fuck treatment - F*ck Feelings: One Shrink's Practical Advice for Managing All Life's Impossible Problems (2015)

F*ck Feelings: One Shrink's Practical Advice for Managing All Life's Impossible Problems (2015)

bonus chapter ten

fuck treatment

Even if you’ve read this entire book from cover to cover and learned all you can about managing expectations, accepting limitations, and wrangling Assholes, you may still be considering getting professional help, but not feel entirely confident you know what “treatment” actually entails.

So now that you’ve read a full guide to handling life’s most common unsolvable problems, we offer you a guide to the most common forms of professional help, along with how to decide whether it’s truly necessary, what kind might work best, what to expect, when to stop, and basically all the information you need to approach treatment without feeling helpless.

In any case, treatment usually provides partial help; the rest is up to you, so you need to get as knowledgeable as you can in order to decide whether more help is necessary or not, and what you can get out of it (that you can’t get from just reading this book).

Getting Treatment

There are many suggested methods for problem solving in this book, from the pleasant, such as exercise and kindness, to the less pleasant, such as setting limits and shutting the fuck up. And then, of course, there’s treatment, including medication and talk therapy.

Treatment happens to put food on our table, but it’s rarely our first recommendation for any problem; it can be expensive and time-consuming, and if you enter it with unrealistic expectations, ineffective or even damaging.

Many people think therapy is a deeply emotional, somewhat spooky process whereby a compassionate, supportive Melfi/Gandalf hybrid therapist gets patients to recognize and experience painful thoughts, memories, and feelings. People assume this therapy gets at deeper reasons for emotional pain and irrational behavior and offers a more permanent and self-reliant solution to persistent unhappiness than just popping happy pills ever could.

Unfortunately, therapy of that kind, like most treatments, is rarely a cure, sometimes totally ineffective, and frequently effective to a limited degree. In any case, insurers would rather pay for you to get a third arm attached to your back to better facilitate the scratching of your ass than cover any kind of frequent, endless, goalless therapy.

As for getting at the root of issues, that’s nice when it happens, but it usually only happens in movies (that aren’t good) with results that are equally unrealistic. In real life, most problems have many causes and many of those causes can’t be changed, even with blinding insight or a good, snotty cry, so if you expect that treatment will provide solutions, you’ll feel like a failure.

People who recognize this simple fact, however, including both therapists and patients, do not see themselves as failures when therapy doesn’t work. Indeed, therapists who recognize the limits of talk therapy have developed many new ways of using questions, ideas, suggestions, and coached behaviors to accomplish specific goals. When considering therapy, it’s important to recognize that you have many treatment options beyond the classic couch scenario, ones that aren’t mysterious, confusing, or interested in your mother.

Most therapies teach a specific technique for dealing with well-defined problems and have measurable goals for managing despair, eating disorders, or obsessive-compulsive symptoms. Very few invite you to describe how you feel about everything, or how your poor dating habits might be due to losing your hamster in sixth grade.

In any case, if you think you need therapy of any variety, there are simple ways to determine whether you need it, where to look, and whether it’s working. Keep in mind, however, that as varied as your treatment options are, and they are extremely varied (see sidebar at the end of this section), all are limited and none guarantee a cure. If you can ask questions and figure out costs and risks, however, you can get the best out of what even we think is your last resort.

Here is what people wish mental-health treatment could provide (but it can’t):

✵ A new you (or at least a you that you hate less than current you)

✵ No more urges to do or say stupid, self-destructive things

✵ A cure (to depression, anxiety, or most of life’s problems)

✵ Better relationships (when the chemistry is bad and the other person is a jerk)

Among the wishes people express are:

✵ To get at the root of their problems

✵ To stop feeling the way they do

✵ To overcome depression and anxiety

✵ To no longer feel like they have to do self-destructive things

Here are three examples:

I often feel somewhat depressed, and have for short periods since high school, but anxiety is what’s bothering me the most lately. I think it’s related to losing my boyfriend, but I don’t know if it means I choose the wrong kind of person and really need to explore why, or whether there’s something wrong with me that ruins relationships, or whether it’s part of a bigger problem that I’ve had since I was a teenager … all of which leads me to believe that I might need to talk to somebody. The problem is, even if my issues are worth talking out (and won’t just pass on their own, like they always eventually do), I don’t want to end up relying on drugs that make it impossible to feel anything. My goal is to figure out what kind of treatment I need, if any.

I don’t think I need treatment, but my wife insists I do. She says I seem unhappy and depressed, and that I can be loud sometimes and intimidate people. Not her, clearly, but she worries about me and thinks it’s affecting the way people see me at work, and when I asked a coworker, he agreed that I seem angry and down sometimes. I trust what they’re telling me, but at the same time, I swear that I feel fine, and I’m never particularly cheery. I guess now that life has me a little stressed out for other reasons, I seem particularly sour, but I’m not sure a doctor can do anything about it. My goal is to figure out what they’re talking about and get help if it’s the right thing to do.

My marriage hasn’t been going well since the kids arrived and nudged my husband to discover how much he likes to spend his evenings at the bar with his close, close drinking buddies. Still, I don’t want to break up our marriage without trying to fix it first, so I finally got him to go with me and see a couples therapist. He talks about how he feels that I nag and criticize him until getting out of the house is the only way to prevent a fight, and I talk about why I’m angry having to hold the bag and be the grown-up all the time. The therapist encourages us to air our feelings and has suggested to him that he really isn’t doing his job, but he doesn’t get it and says we need to find a new therapist who takes his side instead of mine. So couples therapy really isn’t working, but I’m still not ready to give up. My goal is to figure out why it’s not working and whether we should continue or find another therapist (who doesn’t take sides, period).

If you had a pain in your leg that wouldn’t go away, you probably wouldn’t hesitate to go to the doctor, and that doctor would help you pinpoint the pain and give you a variety of options to deal with the pain, and hopefully one would be simple and mostly successful, and ta-da: better leg.

Sadly, persistent psychic pain is less easy to pinpoint, and the brain is basically the human body’s junk drawer; science has a rudimentary idea of what you can find in there, but the exact location of most things therein is unclear. That makes it hard for the doctor to provide you with new information or definitive treatment that will cure your pain, and even harder for you to know when it’s smart to go to the doctor in the first place.

Still, even if brains are far more complicated and less understood than limbs, deciding whether you need mental-health treatment is basically like making any other medical resource decision, taking into account what you can afford, how much your problem interferes with your life, and whether obsessing about it will do more harm than good.

Perhaps because mental health treatment is misperceived as mysterious, people assume it has magical powers ranging from rooting out most kinds of unhappiness to turning you into a flake. In reality, of course, unrealistic expectations lock you into unachievable goals, so count on your own experience and judgment to decide whether treatment is meeting your expectations or likely to do so anytime soon.

If you have anxiety and depression after a loss, it’s easy to assume that the loss caused your pain, and that talking with friends and healing with time is all you need. This may actually be the case if you haven’t been depressed or anxious before, the loss is terrible, and there’s no one around whom you can really talk to. To paraphrase R.E.M., everybody hurts sometimes, so not everybody needs to see a doctor about it.

Most likely, however, your symptoms aren’t new and have persisted in spite of good talks with supportive friends and family. That’s why it’s wishful thinking to believe that treatment can stop symptoms quickly or entirely and prevent them from coming back. Instead, you can expect talk therapy to provide support—help you fight negative thoughts caused by depression, anxiety, and life—and give you a tool for managing your symptoms this time and after future episodes.

Since choosing the wrong person to love is often a key part of heartbreak, look for a positive coach or therapist who can help you nail down the lesson to be learned and figure out some new procedures to help you find better partners and keep you from making the same mistake, while also fighting negative thoughts arising from depression.

As far as looking for the right therapist, do remember to actually look; too many people make the mistake of picking the first name off the list provided by their insurance company and assuming that if things aren’t working with that therapist that means therapy doesn’t work for them, period. Finding the right therapist takes time, and it’s like picking out a good mentor. Look for someone who is interested in teaching the topic you think you need to learn and who has a positive way of motivating you while accepting your particular learning style.

As for meds, it’s always your choice to decide whether they’re necessary; if you think that shrinks can hold your nose and force pills down your throat, you’re mistaking them for veterinarians. Sometimes, the choice to try medication is simple; i.e., if your symptoms don’t let you get out of bed in spite of warm support and good coaching. It’s the same choice you would make for any chronic, severe medical problem, so don’t get moralistic and blame yourself for whatever decision you think is negative.

If others say you need help but you don’t really see what they’re talking about, congratulations for being able to experience suffering without feeling any pain. Obviously, you care about the impact of your behavior on others, even if you don’t have an instinctive ability to feel it or see what it is, and would rather make your wife happy than take your talents to the circus.

Ask yourself whether your grumpiness affects the roles you value the most and in which a little misplaced anger can do a lot of damage, to your parenting, partnership, and maybe leadership. If you don’t think crankiness has much effect, then it’s just an annoying-yet-harmless personality trait, like constantly soliciting high fives or ending every sentence with a question mark. If you do think being crotchety is holding you back, then look for a therapist who seems able to help you spot what you’re doing when you’re angry and manage your behavior more effectively.

If treatment changes your feelings and makes you less depressed and irritable, more power to you, but don’t consider yourself or treatment a failure if that doesn’t happen. Some people are grumpy and poor at self-observation, even when they’re also smart and life is going well. If treatment doesn’t change the source of your problems, you deserve great credit for deciding to improve how you manage them.

If you can’t get a treatment like couples therapy to persuade your deadbeat spouse that he needs to stop drinking and come home after work, remember that your treatment goal is not to change him, because it’s impossible, but rather to see whether he can be encouraged to change. And of course, despite how much your therapist might encourage sharing, remember that insults and character attacks, no matter how justified, rarely make for good persuasive tools.

In this case, your therapist agrees with your complaints but can’t get through to your spouse any more than you can, even without the insults, so stop blaming yourself for feeling needy and angry and not getting your husband to see your point of view. A professional couldn’t get a better result, and they needed nothing but the copay.

Now, instead of trying harder to get him to see the problem, figure out what you want to do about his faults. Find a therapist who blocks you from ruminating about could-haves and should-haves or sharing anger, helplessness, or complaints about your husband, and instead helps you build up your resources and consider your options.

Whether it’s your current couples therapist or a new one, choose someone who can help you announce your intentions to your husband without further efforts to persuade, bully, or defend. Then, whether or not your announcement gets through, you’ll know you’ve done your best to save your marriage while protecting yourself and your kids from an early-stage deadbeat alcoholic.

Try any kind of treatment you think might help, but don’t try the same thing again and again or assume that it would have worked if it were done properly. Instead, use failed treatments to limit your expectations and teach you what you have to live with. Allow yourself to explore your options, whether that means different types of therapy or just different doctors.

If you’ve objectively assessed the severity and impact of your problem and decided it needs attention, it won’t take you long to find out what you need to know about treatment, assuming you’re not scared to read articles, ask questions, and weigh risks against benefits. Then you’ll know what kind of expertise and personal qualities you’re seeking in a doctor, as well as how to measure progress, so you can find the combination that will, ta-da, make you and your brain (mostly) better.

Quick Diagnosis

Here’s what you wish for and can’t (always) have from treatment:

✵ Insight to change your life and improve your behavior

✵ New, better, or more confidence

✵ A wrenching catharsis that will ease your sorrows and teach you to enjoy life, moment to moment, while you’re still alive and not yet dead

✵ Happy, conflict-free relationships with the Assholes in your life

Here’s what you can aim for and actually achieve:

✵ Identify how much control you have over whatever’s ailing you, with or without treatment

✵ Develop a good idea of what treatment does and doesn’t have to offer and what its risks and costs are

✵ Develop your own reasons for determining whether higher-risk, higher-cost treatment is worth pursuing

✵ Make treatment decisions that are worthwhile, whether or not they get you a good result

Here’s how you can do it:

✵ Determine rationally whether your problems are worth getting treatment for, or would actually get worse with too much attention

✵ Ask questions and do a little research to figure out what treatments have to offer and the risk and cost of trying them

✵ Shop for a therapist thoughtfully

✵ Evaluate the effectiveness of a particular treatment, and its costs and side effects, without assuming that a poor result is anyone’s fault

✵ List your criteria for considering treatment worthwhile, aside from its making you feel better

✵ List your criteria for stopping treatment to see whether or not you continue to need it

Your Script

Here’s what to tell yourself/friends/your therapist about your treatment decisions.

Dear [Self/Concerned Friend/Therapist Who Would Like to Take Me On],

I feel like I should be able to [feel/do/relate/function/pitch] better than I do, but I won’t let [frustrated ambition/comments of others/peer comparisons] get me to waste time on treatment unless I believe my problems will possibly [cost me my job/drive away my spouse/cause me to burst into tears or rage in the middle of ordering a burrito]. If I think treatment is necessary, I have no doubt I can learn enough about it to decide what’s [worth trying/inappropriate/total bullshit] and whether the risk and cost are worth it.

Basic Treatments, Defined

While we try to avoid shrinky jargon in this book, there’s no way to avoid it when describing the different types of therapy, many of which (e.g., CBT, DBT, psychopharmacology) sound to the average person like the names of chemical weapons used in Vietnam.

Below we explain these terms by giving a brief description of several therapies, including how likely they are to be covered by insurance, who performs them, their negative aspects, and a one-to-ten rating on the BTPS, aka, the “bullshit-to-pragmatic scale.” According to the BTPS, a therapy with a rating of one is totally flaky and subjective (e.g., new age crystal-type bullshit, relying on willpower, etc.), and a therapy with a rating of ten is supremely objective, measurable, and unbiased (e.g., a kind of therapy that hasn’t been invented yet and is performed by a robot, but some existing therapies get close). Ratings are based on the assumption that the patient is a willing and eager participant in therapy; if not, he’ll rate everything as 100 percent bullshit anyway.

Of course, you can always learn more about each treatment by discussing it with your primary care doctor, looking online, or talking to friends about their own therapy experiences, but for now, here are the basics.

Therapy Basics

Done By

What It Is

Drawbacks

Old-School Talk Therapies
Insurance Friendly?: Sworn enemies—insurers think it’s unfocused and endless and its therapists believe insurers want to rip off patients. BTPS: 3 or 4

Psychiatrists (MDs), psychologists (PhDs), social workers, nurses, the professional hand-holders on Hoarders (see chapter 4). Hereafter referred to as “those in all major clinical disciplines.”

Therapist asks “How do you feel?” followed by painful silence, followed by the therapist’s suggesting squirm-inducing reasons for what you did or didn’t say or why you get angry when you’re really sad or vice versa or something about your mother, etc.

Still popular on TV and among older clinicians, but younger clinicians have more faith in cognitive and behavioral techniques. Not very popular among most patients, who want direct answers and have less patience for painful processes that take forever to show results, especially when it’s on their dime.

Current Talk Therapies
Insurance Friendly?: Yes, but only if there’s a measurable goal and a willingness to stop every few sessions for progress reports. BTPS: 4 to 6, depending on the therapist

Those in all major clinical disciplines, but talking more like consultants or teachers than stereotypical shrinks.

Therapist asking questions and giving advice, support, and criticism. Basically a professional friend who is legally prohibited from gossiping to others or even acknowledging they know you.

It isn’t standardized—very dependent on the talent and steadiness of the shrink and whether you’re on the same wavelength.

Psycho-pharmacology
Insurance Friendly?: Yes, if the prescriber doesn’t overuse expensive medications when cheap generics are available. BTPS: 7

Psychiatrists and nurses only, at least in most states.

Quick visits centered on assessment and prescribing medications that can reduce depression, anxiety, distractibility, crazy thoughts, and hallucinations.

Visits should, but don’t always, include talk therapy about your attitude, illness, and medication. Also, medications are frequently unreliable (fail to work), weak (some symptoms remain), and have side effects.

CBT (Cognitive Behavioral Therapy)
Insurance Friendly?: Usually, at least for a few months. BTPS: 7

Those in all major clinical disciplines, but more often psychologists and social workers than MDs.

Identifies standard negatively distorted thoughts usually caused by anxiety, depression, and other conditions, and then teaches you mental and behavioral exercises for fighting their impact on your beliefs and habits.

No quick relief, but makes you feel stronger if you do CBT exercises, negotiating with and dismissing the negative thoughts that make you feel bad in the first place.

DBT (Dialectical Behavior Therapy)
Insurance Friendly?: Same as above. BTPS: 7

Those in all major clinical disciplines, with special DBT training.

A kind of CBT that focuses on thoughts of despair, self-hate, and self-injury and teaches a set of thought-and-behavior exercises for staying positive and not giving in to dangerous impulses.

Doesn’t immediately reduce your urges to hurt yourself, leave your family, or generally blow up your life. Instead, makes you less likely to actually do any of those things.

ECT (Electroconvulsive Therapy)
Insurance Friendly?: Surprisingly, yes. BTPS: 9 (Was once low—it was tried for whatever ails you until the 1970s—but now very high)

Doctors in hospitals.

A method for causing seizures in people who don’t have epilepsy, because seizures tend to clear up depression (as was probably discovered thousands of years ago). Only administered in hospitals under anesthesia.

Impairs recent memory and requires lots of time and money, because you need to be anesthetized first so the seizure won’t hurt you. However, trust that it is nothing like the bullshit shown in One Flew over the Cuckoo’s Nest.

TMS (Transcranial Magnetic Stimulation)
Insurance Friendly?: Nope—high price, hard-to-prove success rate. BTPS: Probably higher than insurers think

Those in all major clinical disciplines.

A painless method for applying intense magnetic fields to specific areas of the brain, it may help depression without requiring anesthesia or causing memory loss.

Not cheap, not welcomed by insurance, not backed by tons of research. It may require many daily sessions followed by refresher sessions.

Couples or Family Therapy
Insurance Friendly?: Again, depends on whether there’s a focus and time limits. BTPS: 6 (Was low at 4, when all individual problems were blamed on the family. Now not so bad at 6, but still, depends on the therapist)

Those in all major clinical disciplines.

Meeting as a couple or family, uses many different techniques to identify problems and conflicts and get people to work together on solutions.

Not guaranteed to keep things from exploding (think Jerry Springer), particularly if the therapist gives people too much encouragement to air, or fart out, their grievances and share their feelings (see analogy on page 234).

Freudian Psychoanalysis
Insurance Friendly?: Not even a little bit. BTPS: Just check out a book of New Yorker cartoons

Used to be psychiatrists (MDs), now those in all major clinical disciplines who have received years of training in specialized institutes that teach the theories of Sigmund Freud (1856-1939), granddaddy of talk therapy.

Lying on a couch, usually several times a week, with your back to a relatively silent therapist, you are asked to talk about whatever comes into your mind and then analyze it with the invisible therapist’s guidance. Just as Freud did it. Mothers are a frequent topic.

Costly and slow, but impresses some people as very interesting and stimulating, so if you like that kind of thing and have the money ($50K/year) to spend, enjoy.

Jungian Analysis, aka, Analytical Analysis
Insurance Friendly?: Insurance providers are allergic to anything analytic, so no. BTPS: Let’s call it creative and interesting

Those in all major clinical disciplines, but with years of training at specialized institutes that teach the theories of Carl Jung (1875-1961), frenemy of Freud.

Like Freudian analysis, except Jungian analysis asks the patient to focus on dreams, myths, and folklore-based archetypes so they can become one with the unconscious. PS: Jung might have had schizophrenia.

Equally costly and slow as Freudian analysis, but impresses some people as very interesting and stimulating, if you like that sort of thing (and the Deptford Trilogy by the legendary Canadian author Robertson Davies).

Primal Scream Therapy
Insurance Friendly?: NO! AARGH! I HATE YOU, MOMMY! BTPS: Calibrates the low end of the scale, along with Scientology

Those in all major clinical disciplines, but mostly well-meaning psychologists with MAs or PhDs.

Nearly extinct method (popular in the 1970s), held mostly in padded rooms where patients were encouraged to work out their childhood trauma by having tantrums and generally losing their shit.

Loud, dated, and probably not effective. The padded rooms, however, are great fun for kids.

Getting Your Fill of Treatment

Therapy is a lot like dating someone; the only thing harder than knowing when to get involved is knowing when to walk away. There is no marriage in the therapy analogy (just among therapists, as with a certain author of this book), so at some point down the line, your current course of therapy must end.

Most people assume, logically, that treatment doesn’t last forever, but as long as they expect it to make them feel better and gain more control over their lives, they find themselves engaged in a process that never seems to end.

The reason, of course, is that treatment is seldom completely effective, and expecting it to be so means you can stop therapy only when all your pain goes away; i.e., when you stop living. Quitting before you get there, even if “there” doesn’t exist, makes you feel more responsible than ever for the things about your life you’d most like to change.

Similarly, if treatment lifts your spirits and gives you perspective that rapidly disappears when you stop for even a week because your shrink needs bunion surgery, it’s natural to feel you’re not finished yet and won’t be until your good feelings last longer and you’re able to maintain a positive, realistic perspective on your own.

Since treatment of any kind, no matter how frequently it occurs or how deeply it delves into your hidden feelings and painful issues, seldom achieves the kind of change that people expect, it’s reasonable to stop at any time you think you’re no longer benefiting, regardless of whether there’s lots that’s still wrong with you.

Your goal is to get what you can out of treatment and accept whatever ills you can’t solve. Don’t cling to the idea that it has more to offer if you just try harder and longer. You haven’t failed; treatment just isn’t that powerful, and maybe not that necessary.

It’s also reasonable to stop treatment (or at least pull back) if it’s not bringing about measurable improvement, even though you still feel you need it. After all, it’s costly and you may do fine without it, regardless of how anxious you are not to lose it. Ideally, treatment should show you that you don’t need certain things as much as you feel you do, even though it hurts to let them go—like finding the strength to leave an abusive partner or quit drinking—and gaining the courage to quit treatment itself is often a sign of success.

Of course, just because treatment stops doesn’t mean you should ever give up on managing bad behavior or getting on with life in spite of bad symptoms, without a therapist; there are plenty of tools out there, including readings and support groups, that can fill the therapy void. Don’t rely on treatment unless you see strong evidence that it’s making a difference and doing so in a way you can’t replicate otherwise.

Sometimes you’ll find that continued treatment is, indeed, necessary to maintain stability and prevent you from relapsing. If so, use it only when necessary, as measured by how well you do as you cut back. Never depend on treatment for support if you can find another source, because therapy is the high-maintenance ex you can stay friends with only if you don’t fall into old habits again.

Of course, people who know about your problems will always think you need treatment, but that’s their worry talking. You must rely on your own knowledge of available treatments and your experience with them to tell you whether or not you do need treatment again.

In the end, you probably don’t need treatment for a long period of time and are better off relying on what you’ve learned and other sources of strength, knowledge, and comfort to manage problems. In other words, you may have moved on, but the time you and treatment shared together will always be special.

Here are reasons for stopping treatment that you’d like but probably can’t have:

✵ Removal of the angst center of your brain

✵ An acquired immunity to criticism

✵ A learned inability to bicker or create conflict

✵ Solid confidence in your ability to take care of yourself, regardless

Among the wishes people want to fulfill before stopping treatment are:

✵ To first get better control of symptoms

✵ To first figure out why they can’t stop their troubling behavior

✵ To completely finish healing

✵ To find a way to hang on to the one thing that has helped them; i.e., therapy

Here are three examples:

I like seeing my therapist and she has helped me get over my shyness, but my social life is fine now and I’m just not unhappy, so I wonder whether I really need to see her anymore. She says we haven’t gotten to the root of my problem, so my shyness will probably return and get in the way of having a serious relationship, but I just don’t know. My goal is to figure out whether I need to continue and why.

My therapist has been my lifeline for the past five years and I don’t know what will happen if I have to stop seeing him. I can tell he’s worried, too, but my insurance says that it’s not “medically necessary” and won’t pay for it. Before I saw him I was very depressed and made a suicide attempt. Now I’m still depressed, but I’ve been working steadily and have a couple friends. I’ve got a long way to go, and I’m afraid of going back to the way I was before. My goal is to get the insurance company to see that my treatment is medically necessary to keep me from sliding back into the pit.

I was put on two antidepressant medications a year ago when I was very depressed, but I’m not sure I need them anymore, and I think they do nothing but make me fat and tired. I’m back to my usual blah mood, and I don’t see why I should continue medications that may be doing me no good and are probably making me feel worse by making me look and feel like a hibernating bear. My goal is to get off medication.

Treatment and its results may always feel personal—and how could they not, given how they focus on your private thoughts, honesty, and commitment—but when assessing therapy’s effectiveness, it’s best to imagine that you’re a management consultant, your therapist is an employee, and the client is your life. It’s your job to figure out whether your therapist is still a valuable part of You, Inc., or whether, based on his performance, it’s time to let him go.

As you may have learned from films (Office Space, Up in the Air) or from the personal experience of being brutally laid off from your job, management consultants are neither sentimental nor compassionate. That kind of objectivity can be difficult when reviewing your own treatment, but if you can accept the evidence of your own experience, even if it’s disappointing, you can make hard choices the smart way.

Other people may urge you to continue treatment because they wish you didn’t have to suffer so much, and while it’s easier to dismiss those people when they’re friends and relatives, it’s harder when the main person who believes you need more from therapy is your actual therapist.

It’s important, of course, to value your therapist’s advice—if you’d never taken his advice to heart, you probably wouldn’t have made any gains at all—but ultimately, you’re the only one who can evaluate therapy’s effectiveness, both for your life and your wallet, and decide whether it’s still worthwhile. He may be a problems expert, but you’re the only you expert, and your opinion on your progress is the final authority.

Ask yourself whether the lingering fears and insecurities that therapy hasn’t alleviated are doing you any harm, other than causing you to be anxious, unhappy, and self-doubting. Sure, these are not enviable emotions, but at normal levels, if they don’t impair your ability to work, be decent, or live, they can actually be beneficial, since fear can help you be aware of dangerous situations, and self-doubt can get you to double-check your results. Simply put, feeling bad is sometimes good for you.

You’re doing a respectable job proving to yourself, day by day, that you can take risks, do new things, and become accustomed to doing things that scare you but won’t bother you nearly as much after you get used to them. Your therapist did a good job, too, which is why you should feel confident telling him it’s over.

If you feel your therapist is doing a job for you that no one else could and are worried that something—running out of money, an insurance decision, your therapist’s departure—will cut off your therapy and your lifeline, remember that feelings are not necessarily reality, and that severe depression and anxiety have their own way of making you feel like you’re much more vulnerable and dependent on treatment than you are. If your therapy is making you feel even less independent, it’s also less beneficial than you think.

Test out the reality of your need for treatment by cutting back on the frequency of your visits and finding other sources of encouragement, like twelve-step groups, depression-support groups, and friendships with people you can count on. If you haven’t done it already, educate yourself about DBT exercises that you can practice when you’re feeling self-destructive and hopeless. Yes, you may not feel comfortable sharing intimate information with anyone other than your therapist, but it’s something you can learn and it’s well worth doing.

Whether it’s your own bank account or your insurance benefit that’s running dry, don’t let panic discourage you. Create a program for shifting your sources of support and, almost always, you’ll find you can reduce your dependence on weekly treatment. Even if you continue to need treatment, you will probably not need it regularly or weekly, so you will lower your costs and make it easier to negotiate continued support from your insurer.

If you’re less worried about becoming dependent on a therapist and more worried about dependency on medication, then your assessment requires slightly more objectivity, since you’re trying to ignore not just feelings of panic but also the stigma of psychotropic medication.

Assessing medication also requires you to weigh a whole new set of costs and benefits; i.e., is not being miserable/anxious/paranoid worth not being thin or able to stay awake or capable of getting a boner?

Since you’re the one who knows best whether your symptoms are severe enough and happen frequently enough to be worth preventing, you’re also in the best position to decide whether the medication is effective enough to justify the side effects. If you’re not sure, talk to your doctor about stopping your meds, at least temporarily; it may give you an opportunity to test the medication’s effectiveness and also to see whether it’s responsible for symptoms that may be side effects. (Just don’t go cold turkey on your own, because some medications can be harmful if discontinued too quickly.)

Another thing you might learn from talking to your doctor is that, if a medication is obviously effective and you tend to get relapses without it, taking it forever as a preventive may actually protect your brain from subtle damage that occurs to some people who have chronic depression over many years. If the idea of being dependent on a medication that long is unacceptable, just think of your meds as brain insulin; diabetics aren’t ashamed that they require a lifelong drug treatment, and neither should you be.

The higher the risk from side effects (like the tendency of certain antipsychotic drugs to actually cause diabetes), the more important it is for you to stop the medication as soon as you know it’s ineffective or you find a less dangerous substitute. Your job is to consider the risks of stopping medication versus the risks of continuing it. Then, whatever decision you make will be a good one, even if it’s not good for your waistline.

Don’t make decisions about stopping treatment any more emotional, frightening, or mysterious than they have to be. If you trust your own observations and accept the fact that all treatments have limitations, you can be sure you’ll get the most out of whatever treatment you’re evaluating and do whatever’s best to make You, Inc., as successful as possible.

Quick Diagnosis

Here’s what you wish for and can’t have from treatment:

✵ Relief from all intractable, no-good-reason-to-have-it depression and anxiety

✵ An understanding of why you do unreasonable things that actually gives you power to control those things

✵ Elimination of the dark, nasty, angry, obnoxious, addictive, and otherwise self-destructive parts of your personality

✵ Better relationships with people who don’t want or expect to have a good relationship with you

Here’s what you can aim for and actually achieve:

✵ Develop rational methods for determining what you really control

✵ Rate yourself according to how well you cope with what you don’t control, regardless of what your instincts tell you

✵ Learn tricks for managing your weaknesses

Here’s how you can do it:

✵ Use treatment as a tool to discover the limits of what you control

✵ Find out what treatments are available, what they offer, and what risk they pose

✵ Define the conditions of illness or disability that, in your opinion, make looking for treatment necessary

✵ Define the conditions for progress that, in your opinion, make treatment effective and worth continuing

✵ Stop, suspend, or reduce the frequency of treatment if you don’t see your problem improving

Your Script

Here’s what to tell yourself/your shrink when you’re considering starting or stopping treatment.

Dear [Self/Shrink/Concerned Friend],

I often feel that my life is a [mess/sewer/vale of tears], but even so, I’m actually coping pretty well overall. I want to find out whether treatment can help me stop [crying/swearing/being afraid of everything, including my own shadow] and I’ve read up on what’s available. I will continue to look for help until it’s clear that I’m as [antonym for “broken”] as I’m ever going to be, and then I’ll know I’ve done my best to manage my psychiatric/life problems.

Lower-Cost DIY Treatments

Before you commit to therapy, or if you just can’t afford it, we recommend you try less costly alternatives to professional treatment. Below is a sampling of such alternatives, listed in order from those with the highest benefit-to-risk ratio to those with the lowest (and highest absurdity factor).

Useful For

Effectiveness

But

Exercise

Depression, anxiety

Reduces anxiety and depression within hours, or at least distracts you from them for a while

Relapse is rapid after an injury (as if you weren’t already hurting)

Diet, Vitamins, Health Foods

Depression, anxiety

Very hit-and-miss, so you don’t know until you try it, but diet means what you eat, not necessarily eating less; nobody feels happier when they’re starving

Don’t get superstitious about all the things that seem to hurt or help, with very little real evidence, and wind up on an all-Cheerios diet because your depression cleared up the morning after you had a bowl

Twelve-Step Groups

Almost everything

Helps you fight addiction of any kind, or even just negative thoughts when they’re not rooted in addiction

You have to find a group that has what you need, and some don’t

Meditation/Yoga

Anxiety

Definitely helps a little bit, and some people are helped a lot

Doesn’t help everyone, the effect is limited, and like exercise, yoga has an injury factor

Scientology

Gives a certain kind of person a feeling of meaning and community

May fill a void? Or at least get you closer to Tom Cruise.

It’s not cheap, and it’s not, shall we say, inclusive to outsiders or forgiving of insiders who decide to leave

Lobotomy

Stops life-threatening symptoms, like depression and suicidal urges, but may leave you with seizures from just a wee bit of brain damage

Very often effective when nothing else is, but we’re talking serious Hail Mary here

Not without risk of taking away some function or part of your personality you value, so not administered by almost anyone since the 1960s. That’s why it’s available only if you do it yourself with a chopstick or golf pencil (but never, ever do that).

Getting Treatment for the Unwilling

If “Things You Can’t Control” was a round on Family Feud, then the number one choice, above “natural weight” and “the weather,” would be “other people’s will.” When you want to get mental-health treatment for someone who believes they don’t need it, it’s natural to push them in any way you can, but if you thought controlling someone was difficult, try controlling someone who can’t control his own mind. Your urge to drive him to treatment may just drive you nuts.

Perhaps your hope is that once he’s “in treatment,” even if he feels coerced and reluctant, something about the shrink or treatment process will grab him, change his mind, and allow him to be helped. Then he won’t just forgive you for pushing, he’ll thank you for your lifesaving heroics.

Unfortunately, treatment for mental illness is the same as for medical problems and usually requires patients to be actively motivated. Push too hard, and she won’t be thanking you, just ignoring you out of frustration and even rage; if you’re trying to help a relative, you’ll have an actual family feud on your hands.

The problem is that if someone enters talk therapy reluctantly, they wait for it to do something to them rather than for them, passively complying rather than getting involved and doing the homework. If she complies with medication prescriptions, she will quickly object to side effects and stop taking them before they might be effective. If your goal is to show her that treatment can save her, her goal then is to show you that treatment won’t work, and she will usually succeed.

There are exceptional circumstances, however, when forcing someone to get help may be worthwhile, and there are other circumstances when advising someone to get help may pay off in the long run, even if your advice is ignored for the time being. Knowing those circumstances, and accepting the limits on your ability to get people to accept treatment, will make you much more effective than if your philosophy is to push hard whenever you see someone who needs help.

Exceptional circumstances always exist when you think someone might hurt themselves or someone else; that’s the only time that the police and mental health clinicians have the power to put someone in a mental hospital against their will and keep them there for what is usually a short stay. Even then, it’s up to a judge to review the case and decide whether the risk of harm is severe enough to force them to stay there and accept treatment. If there’s a risk of harm, you should know what you need to observe and do to start the ball rolling on a commitment evaluation.

(Please note: in most Western countries, the days of having someone hauled off and involuntarily and indefinitely committed to a white-tiled asylum ended long ago; the laws have changed dramatically in favor of preventing unnecessary commitment, and almost all of the long-term state hospitals have been demolished or turned into fancy condos.)

Adolescents who have never been treated sometimes respond well when they’re forced to try it, so if you know what treatment he’s had before, and have leverage, you can sometimes get an adolescent to get the help he really wants but has been too angry to accept.

In any case, you can learn how to sell people on the advantages of getting help and even covertly offer some ad hoc therapy yourself without bullying or implying she should do it to make you happy. First, however, you must learn to control your helplessness so you don’t wind up expressing anger or fear.

While it’s usually impossible to make someone get help, it isn’t always, and learning how to describe treatment as a valuable choice, rather than a punishment or obligation, is your best approach. Aim to teach someone, not control them, and she may make the right choice on her own.

Here’s what you would like to offer (but can’t) for those who refuse treatment that they obviously need:

✵ A guarantee that going to therapy will make their depression, anxiety, drug addiction, etc., all better

✵ Treatment that promises a reliable cure without any effort on the patient’s part

✵ A mental hospital/rehab facility that feels like the Four Seasons and doesn’t smell like Lysol and pee

✵ The one, magical therapist who need only make eye contact with them to make them want treatment

Among the wishes people express are:

✵ To get someone help before they hurt themselves, lose their jobs, and drive their families away

✵ To get someone to see what his symptoms are doing to him

✵ To stop addictive, self-destructive behavior

✵ To prove to someone that treatment won’t fail this time

Here are three examples:

My father has been depressed and irritable for the past two years, since my mother died, but he won’t get help. He was always a gruff guy, but my mom would balance him out and reveal his lovable side. Now he’s just a miserable bastard. I think he might even admit to himself that he’s become unbearable—that’s part of why he’s miserable, maybe—but when I bring up the idea of talking to someone, he just says that therapy is gay and shrinks are lying crooks. Meanwhile, he has driven some of his friends away and my kids dread visiting him. My goal is to get him to get help.

My girlfriend admits that she’s depressed, but she insists that there’s no point in getting treatment because it’s never helped her in the past. Her parents first sent her to a therapist when she was eight, and even after getting treatment off and on for years, it didn’t change anything. She only agreed to go back to therapy as a condition for being readmitted to college after dropping out, but it had no impact. I keep catching her crying and I see the cuts on her arms, but if therapy isn’t an option, I feel totally helpless. She can be so smart and sensitive and fun when she’s not depressed, so I know she can feel better, but she insists she’s powerless to change her moods. My goal is to figure out why therapy doesn’t help and find something that will, because if I can’t help her, I don’t know if she’ll survive, let alone if our relationship will.

I don’t think my brother has ever gotten the help he needs. He has been in and out of hospitals for the past ten years with multiple diagnoses—depression, psychotic depression, schizophrenia—and he’s had years of therapy and many medications, but nothing seems to work, and nobody can say definitively what’s wrong. Now he’s suicidal again, but I don’t know if he’s on any medication, or been prescribed meds and is just not taking them, or even if he has a therapist at the moment. I just know that I can’t force him to get one or take his pills, and that he’s gotten so good at hiding things from me, even the crazy thoughts he’s probably having, that if he’s determined to die, I can’t do anything to stop him. My goal is to figure out where he can find someone who can really help him and then make him get an appointment and stay alive.

Since mental illness is in so many ways a total mystery, it’s odd that people assume that it can always be solved with treatment. Total mysteries don’t have absolute solutions, so if treatment doesn’t work, the answer isn’t always to keep looking for new treatments, but to look beyond treatment entirely.

After all, some of those in great distress may have already given treatment a good try with no (or not enough) results, and others may believe they’re the only sane person and everyone around them needs professional help. You can’t close your investigation and push someone who is unwilling into treatment if it’s already clear that it isn’t going to help.

On the other hand, if you think someone is in danger but too sick to take care of himself, then that’s not a mystery, just a nightmare, and you may decide he needs to be hospitalized regardless of whether he agrees. The only question is whether someone is likely to hurt himself, and if the answer is yes, then close your investigation and ask the real police to come running.

In short, don’t be afraid to get creative and use your own judgment. If you can gather a little information and ask yourself a few simple questions, you’ll often know whether treatment is worth pushing and how hard to push, or whether you need to turn your inquiries elsewhere.

If someone you love is suffering from depression and loss, it’s natural to urge them to get help with their grief. If that depression has turned them into a nasty Asshole, however, urging them to do anything will just allow them to give that grief to you.

To paraphrase the old saying, if you can’t get the nouveau Asshole to go to therapy, the therapy must come to the Asshole. Make like a therapist yourself and find a positive way to describe his negative behavior and what it’s doing.

After all, your advice and encouragement are perhaps as valuable as anything a therapist could offer. Very often, therapists are in no position to observe how a patient behaves with other people and only know what their patients tell them. You may be in a much better position to observe the problem and give particularly relevant advice.

As such, you could say his irritability, which he used to express in a way that was funny and warm, now drives people away, including those he obviously loves and who love him. You wonder if he sees the problem and, if so, whether there’s anything you can do to help. You can think of several promising possibilities, beginning with a talk with his regular doctor about a variety of treatments. That way, you cover all the bases any counselor would, only you don’t get paid for the referral.

Like any decent therapist, don’t promise that he’ll feel better. Indeed, he may feel worse, in the short run, if he stops being mean. Instead, promise him that he’ll have better relationships in the long run and like himself more.

Protect yourself by limiting your exposure to uncontrolled irritability, making it clear that you’re stepping away reluctantly and not punitively while respecting his decision and conveying confidence in your own view. You may never get him to get treatment, or get everything possible out of your excellent amateur treatment, but you’ll know you’ve given him a respectful, positive push and done all you could.

When someone declares that treatment for depression hasn’t worked and isn’t worth pursuing, you’re right to wonder if she’s really tried every reasonable option or if irrational pessimism is controlling her. At that point, try to learn enough about possible treatment options to judge for yourself.

If you think there are treatments she hasn’t tried, tell her your opinion and see how she responds. If she’s too fed up with treatment to listen, don’t feel responsible for getting her to change or you’ll go from being her pleasant partner to her overbearing parent in record time.

Instead, accepting the fact that change is highly unlikely, ask yourself whether she has a problem with negative, rigid thinking in other areas of her life. Then decide how much it’s likely to affect your relationship if you spend more time together and what kind of limits, if any, to put on your relationship.

Announce your limits in a positive way. Let her know that you respect her ability to tolerate depression, but you think her treatment decisions are too negative and have deprived her of opportunities for help. You can accept a partner who has depression, but you can’t accept someone who doesn’t take good care of herself. If she can’t accept that, you know you’ve done your best and can move on.

If someone you love is very sick and might be at risk of suicide, don’t distract yourself by blaming the failure of prior treatment. Like all illnesses, there are forms of mental illness for which modern treatment, no matter how well done, is inadequate. Forget the past and do what’s necessary now.

Ask yourself whether you’ve heard him talk about death, murder, or escaping unbearable pain, or seen him running into traffic or grabbing extra pills “by accident.” If you have, tell it to the police and then to the nice emergency room shrink who will decide whether or not to lock him up. Don’t worry about whether he’ll blame you for stealing his freedom and giving him nightmares; just do the right thing and make sure he lives to be angry at you another day.

If something bad happens, don’t focus on who’s to blame. Respect the fact that severe mental illness is tough to live with and value the many ways you and others have tried to help. Some people say that suicide is a result of cowardice or failure on the part of loved ones to act, but those people are, to use the clinical term, fucking idiots; there’s is no such thing as failure when you continue to love and care for someone who is desperately ill and has lost much of his original personality. There’s no such thing as cowardice when someone bravely fights a disease just by getting out of bed every day, even if they eventually can’t do it anymore.

Never assume that treatment is the solution when all the clues point elsewhere. Give yourself the opportunity to decide for yourself whether additional treatment is likely to help, whether it will ever be accepted, and whether you’re morally obliged to call the cops if it isn’t.

You may feel like you’re trapped in an impossible enigma, but in reality, some solutions are impossible and some mysteries can’t be solved. Still, helpless feelings need never stop you from doing everything you think is necessary to help out and find answers, even if they aren’t the ones you were originally looking for.

Quick Diagnosis

Here’s what you wish for and can’t have:

✵ The ability to scare people into doing what’s necessary to help themselves, since reason doesn’t work

✵ The power to make treatment work if they reluctantly agree to try it

✵ Relief from fears of what will happen if he doesn’t get help

✵ The ability to retain his trust while you tell him what he doesn’t want to hear

Here’s what you can aim for and actually achieve:

✵ Trust your own assessment of the quality of a person’s treatment decisions

✵ Urge better decision making without becoming negative or emotional

✵ Ask the police and emergency room doctors to take over decision making when you decide it’s necessary

Here’s how you can do it:

✵ Ask about wishes to die, give up, kill, ingest, or punish

✵ Urge someone to consider what she wants treatment for, rather than what she wishes treatment would have done for her

✵ Gather information about past treatments to determine whether this one has something new to offer

✵ Warn about the power of depression to cause negative thoughts about the value of treatment

✵ Hand responsibility to crisis responders if you think someone’s at risk of harm

Your Script

Here’s what to say about a suffering person’s refusal to accept treatment.

Dear Miserable [Relative/Partner/Guy on the Rail of the Golden Gate Bridge],

I hate to see you [suffering/drinking/sleeping all day] and would love to see you get [help/medication/therapy/your ass kicked/a much better attitude], but I know you won’t. From what I know about your past treatment and treatment in general, there are treatments that [might help/won’t help/couldn’t hurt], and I think that, after considering the benefit-to-risk ratio, you [do/don’t/could] owe it to yourself to try them. I will always respect the fact that you have [synonym for “heavy bullshit”] to deal with, but will [say nothing more/doubt your ability to make smart decisions/call the cops] if you don’t get more help for yourself.

If you equate treatment with a cure, you’re bound to be shocked, helpless, and dismayed when it underperforms. If you take the trouble to find out everything you can about what’s available, what it can do and can’t, and who can do it to your liking, you’ll find yourself making better use of treatment and managing your problems well on your own when treatment has nothing more to offer.

afterword

well, fuck me

Ultimately, there’s no perfect way to find the professional who will be the ideal ear. Personally, I think two important qualities to look for in any clinician are a sense of humor and, while this might seem unbelievable given my tone in the previous pages, a touch of humility.

If you’re supposed to embrace the uncontrollable nature of life and human suffering, your doctor should be able to do the same, and some MD/PhD who acts like a master of the universe probably has too much hubris to understand that sometimes we are simply life’s bitch.

While I have two Harvard degrees (“the deuce”), a loving family, and a job that allows me to spend my days telling patients when they’re being stupid, I’ve also had to eat a fair number of shit sandwiches in my time. Not long after I turned forty, my father died after years of suffering from dementia that continued during my years in high school and college (a place where, I admit, I was often struggling to keep up with my classmates). For years he had been the wise, calm rock of our family. His dementia, together with an injury that thwarted my mother’s musical career, transformed my parents’ marriage from ideal to, in a word, unpleasant.

I know now there was no helping them, because many people tried, including, of course, my sister and me (a dysfunctional family is the usual reason for wanting to become a therapist). For many years, I searched for the right words or an illuminating insight that would allow me to alleviate their pain. Finally, as I realized there was nothing I could do, I began to appreciate what they had really achieved.

During all those conflicts, my father never lost his temper, and despite her frequent frustration and anger, my mother never abandoned her family. Their unhappiness never induced them to forget what was important. My respect for them knows no bounds, nor does my appreciation of how un-fucking-fair life can be.

This book is not truly complete until I make one more thing as clear to you as I do to my patients: that I am as prone as anyone to the stupidity of wishful thinking and the humiliation of owning various permanent emotional and behavioral handicaps. I enjoy adopting a scathing and condescending tone when addressing you, and them, because I take great pride in being, myself, the sometime king of stupid. Like all human beings, I am fucked, but I am proud.

So no matter what you plan to do—who you plan to seek treatment with, or if you don’t seek treatment at all—remember that there’s no such thing as “fair,” feelings are stupid, life is hard … and you’re going to be relatively okay, even if you won’t be happy, because your goals are realistic and your efforts to reach those goals will make you proud. Then, the next time life gives you a shit sandwich, slather that puppy in ketchup and enjoy. They’re on everyone’s menu. Even at the fine dining halls at Harvard.

—Dr. Bennett

acknowledgments

Both Bennetts:

We owe special thanks to our agent, Anthony Mattero at Foundry, who immediately got what we were trying to say (as well as our sense of humor), then got us to say it so everyone could understand, then got us a book deal.

Thanks to Liz Gallagher, who introduced us to Anthony, and Quinn Heraty, our lawyer, who has nothing to do with Anthony, but is still great.

We are also grateful to Trish Todd, our editor at Simon & Schuster, who is so smart, kind, and insightful, we spent a long time thinking we had dreamed her. And she let us keep the title, which was also a total fucking dream come true. Thanks also to the rest of the Simon & Schuster team: Kaitlin Olson, Stephanie Evans, Navorn Johnson, Andrea DeWerd, Amanda Lang, and Jon Karp.

In the book, we often refer to the rules for choosing friends that you can accept as family, and these are the friends/families who occupy that special position in our lives: thank you Cottons, Steins (and Kelders, and Carmels), and Nadelsons (and Glebas). Thanks also to actual family who are nevertheless friends, some of whom (Peter Bleiberg, Naomi Bennett, Vicki Semel, and Dee Robinson) were willing to talk with us at great length and help us work out the ideas in this book.

Thank you, Eudora Prescod, for helping to raise the younger Bennett and keep the elder Bennett on his toes.

Here’s where we lovingly acknowledge the other Bennett offspring, Rebecca, who has not written a book, but has done one better by carrying on the family traditions of becoming a skilled doctor and, with her amazingly good-natured husband, Aaron, having a family. We also want to thank their brood of boys, none of whom are currently old enough to look at the cover of this book, let alone read it.

The biggest thanks goes to Mona Bennett, MD, mother/wife, who is not only the head and heart of the family but this book’s spiritual adviser and unofficial third author. This book would not exist without her, period (nor would one of the authors). Her expertise—in psychiatry, poetry, rustic furniture building, small-dog wrangling, campfire songs from Camp Navarac, etc.—is too vast to be contained in any book. In short, M, we love you, and we thank you, for this and everything else.

Do we have to thank each other? That seems tacky. Never mind.

Dr. Michael Bennett:

I thank my college mentor, Professor Robert Kiely, for encouraging me to see a moral force in the magic of a work of art that, however powerful, could be constructive, destructive, or both.

I thank Joseph Conrad, who taught us that every therapist and idealist must beware his inner Kurtz.

I thank my Beth Israel hospital therapy supervisors, whose well-coached scripts helped us shrinks-in-training to respond to a patient’s deeper needs while side-stepping expected feelings and conversations: Ted and Carol Nadelson, Paul Russell, John Backman, Alicia Gavalya, Malkah Notman, and Joan Zilbach. Without being overly optimistic about treatment, they believed strongly in the value of trying to make your life better, even when it sucked and was likely to stay that way. Particular thanks to Carol, my mentor and matchmaker, who insisted that I had a book to write if I had something I really wanted to say.

I thank my old Upper Canada College buddies, Bill Johnston, George Biggar, Jim Arthur, and Brian Watson, for warm friendship, and my newer Toronto buddy Gail Robinson, who assures me that Canada is much more sensible about psychiatry than the U.S.

I thank my colleagues and friends at the old Massachusetts Mental Health Center who aided, abetted, and debated the views in this book when they ran against the prevailing culture: Jon Gudeman, Laura Rood, Steven Kingsbury, John Vara, Annette Kawecki, Robert Goisman, Dan Pershonek, Paul Riccardi, Barbara Dickey, Sondra Hellman, and Josephine Nazzaro.

I thank my patients who, by and large, give me the benefit of the doubt when I seem offensive and take it on faith that my intentions are good. Although we have taken great pains to remove any and all specific, personal information, the spirit and energy from their part of our conversations is what makes this book a dialogue.

Sarah Bennett:

Thank you to the following people I don’t know, but admire, and whose work I found especially encouraging and cathartic during the writing process: Joss Whedon, Jason Isbell, David Ortiz, Jill Soloway, Maria Bamford, Roxane Gay, Rob Delaney, and Amy Sherman-Palladino.

In addition to the family co-thanked above, extra thanks to the cousins Mitchell—Mary-Jane, Eyan, the Mitchell brothers (yes, just like on EastEnders)—my caring local family in Fort Greene, and Eilene and Bill Russell and Sherry Lee, my devoted local (unofficial) family in NH.

Thanks to these excellent friends, in order of seniority, because that seems fair: the five-ish-year club is small, because women over thirty rarely make new friends unless they have kids or join a cult. So thanks Mary Lordes and Tabitha D. Lee, and thanks again to Liz Gallagher, the rare hippie with a good sense of humor, for her generosity, positivity, and occasional futon use.

The ten-to-twenty-year club: Angela Boatwright, Lizzy Castruccio Kim (and the familia Castruccio) and Jimmy Kim, Jon Hart, Ashrita Reddy, Melissa Ragsly, S.D. Gottlieb, Simon Goetz, Ali Chenitz, Paisley Strellis, Amanda Nazario, and Kesone Phimmasone. Never did I think I’d have such long friendships with people I’d originally baited with mixtapes.

Thanks to even more friends of various vintages: Molly Templeton and Steve Shodin, Tobias Carroll, Alex Eben Meyer, Sarah Bridger, Diana Rupp, Quinn Heraty (again! Never too many times!), and Ben Strawbridge, who get their own special grouping because they haven’t just logged many friendship years but helped with this book specifically, whether they know it or not.

Amy Baker helped so much with the proposal, plus she ran a hockey league with me and has an unofficial medical degree, so she knows she’s hot shit (or at least she does now).

The twenty-plus club; i.e., those ladies with whom I survived high school: Elanor Starmer, Julia Turner, Dr. Rebecca Onion, and Dr. Cristie Ellis. I did many, many stupid things between the ages of twelve and fourteen that would have made anyone think twice about starting a friendship with me, yet these ladies did and we’ve since had the privilege of doing many stupid (and not-stupid) things together. I thank them (and their families, old and new) for their love and support in this and everything else.

For her friendship, love, and generosity, Emma Forrest is filed under “timeless.” She’s the goddess of chutzpah, the lady of the canyon, the woman who originated the phrase “Seth Green is so short that Prince uses him as a vibrator.” I love her and her family, both in the UK and in LA, and she is one of the funniest people in the world.

Maysan Haydar is the kind of friend who will never ignore your call, surprise you with tickets to see Soul Side, and load her husband and three genius, exquisite young children into a minivan to drive from Ohio to New Hampshire to visit you, and during that visit, she will bake a spinach pie, and it will be excellent. Maybe she’ll just do all that for me, along with so much more I can’t repay, which is why my last acknowledgment, to her and the thousands of Haydars everywhere, will have to do.

about the authors

DR. MICHAEL I. BENNETT, educated at both Harvard College and Harvard Medical School, is a board-certified psychiatrist, a Canadian, and a Red Sox fan. While he’s worked in every aspect of his field from hospital administration to managed care, his major interest is his private practice, which he’s been running for almost thirty years. The author of F*ck Feelings with his daughter Sarah Bennett, he lives with his wife in Boston.

SARAH BENNETT has written for magazines, the Internet, television, and books. She also spent two years writing for a monthly sketch comedy show at the Upright Citizens Brigade Theater in New York. When not living by her philosophy of “will write for food,” Sarah walks her dog, watches Red Sox games, and avoids eye contact with other humans. Somehow, she lives in New Hampshire and works in New York. F*ck Feelings, written with her father, Dr. Michael I. Bennett, is her first book.