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

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

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

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

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

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

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

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 I’m sure you know lots of good relationships where one partner or the other gets withdrawn at times, and unless you’re an unusually outgoing person living an unusually lucky life, it’s only a matter of time before you or your significant other gets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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

People like to think that trusting an inner voice—their gut, their instincts, the force, etc.—will always lead in the right direction. In actuality, instincts and body parts are better known for causing instant urges (a.k.a. “feelings”) that ignore logic and implant convictions that the sky is falling, love occurs at first sight, and advertising never lies. When it comes to major decisions, don’t trust your gut (which, as we’ve pointed out before, is literally full of shit). Find out facts and figure out the odds before doing something that scares you, titillates you, or gives you an enormous Visa bill.
-Dr. Lastname

My brother is a good doctor, and an especially good one given that he’s struggled with depression his whole life. When his own illness needs attention, however, he becomes a terrible patient. He doesn’t get depressed often, but when he does he obsesses about the possible side effects of each medication and so doesn’t take what’s recommended, takes half the prescribed dose, or insists on his doctor giving him something less harmful (and much less effective). The result is that he drives his doctor (and me) crazy and takes a lot longer to get better. When I tell him he’s over-reacting to his fears, he tells me “I’ve learned to listen to my body.” I know he’s a doctor, but I think his body’s lying. What can I do to help him when he’s sick?

It’s a sad fact of mental illness that it often prolongs itself by disabling a person’s ability to seek and select appropriate treatment. Like any smart disease, it knows from self-preservation (in all the ways your brother does not).

That means you can’t necessarily get through to your brother by reasoning or addressing his fears. In your brother’s case, it’s unlikely, not just because you and his doctors have tried and nothing works, but also because he is a doctor, and the side-effect of trying to treat a doctor is a giant pain in the ass.

Recognizing his response as inherently unreasonable and illness-driven, however, can build your confidence in your own opinion to the point where you don’t have to persuade or argue. If he insists on listening to his body, you can serve some truth to his brain.

Yes, medications have potential side-effects and some of them can be dangerous or unbearable. On the other hand, that’s true of all medication, which means you don’t choose a medication because it’s known to be safe, but because it’s relatively safe compared to the condition it’s treating and less risky to try than doing nothing. He probably tells all of his patients that, even if his body isn’t giving him the same message.

Don’t then reassure him that medications are safe, things will turn out well, or his body will deliver good news, because you’ll just be burdening yourself with responsibility for easing his anxiety. Instead, acknowledge his anxiety without offering it respect.

You don’t need to be a doctor to know that he’s anxious, life is hard, medication uncertain, and anxiety is a symptom of his illness. In your opinion, however, he needs to man up, stop listening to his body or the many fears his illness is pushing through his body like a speaker, and start to follow through on the decisions the professional, reasonable side of his brain has already made (or that have been recommended by the doctor he chose to advise that side of his brain). Appeal to the part of his mind that is healthy, instead of negotiating with the part that’s sick, suffering, and nutty.

Patients of any profession have a right to trust their instincts, but when you’re suffering from a disease that pointedly impairs instincts and strengthens fears, it’s time to admit that your body’s voice is secondary and get a second opinion.

STATEMENT:
“It hurts to see my brother suffer and dither, but the best I can do is to refuse to listen to the dithering, remind him that he makes good decisions (when he’s himself) and urge him to follow through on his current treatment plan, which represents those decisions. If he can’t, I may feel helpless, but I’ll believe in my message, deliver it when I can, and take pride in having done my best.

I still don’t understand what went wrong with my marriage. He was my best friend, we got along well, he liked his work, and we had 3 wonderful kids. Then he decided I was boring and got a divorce. My heart always told me he was the right guy. If I can’t trust him, I’m not sure I can ever trust anyone. My goal is to figure out what went wrong and get my confidence back.

It’s not uncommon to hear someone describe their spouse (or, more likely, their ex) as their “best friend.” And if that someone had known their spouse for years, gone through hard times together, and seen evidence of loyalty, fidelity, and reasonable self-control, then “best friend” would be the right term. May they get matching necklaces and/or tattoos and live happily ever after.

The problem is that there’s a big, sad difference between that kind of best-friendship and feelings of closeness that can arise quickly from interpersonal chemistry, mutual interests, common enemies, and one or both parties trying very hard to be attractive.

Instant best-friendship can feel just as close and important as the real thing, but the major, crucial difference is that the person you feel extremely close to is someone you don’t really know from a hole in the ground.

So forget about how well you got along with him and what your heart told you; those are feelings, like the body messages above, to take under advisement. Ask yourself whether your husband was good at standing by his friends and not getting carried away by ambition or new attractions.

Chances are this is not the first time he’s gotten tired of the old and jumped to whatever made him feel better. You just didn’t want to think he would do it to you, because your heart was having such a good time and you didn’t want to spoil the party.

Nobody wants to hear it when their heart is broken, but the only way to get over being dumped is to suffer for a while and learn from what went wrong. Don’t learn to distrust people or your own sense of being loveable and acceptable to those who know you well, because that’s not the problem.

Instead, learn to distrust your heart when it insists on working solo, without the ol’ brain as a co-pilot. Learn to trust your experience, which tells you that people don’t change, and that you can trust people who have always been trustworthy, once you know them well enough. You can still listen to your heart, but insist on hard proof.

Your heart may now tell you that you and the kids are rejectable, but don’t listen. Anyone who knows and loves you will also disagree with that, especially your real best friends.

STATEMENT:
“Being dumped by my trusted partner has left me hurting and doubting, but I have no reason to doubt myself or my own ability to be a good wife and friend. The only thing I need to improve is my asshole radar.”

My wife is a good woman, and she loves our son, but she has a trauma history and when she gets anxious, she gets very negative and loses hope in us, herself, and our future. Antidepressants helped some, but less than we hoped. Two years ago, before our son was born, her psychiatrist showed her that negative thinking was half the problem and urged her to get DBT, a kind of cognitive behavioral therapy that would help her develop positive thinking habits. She didn’t follow through but seemed to be doing well until the other day, when I discovered she’s been drinking secretly since she delivered. She says alcohol is the only drug that helps relieve her anxiety, which has been overwhelming. My goal is to find something else that will help her.

Everyone is entitled to anxiety-relief, a fair life, and a healthy body. Along with that entitlement comes the guarantee that everybody (except for a few lucky jerks) has to pay the price.

At this point, her motto is, to paraphrase the New Hampshire license plate, “live free (from anxiety) or drink.” If it were up to you, she wouldn’t feel this way, but it’s not, and you’ve got to tell her that neither freedom nor booze is an option.

Theoretically, there should be a good medication for anxiety, but in actuality all current medications are a compromise. The reliable, effective drugs—benzodiazepines—are also addictive, and the safe, non-addictive drugs—antidepressants and others—are less reliable and slower to take effect.

So, while most people get some anxiety relief from medication, there will always be a few people who don’t. Unfortunately, they’re the ones who are most vulnerable to alcohol addiction and have the most reason to wonder how they can be expected to tolerate anxiety without its benefit.

The sad fact is that she’s fucked, and as long as she’s unwilling to accept that fact—and her question implies that she is—she’ll make herself worse. Helping her means helping her face facts, then seeing what she can do.

There’s no immediate relief, and sobriety, which is what she needs, will begin by making her feel worse. That said, if she can stay sober, she can learn new ways to get stronger. The psychiatrist was right—DBT will help, and so will AA.

Let her know you’ll stick with her if she tries, and protect yourself and your child if she doesn’t. You’re not warning her because you’re angry or want to control her, just because you’re stating the sad facts of life.

Hopefully, once she realizes what’s at stake, and accepts the lack of feel-good alternatives, she’ll be ready to make sacrifices to preserve what’s truly valuable in her life.

STATEMENT:
“My wife’s pain is real and it’s hard to see it without feeling she deserves better, which she does. If she can’t find the strength and motivation to get sober, however, she’ll become a dangerous parent and weak partner. I love her and believe in her potential strength, but I must do what’s necessary to survive if she can’t get herself under control.”

My wife has been horribly depressed for the past 6 months and none of the medications that used to help her are doing much good now. ECT, the treatment they use when medications don’t work, caused her too much memory loss and she can’t do it again. Her psychiatrist says the only medications that might work are ones that sometimes cause weight gain, so she refuses to try them. (Another psychiatrist, whom she saw for a second opinion, agreed.) Now she’s suicidal and insists that there should be a medication that won’t cause weight gain and that she needs to find a psychiatrist who can help her. My goal is to help her, but she’s making it impossible.

Weight gain is bad for her health, as well as her looks, self-esteem, and pants budget, so it’s understandably the side effect your wife hates the most.

The one positive sign in all of this is that your wife is eager to find treatment, even if she’s got the wrong priorities (which is better than reacting like the wife above and looking in the wrong places). The key is getting her to look harder, expect less, and be willing to put her mind above panic about her body.

After all, she should remember that side effects are usually mentioned in the same phrase as the word “risk,” which usually means less than 100%, and that weight gain never appears overnight, so she will always have time to recognize it and respond before acquiring 10 new pounds and a need for bigger pants.

Of course, depressed people often don’t think rationally–weight gain, panic, misery—but that’s where you have to come in and remind her that, unfortunately, a risk of weight gain is a possible side effect of almost all psychiatric medications that are used after the first round or two of treatments fail.

So, if you can’t persuade your wife to take it one step at a time before she rules out meds that might cause weight gain, tell her that she has no other choice. She’s done a good job trying medication, hasn’t been lucky, so now comes the same tough choice that cancer patients face about chemo: brace for possibly serious side effects, or make the most of living with your illness.

If she clings to false hope, expect trouble. You’ll be living with a hypochondriac who puts the search for treatment ahead of other family priorities and blames you and others for not being helpful. The longer she looks for a non-existent solution, the longer she postpones hard choices and distances herself from what’s good in her life.

Show respect for the courage it takes to make tough risk management decisions when there’s no good option. Remind her that there are often good ways to manage bad side effects. Assure her you’re there for her no matter what size pants she wears.

STATEMENT:
“I don’t understand why my wife isn’t able to recover from depression the way she did before, but I know it’s not her fault or the medications’ and that her options are now limited. I’ll encourage her to make tough decisions and respect her, no matter what decision she makes. I’ll make adjustments to help her manage her condition. If she avoids reality, however, I will not accept responsibility for relieving her pain or re-ordering my priorities to help her find a non-existent cure.”

So you say “fxck feelings” and act on what I can change. How do I sit through a feeling and get to the other side of it without resorting to destructive habits (eating/not getting out of bed/no proper sleep because if I go to bed I will think and feel and remember as I’m falling asleep of all those things that I don’t want to keep remembering and that make me sad) that compound those feelings instead of dull/diffuse them? My goal is to live (emphasis on the word “live”) through a feeling until it goes away or at least becomes akin to white noise, instead of distracting myself away from a feeling with destructive behavior/habits to avoid it until I’ve made it ten times worse.

In one of her short stories, author Lorrie Moore describes two explorers captured by an angry tribe of natives in the jungle. The explorers are offered the chose of “death or Roo Roo,” and the first man choses Roo Roo, which turns out to be lethal torture. The second man then opts for death, so he is killed…by Roo Roo.

What you’re dealing with is a death-or-Roo Roo situation.

You either let depressive sleep impulses drive you to destructive habits that feel better in the short run and hurt you more in the end, or you suck it up until it’s not so bad (or you get distracted by something worse) and even then it’s not great. Alas, it’s a jungle out there.

The good news is that you’re seldom as screwed as you think. Depression will tell you that you’ve messed up, there’s no point in getting up, you’re falling behind, you won’t be able to explain your absences, and you’re bound to get fired. Those are thoughts that feel like truth, but, despite what depression tells you, aren’t.

If you accept those thoughts as truth, they have the power to make you feel, not just screwed, but damned and cursed. Those are the feelings that should go get fucked, because bad feelings cause bad thoughts that will fuck you if you don’t oppose them with your own wisdom and self-respect.

The depressive sleep habits you describe can destroy your confidence. It’s hard to get up, your sleep schedule makes it hard to work, you’re tired all the time, and you get colds. Your sleeping pills don’t work for long, you can’t give anything enough effort, and it’s easy to feel that your life is falling apart and that your health won’t survive the stress. Before long, you’re sick and tired of being sick and tired.

If you accept your powerlessness over a depressive sleep disorder, however, you’re no longer responsible for either causing or curing it, just coping with it. You can’t help feeling like shit every morning, but you’re a hero if you nevertheless drag yourself out of bed and out the door. You can’t help dreading bedtime, but you’ve got to respect yourself for trying to sleep while managing the painful thoughts.

So try to get up on time, regardless, and not nap during the day. Avoid alcohol and caffeine, keep to your evening routine and bedtime, and try what medications you can. Remind yourself that this will pass and that your basic health is OK, even if you have no vitality or ability to resist common viruses. Above all, respect yourself for the tremendous effort it takes for you to live your regular life.

Getting through painful feelings takes more than perseverance—it also requires an active respect for the good things you’re doing with a bad situation. Life is full of “Death or Roo Roo”-esque situations; the best you can do is respect your choice and bring the same values to the next one.

STATEMENT”
“I feel like I’m barely holding on and I can’t stay awake or think clearly, but I’m still trying to live my life my way, even if I’m forced to do it in slow motion and with tooth-picks propping up my eye-lids. I never thought it would be this rough, but I never realized how tough I can be.”

I love my girlfriend but I can’t stand watching her starve herself to death, which is what she’s doing without being able to admit it. She’s told me she had treatment once for an eating disorder, but she won’t talk about the details and she denies that it’s a problem now. I wish she was seeing a therapist, but I can’t be sure she’d be honest with a therapist if she saw one. My goal is to see her get healthy.

It’s no accident that all the problems we hear about at fxckfeelings.com are not solvable; after all, if they were solvable, we wouldn’t be hearing about them. A woman who can’t stop starving herself is one of the classic incurables.

As far as your goal goes, you’re screwed, and it would be easy, given your love and frustration, to see your relationship as a failure because you just can’t get through. You can’t get her to talk about the problem, you can’t be sure she would be honest with a therapist if she had a therapist, and you can’t get her to agree on an approach.

If you don’t see her problem as your failure, however, there’s stuff you can try. As clinicians who treat eating disorders will tell you, you can be quite direct in a positive way if you aren’t angry.

Tell her that, as much as you love her, and as good a companion as she is in other ways, her inability to control her eating behavior is dangerous and unacceptable and that, if she wants to continue dating you, there will be rules to follow. That’s just a positive re-statement of the fact that, if she doesn’t gain weight, your relationship won’t last.

Impose conditions that use your relationship as the reward but minimize your control and responsibility. They might include her seeing a therapist who’s mandated to speak with you, developing a meal plan, and including you in strategy meetings about what to do if she isn’t making progress.

Your goal isn’t to make sure she’s compliant with a plan so much as it is to make sure she’s trying. If you can’t cure, be helpful, but only if she’s willing to help herself.

STATEMENT:
“I can’t control my girlfriend’s anorexia or the pain of watching her starve, but I use what little power I have to push her into treatment, knowing I have no better alternative. What counts is doing what I can, knowing that my feelings about this are probably not going to be great, no matter what I do.”

I hate it when my husband and I squabble over something stupid, and then he falls silent and stops communicating, and it’s like he’s left the room. It drives me crazy. It’s true, I’m not thrilled about doing his bidding when I don’t have the time, or when his requests don’t make any sense, but if he let me know how important it is to him instead of sulking, I’m sure I would do it and then we wouldn’t have to go through this pain. My goal is to get him to communicate better.

If you’re the sort of person who can’t stand it when someone you love is angry and silent, your best mate might be a parrot.

You may try to find ways to help your beloved and avoid your pain, but don’t. Sometimes, reaching out to angry people will get them to lash out at you because they want a time-out, or it will let them know they can get to you by sulking, so they’ll use silence as a weapon.

Anger sends the same signal from any animal, from human to bear—go away, or stick around at your peril.

Worst of all, pushing an angry person can force them to say things that were better left unsaid. That’s why it’s often better to go to bed angry but quiet, rather than trying to reach a mutual understanding when you’re tired. There are times when it’s important simply to not try to connect.

Besides, you don’t really want to do your husband’s bidding just because he tells you it’s really, really important. Sometimes you’re too tired, or you think it’s his job, or you’re irritated and don’t want to do anything for him. It’s OK to admit you don’t always want to do what your husband asks, just like it’s OK to let him sulk when you feel that way.

Once you admit that, you can stop trying to think up solutions that won’t work and accept the fact that the kind of negative interaction you describe is unavoidable. It’s called marriage. You can’t make it better, but you can make it worse.

Yes, there are some people who are not as sensitive as you are to close-person-withdrawal syndrome—that’s the way they’re built. Either that, or they’ve been married so long, they’ve built up calluses. In any case, your hurt is a fact of neurology and the trait behind it is probably responsible for qualities you value, like sensitivity and attachment.

More important than avoiding hurt is knowing that you will follow you own priorities when your husband asks you to do something, regardless of fearing his disapproval or withdrawal. Either accept that marriage isn’t all “I do”s and “I will”s, or make room for your new winged companion.

STATEMENT:
“I’ll never enjoy it when my husband retreats into his pissed-off cocoon, but he never stays there forever, and I’ve gotten good at changing the subject and pretending that there’s nothing wrong until he comes out of it. I refuse to let my fear of his withdrawal control what I say and do.”

Ever since my stroke left me partially paralyzed 6 months ago, my wife has become ineffective and infantile. I know my illness hasn’t been easy for her, but I’ve got good nursing care and she doesn’t have to wait on me, so there’s no reason for her to look exhausted and complain about the stress of my illness and then run around in circles and not get anything done. I’m going to get an expert to teach her how families of stroke-victims cope with their problems. My goal is to get her to cut the crap.

It’s clear that your stroke hasn’t impaired your moxie, and that’s great. Moxie must be wielded carefully, however, because your wife is also your chief assistant and you won’t get her on a positive track by telling her what she’s doing wrong. For that, you’ve got to start with what she’s doing right.

Having her blame you for her dithering can put you on the defensive, of course, particularly if you feel guilty about the trouble your illness has caused your family. So your first job is to convince yourself that it’s part of her marital job description, and yours, to help out when the other guy gets sick, and that you’re doing your best to rehabilitate yourself, so you have nothing to apologize for and no need to feel responsible for her anxiety.

Then, ask yourself whether your stroke has disrupted her routine and whether she’s relied on a routine to stay organized. If losing her schedule is likely to set her adrift, then she may need as much rehab as you do, and your idea of getting advice from coping-with-stroke experts may be very helpful.

The sad thing, probably, is that there’s no way for tough talk to set your wife straight (it’s more likely to get her dithering faster). If, however, you accept the idea she’s not well equipped to cope with life with a stroke-stricken husband, then you’re ready to do positive things with the girl you got. You can be much more direct about her shortcomings if your emotion isn’t negative.

Remind her that you’re buoyed up by her love and caring, and coach her, or get her some coaching, on how to re-build her routine. Push her to accept her inability to make you better or get back the life you used to have, so you can focus on making the best of the life you have now.

Be positive about your own efforts to regain your independence and suggest that she, too, has a transition to make. You can keep your moxie and your marriage.

STATEMENT:
“It’s no fun watching my wife melt down when I’m the one who should be upset, but we’re still together and I don’t think she can help her reactions much more than I can help how my nervous system behaves. I’ll keep my irritation hidden, if I can, while I remind her about the good things we’ve built together and the positive things she can do when she settles herself down.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I need to find a doctor who will tell my daughter she needs to take her medication. She’s always had a problem with depression, and she did well in high school when she took antidepressants. Now, however, she’s 24 and very reactive to however she’s feeling, whether it’s not getting out of bed, or not working, or feeling dizzy and deciding it’s the medication and stopping it. My husband and I can’t get her to stick with anything, and she won’t listen to us in any case, so our goal is to get you, or some professional, to tell her what she needs to do.

Whenever parents want a doctor to tell their kid what to do, you can be pretty sure they’ve lost faith in themselves and overestimated the power of communication/a medical degree.

And no, it doesn’t matter how old the kid is or how many Harvard degrees the doctor has; the doctor doesn’t have more power than the parents, no matter how powerless the parents feel.

In your case, I don’t know whether your daughter can be induced to take her medication, but I do know that she’s not going to be persuaded by the authority of a doctor at the age of 24 if her own experience and your words haven’t done it by now.

The probable reason for her unresponsiveness, by the way, isn’t stubbornness or a lack of respect, but a lack of control over her own impulsivity (probably enhanced by depression). In other words, it’s not clear she can make herself take medication regularly, even if she sincerely believes she needs it. At some point, other impulses take over, like the impulse to stay in bed indefinitely.

Fortunately, even though persuasion is probably useless, you have other tools that a mere doctor can’t touch. You can access them if you believe you know what your daughter needs, regardless of what she has to say about it.

For instance, if you believe that she needs to get up early and follow a daily activity regimen, then let her know that’s what you’ll pay for. If she says she’s too blah, tell her you know it’s hard, but she needs to try, and that she might be able to do it if she puts together a schedule and asks friends to help her keep it.

If she argues that she can’t do it until she feels better, tell her that you don’t know when she’ll feel better, so she’d better start trying to keep busy now, and maybe that will help her feel better later. Your tone should say that you believe what you believe, and there’s no point in arguing.

If she tells you that you don’t know what she needs, tell her that you’re the mother and you have a good idea what she needs. Don’t ask a doctor to be the authority– get whatever information you need from the doctor, and then assume you’re the authority. At 4 or 24, your kid needs to hear the same thing; you’re the mommy, that’s why. End of discussion.

If your incentives don’t work, don’t blame her or yourself, because, again, you don’t know whether she’s too sick to have the control she needs. By putting a priority on self-control, however, you provide her with a blueprint for moving forward that is not reactive to negative feelings or thoughts or painful side-effects.

You’re urging her to embrace goals that arise from her values and that she can stick with, regardless of how she feels or how much she accomplishes. Knowing medicine isn’t as important as knowing your daughter and what’s best for her. If she won’t listen to me, you can, and I’m telling you you’re the most qualified professional for the task.

STATEMENT:
“I’d like to think my daughter could respond to persuasion from someone she respects, but I suspect it’s not true. I’ll push her towards doing as much as she can, regardless of how she feels, and hope that incentives for good habits will take over where persuasion has failed.”

I need an answer about what’s wrong with me, medically. I’ve always been healthy and athletic, right into my early 70s, and if there’s something I can do to improve my health, I’ll do it. Along with my husband, I ran a small company before I retired, and I’m good at getting things done. Lately, however, I’ve been having bowel problems and dizzy spells and fatigue that no one can explain, and I’ve gone to some terrific doctors. It’s gotten me down, and I haven’t been exercising or getting out as much as before. I need some answers about my medical problems so I can get going and get my old life back.

The weak side of being a great problem-solver is that it’s hard to change your expectations when you hit a wall, and old age is a wall. You’re accustomed to believing in the value of hard work, perseverance, intelligence and ingenuity. That’s a dangerous belief when their value happens to be zero.

What happens when hard work, and your belief in hard work, don’t work, is that you feel like a failure, try harder, and feel worse. You can’t undo the effects of aging, but you can always make them worse. I’m sure that isn’t a comfort, but it’s the truth.

Give yourself credit for getting yourself the best medical care, and then suck it up and admit that there’s nothing more you can do to get a diagnosis or find a cure. Cry if you must, but then figure out what comes next (besides death, which is everyone’s sad conclusion).

What comes next, once you give up on getting to the bottom of your medical problems, is using your good, well-developed discipline to get yourself going and re-claim as many of your old activities as possible. If being strong means achieving great results every day, then you may never be strong again. If you decide, however, that being strong means achieving all you can with limited equipment, then you’re about to become stronger than you’ve ever been.

Once you accept that there’s no curative treatment for aging or mortality, you can explore a wide range of treatments, including medication, that may improve your symptoms. Nobody lives forever, but there are plenty of ways to live a little better, and do what’s meaningful despite diminished capacity, at any age.

STATEMENT:
“It feels like a defeat to accept the limitations of age, but it’s actually a bigger defeat not to. Once I’ve completed a reasonable search for a definitive answer, I need to stop myself from searching further and re-order my priorities. I’ve got defective equipment and correcting the defect isn’t my department. I will do my best with the equipment I’ve got.”

I like my wife, except when she doesn’t take her bipolar medications, which she hates, and then she becomes nasty, irritable, and overbearing. She makes my life miserable, and I worry about her impact on the kids. My goal is to protect the kids and get her to take her medication.

The best way to keep someone from taking their medication is to persistently ask them whether or not they’ve taken their medication.

That’s not to say that leaving the issue alone will insure she takes her meds, either. The point is, if she doesn’t want to take then, she won’t. The second part of the goal is a no-go.

The best you can do is tactfully encourage your wife to look for her own reasons to take medications. Having done that, you can predict whether it’s ever going to happen, and direct your life accordingly.

That’s the same rule you would use for a spouse with any ingrained bad habit. Begin with acceptance, make a realistic, nothing-but-positive-emotion pitch, then end with acceptance. It’s a helpful suggestion sandwich on acceptance bread.

Ask yourself why, from the point of view of her values and perspective on life, she would want to take medications, given the fact that she hates the idea of them, the smell, the appearance, the side effects, the fear of possible side effects, the cost, the implication that she’s ill, the memory of being told what to do, etc., etc. There’s no reason that she or anyone else would ever want to take medication for mental illness, except for desperation.

Then ask her whether, from her experience, she’s reached that state of desperation; if there’s reason to think she has lost jobs or relationships because of symptoms, or whether she’s been too emotional with the kids. Urge her to gather information from others, not just from you, even to tape herself, if necessary. You want her to do what she thinks is right and necessary. It’s her decision, and you want her to make one she believes in, using rational methods to make it.

If she’s willing to consider that method, give her time to do a survey and observe her own behavior over time. Give her your observations in a neutral way, without condemnation. If you think her symptoms have fucked her up, that’s your opinion, and you’re not implying fault.

Symptoms are a torture that’s beyond her control, so what counts is what she does with them. If she doesn’t have the capacity to observe them, there’s nothing much she or you can do to open her eyes or change her mind.

If all else fails, purchase a copy of my imaginary best-selling cookbook, “Cooking with Lithium” and its exciting sequel, “Baking with Depakote.” A dog will take pills with some peanut butter or cheese, but I don’t think your wife will fall for that; she’s mentally ill, not stupid.

After that, it’s your call whether you and the kids are better off living with Bipolar Mom or not and, in either case, what you can do to stay clear of her bad behavior. You can’t make her better; but, if you can accept that fact, you may be able to persuade and/or incentivize her to get real.

STATEMENT:
“If I can keep my emotions in check, there’s much I can do to encourage my wife to get back on her meds. If that doesn’t work, I will know that I’ve done my best, there’s no reason to fight with her, and my responsibility is now limited to finding the least destructive way forward. Happiness is not an option.”

Some days, I find it almost impossible to get up and take a shower, so I don’t. There are also weeks when I never even get out of the house. Fortunately, I have a wonderful wife, she’s a nurse, and she supports the family and takes good care of me, but I don’t know what will happen to me if she dies before I do. The only time I can get going is when my sister comes to town—she’s got a forceful personality—and she gets me up and out. Otherwise, nothing helps, including the medication I get from my psychiatrist. My goal is to find a medication that will get me going.

When medication goes up against bad habits, medication usually loses. That’s because medication is seldom very strong, and habits have a way of grooving themselves into your brain, attitude, assumptions, rationalizations, and relationships.

Your habit has got you bad; it’s been going on for years, prevented you from living a life, and shaped your most intimate relationship. If your spouse and your kids can’t get you to shake your routine, then medication by itself doesn’t stand a chance

That said, all is not lost. You do better when your strong-minded sister comes to visit, which means that social pressure can sometimes pry you out of your sedentary, sedimentary existence. That’s what behavioral therapy is all about.

Let’s be clear from the beginning, however, that there’s a big part of you that doesn’t want to leave your house, or do much of anything, unless your feelings change, and that isn’t going to happen. For example, a drunk will often moan about much s/he needs to stop drinking…before downing 10 shots night after night.

So no matter how strongly you tell me you want to get up and out, we know you don’t. The first step then, as they say in a 12 step program, is acknowledging your helplessness to control your addiction. Otherwise, you won’t get far.

If you’re still interested in changing—not finding a pill that will do it for you—there’s lots you can do. You can invite your wife to stop supporting your bad habits by telling her to do the things you like if you’re taking care of yourself, but leave you alone otherwise. Ask her to schedule good things for the two of you to do together and leave without you if you back out. Ask your friends if they’ll help you in the same way, and get a coach or therapist to help you stay on track.

As long as you accept your lack of control, you won’t get over-confident or count on any one trick—or medication—to give you a handle on your sloth-demon. In that context, medication may help.

Expect yourself to wiggle out of your agreements, but don’t give up. Remind yourself that time is short, and you have some living to do. Be prepared to hurt, because changing habits like these does hurt. If you slip back, do better next time. Just keep going, one day/shower/step outside the house at a time.

STATEMENT:
“I’ll never know why I can’t get myself going, and it’s hard to change my habits. If I let people know I need help, and use that help to push myself back into the land of the living, I’ll be doing what’s most important to me, and that’s what matters.”