We first met Trish on these pages in March of this year when she described how her husband Rick was in an automobile accident and paralyzed from the shoulders down needing extraordinary care. Contrary to doctors’ recommendations, she took him home instead of placing him in a nursing home.  Now she works full time, cares for her husband and is raising their children.

In her first letter, she said she was angry at almost everybody.  In addition to all of her jobs, she still had to battle with the health care system, nursing agencies and her insurance company.  Trish had been in crisis mode for years and was exhausted but felt she had no options.  Mostly she was worried about her ability to do all of her jobs effectively.

I recently heard from Trish again, but this time she is not just looking outside to understand her suffering.

Dan,

You mentioned earlier that I must feel so very alone in this process.  I do.  And now I am beginning to wonder if my husband and I have sort of a drug addict/enabler relationship.  My husband doesn't have to deal with anything.  If his battery charger stops working, it's my job to figure out a solution.  He sits back and says: "Trish, what are you going to do?"  Since the first day of the accident, I made all the medical and legal decisions because he was unable to.  I hired a contractor and had our house remodeled, I hired, trained and supervised caregivers, I found his doctors and his medical suppliers.  At some point I wanted him to help manage his life, but that has never fully happened and maybe I don't allow it.  If he doesn't do something that is required, I immediately swoop in and make it happen because I worry something serious will happen if I don't.

Today he was going to a new doctor.  He screwed around all day yesterday playing on the computer, reading and watching movies while I worked at my "away job" and then came home and did my home job.  After I got him to bed, he has the nerve to ask me to type up a medication list for his new doctor.

I was a little angry and a little tired but did I do it?  Of course I did because I wanted the doctor to have the right information.  Am I an enabler?  I want to stop.  I want him to take care of the things he can, but he never does so there I am doing it.

Talk about feeling alone.  I feel like I am the only one worrying about this stuff.

When we were growing up, I saw how my mom made my dad so helpless.  To this day he can't (or won't) make a sandwich for himself because he is so used to my mom doing everything for him.  He owned a large manufacturing company until he was 70 but he can't use a microwave, a washer or a stove.  Except for the fact that he can walk in use his arms, he is nearly as paralyzed as my husband.

So now I am thinking I have turned into my mother, but how do you change things now? 

Trish,

Dear Trish,

 This is issue arises in almost every caregiving relationship.  Of course you know the answer or else you wouldn't have concluded your letter the way you did.  But before I answer your question about what can be done, I want you to answer mine.  Are you willing to change?  Please don't read anymore until you think about that question for a few minutes.

If you are able to answer that question with clarity and integrity, you will probably feel better.  Even if you are not willing to change, or too scared to change, then make a conscious choice to continue things as they are for now.  That choice doesn't change anything on the outside, but it does change your relationship to your life.  By making a choice, you are taking a more powerful position than feeling like a victim of his spinal cord injury, your mother's genetics or your own neurosis.  You've made a difficult choice.

But genuine willingness to change is also a difficult choice because then you have to confront many of your greatest fears.  Clearly one of the fears is whether your husband could survive if you gave up control.  I also wonder if this role of caretaker or "the responsible one" has become part of your identity. I have a sneaking suspicion that you have been doing this to a certain extent much of your life. 

Change is difficult and takes two things: devotion in practice.  

You must be devoted to the process regardless of your anxiety or how long it takes.  In my work, I find that is the single most important factor in whether couples stay together or people improve -- a heartfelt devotion to getting through it no matter what. 

Now let's talk about practice.  We know that some of what keeps you stuck where the demands of your outside life.  But the other thing that keeps you stuck is your "habit" of self-sacrifice and being the responsible one.  So here is what I ask to begin your practice.  Take 20 minutes every morning, sit comfortably in an erect position with eyes closed. Once you have settled, track your breath.  Just notice every in breath and every out breath, best you can. Your mind will race away frequently because that's what minds do.  But when it does, gently bring it back to the breath.  And here is how this practice is a wonderful way to begin to change your habits.  Every time you bring your mind back to your breath, you let go of something.  It could be thoughts or emotions or stories you are telling yourself about what needs to be done etc., but whatever it is the moment you come back to your breath you are letting go of your narrative.

We will talk more about first steps in setting boundaries with your husband, help to deepen this practice of letting go, and other ways to care for yourself.  But for now, 20 minutes a day to simply breathe and let go of your thoughts and a devoted to the well-being of the person you are. 

Hi
Only read part of the article question from Trish about her son completing suicide and about some of her feelings, thoughts, actions to date. My heart goes out to her and i am so sorry that she is part of this fratermity where just try to live as "normally" as possible in a now very abnormal world. While there are differences in the way our precious children died and each person's grief is uniquely theirs, there are some things that we may well have in common.
Please reassure Trish, that I left Bruce's room the same way for many many yrs and only dusted surfaces. When I was able to, I took pictures of every inch of his room and then very slowly dissassembled his room. In a trunk are the sheets he slept on that I never washed. In my closet was the last towel he used...never washed. I carry a shirt he wore (it had his sent - like some of his sweaters) with me on every trip. All that she is doing, feeling,sensing is so very "normal." While it may not be for everyone, I am so happy you suggested Comp Friends. Paul and I were members for several years. It may not be for everyone and each at their own point may move away from the meetings for whatever their personal reason may be. Same for therapy. I was receptive; Paul and Marshall were not. I shopped very hard until I found someone who could work with the excruciating pain and the type of pain that is fortunately alien to more people than not. Acceptance of and respect for our different ways of grieving is of paramount importance as it takes it many shapes and forms. My belief becomes stronger, especially when a young sibling dies, that the siblings are the "lost grievers." People ask parents, grandparents etc how they are doing; oft times the surviving sibling(s) are left out of the verbal compassion and personal contact that is desparately needed. I am very sensitive to these siblings and when people ask me "what can I do/say to relatives and friends, I never fail to mention reaching out to the siblings whose loss/guilt/aloneness now abnormal world is just as profound as for parents.
I wish Trish and her family Gentle Moments and my hope is that they listen to their own internal drummer as they try to take steps forward. It does not get better; it just gets different.

Dan Gottlieb is chatting today about when parents lose a child. He will be joined by his guest Trish (see post below) who lost her son through suicide.

Dear Dan,
Recently our beloved son Kenny, just 19, ended his three-year struggle with depression by taking his life.
Despite the fact that it's been almost half a year, I think of him constantly. Memories of him flood my mind all day long, especially when songs come on the radio. I still cry because the music gets me. I think to myself, Kenny liked this song.
We go out to a restaurant and see something on the menu and I think Kenny would have liked this. We all do this, including my husband and my daughter.

I drive through town and see things that remind me of him. I go into his room and it still smells of him. I have the last outfit he wore and I haven’t washed his sheets. I go in there because it makes me feel sad and happy at the same time. It makes me feel close to him.

Can you please tell me if the pain will lessen? When does it stop, and when does it get easier? When is it ok to let go?

I am torn apart by so many emotions, especially anger. I even feel angry at Kenny sometimes and that is hard. Your heart is angry but your head tells you he was sick. I

 feel angry at some of my family and some people in the community. If Kenny had died from cancer, I would probably feel less alone right now. Some people were very supportive and caring, but others were silent.
I haven’t gone to the grocery store or church since Kenny died, the memories are too painful.

 I don’t want to see anyone.I am also worried about Kenny’s sister. All these months later and she still has not yet cried for Kenny’s loss. All of us need help.
Thank you.
Trish  

Dear Trish,

I am so very sorry for your loss and your sense of isolation.

Whenever we experience trauma, we feel alone and the pain of the alienation can be excruciating.But when you lose a child to suicide, the isolation is so much worse. It's too terrifying for anyone to imagine. And in today's world, the risk of losing a child to suicide or anything else feels much higher and more frightening. So we turn away from our fear and helplessness, and turn our backs on you.
In psychological terms, six months is like yesterday. Your brain cannot fathom what has happened let alone what it means or how to cope with it. That's why these unexpected thoughts and emotions land like a tsunami. I'll bet you sometimes forget that he's gone, and then it starts all over again. And for most parents who lose a child, the guilt can feel soul-crushing; they ask themselves if they did all they should have done.
Of course you are angry at Kenny. After all, he left you in a violent way. Same with your community and your family. It must feel as if they also have left you.
Sometimes the unconscious experiences death as a murder when something evil has stolen someone precious from our lives. In the last scene in Miss Saigon, the main character’s lover commits suicide in front of him. As he cradles her in his arms, he lets out a bloodcurdling scream of grief and rage. That is the kind of scream your whole family must feel.
In Alcoholics Anonymous, a famous saying is “One Day at a Time.” Anyone in crisis will tell you that sometimes it's one hour at a time, one minute at a time. The task is to live the next moment and then do it again.
And letting go? You will never let go, and probably don't want to. Most parents I have worked with tell me the pain is excruciating but they wouldn't want to part with it as that pain is their connection to their child.
Over time, your connection to Kenny will have more texture than trauma. The pain will always be there, but there might also be warm affection, quiet longing and even gratitude for the years you had together. But that takes a long time. Not work, but time.
In the meantime…
As you know from what happened to Kenny, 90 percent of suicides happen to people with some form of mental illness, typically depression. So I understand your anxiety about your daughter, because depression has a genetic link and stress increases one's risk for a depressive episode. Do what you can to help her feel safe enough to share her feelings. But be aware that males are three to five times more likely to commit suicide than females.
We haven't heard a word about your husband’s feelings or the state of your marriage. I am sure he is in terrible pain. Men tend to be less expressive, which can add stress to a marriage that’s already stressed.
So you’re right. All three of you need help.
I would recommend your family try a few meetings of “Compassionate Friends,” a self-help group for families who lost a child. And I would recommend family therapy with someone who is skilled in dealing with this kind of trauma.T
There is so much more to say and so little space to say it so I have another offer. You could use me as a resource and stay in touch via e-mail and web chats.

Trish will be joining me on Tuesday's web chat

Dan will be joined for this chat by Dr. Molly Layton a Philadelphia based psychologist and family therapist who is a contributing editor to "Psychotherapy Networker" magazine.

They will talk about difficult relationships and other issues viewers want to discuss. 

Hi Dan,

 

Thanks for listening to me. I have a 20 yr old adopted son whom from age 4 has been diagnosed as ADD, OCD, bipolar, impulsive, angry, paranoid, mood disorder, etc., and recently diagnosed as border line personality, soon to be called emotional regulation. He gets into raging cycles that he can't get out of. He has probably been to ten therapists and had fifteen different medications over the years and he is still not under control. When he does take his medications, he takes them sporadically. He cancels doctors' appointments frequently.

 

As he has gotten older he is more difficult. We have called our local police several times due to his threats and physical confrontations. Most of the occurrences have been in our house, and fortunately no one has been injured. He doesn't change his attitude even after the police come to our house.He clearly does not think in a rationale manner about many issues.  If we have to call the police one more time, he will go to jail.  I feel so badly for him since I know he is not in control of himself.  The local police feel that what he does are criminal issues.

 

It seems the only way that a mentally ill person can receive structured mental help nowadays is when a person threatens suicide or threatens another person's life and goes into a hospital. Otherwise they go to jail. About 20% of the people in jail now have mental illnesses. I believe there are some counties that are working on helping mentally ill people in jail.  However, I don't know if they will still be saddled with an arrest conviction.  Unless there is a miracle, my son will end up in jail.  Is there any hope for my son and the other mentally ill people in jail?

 

Dear reader

I don't know what to tell you about your son other than an intensive course of the inpatient treatment followed by highly structured outpatient.  He can emotional regulation but he will need medication and a great deal of social support to do so.

I would also like you to know that we are doing a two-part series on my radio show about mental illness.  On September 12 we will be talking about its impact on families and on the following week, we will be talking about policy, politics and programs.

As you so aptly pointed out, what happens to so many with mental illness is tragic.  As a society, we should be ashamed.

Dear Dr. Gottlieb,I read your column regularly in the Philadelphia Inquirer and often the topic involves depression as it did today.(I also suffer from S.A.D. by the way but in Febrtuary)  As often as depression is discussed in the media, I rarely hear anyone talk about how men can have extremely different symptoms of depression than women.  My husband had become impossible to live with and I was to the point of filing for divorce. He was constantly angry, irritable and verbally abusive.   While trying to enlist the aide of a friend of his to see if he could talk some sense into my husband, he asked if It was possible my husband was just depressed. Though he had been out of work for nearly a year with no prospects and, had been turned down several times for jobs he was well qualified for, the thought had never crossed my mind.  The typical symptoms of depression; sadness, helplessness etc weren't there but I did a little research and was STUNNED to see that men often show depression in a different way with aggression, nit-picking, argumentativeness etc. I printed out this information and after yet another after-fight apology from him, gave him the list.  Reading it, he cried. He took the information to his doctor and began taking an antidepressant.  I got my husband back! I feel very lucky that my friend suggested depression because I would have never suspected it and it saddens me to think of how many  relationships end because the males are being difficult due to depression and not just being a**holes as it appears on the surface. It would be very helpful if you would touch on the anger/irritability/abusiveness symptoms of depression in a future column. It was life-changing information for us and with the current economic situations that people are facing, I'm sure more and more families would find this insight useful. .

 

Hi Dr. Dan:
How does one be in a relationship with a narcissistic parent?
I am an only child and my parents were divorced when I was 8. My mother passed away from illness when I was 21 so my father is all I have. He has some health issues but none that would keep him from working. He chooses not to work, and live off the government on social security. 
I can go on and talk about the false suicidal threats he pulled, the number of times I gave him money, a place to live, etc…
And it's not just financial. I have also been in a parental role emotionally. My father has never had much interest in my life.
Recently I was telling my father about a treatment I was going to start to treat for a skin condition. He interrupted me in mid-sentence to tell me about his friend's child. I realized that his self-absorption was even more severe than I realized.
Yesterday was my birthday and he did not bother to call me or see me. This was a first but no surprise. I'm wondering how I should proceed. Do I not call him on this? Do I ignore him on his birthday?
I think the bigger issue is how much I give to a parent who gives so little back? I invite him over for dinners, take him out to eat, get him presents on father’s day, etc... I guess I do this out of my own guilt and fear of losing a connection with him. Deep down I have a fear of him dying. I realized this a few years ago when he used suicidal threats to manipulate me.
I’d appreciate any thoughts on how to handle this.

Tired daughter 

Dear tired daughter:
Although your father may be depressed, he shows many signs of a narcissistic personality disorder. Those with this disorder believe they are “special.” They require excessive admiration, display an unreasonable sense of entitlement and lack empathy.
Personality disorders are notoriously difficult to treat because like your father, these people with these disorders don’t think they have a problem. So they rarely seek treatment. When they do, they usually lack the commitment required to begin modifying one's personality
.I understand that you are angry at his manipulation and that he cares more about himself than his only child. And I understand the terrible imbalance in this relationship.

But your letter tells me more about his behavior than it does about you. You are the one who is suffering

.If I were to ask you what you really wanted, you might say boundaries. But as I read your letter more carefully, I hear your continued devotion for this man and fear of his death, I wonder if what you really want is something beyond boundaries. Maybe you have an unspoken longing for the father you may have wished for since you were eight years old.

 Perhaps your tenacity is about something you have carried deep inside your heart for many years: Hope.

 I am sure you know in your head that he won't change, but maybe your heart doesn't know that because it is just too painful. I would suggest the real source of your suffering is unrelenting hope.

You've had three significant deaths in your life. A divorce is like a death to an eight-year old child, and of course your mother's death came when you were 21. I am sure in whatever way you did, you acknowledged and grieved for these losses.

 But the one death you have not dealt with is the death of your dream to have the father you want.

Once you stop fighting with him and for him, what's left? Then you would be in a relationship with a man who is emotionally unable to connect, a man who, because of whatever defect, is incapable of compassion.

You would be in a relationship with a man who is broken and in many ways childlike. If you can mourn this loss and relate to this man as he is, he might feel less dangerous to you. And you might be able to set boundaries without resentment.

One more thing. I would suggest that your fear of his death might be about love. Despite his outrageous behavior, it sounds as if you still love this man.

Love is not a zero-sum game. Love without expectations feels good. Love with expectations causes suffering. Once your dream for the father you've always needed has died, you might find yourself able to love the father you have.

I hope so.

Tuesday's chat with Dan Gottlieb has been canceled for Sept. 29. We will resume on Tuesday Oct. 6.