on the west coast), so I’m ending my treatment with her. She asked me recently though whether I was going to continue my treatment in my new town or whether I thought I’d taken it far enough, and I realized I honestly don’t know. She had some suggestions in terms of determining when and why to end therapy, but to be honest, they didn’t really help. I’ve been in therapy long enough that I don’t really remember how I coped beforehand, and while I feel much less tormented than I did when I began therapy, I’m not sure if my state of mind will crumble once I’m no longer getting help. How do you think one can determine when therapy has run its course, or whether there’s more to be done?

There’s a simple way to figure out how much talking psychotherapy you need: imagine paying full fee for it.

Before you crunch the numbers, ask yourself why you started therapy in the first place. Forget self-improvement, introspection, or generally pondering your bellybutton. Figure out what’s so bad about the way you feel and/or handle your life that you need to continue to spend lots of time and money on changing it.

Having failed to solve your problems over the past 5 years, you should wonder whether you can realistically expect a cure in the next year (no way) or whether you need maintenance treatment to keep you from slipping backwards (which is what you’ve been wondering all along).

At the same time, go back to the original question and ask yourself how much you can afford to spend on treatment each year and whether you should hold a few sessions in reserve for use in emergencies.

Unless you’re rich, don’t waste time worrying about how stopping treatment will make you feel. Instead, try stopping and see what happens. Even if you miss your therapist’s support, lose confidence, and re-experience your nervous stammer, suck it up, give it time, and the earth will continue to turn.

Next, think of therapy as a course that’s supposed to give you a specific marketable skill in exchange for your hard-earned debt. Don’t think like a college kid; you’re not there to party, please your parents, or become cool. If the first few sessions don’t deliver what you need, drop the class.

If you do have ample insurance coverage for therapy, don’t let it make you forget basic resource management skills. For one thing, many insurance policies are stiffening the limits on outpatient psychotherapies and are about to force you to do the above.

For another, being an active manager protects you from unnecessary dependence and time-wasting. Give your therapy specific goals, then examine how close to those goals you’ve come.

If therapy is more about discussion, then save the insurance hassle and start a search for a fun hairdresser. You can get your hour of talk and never have a bad hair day.

STATEMENT:
Here’s a statement that keeps you focused on making the best of limited resources instead of going for all-you-can-eat and then feeling deprived and abandoned. “I like psychotherapy and feel it’s been good for me, but it’s time, before it eats up more time and/or money, to think hard about how badly I need it, how well it’s working, how much is necessary, and how much I can afford to pay for it. The more I answer these questions for myself, the less likely I am to depend on experts to tell me what I need.”

I am a divorced 26-year-old (I have been divorced for almost 5 years). My marriage was a toxic abusive relationship. Regardless of that, I feel “happy,” I have realistic career goals, a loving family and boyfriend. Everything adds up, but I feel as though my happiness is a mirage. I’m happy with everything and everyone but myself. I just never add up to what I feel I should be or can be, especially when it comes to the number on my bathroom scale. I feel as though I will never be thin enough. I know it is unnatural to feel this way, being that I’m thin for my height, but I worry I am spinning on the edge most days looking at nutrition labels and focusing on the number of the day. How can I over come this mind game? Why did it bloom so late after my divorce? Is it even from my divorce or was this monster seeded a long time ago?

Most people aren’t happy with the way they look or how much they weigh, and all people spend at least a little time each day being unhappy, but many still manage to live normal, albeit slight chubby/grumpy lives.

As to the source of your insecurities, your guess is as good as mine and the many other scientists, clinicians, and desperate-for-a-topic writers who explain this phenomenon. It could be your ex, or it could reading too much Cosmo.

These experts assume, for the most part, that you wouldn’t be so self-critical if you didn’t listen to magazines, celebrities, or your critical-yet-well-meaning grandmother, and just believed in your self. They tell you that self-esteem will conquer all. Of course, they’re wrong.

There’s lots of evidence that self-hating body thoughts can happen to people with perfectly good self-esteem, nice families, and normal bodies. Instead of obsessing about why you feel this way the same way you obsess over calorie counts, stop and ask yourself, first, whether these thoughts are doing you much harm.

I know they’re causing you pain, but ask yourself whether they’re affecting your health or relationships. Right or wrong, you can think you need to lose a few without hiding major parts of your personalities and or being a bad friend or parent.

If you think your body-hate isn’t doing too much harm, try ignoring it. Certain kinds of psychotherapy may help, but watch out if you find yourself becoming more self-obsessed and blaming yourself for not getting better. The mark of good psychotherapy, like good coaching, is that it gives you ideas and motivation for managing a problem without increasing your expectations of control.

If body-hate is hurting your health or relationships—if you purge, have become anemic, or acquired any number of the dire symptoms that come with an eating disorder—assemble a treatment team, including a primary care physician, a psychiatrist and dietitian, and don’t hesitate to put yourself into an around-the-clock “eat-your-food” camp if it’s necessary. It can save your life.

In any case, don’t pin your hopes and self-esteem on self-control, or self-hating thoughts will just get worse. If you make it your job to keep trying and regard the illness as you would the weather, it can’t touch your sense of who you are.

You need never see yourself as a food nut or anorectic; you’re simply a person with eating issues, which puts you in the same camp as 90% of the population. You might feel like shit, but you are truly not alone.

STATEMENT:
“There’s nothing wrong with my values or approach to life, and I’ve managed to build a good life, except for one problem. I have an obsession about food and weight that sometimes drives me crazy. I don’t know that I can stop it, but I will always do whatever is necessary to keep it from ruining my health and relationships.”

I feel horrible about this, but ever since my husband gained weight, I find myself feeling much less attracted to him. Neither one of us has ever been super-models, but after 10 years of marriage, I’ve managed to keep my weight from getting out of control and he hasn’t. I tell him he should eat less because of his health, and he makes a half-assed effort, but the truth is, I also just hate his body like this. I’d never tell him that though because he’d be heartbroken and I’d feel like such a jerk. I’d never leave him over this (we have a family), but not having sex is putting a strain on our relationship, which makes being together so much harder. How can I want to be with him if he keeps letting himself go?

The fact that we spend billions of dollars improving and preserving our sexual attractiveness should be a clear indicator that we have absolutely no control over it.

Specifically, we don’t control what aging does to our bodies or how we respond to those changes, in ourselves and others. That’s probably one of the best reasons for not making a big deal out of it; the more we try to control it, the more it tortures us when we can’t.

Many think over-eating should be more controllable than aging, but to those people I say, try keeping your weight down while making a living, raising a family, and living in the golden age of Oreo Cakesters.

Even if you achieve your ideal body weight, you know how easily stress, sorrow and even inattention can open the door on your bad old habits. As Bush II discovered, there’s nothing more demoralising than declaring victory when you’ve temporarily got the upper hand on a problem that is never going to go away.

Even if weight control is easy for you, you know that it’s not easy for most people, like your husband, regardless of how much they worry about it. Worrying makes us hungry, as does reading about one more diet that does no better than old diets if you measure progress after a year or two. So, as much as you miss the old sexual attraction and worry about your husband’s health, don’t get obsessed with the “would-have, should have” of weight control. Blaming him isn’t fair, and will make the problem much more personal.

We’ve had lots of laughs at the expense of those idiot Victorians who advised women who didn’t like sex to “lie back and do it for England.” Sadly, it seems like there was great wisdom in that advice, particularly when you care about your partner and you’ve run out of other options.

First, though, don’t let guilt over your own negative sexual response—or anger at his “letting himself go”—prevent you from exploring those other options. Your husband probably wants to lose weight, if for no other reason than to improve his health. With his agreement, explore all the ways you can create “structure”—incentives and habits— in your daily home routine that will encourage exercise and caloric restraint.

Without letting yourself become a calorie Nazi, (which, for most of us, would be a worse sex-killer than growing a lady-beard), see if you can shape your menu, pantry contents, and exercise schedule.

If nothing works, fall back on your marriage vows. The reason you make vows is not because you’re fickle and likely to change your mind about your partner, but because life is hard and will eventually take the things that are fun now and make them difficult. You can try to help him lose weight (and help yourself), but if that doesn’t work, you need to help your marriage.

The test of a good marriage is not whether it’s fun, but whether two people continue to like and respect one another when it’s not. Through sickness and health, slim and flabby.

STATEMENT:
“It hurts to have a sexually repulsive husband, particularly after I’ve tried to help him slim down, but the purpose of our partnership was always to create a family and look out for one another, and was never about being young and sexually attractive forever, so I respect myself for putting up with this loss for the sake of a marriage that I value.”

I recently started going to a doctor for my depression. She thinks I should take pills, I’ve seen lots of articles about how antidepressants don’t work and the main reason they’re prescribed is because of the huge investment that big pharmaceutical companies have made in producing and marketing them. It makes sense to me that there are better natural, holistic solutions that get played down by the medical establishment because they can’t make money for anyone and threaten the profits made by those companies. My goal is to find treatments that work best, not the treatments that server the corporate interests.

The problem with most criticism of current drug treatments is its hopefulness; it implies that there are good, effective, cheap and low-side-effect treatments for depression (that are being suppressed). If only principal clause of that statement were true.

Sure, a magic bullet, holistic or otherwise, would be great (there are lots of other unsolved and incurable problems I can work on, so I’m not worried by the hit my business will take).

The truth is, however, that current treatments are time-consuming, weak, often costly, sometimes risky, and not guaranteed to work

Please resist the temptation to change the subject to tell me why current treatments are costly and often ineffective. You’re entitled to be angry about that sad fact, as about any other of the tragic, unfair and irritating facts of life, like tailgaters, the fact they cancelled “Firefly,” and almost anything having to do with hospitals and health insurance.

As much as I agree with you, I don’t want to hear it; you’ve got a job to do, and anger is a distracting escape from facing what you need to deal with if you’re going to manage treatment decisions for depressive illness. Instead of getting mad at your hand, play the cards you’re dealt.

Your treatment choices for depression aren’t that complicated…once you accept the fact that there’s no way to tell in advance which treatments are going to work or what side effects you’ll encounter. If you’re not in a hurry (i.e., if your depression isn’t about to push you out a window or immediately end your relationship with wife and family), you begin with non-medical treatments, like cognitive behavioral therapy, exercise, and diet and life-style changes.

If the symptoms are severe or longstanding or coming back after previous bouts, then you also experiment with antidepressant medications. This isn’t because Pfizer decrees it so, but because non-medical treatments are unlikely to perform miracles and an antidepressant medication improves your chance of recovery, even though it also has possible side effects.

If you want to try holistic remedies first, by all means, go ahead, but approach those treatments with the same care you would conventional ones; do your research to see what the data show in terms of results and what the side effects might be. Most data are inconclusive, but if you believe the treatment is working, then take that placebo to the bank.

Either way, you know the major principle of risk management: the more desperate your condition, the greater risk (pain, side-effects, cost, etc.) you should be prepared to bear in your effort to manage it. Draw on your own experience of your symptoms, their severity, and their impact on your life, as well as what the experts tell you about them, to decide how desperate you are.

It’s not a big pharma conspiracy against your health; your options just aren’t that great, and you have to figure out which one will work out, if not perfectly, then best.

STATEMENT:
Include your doubts about medication in a statement that focuses on management, not resentment or silly hopes for hidden cures stashed away in a cave with Sasquatch. “If I ever decide to use medication, it will be because I’m desperate and other methods haven’t worked. At that point, I’ll try to figure out their benefits and risks by looking at scientific, controlled studies, not emotional statements based on single cases or uncontrolled, badly selected patient populations. I will consult specialists and authorities to explain why they place faith in particular data or don’t like someone else’s data; but I will then make up my own mind, shutting out my emotional response to charisma or sincerity or a desire to include everyone’s opinion. When it comes to decisions about my health, I deserve a good, objective risk manager—me.”

I know the tranquilizer I take is addictive and interferes with my memory, but it’s the only thing that works when I get really anxious, and the other drugs I’ve been given for anxiety made me sick and didn’t work. I’m anxious because I’m stressed by some unusual recent events, which I’m sure I’ll get over in time, and then I won’t need to take medication. So my goal is to get the medication that works for me and avoid the stuff I know is going to make me sick.

It’s wonderful to get relief from severe anxiety, which is a terribly painful and frightening sensation. So I hate to make you more anxious by telling you that, unfortunately, there’s no good, safe medication that provides rapid relief.

The medications that provide rapid relief pose high risks of addiction and impair memory and balance, and the medications that are safer don’t provide rapid relief. That’s not very reassuring, but if you don’t cowboy up and face that fact, you’re in for trouble.

Remember, anxiety isn’t the worst thing that can happen. Much worse is what anxiety can make you do, like avoiding whatever stirs it up, medicating with alcohol, and making it your goal to feel less anxious. Given these dangers, your real goal is to do what you can to reduce anxiety while not letting it change what matters to you.

Don’t stop trying alternatives to addictive drugs because previous trials failed—that’s anxiety whispering its lies. It tries to tell you that everything that caused you pain in the past should be avoided now and in the future.

If you find yourself listening to that shit, you desperately need some cognitive therapy to help you straighten out your thinking. You can get it from books or a therapist or hanging out with anxious people who have learned how to manage their fears. There isn’t an actual Anxiety Anonymous, but there are groups like it.

If you stay with your current plan, you’ll not only lead a restrictive life, but you’ll tend to choose immediate relief over long-term advantages, whether it’s in treatment, jobs, or relationships. At that point, your anxiety is managing you, and that’s a real cause for worry.

STATEMENT:
Here’s a statement to keep you strong. “I need to develop new methods for dealing with anxiety because, as much as I wish it weren’t true, anxiety will always come back, eventually, and the tranquilizers that give me great relief in the short run will cause problems if I take them for too long. There are lots of non-medical techniques I should learn; and, if they aren’t sufficient, there are lots of non-addictive medications I should try that have a very low risk of causing serious harm. I need the courage to do what makes most sense to me, not what my anxiety would prefer.

My psychiatrist thinks I should increase my medication, but it already makes me sleepy and has caused me to gain 10 lbs. If anything, I’d really feel better getting off it entirely, because I hate being dependent on it. For the time being, I know I need it, because I’ve barely recovered from my last depression, but even thinking about increasing the dose makes me feel depressed. I’ve seen this doctor throughout my entire illness and she’s been very good with me up to this point, but now that I don’t agree with her I don’t know what to do. I don’t want to have to take more medication.

It’s much easier to have an agreeable disagreement if you’re not pushing someone with your emotions; after all, lawyers use evidence, not tantrums, to win a case.

Still, it’s hard not to push with your emotions when the issue is personal and scary. Unfortunately, you don’t have a choice.

If you don’t put your emotions, you’ll sound (even to yourself) like a kid who hates needles. Your doctor will then feel like you need protection against your fears and impulses, and so will become even more insistent and condescending (and afraid of a liability lawsuit when your fear turns to anger).

That attitude will make you feel more like a helpless kid who isn’t being heard, and long story short, it’s a vicious circle we’re all familiar with, and it requires you to shift approaches, not give in.

Besides, if you’re pushing someone with your emotions, you’ve got to wonder whether you’ve conned yourself into doing what you want, rather than what’s best for you.

Switch your language (and maybe your way of thinking), list risks and benefits, and prepare a list of the questions you need answered to make a good decision. Put your feelings aside, put facts first.

No one likes medication, but it’s your job to know enough about the possible course of your long-term, incurable mental illness to judge whether the beneficial promise of a given medication outweighs its costs and sluggish, chubby side effects.

Becoming educated about your illness and its treatment is the only way to avoid being a medical victim who feels helplessly reliant on a doctor’s judgment.

If you want to have a discussion with your doctor that doesn’t sound like you’re trying to escape the ouch of your camp shots, learn what your odds are for relapsing and whether resuming meds at the beginning of a relapse can be counted on to stop your symptoms before they damage your life and/or your brain. Also, find out what the chances are that a higher dose will make a positive difference in the short or long run.

Don’t forget to ask what evidence the doctor is drawing on for his answers. Then you’re prepared to announce your verdict as a responsible adult.

STATEMENT:
Here’s a formula for a worst case, high risk disagreement. It alludes to your fears but sticks with a managerial point of view. “I know that rejecting your recommendation carries a 10 percent higher chance of relapse, that there’s no guarantee that we can stop a relapse once it’s started, and that relapse can cause a little brain damage. But I’ve weighed these odds against the risk and side-effects of the medication and my own conviction that I’m less vulnerable to relapse now and I’ve chosen to keep the dose where it is and wean off in the not-too-distant future.”

Admittedly, I’m a neurotic, depressive guy—I’m a New Yorker, I’m normal here—but when I had a shitstorm a year ago when my girlfriend left me and my job changed/became horrible, I started going to a therapist. It was helpful to rant and get some perspective, but now I really think I’ve come through the other side of the situation and don’t need therapy anymore. My therapist, on the other hand, thinks I still have a lot of work to do, because we never really talked about my relationship with my father (not great) or why I had trouble with my ex-girlfriend. Thing is, I don’t really think my dad has anything to do with anything, and I know what my problem is with my ex-: I chose badly. How do I convince my therapist I’m ready to leave and that there’s nowhere deeper to dig?

There are always therapists out there who, when it comes to accepting the fact that people are the way they are and treatment is a limited tool, need more therapy than their patients do.

What your therapist may have trouble facing—more so than you—is that your treatment has produced all the change and relief that it’s going to, despite the fact that you still have pain and other problems.

Many therapists can’t accept imperfect results. They feel they’ve failed if they can’t help you and, so as long as you’re suffering, they’ll look for a deeper level of change.

If they could bring themselves to accept you the way you are and let go, they could also become more creative about teaching you methods for minimizing the harm your behavior can cause. Obviously, this is not the case here.

So prepare for your decision by gathering data about whether or not it’s really time to stop. See your therapist less often, or take a designated break, and see what happens.

If you slip back into that shitstorm feeling, your goal is to figure out what the treatment was doing to help you, whether you can get that help for free from any other source and, if not, how often you need to see your therapist to sustain the benefit.

If, after running that test, you decide to stop treatment but don’t want to get drawn into a fight with your therapist in which you sound like you’re trying to avoid your homework and your therapist sounds like a concerned adult, there are 2 options.

You can lie, and tell your therapist you’re feeling better and last night you had a dream about a happy bird flying high above the clouds and missing its nest down below but confidently soaring towards the mountains in the distance where your dad and ex-girlfriends were waiting to give you a hug.

Or.

You can be straightforward and truthful, telling your therapist exactly what you told me, backed by the results of your experiments with withdrawal, and stick to it.

After all, you’re an adult who can make your own decisions, and your therapist will have to accept your decision. And if s/he can’t seem to cope, s/he’s the one who needs time on the couch.

STATEMENT:
“I know I’ve still got problems but I think I’ve got what I’m going to get from this treatment and I’m managing things well enough. I wish I were less grouchy but I don’t think that’s going to happen and, meanwhile, it’s not doing me any harm. I’ll always look for new ideas about how to manage my problems but, for now, I don’t think I need more psychotherapy.”

I know that my depression is one of the main obstacles keeping me from getting a new job; I got laid off three months ago, and even though my meds had stopped working way before that, I had enough discipline to push through. Now I don’t have a workplace to go to, I have trouble getting motivated enough to do anything, so between my inability to get out of bed and the fact I look like a mess, interviews aren’t happening. My wife is pissed because I’m not motivated to get new work and I won’t go back to see the psychiatrist, but I don’t see the point in trying this new prescription, because it’s my fourth medication so far, and I don’t understand why the first medication I took, which worked the best, stopped working, and why none of the others since has done the job. I don’t see why I should waste my time getting treatment if it isn’t going to work, but my wife thinks I’m being complacent and lazy. My goal is to find some way to get better or at least get her off my back.

You’re reinforcing something I’ve been telling my children their whole lives; life is unfair.

It was unfair for them when I wouldn’t by them a Happy Meal or the latest Nintendo game, even when they deserved it, and it’s unfair for you now that you’ve lost your job and can’t find the right meds. Unfair is unfair, as they say (or at least as I say).

The trouble is, it isn’t a fair world for anyone, young or old, and you won’t survive if you can’t take your lumps and keep on going.

The less you do, the more you scare and burden your wife, who gives you an earful, which makes you more depressed (as does doing nothing), and so on down the pit that leads to self-pity and divorce, all of which you can blame on your wife, who will be happy not to hear it.

Let’s get your expectations about depression straight. If anyone told you that antidepressants were effective, they were using the medical meaning of the word, not the English meaning.

The English meaning is, “usually works,” but the medical meaning is, “better than nothing.” You might get helped by antidepressants, but never count on it. Meanwhile, you’ve got to take care of yourself, so ask yourself how you’re going to manage, not why you can’t get a cure or stop your wife from being critical.

Consider the job description for a depressed survivor in an unfair world. If treatments don’t work, your job is to suck up the pain and ask others to give you the prompts, reminders, and coaching you need to keep going. If a treatment might help, pursue it.

Remember, when you had a job to get up for in the morning, you found the strength to keep moving and work all day, regardless of how bad you felt. Now that you don’t have a job, create a schedule of activities and meetings with people who are expecting to see you.

It isn’t easy when you’re unmotivated and unemployed, but you still have a job, assigned by you, and that’s to prevent your disease, unfair as it is, from taking over.

If you’re angry, disappointed, discouraged, or resentful, it’s also your job to shut up and not let your negative feelings become nasty words. Don’t expect your wife to be positive; after all, you’re not, and it’s an infectious venereal disease, bouncing back and forth.

You want your wife to help you recover, so put your negative feelings aside, reassure her that you continue to care about her and finding a job, and enlist her help in fighting an illness that can’t be helped.

After all, life provides us all with hard times, whether or not we deserve them, all the time. Don’t add to the unfairness quotient with your own behavior; if life pushes you down and hands you an unHappy Meal, there’s always something you can do, even as a depressed person, to push back.

STATEMENT:
Hit yourself upside the head. “Depression is sapping my natural motivation and ability at a critical time, but my goals haven’t changed. I believe in work and independence. I won’t let false pride, resentment, or negative thinking stop me from doing my best and asking others to help me.”

My husband and I are at the stage where we should start thinking seriously about starting a family. The problem is that his father and that entire side of the family have a history of severe mental illness, so he’s not just afraid of having kids, but of even adopting, because he’s afraid he might get sick down the line and ruin our future child’s life. When we got married, it didn’t seem to be a problem, but as his own father has gotten more and more nutty, he’s become convinced that having kids is a bad idea. I want to stay with my husband, but when we got married, he knew that I wanted a family, as well. And I’m OK with adoption, but it’s a long, expensive process, so if we want to go that way, we have to start now. Basically, my goal is to get him to come to his senses, or at least be willing to take a risk.

Life is tough, and having a child—creating a life—is risky. In fact, it is never not risky, even at the best of times, regardless of all that crap on TV about the power of eating right and giving birth in a bathtub, so don’t reassure him that things will turn out OK, because then he’ll have truth on his side.

After all, while modern medicine greatly reduced the rate at which pregnancy killed mothers, it hasn’t changed the way genes sort out randomly and often badly. So, whether you’ve got mental illness in the family or not, there are always tons of bad genes floating around and having a kid is a dangerous lottery.

The question isn’t whether having kids is dangerous (it is, always and forever), but whether your husband has the balls to take on the usual, scary, risky human lottery that is, for the time being, the only way to begin a family.

Once you accept that the risks are real and the results sometimes devastating, you can take pride in the good qualities that you bring to parenting.

You’ve got a good team; you seem open-minded, and he has lots of experience handling mental illness, which he’ll need for those many problems over which good parents have no control.

Remind him that many of those dangerous genes are also beneficial and it will be your job, as parent, to help your kids to manage traits that may be both a gift and liability, be it depressive sensitivity or athletic hyperactivity.

If your husband can see that there is no such thing as risk-free child-rearing, then you can calmly assess which parenting option—standard conception, adoption, foster care, whatever—would work best for you both.

Then, in the most educated way possible, take the risk of your life and take pride in your work, regardless of the (inevitable) helpless times. Just don’t let fear make you throw out the baby plans with the (birthing) bathwater.

STATEMENT:
Your message is: “Absolutely right, having kids is scarier than hell, but that’s the way it is. Don’t panic. We’ve got some good stuff going for us and, regardless of what happens, we’ll do a good job.”

Living with my mentally ill 30-year-old daughter is wearing me out. My wife and I can never leave her alone, but we also can’t take her with us because she gets uncomfortable when she’s around people she doesn’t know and says inappropriate things in a loud voice and has to get up and leave. The problem isn’t her, though, it’s my wife, who is so worried about what will happen if we put her in a half-way house with other sick people that she can’t think clearly about it. We’ve got some money, but if we paid for my daughter to have her own condo and a nurse to keep an eye on her, the money wouldn’t last long. Then again, if she continues to live with us, we won’t last long. My goal is to get my wife to see that we have to get her into a state-supported program, for her sake and ours.

You hope to get your wife to see that your mentally ill daughter needs to live independently, but if you were making any progress in that direction, you wouldn’t be writing.

Let’s assume then, at least for the moment, that your hopes are false and your wife can’t let go, and if she can’t let go, she’ll always be thinking of new ways to make your daughter feel more comfortable and better understood. Which makes your goal a more and more distant dream.

It also means less legitimacy for other priorities, like preparing your daughter for life after you’re gone, or tending to your own needs or the needs of other kids.

When your wife’s approach wears you out (and it will, if you aren’t a saint), you’ll get angry and then she’ll blame you for making your daughter feel unloved and causing conflict that makes her sick.

As such, your wife’s not letting go will make things worse, as will your own refusal to let go of pushing your wife to let go. So, let’s stamp out your presumably false hope and ask how to make the best of things if your wife won’t change course.

First, figure out what you think is the right way to proceed, given the limitations of your resources and the nature of your daughter’s illness. Whatever you do, don’t expect what you have to do to feel good, because whatever it is, it won’t produce a cure or happiness, and won’t provide the guilt-blocking pleasure of unrestricted giving.

Then get advice from experts about her illness and what public benefits exist. Talk to other parents who have dealt with this issue, and count your savings. After that, put together a plan that represents the best compromise for dealing with two absolutely unavoidable and insoluble problems: the riskiness of independence when you’re mentally ill, and the costliness of long-term care when you’re not super rich.

Finally, ask yourself what you can do to implement this plan without your partner’s help, while encouraging her to join you if she chooses. You need to be able to stand by your plan so that her fears or criticism won’t paralyze you or draw you into argument.

You can’t reassure your wife that things will turn out well, but you can show her that you believe your way is best. If you appear calm about your plan and confident that you’re doing the right thing, she may eventually feel less responsible for all the bad things that could happen to your daughter and better able to do what will work best in the long run.

STATEMENT:
I have a duty to push our daughter towards independence while also attending to other responsibilities. I know this will cause her pain in the short run and deprive her of help I wish I could afford, but can’t. If I put together the best plan I can, however, I can take pride in being a good parent and offer that confidence to my wife and daughter as an alternative to fear.

My wife and I recently retired and we’ve been looking forward to a good life together, but recently I noticed she’s been getting forgetful and I wonder if she’s developing Alzheimer’s, which runs in her family. I hate to admit this, but I don’t think I’m capable of taking care of someone with Alzheimer’s, even if it’s my wife, whom I love very much. I can’t talk to her about it, because I don’t want to frighten her, and most of the time when I think about what to do, I just want to get away. Should I persuade her to get an evaluation so it can be treated? My goal is to do something to prevent this disaster from happening.

Getting into a panic with the goal of preventing Alzheimer’s is as useless as being paralyzed with fear over anything you can’t help, from the Rapture to the weather forecast to the Red Sox prospects in 2010.

Yes, you can urge your wife to get a physical and whisper to the doctor that she seems a little forgetful, and that will get him/her to check out curable causes of memory loss, like vitamin deficiency and depression.

At that point, believe it or not, you’ve done your job. If you press further by urging her to get cognitive testing and trying all available treatments, you may well make your lives worse.

A better goal for almost all the chronic problems of aging is to do what you can to treat them and then forget about them. You don’t want her to become her illness; you want her to live her usual life as much as possible.

For most people with memory loss, there’s no impending disaster. It’s only later, if and when it becomes severe, that people lose their personalities and require constant watching.

In your wife’s case, later may be a long, long time away. Meanwhile, you’ve got a life together that you don’t want to ruin by worrying about something that may not happen. Your goal is to fight fear, do what’s necessary for a possible illness, and live life as usual.

Your goal also isn’t to be extra nice to her; forgetfulness can be irritating to live with, and if you try too hard to be nice, you’ll get extra nasty. Instead, just try not to be mean, and give yourself credit when you can keep yourself in check. That’s always helpful in marriage, whether your spouse is demented or not.

STATEMENT:
Reassure yourself. “If there’s something that will actually help my wife with her memory, I’ll do it. Otherwise, it’s business as usual for as long as possible.”

I’m fine now (I’m 14), but I’m trying to figure out how to deal with a crazy father who physically abused me until a couple of years ago—that’s when my mother finally figured out what was happening and had me come live with her. The trouble is, I guess you could say my father doesn’t see reality the way other people do and he never remembers hitting me. In his mind, when he’d hit me, it was because I was trying to destroy him, so what he tells the judge is that he loves me and that my mother is a raging alcoholic who has brainwashed me to hate him (my mother stopped drinking after the divorce, years ago) and he really believes what he says. My goal is to get him to stay away from me and convince others that his version of reality isn’t real.

Kids aren’t the only ones who have trouble accepting the fact that we often can’t protect ourselves from scary crazy boogeymen, particularly when the craziness isn’t obvious, and the boogeymen are family.

We’ve said it here before: certain crazy people are not obviously crazy and are particularly good at persuading other people to see them as injured victims because they truly, truly believe they are, no matter what really happened. It’s a kind of sickness for which no one has the cure, and nobody feels sicker than the victims in the wake of these sickos, who don’t necessarily feel sick at all.

So cops, judges and social workers often can’t figure out who is telling the truth for a long time. Meanwhile, they often make mistakes and put restrictions on kids and families that hurt everyone and cost more money than the family can afford. It’s a sad fact of life, but they’re trying to do the right thing.

The system usually works to try and protect the weakest party, and when you’re aggressive, even if you’re just aggressively trying to get people to see the truth, you make sickos look that much more weak and innocent. It’s unfair, but pushing hard to express the truth will often push it underground.

So Dr. Lastname’s advice for kids is the same as for adults: don’t think that expressing your emotions sincerely and eloquently will solve the problem. If your father is sincere and has a good lawyer, he’ll persuade the judge that you have, possibly, been brainwashed by your mom, and they’ll treat you like a poor, emotional kid who deserves pity but doesn’t really know his own mind. Then everyone will spend lots of time visiting shrinks. Thanks for the business, but no thanks for the bullshit.

First things first, give up on the goal of convincing others, and try instead to make positive sense of this experience and prepare a statement that you could, if necessary, read to your father.

The less anger and fear you put in your statement, the more it will help others get at the truth. I’m not saying you shouldn’t have negative feelings—of course, they are what they are—but the goal of your statement is to keep out the negative feelings without in any way holding back on the facts of what really happened.

You might not make his sickness go away or get people to see the truth, but being clear, honest, and emotionless is the best protection against the boogeyman.

STATEMENT:
Here’s an example. “I think it’s a bad idea for us to spend time together. I know you care about me and want to see me, but I think you forget about the bad things that happen when you get upset and lose your temper. You forget about (put in details, including bruises and dates). I don’t want to hurt you and I want you to be happy but I don’t think we should spend time together until I’m old enough to protect myself from your temper. Sincerely.

I’d like to get help for my wife’s younger sister because she drives the family crazy. Simply put, she’s a lying drug-addict, and my wife’s parents are always trying to help her in a way that ruins things for the rest of us—they give her money, pressure my wife and me to accept her at family events, and then make us feel guilty if we don’t want to see her. She’s totally poisonous as she is, but I know she can’t help herself, and I’d like to get her real help, not just hand-outs and pretending everything’s OK, so we don’t have to continue like this.

Your goal is just as bad as your wife’s parents’ goal, because you’re both assuming that your sister-in-law can be helped when all the evidence points the other way. They’re throwing their money away at her directly, you’d be throwing your money away at “real help” she isn’t ready for. It’s a lose/lose.

Really, everyone wishes your sister-in-law could be helped, but proceeding on that assumption when it’s not true is a good way to make things worse, and that’s exactly what you’re complaining about.

The sad fact is, treatment is often hopeless. You know that’s true for lots of medical problems, from cancer to Crohn’s disease, so why not accept the fact that it’s equally true for everything else.

Instead, stick with the realistic hope that she’ll change someday, and that you (and others) will have an opportunity to help. It might happen, but it’s not something that you can make happen or are responsible for.

In the meantime, don’t blame her, because there’s a good chance she has as little control over the problem as you do, even though it’s her body and her problem. Blame life, it sucks more reliably than anyone or anything else.

Now that you’ve listened to me and given up on your goal of getting help for your sister-in-law, realistic thinking suggests some positive things for you to do. Since you’re not responsible for saving your sister-in-law or protecting your parents-in-law, you can bow out of family events you don’t really want to go to.

Ignore feelings of guilt or responsibility. You’d help if you could, but you can’t, and there are other important priorities, like going on with your life and enjoying time with those you love.

STATEMENT:
Prepare a statement that responds to the most guilt-provoking accusations you can imagine. “I’m concerned about my sister-in-law and take full responsibility for helping her whenever possible. One thing I’ve learned, though, from watching her parents do a wonderful job of trying to help her is that, for the time being, it’s just not possible. When it’s not possible, we do more good by distancing ourselves from her problems so as to limit their harm and provide her with more incentive to change. Distancing ourselves from her problems does not mean distancing ourselves from her. The better we protect ourselves, the more welcoming we will be if and when she begins recovery.”

I just started at college, and I like my roommate, but she’s bulimic and hard to be around. Not just because she’s sick (and everybody on the floor knows about her problem, it’s hard not to), but because when she binges, it’s on my food because that’s what’s closest, and she always feels really bad about it and cries that she wishes she could stop, but then she doesn’t offer to pay for it and it’s costing me a lot of money. Part of me just feels bad for her, because she’s clearly really messed up, but another part of me is pissed because I’ve lost a lot of money this year on food that she’s eaten and thrown up, and that just makes me feel guilty like I’m a bad person for putting my lost money above her health. I want to move after the break, but I don’t want her to feel abandoned. My goal is to help her and myself.

Welcome to that other part of college, Hard Knocks University, where the class Helplessness 101—what to do when you can’t help both someone and yourself, and sometimes you can’t help at all—is a frosh requirement.

The tough part is not the decision, but accepting the shitty nature of your options. Bulimia, like any chronic condition (depression, addiction, etc.) is not completely curable, not by you or certainly the patient herself.

If you buy into the psychobabble about body image and low self-esteem, you might think you could help her by praising her strengths, noticing her attractive qualities, or getting her to think about the superficiality and limitations of attractiveness. Ha!

Whether it’s coming from you or the Mormon Tabernacle Choir of Therapists, your therapeutic support is not going to change those mysterious urges to binge and puke. Buying into that notion will waste you even more time and money than all the cash you’ve already flushed away at the supermarket.

Bulimia, like all addictions, can turn people into assholes. Don’t get me wrong, they don’t choose to be assholes, but when you’re more interested in binging and purging than in anything else, including other people’s feelings and squaring your debts, you’re an asshole. Or really, you’re a normal, possibly good person suffering from a bad case of asshole-itis.

It’s a humiliating thing to say about ourselves, but what helps most in controlling dangerous behavior, when all else fails, is to be treated like a soldier or dog-in-training in a program where our every movement is controlled. That’s the kind of treatment that saves lives when bulimia gets dangerous.

Obviously, it doesn’t cure it, but it stops us from going over the cliff until we can get enough control back to keep it down to a barf or two a day.

So the most you can do is let her and others know if you think her life’s in danger. Otherwise, you’ve got little influence over her for good or ill, and you’re living with an asshole you can’t cure who’s costing you a bundle.

You may wish you could help her, ease her pain, and not make yourself feel guilty by locking the refrigerator if you don’t get a check. Well, I hate to say this, but fuck you. That’s a goal of feeling good, which is much like her goal.

If, however, your goal is to make the best of this situation, it’s not to feel good but to do what’s right by helping her if you can and otherwise preserving your resources for worthwhile causes.

That means bearing the pain of watching her in pain, feeling helpless, and ignoring the guilt of receiving a look that accuses you of adding to her misery. It also means letting her know you’re there if she wants to get real help, establishing your refrigerator perimeter, and getting to eat your own damned ice cream.

STATEMENT:
Prepare a mission statement that protects yourself from false guilt. “I can’t help my roommate feel better or control her eating behavior, but I can watch out for her if her life is in danger and I can encourage her to be a stronger obsession manager by requiring her to pay for what she eats. In doing so, I may temporarily make us both feel unhappy; but that’s an unavoidable part of her recovery and my self-protection. It’s the work we both must do to pass this course in making the best of a bad situation.”

Since there’s no easy way to say it, I’ll just put it out there that I have a problem with my anal sphincter (a botched surgery when I was a kid that left me with very little control). Like everyone since then, my co-workers notice that I sometimes smell bad and like to joke about it, usually but not always behind my back. I do my best to control it, and I’ve seen specialists about it, but what it comes down to is that everyone is happier when I keep my distance and I just wish I could find a job I could do from home. I even avoid attending family events and leave early when I go because I don’t want to embarrass my parents (and I obviously avoid women and people in general). I just transfered to another branch, and now I’m terrified about the reaction of my new co-workers. I know this sounds like a joke, but it isn’t. My goal is to find a treatment that can control this problem or a lifestyle that is less full of humiliation.

By now you should know that you can’t have what you want, either a sweet-smelling body or a solitary, well-stocked bat cave to retreat to. Forgive the pun, but tough shit.

You’re fucked, and if you keep trying to eliminate the problem you’ll never live your life and your parents will die and you’ll regret the things you didn’t do with them or the other things you want to do with yourself like make more money.

Now that that’s cleared up, ask yourself what your goal is when the goals you’ve been chasing are unattainable and there’s no way to avoid a shit-load of pain (last sly double-entendre, I swear).

The obvious answer is to try to reduce your sensitivity to humiliation so that you can live life as fully as possible. It would be nice if you were a natural-born comedian who could deflect nasty jokes, or an insensitive clod who never understood them in the first place; but you’re not. Now that you’re an adult, however, and no longer a school-kid, there are lots of other things you can do.

First, confront the Madison Avenue notion that your self-esteem depends on attractiveness. Your goal isn’t to be attractive, but to make people feel as comfortable as possible with your ugly side while you pursue your other goals.

So pretend you’ve got a colostomy and that’s the way it is and learn how to be shameless. Wear a diaper if it will help, just learn how to not take shit personally and put together a list of what you want to do with yourself and do it. That’s your goal.

Make people more comfortable by telling them, frankly, that you have a GI problem that sometimes causes bad smells and you can’t stop it but that you’re pretty good at managing it. That’s why you, for instance, use incense and deodorizers, and sometimes have to leave meetings unexpectedly. If your smell is a problem and you don’t notice it, you don’t mind having it pointed out to you.

Keep a candle burning on your desk. Be the first to let them know when you’re having a bad day. Read a book of bathroom jokes beginning with “What died in here?”

Your goal isn’t to control your colleagues; that’s impossible with heaps of cash or hypnosis, so accept that they’ll be nice or nasty, as they are. Instead, create a wall between you and your problem and invite them to see your problem as something apart from you. Lots won’t, but a few will.

After all, you’re not a bad smell, just a guy who’s trying to do a good job despite a tough, humiliating handicap. That’s something to be proud of, a much bigger accomplishment than being sweet-smelling and attractive. Fuck advertising.

Give your parents similar directions, letting them know that you’re happy to attend family events, but you’ll let them know if you’re having a bad day and you won’t take it personally if they’re planning a big event in a poorly ventilated space and don’t want you to come.

You can’t control your problem or how people react to it, but you can’t let those factors take over your life completely. After all, even for those of us with cooperative anuses, life often stinks. You just arm yourself with Fabreze and carry onward.

STATEMENT:
Prepare a manifesto that keeps you focused on your own priorities rather than the reactions of idiots. “My job is to lead my life and try to make a living and find friends, and I’m not responsible for my bad smell. I manage it well by protecting others and making it easy for them to protect themselves. My bad smell may humiliate me; but it can never outweigh my pride in not letting it stop me.”

I have been basically bedridden now for almost a decade with constant pain and fatigue, and I’m not even 50. I have been diagnosed with many auto-immune diseases, as well as central nervous system disorders that have led to constant pain, and am on a diet of many medications for pain, neurological disorders, and sleep. I find myself asking why bother? I have lost so many years of my life; my “thrill” in life is getting through a grocery trip. My body is weakened and aged, I cannot please my husband, my now grown children see a mother who is weak and sad. Before this, I was an active, involved, strong woman looking forward to a wonderful active life with my husband, and ready to see my children become healthy adults with families of their own. Now I see a life of pain that no medication has been able to stop, the constant craving of sleep, and utter depression.

If your goal was to be have a wonderful active life with your husband and watch your grandchildren grow, you were screwed before you began.

We all wish for a life like that, but the reason I’m open for business is that none of us can make such a life happen, even with a perfect start and wonderful marriage, not in this world. So if you make a goal of wishes like these, you’ll feel like a total loser when uncontrollable things happen, like incurable illness and pain.

A better goal is to find a partner who is sufficiently strong, caring, and devoted to kids so that he will shoulder the load when you can’t and stick around when you’re not much fun to be with. Lucky for you, you’ve succeeded.

Your goal with your kids is to show them how to be good, caring, productive people in spite of all the unfair shit that life will throw at them, and that’s what you’re succeeding at now.

Your husband and kids may be sad and hurting for your pain, and you’re hurting for theirs. Happiness and pain relief, however, were never what was most important about your goals, so never say that you’ve lost “so many” years of your life.

For all those years, you’ve coped with illness while raising a family. If you put aside the negative thoughts that pain and depression have put in your head, I’m sure your family still considers the day better if you’re around than if you’re not, so that’s many years of living with pain, and sharing life with your family.

I’m old enough to have many dead friends, some of whom died painfully. Some reached the point where pain was too much and it was a relief to go, but one secret that doctors know, and people who care for dying patients, is that dying people often show us how to live. They discover their priorities and share their courage.

It’s painful to work with them but also enriching, and so it has been with my friends. I think of them often when I need to remember what’s more important than pain.

STATEMENT:
Help out your family by writing a statement. “I know it gets depressing when I seem to get weaker and hurt more, no matter how much good love and care you give me. But I want you to know that my time with you is precious and that I’m proud of how strong you’ve been and what a good job you’re doing. It’s normal to get discouraged, overwhelmed, and angry. It’s also normal to give up and bicker and get away from this burden. But we haven’t done that in this family. In this family, we hang together and try to help one another and I’m proud of you.”

My husband and I were having problems for a long time (we both acknowledged this), but then, as things were coming to a head, he suffered a severe stroke. From that point, the status of our marriage seemed unimportant; he was my husband and he needed my help. For over a year, I stayed with him through physical therapy, rehab, just several grueling months of watching him learn how to speak and walk again. He’s still not 100%, but he’s no longer dependent on me or anyone else…which is why I want to talk to him again about getting a divorce. I’m not sure whether I’m just worried about being perceived as a monster (I know, who cares what other people think), but whether I really am being a monster, even though we were talking about divorcing before his stroke ever happened. I know he’s in an impaired state now, but just because he has to suffer a burden for the rest of his life, doesn’t mean I have to suffer our marriage. My goal is to go back to the things the way they were before the stroke, and go forward from there.

To my mind, living up to your marriage vows is important. That said, living up to your vows isn’t just a matter of keeping your promises, because there’s too much you don’t control about what happens to a partnership after it’s formed.

Your wish for your marriage is that you support one another through thick and thin, but reality may make mutual support impossible and turn the marriage into a severe burden for one or both of you. This happens frequently if your partner has an addiction or a problem with other out-of-control behavior. It also happens when it turns out that you just can’t get along.

Despite your best intentions, your marriage goal is not to support one another unconditionally, but to do your best to create a good partnership and manage it constructively if it’s not.

In deciding whether or not to stay with your husband, accept that, of all the factors involved with your next move, your feelings are not what’s most important. Someone may be a pain in the ass to live with, but you and your kids, if you have them, may be better off with the marriage as is, regardless.

Yes, you may be able to provide better care than he could get elsewhere, but, if you really can’t get along together, being trapped in a close relationship by his disability will be hell for both of you. Accept the reality of your bad chemistry before considering alternatives.

It’s unlikely that your decision will make anyone feel good because that’s not possible. Your goal is not to make a decision that feels good, but to assess the good and bad that will come about from staying together versus splitting up, and arrive at a decision that makes the best of things.

Don’t focus on what other people would think, or what you would feel, or what could have been. Focus on what makes the most sense for the future.

STATEMENT:
Write a statement that will help you make your assessment without being overly influenced by anger or guilt. “I’ve done a good job of caring for my partner and I think he’s strong enough to be OK if I decide to leave. Now it’s my job to add up the value of staying versus going. I’ll assume, at this point, that the bad chemistry between us can’t be helped and is nothing but a fact that I must include, without blame, in my decision. I can’t expect my decision to make anyone happy in the short run. But if I’ve tried hard to make our relationship work and to find a good way of dealing with the fact that it doesn’t, I’ll make a good decision.”

I’m an early middle-aged woman, lucky enough to have the problems that come with getting saner and older. I grew up in one of those sad alcoholic homes from which I never gave up working to extricate myself. I screwed life up at first but have been recovered from alcoholism over twenty years, similarly recovered from eating disorders (bulimia, anorexia, binge eating), returned to the school I had ditched to finally graduate with honors, kept jobs (now retired) and, a real miracle, I have been married to a terrific guy in my sobriety and am (for real) happily married. I have solid loving friends. I’ve seen therapists for the depression, which intermittently interferes but even found a half-assed but useful medication. A good life…except for the real problems that come with age. That wonderful husband has a couple of chronic diseases, my best friend died of the cancer I survived, and everyone is dead in my small original family. I am experiencing that trapped childhood feeling of being in a world in which I am helpless and those I love are hopeless and going away. I realize I must just feel the hurt and keep on anyway, but I am tired, and my stamina is more fragile now. I disappoint those I love and make mistakes more. Goal in writing you: To get a better grip on myself and accept more deeply that I cannot change the pain of life. I would like to not keep blaming myself, a old bad habit that lingers. Sorry I’ve gone on so long but I guess I wanted to show that I have really tried to help others and myself even if I’m whining now.

You see your goal as rising above the pain of aging, but you can’t fool me (remember, I went to Harvard): your deeper goal is to help people, to the point that their aging has worn you down and caused you to forget that you have other goals. For example, not getting worn down unless it’s really necessary.

So it’s not aging that’s your problem, but what aging has done to your ability to help others while keeping your priorities straight. That’s what I think is causing you the most grief. After all, if you were old but weren’t as responsive to the needs of others, all you’d have to worry about is your bad back and Tivo’ing NCIS.

On top of ascertaining your real goal, I can also guess you’re not from Samaria, so you don’t have a Samaritan license (funny, you don’t look Samaritan). That’s the first thing that’s wrong with your initial goal—wanting too much to help others.

Second, helping others feels good, so you know it’s got to be bad. Third, it makes you feel less guilty (even though you did no wrong in the first place) which is the same as two.

Fourth, it elbows out your other responsibilities, like enjoying your few remaining days and being nice to your not-yet-dying friends. Fifth, it makes you tired, depleted, and depressed and in need of my services…actually pretend I didn’t say that, because I need the work, but finally,

Finally, six, it will make nice people hate you because they have to be needy and dying to get your full attention. Again, this wish doesn’t discriminate based on age.

You and I know what’s wrong with very nice, recovered alcoholics: they’re addicted to helping others. So your goal isn’t to help others; it’s to ration your help so you have time and energy for equally legitimate and necessary priorities, like making a living, being a good friend to those who can give as well as take, and feeding your own soul.

Yes, you carry sadness and are surrounded by it, but the more you focus on it, the more helpless you’ll feel, which will make you sadder, until you’re stuck in a pit.

So accept the sadness, as you do, and start over. You’re fucked, your husband is fucked, and, as the old Spiritual says, “all God’s children be fucked.” Hallelujah. Both your sadness and his illness, however, haven’t stopped you from caring for one another and making one another’s lives richer.

Indeed, your sadness has probably made you a better writer and more empathic friend, and your ability to manage depression, alcoholism, and an eating disorder has given you strength that I’m sure has benefited others.

I’m not saying you’re lucky—that’s bullshit—but stop focusing on your inability to make sadness and loss go away, and instead on what you’ve done with it, and be proud. Be proud of being unlucky and not letting it stop you, turn you inwards, prevent you from using your gifts, cripple your friendships, or inhibit you from taking risks.

You feel like shit, but it’s just a feeling. Your actions are a triumph and that’s what you should be reminding yourself. Now stop whining and be proud.

STATEMENT:
Prepare a statement to block off the helpless misery of your meditations on loss. “My life has included more than its share of pain, loss, and out-of-control behavior and I’ve been sensitized to seeing the sad side of life. But I have been unusually good at living a full life in spite of my feelings, gaining control over my behaviors, and turning into a good person who gives courage to others. That was always my goal and that’s what I’m doing. I’m not really helpless at all.”

Recently, I suffered a health setback and I don’t know whether I’ll ever get better. Without getting specific, I have physical problems that are hard to talk about with anyone but my closest friends, but they slow me down and I don’t get as much done as I used to, either at work or home. I’m in my 40s, and I’ve always been active, productive, and social, so most people don’t know what to make of the change in my behavior. The real issue that’s come up involves my work, because my boss will notice, sooner or later, that I’ve taken a lot of sick days and that I’m not getting as much done. I believe in your philosophy of living by your own standards and not depending on what others think of you, and I’m worried, in any case, by how he’d respond, so my goal is to keep quiet about my illness and respect myself regardless of his questions or criticism.

There’s enough unavoidable pain in life so that you don’t have to embrace additional pain in order to build your pride. This includes the pain whose nature we dare not speak.

Besides, you have other priorities than proving your toughness to yourself, like making a living, taking care of people who depend on you, and making your relationships no more difficult than they have to be.

Pride in your toughness is unaffordable; instead, embrace shame, and be proud that you can.

Having an incurable condition brings out the worst in people if you’re not careful, and sometimes it brings out the worst when you are. Your wife and kids (and boss) will try hard to get you back to your usual, happy self, and then wonder where they, and you, have failed.

An incurable condition will tend to make you grumpy and depressed, and they’ll blame your negativity, not your pain, for making you sick and them miserable.

Your boss, if he notices a change, will launch into his usual executive procedures for establishing accountability, restoring motivation, and developing an explanation that will satisfy his boss that the problem is under control. If you don’t give him an explanation, he’ll assume he’s running into psychological resistance, try harder, piss you off, get a more negative response, and so on.

So watch out. You’ve got an incurable condition—”fucked” is the medical term—and you’ll be double-fucked if you don’t counteract the negative impact it will have on your relationships.

If the details of your illness are private, that’s fine, but the fact that you’re ill, especially if it affects your performance, isn’t something you can afford to hide from your employer if you want to stay in his employ. Speak up, and respect yourself for doing so, not in spite of it.

STATEMENT:
Write a statement to shield yourself from the expectations of others (and yourself). “I’ve got a condition that I’m working on with my doctor and the good news is that it won’t kill me, but the bad news is that it’s painful and makes it harder for me to get my work done and be as energetic and social as I used to be. So I need to prioritize carefully, while I try to keep the pain managed. Don’t hesitate to let me know if you think I’m falling behind in any major way. My feelings won’t be hurt, and it will help me adjust my priorities and be as effective as possible.”