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

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.

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.

Hi Dr. Gottlieb,

My young daughter is having a difficult year. She has been doing various sports and playing music for several years with much success. But this year, her first in high school, things are not going well.

She has been getting low scores in her athletics compared to her friends. She also did not make the high school band while her friends were accepted.

She has always excelled at everything and now is beginning to feel that she is not talented and is becoming depressed and withdrawn.What’s  the best way to talk to her about this?  

Dear Susan,

 I'll get to the “how to talk to her” part in a minute, but let's first figure out what the problem might be.

What your daughter is experiencing is too common among many girls her age. Children that age are beginning to learn about their identity, how they are the same as and different from their parents and friends. One way they do this is by experiencing success and failure, watching peers, and having plenty of downtime where they can dream about the future.  

In today's world, however, not only do children not have enough downtime, they don't have the luxury of failing. A generation ago, children’s afterschool activities were about play; now they are about achievement. And “average” has become the equivalent of failure!

The goal is no longer to do your best; it’s about living up to some impossible standard. This push for perfection comes from the family, school and peers and the larger culture. I actually heard a car commercial last year that said: “Good enough is no longer good enough!”

So what is it like for our children to grow up in that culture? Overachieving girls often come from families whose parents model high achievement and self-sacrifice. Failure is crushing to these children because it's not about what they have or haven't done, it's about who they are. “If I fail,” many of these children think “that means I am a failure.” The stakes are sky-high for each event.  Even when they succeed, the sense of accomplishment doesn't last because there is always more to accomplish right around the corner.

At its extremes, perfectionism can be a symptom of Obsessive-Compulsive Disorder and can lead to depression or eating disorders.  Susan, your daughter might not be this extreme at all. This could present you and your family with an unexpected opportunity to make some changes.

Of course your daughter has to learn the value of failure. Without it, she would never develop resilience. Surveys show that many of today's children, when they hit the workforce, have plenty of knowledge but poor problem-solving skills and not much resilience. That's because they have been pressured to achieve and protected from failure most of their lives. 

So how do we teach your daughter that failure is ok? Not by lecturing! One way is through role modeling. Tell her about the failures in your life, past and current. You might also want to say what failure feels like and what it meant to you when you were younger and what failure means to you now.

Perfectionists often feel as though no one understands them, so don't try to talk your daughter out of her feelings; it will just make her feel more isolated. Instead, help her give voice to the emotions underneath her thoughts about being a failure.  

Remember, the fear of failure is about avoiding fear more than failure. Usually when children voice fear, we help them avoid it. But imagine the sense of freedom if she could give voice to her fear, and you could help her learn to tolerate that fear. And then when she does fail, you can talk about how she might feel badly, but she has less to be afraid of.Here's the big opportunity. Your daughter needs role models for hanging out and having fun.

Everyone in the family has to be able to relax and laugh at themselves. Laughter is like chicken soup for perfectionism. An early supervisor once said that the world is full of people trying to act like filet mignon when we know deep down we are meatballs! We need to stop trying to be the person we think we should be and spend more time hanging out with people we love.

Dear concerned husband,

Sometimes marital problems are mostly because of one person.  Sometimes, but not often.  Certainly this is the case with the abuse or violence where one spouse feels unsafe in the matter.  If you haven't harmed her physically or psychologically, nevertheless If your behavior is so irritating to your wife that she will not go into therapy until you have done some work, so be it.

On the other hand, if she is willing to go into therapy with you, I would recommend that.  Very often in marital therapy I have one spouse working for an entire session, sometimes two or more on their issues.  That way the observing spouse can get to see and understand you from a different perspective.  Because after all, the goal is not just behavior change, the goal is mutual respect and understanding.  I am sure your wife would also benefit from talking to a therapist about her marriage with you sitting in the room.  It would help you understand the impact of your behavior beyond her surface reaction.

I hope that helps

Dear Doctor Dan,
I am a faithful reader of all things Gottlieb, so I am hoping you could advise me about some distressing issues in my life. 
How can I go about helping my daughter find a therapist for my grandchildren who are ages eight and five?  Their parents recently divorced and the older child is having real problems with sleeping overnight at his dad's house.  He says he is ok with spending time with daddy but does not want to stay away from home.  He has no trouble sleeping overnight at my house but has done that since birth quite a lot.
My daughter says that her ex tells her that the child "has to learn to cope" and that is what they have been doing.  I think it will take a matter of time and will resolve itself,  but I also think they could use some counseling to deal with this issue and other divorce related things. 
Can you guide me so that I may guide her in steps to find a compatible counselor 
Thank you
concerned grandmother 

dear concerned, 

Your letter brings up several issues, so let's talk first about what needs to be done and then we can talk about what you can and cannot do to help make it happen.

Although divorce harms all children, according to the American Association for marriage and family therapy, only 25% of children of divorce have serious long-term emotional difficulties.  Although this is a very high percentage, keep in mind there is a good chance your grandchildren will be okay without intervention.

But there are many things parents can do to help mitigate the effects of divorce.  The first and most important issue is safety.  All children need safety in the wake of this upheaval, but especially young children.  And children find safety in consistency and predictability.  Much as possible, schedules should remain the same week in and week out, especially in the months following a divorce.

Most children of divorce feel that the bottom has just dropped out of their lives and that everything they knew to be true is no longer true.   So your grandchildren need to be reassured with words and actions that they are loved by both parents and both will take good care of them.  So both parents must be very careful not to cancel plans and to show respect to one another in front of the children.

I often tell divorced parents that they must love their children more than they hate each other.  Therefore they must develop a workable plan that gives children easy access to both parents.  And of course, no parent should never ever speak angrily about their child's other parent.  At best, it sets up a loyalty conflict for the children.  And worst, children feel they have lost both parents.

Believe it or not, I would not recommend counseling unless they are showing signs of distress.  Signs to look for include
·         acting younger than their chronological ag
·         moodiness
·         sleep difficulties
·         acting out in ways they hadn't before
·         problems with friends or school
·         irrational fears and compulsive behavior.

Many children of divorce will show some of these symptoms in the short run, but if they persist, it's time to seek help.  But I wouldn't automatically seek counseling and here's why: children of divorce already feel pretty alone and wonder if there is something wrong with them which may have broken up the family.  If they are "sent" to therapy, the process itself could reinforce that belief.  I believe that if younger children of divorce need therapy, it should be family therapy unless there is a compelling reason not to.

Finding a therapist?  Make sure the therapist is trained in marital and family therapy.  But even so, not all family therapists are trained in working with small children, so you need both.  You should be able to find one in your community through the American Association of Marriage and Family Therapy.  Alternatively you could look up your State Psychological Association or National Association of Social Workers.  But please make sure whatever therapist you find is trained in both divorce and working with young children.

So now we come to you and what you can do. First, divorce is a trauma not just for parents and children, but for grandparents also.  Just like your grandchildren, you may have gone through these years thinking that your children and grandchildren were safe and secure.  And now this.  I have spoken with so many grandparents of divorce children whose hearts are broken by what's happening to their children and grandchildren. It feels the stakes are so high and you feel so powerless.

I will assume you have a good relationship with your daughter, but it's also important that you maintain at least a respectful relationship with your son-in-law and avoid criticism or blame.  If your daughter wants to do so, listen to her with compassion and empathy, but please try not to reinforce her resentment or help her feel like a victim.  As I am sure you know, if you were to get in the middle, the outcome is never good.  I've talked before on these pages about how and when to offer advice to our adult children, when it's respectful and when it is intrusive.  And I have said that within very broad limits, we have to respect the resilience and problem solving skills of our adult children.  But when grandchildren are involved, it gets more complicated.

Feel free to tell her about your concerns, but please don't push as your daughter feels vulnerable enough.  Offer to be an additional resource for your daughter, grandsons and even your son-in-law.  If you are able, spend extra time with the children it might help everyone out.  And perhaps you could even include the other set of grandparents in some of the social activities.  It would certainly make the children feel better.I hope this helps and I wish everyone healing.