But one aspect of getting divorced — or breaking up with your boyfriend or girlfriend — that can and probably will cause all kinds of problems is if you end up having sex with your ex. Oh yes, it happens. Hey, don’t look so shocked, you know you’ve done it.

Sometimes it’s not a planned thing. Sometimes it just ‘happened’ that one night when he came over to collect his Eminem CD’s, slanket, and favorite Big Bird mug. Or you may have a regular thing going on because your ex is ‘so damn hot’.

Whatever the circumstance, you might want to ask yourself, “Is this really a good idea?”

Whom you choose to have sex with is up to you. However, having sex with your ex could be setting yourself up for an ultimately unsatisfactory, long-drawn-out experience.

For both parties, the idea of losing a long-term relationship and being alone can be scary as hell. Often the attachment with your partner is still going to be strong in the early stages of divorce or separation, so letting go of that is going to be incredibly hard. You’ll have much shared history and familiarity. Thinking you can just turn your back on that and move on overnight is unlikely. Which is why, if your ex calls, it’s easy to give in and go running to the safety of someone who knows you.

The trouble is, sex probably isn’t going to solve past problems, especially if those problems were around communication, appreciation, emotional support or trust.

It’s amazing how the world looks like a better place after sex. That sense of happiness that intimacy brings is due to endorphins being released into the brain. Essentially, sex is crack for your brain. For that brief period after sex, anything will seem better. You’ll forget the midnight arguments, verbal abuse, and how sick you feel when they clip their toenails in front of the TV while you’re trying to watch “Castle.”

If you’ve got to a place in your relationship where divorce is the only solution to your differences, then there’s a good chance sex with your ex will only complicate matters. But if you still want to go ahead and do it, then do it. There is no right or wrong in this situation, only what you think is right for you.

However, here are a few things to think about before making a choice to get jiggy with your ex:

• Why did you get divorced or breakup in the first place? Did you have a good reason? Will sex make that right?
• Do you still have strong feelings of love for your partner, or do you just have fear of being alone?
• Are you or your partner using sex to try to keep the relationship going instead of facing the discomfort of ending?
• Will having sex muddy the waters? If you plan on moving on from your ex, being intimate with them means you’re not moving on.
• Is this an exclusive thing? Are you OK being a sex-buddy? Who else are they having sex with? Are you using protection?
• How will you feel if your partner tells you they’re seeing somebody else?

Remember, the reason to get divorced or to breakup is to dissolve the relationship — dissolve, as in make disappear.

Getting back with your ex for the occasional night of passion might seem fun, but it usually prolongs the inevitable ending, which can make it harder to forge new healthy relationships. An ending that you face and accept, no matter how uncomfortable in the short-term, will be better in the long run. Still, the choice is yours.

However, losing a mom has a powerful effect on young adult daughters. In her research, Bhatia found that a daughter’s sense of identity is especially shaken. “They don’t know what being a woman is all about.”

Daughters also doubt their own role as mothers. “Most motherless daughters are very insecure about how well they could mother without their mothers’ advice, support and reassurance.”

Cultural identity is affected, as well. As kids and teens, many daughters are too busy with school and other activities to focus on their traditions, Bhatia said. They assume they’ll be able to learn from their moms in the future. But once their mothers pass away, they “find they don’t have anyone to learn from.”

Many daughters feel like orphans, Bhatia said. Fathers may become “absent and withdrawn, and are unable to tend to their [children’s] emotional needs.” Moms typically form the foundation of the family. They “take care of everyone and keep the family together. If there is a conflict, mom is the mediator.” So when mothers pass away, the family can fall apart. To regain their family’s stability, daughters set aside their own grief and assume their mother’s role.

Motherless daughters also can experience a persistent grief for years, which peaks during milestones, like their own pregnancy and post-delivery. “When you become a mother yourself you want to be mothered,” Bhatia said.

Daughters who didn’t have good relationships with their moms still experience a profound grief. They grieve for what could’ve been. “They grieve for the opportunity to improve their relationship,” Bhatia said.

Motherless daughters may have problems with their other relationships. They tend to feel especially distant from their peers, because of both “jealousy and lack of commonality.”

“In intimate relationships, motherless daughters are far more needy because they’re trying to fill that void. They try to find in their intimate partners that nurturing that they used to get from their moms.” They’re also not able to give much back to their partners, which causes resentment.

To prevent this, Bhatia suggested motherless daughters gain insight into their behaviors and “utilize other resources to gain that nurturing, such as a friend or maternal figure.” Individual and couples counseling also can help.

Below, Bhatia shared other suggestions for motherless daughters to cope healthfully with their loss.

1. Carry on your mom’s traditions.

Instead of solely focusing on your loss, incorporate the traditions you grew up with into your own life, Bhatia said. If you’re a mother, this also is a great way to teach your kids about their grandmother, she said.

2. Participate in fundraising efforts.

Helping others who are in a similar situation can be a tribute to your mom, Bhatia said. For instance, if your mom passed away from cancer, you might participate in events sponsored by the American Cancer Society, or make a yearly financial contribution.

3. Create a collage.

A collage is a tangible tool for retaining your connection with your mom, according to Bhatia. It’s a way for you to see her every day and feel her presence, she said. “Instead of forcing yourself to disconnect and get over your loss, what’s more helpful is to hold onto your memories and keep those connections.”

4. Accept your different identity.

Again, a mother’s passing is a powerful loss, which can change your identity. Bhatia wants readers to know that this is OK. It’s OK if you’re different today. “Allow yourself the opportunity to explore different prospects without the approval of your mom.” If your mom wasn’t supportive of your career or life choices in the past, “understand that as time progresses, things change. [Your] mom’s opinions would’ve evolved, as well.” For many daughters, their image of mom stays static, she said, but people naturally change over time.

5. Participate in support groups.

Many motherless daughters feel like they don’t fit in and can’t relate to their peers, Bhatia said. Talking with women who’ve also lost their moms and share similar experiences reminds you that you’re not alone. It helps you connect with others, create a sense of belonging and build a support system.

6. Find a maternal figure.

For instance, you might become close with one of your mom’s friends, who are often very similar to your mom, Bhatia said. And you might learn more about your mom, she said. “When you’re not able to do that, seek out older females who might help to guide you – almost like a maternal surrogate.”

7. Seek individual or family therapy.

For the participants in Bhatia’s study, individual therapy was incredibly helpful in processing their mother’s passing. Family therapy also is helpful for daughters, dads and siblings to process their grief and be honest with each other in a supportive environment, Bhatia said.

Coping on Mother’s Day

Naturally, Mother’s Day can be especially hard for motherless daughters. “Many motherless moms don’t celebrate the day and deprive themselves of that opportunity,” Bhatia said. They may feel guilty for celebrating without their mothers.

Bhatia encouraged daughters to celebrate the day and enjoy the appreciation of their families. This “reflects the fruits of their own mothers’ labor and thus honors them, for they wouldn’t be the mothers they are without that strong primary attachment.”

Also, motherless daughters can continue to buy a card for their moms, she said. In it, they can express what they truly want to say to their moms and reconnect in a meaningful way.

As Bhatia said, “just because your mom is gone, it doesn’t mean you’ve lost your attachment or connection to her. Your mom will always be there to help you navigate through life.”

How great is that? Here’s a Roman general, top of the pile, a massive celebrity (like the Jay-Z of his day), and there’s this slave reminding him that he’s mortal and not to get too high above himself because he too can die.

Personally, I think we need more of that today — humility and the awareness to realize and accept that we are mortal, destined to die.

Death rarely is a fun topic to bring up, especially when you’re picking up a grande latte at Starbucks first thing in the morning. Not because it’s not an interesting subject, but more because people rarely acknowledge or want to think about their mortality.

So why is talk of death an unusual subject? It’s a shared experience every human on the planet will go through (hands up if you’re about to stop reading this article because it’s too heavy). Richard Dawkins put it most elegantly: “We are going to die, and that makes us the lucky ones. Most people are never going to die, because they are never going to be born.”

Isn’t that amazing? We are so lucky. We are here and now. We can feel emotions such as love and happiness. We can express joy and laughter. We can feel warmed by the sun, chilled by the wind, cooled by the rain. We can witness so much beauty in the world, gasp at nature’s creativity, do amazing intellectual feats to understand it all. Yet, we’re still unable to stop the inevitable degradation of our bodies and eventual death. Bummer.

The idea of death seems to go against our Western philosophy of being able to choose what we want. We can choose to buy that big 60″ HDTV with the surround sound home-cinema system, but we can’t choose not to die. Who decided that nonsense? No wonder most people will do anything they can to avoid the inevitable (myself included).

Have you ever seen the movie “Logan’s Run”? That film had a profound affect on me when I was younger. In the film, to control population, when people reach 30 years old they’re summoned to the carousel to be ‘renewed’ (killed), and I used to think that was a great idea — until I reached 30 and realized it’s a terrible idea!

So what is our problem with thinking and talking about death? In his Pulitzer-prize winning book Death Denial, Ernest Becker argues that most human action is taken to ignore or avoid the inevitability of death. But this type of thinking is totally irrational because death is inevitable, and this denial will only cause major complications in our lives.

I think many people are realistic enough to hold a healthy preference about their own death, “I’d really prefer not to die, but I also know that it will happen one day.”

However, there are many more people that hold a rigid demand about death, “I absolutely must not die, it is too terrible to comprehend. I can’t stand it.” Due to this unhealthy thinking, people often become overly busy, doing things to distract themselves from thinking about their mortality. Others strive for wealth and power as a way to shield themselves from the inevitable — “maybe if I’m rich, I can buy my way clear of death.”

Unfortunately, it doesn’t work that way. Just ask Steve Jobs, Joe Weider, or Jerry Buss. It doesn’t matter how much wealth or fame you have, or how busy you are, you can’t beat death.

The other way society avoids thinking about death is with this relentless drive for immortality. You’ve got to look young in society to be acceptable, so take your pills, exercise, stop drinking sugary soda, pray and you might live forever. But hasn’t this irrational goal held humanity back and caused irreparable divisions between people and cultures?

Let’s face it, death is a non-discriminatory experience. Our denial about something that is as natural as birth needs to be accepted and valued. Let’s bring our fear of death to the forefront of our awareness. Death denial will only lead to a life of fear and anxiety, and that’s not healthy.

How do we deal with those who embrace an ideology of destruction?

How do we reckon with those who suckle their children on hatred?

What do we say to ourselves, to our kids, to our loved ones when a horrible thing happens?

We will all have different responses to these questions. Here are mine…

• We remember the words of those we hold in high esteem.

  “When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’ To this day, especially in times of disaster, I remember my mother’s words and I am always comforted by realizing that there are still so many helpers – so many caring people in this world.” — Mr. Rogers

• We cherish what we hold dear.

  We hug our kids a little tighter. We appreciate our loved ones even more. We commit random acts of kindness to make life easier for those we know and, perhaps more important, for those we don’t know. We cherish the freedoms we have and are grateful to those who dedicate their lives to making that freedom possible.

• We reach out to those more vulnerable than we are.

  Of course, we do what we can do for those directly affected by the tragedy. But we do more than that. We extend a helping hand to those who are more vulnerable than we are. They may need to share their story, to dissolve into tears, to quiver with fear, to explode with rage. Whatever they require, we are there for them. It’s healing for them; it’s healing for us.

• We do not define the human race by its worst elements.

  People are fantastic! They are kind. They are compassionate. They are big-hearted. They are considerate and generous and loving and sympathetic. Need I say more? And yes, there are those who are cruel and cold and brutal and mean. But we do not let ourselves be corrupted by those elements. We deal with them when we must. But we do not allow them to corrupt our hearts.

• We resolve to become more resilient.

  We may consider ourselves to be anything but resilient. Indeed, we may view ourselves as nervous, unable to deal with storm clouds and ticking bombs. We want life to be safe. Why not? But we recognize that life is fragile. Hence, when tragedy strikes, we strive to become survivors, not victims. When we are ready and only when we are ready, we resolve to do what we can to make ourselves and our little corner of the world a better place. We rejoice in the wonder of life and feel blessed to be a part of it, no matter how awful it is when horrible things happen.

Stay safe and take care of yourself and your family.

In my 20 years living in the Boston area, I cheered on the runners on many occasions and now, even from far way, these events feel close to home.

Experiencing trauma can have a dramatic effect on our bodies and our minds.  And although it’s a different experience to witness a trauma on television, it still can affect us.

When you perceive a threat, the body activates the stress response. The stress response occurs in both your body and brain.

The body’s response to acute stress is a preparation for emergency.  Adrenaline and other hormones are released.  The body shuts down processes associated with long-term care.  When under immediate threat, digestion, reproduction, cell repair and other body tasks related to long-term functioning are unimportant.

Of immediate importance is survival.  Increased blood sugar can provide extra energy for muscles. Increases in cortisol counter pain and inflammation. Blood pressure increases. Blood is diverted from our extremities to our major muscles to provide us with extra strength. Increased endorphins can help us ignore physical pain.

You can see the effects of these changes to the body in many of the symptoms of stress, such as racing heart, dizziness, nausea, shortness of breath, shaking, feeling hot and flushed, and sweating.

But it is the impact of trauma on the mind that is often the most disturbing.  Traumatic events can leave us feeling unsafe.  They can disrupt our beliefs and assumptions about the world. Your sense of your ability to control your life may be shattered. You may question how much influence you have over your life and your life choices.

A trauma, such as the one the occurred at the Boston Marathon, can leave us distrustful of other people.  You may question your basic trust of other people in the world.  Trauma can affect your ability to be intimate with others and may impact your feelings of self-worth.  Those who survive the trauma often feel guilt and wonder why they lived when others were less fortunate.

As we grow, change and have varied experiences throughout life, our beliefs and assumptions typically evolve over time.  With trauma, those beliefs and assumptions that we use to make sense of the world around us change nearly instantaneously.

It’s common to experience a wide range of psychological symptoms, including intrusive thoughts, worry, difficulty sleeping, trouble focusing, bouts of crying, blame or self-judgment and lack of satisfaction.

The effects of trauma also can cause intense emotion, including extreme emotional fluctuations, unhappiness, anxiety, loneliness, anger, and irritability.

Multiple traumas or repeatedly being exposed to life-threatening events can have a further impact on your body and mind. Parts of the brain can become sensitized, causing you to be on high alert and to perceive threats all around, leaving you jumpy and anxious.

Other parts of the brain associated with memory can actually shrink, making it difficult to consolidate and form new memories.  Prolonged stress can effect the development of a number of health issues, including diabetes, obesity and hypertension. And repetitive stress affects our moods, brings on anxiety disorders, and affects our experience of chronic pain and our ability to control food intake.

But when horrible events occur, such as those that occurred at the 2013 Boston Marathon, we also see the generosity and caring that is a large part of human nature.

Countless individuals ran to help without a second thought.  First responders, medics, EMTs and even bystanders jumped into action to do what they could to save lives.  Runners crossed the finish line and kept on running straight to give blood.

As we deal with the impact of violence, we can also keep in our minds the heroes and the strength of the human spirit that brings us together when we are faced with senseless tragedy.

Image: Wikimedia Commons: Aaron “tango” Tang

We stay silent. We say stupid things. We go from being sensitive, sensible, kind adults to rambling niceties or making downright rude remarks.

Illness, understandably, makes us nervous.

Fortunately, Pogrebin’s book helps us navigate the muddied waters of illness and mortality. It’s packed with practical tips and valuable insights.

Pogrebin was inspired to write the book after observing the varied reactions from her own friends to her breast cancer diagnosis. Some friends misunderstood her needs and acted awkwardly. Others were supportive and compassionate.

In the book, she shares these personal experiences, along with powerful accounts of people offering support to others. She also shares the words of almost 80 of her fellow patients at Memorial Sloan Kettering Cancer Center. She interviewed these individuals to find out how they really wanted to be treated.

Here’s a snippet from Pogrebin’s book on communicating with a sick friend.

What Not To Say To A Sick Friend

Pogrebin advises against saying phrases like “Everything happens for a reason” and “You need to be strong for your kids.”

Even seemingly positive statements become anything but. For instance, let’s say you’re trying to cheer up a friend who just received a cancer diagnosis. You might say something like, “I know ten women who’ve had breast cancer, and they’re all doing fine” or “My sister had a double mastectomy, and she’s climbing mountains!”

One cancer patient told Pogrebin that these comments were insulting and dismissive. They also didn’t mean anything to her: “Every woman and every cancer is different,” she said.

Another seemingly positive but problematic phrase is “You look great.” According to Pogrebin, when you focus on your friend’s appearance, it can discourage them from telling you how they truly feel; if they don’t look good, they won’t believe anything you say; and if you don’t compliment their appearance in the future, they might assume they look worse.

What To Say To A Sick Friend

Pogrebin stressed the importance of being honest with your sick friends. She also notes that everyone should be able to say these three statements: “Tell me what’s helpful and what’s not;” “Tell me if you want to be alone and when you want company;” and “Tell me what to bring and when to leave.”

In addition to honesty, it’s also important to express empathy and availability. Pogrebin includes a list of seven phrases that sick people want to hear. All of these include empathy or availability or both elements.

• “I’m so sorry this happened to you.”
• “Tell me how I can help.”
• “I’m here if you want to talk.”
• “Just give me my marching orders.”
• “That sounds awful; I can’t even imagine the pain.”
• “I’m bringing dinner.”
• “You must be desperate for some quiet time. I’ll take your kids on Saturday.”

The Commandments of Conversing

In her book, Pogrebin features a list of 10 commandments for conversing with sick friends. For instance, she suggests celebrating your friend’s good news and not downplaying their bad news. This doesn’t mean sugarcoating or “slapp[ing] a happyface decal on a grim diagnosis,” she writes. Instead you can say, “Tell me what I can do to make things easier for you — I really want to help.”

Also, treat your friends the same way you always have, but don’t forget their new circumstances. For instance, tease and joke around with them, but “indulge their occasional hissy fits.”

Talk about other things. According to Pogrebin, this helps “speed the journey from the morass of illness to the miracle of the ordinary.”

Similarly, emphasize their skills and talents, which will help them feel valued. This can be anything from asking a poker aficionado for pointers on playing to asking a retired teacher for guidance on college applications for your teen.

Unless you’ve been there, avoid talking about yourself or telling your friend that you understand what they’re going through. Avoid complaining about comparatively small things. (“Don’t tell someone with congestive heart failure that you have a migraine headache, as painful as it may be,” Pogrebin writes.)

Before saying anything, make sure you know the facts of your friend’s sickness and situation. Pogrebin shares the story of one woman who had three friends tell her that they were glad the cancer was caught early. It wasn’t.

Don’t treat your friend like a child or pressure them into being positive. Positive thinking can help people endure tests and treatments, but it’s not a cure. Don’t imply that negative thinking caused or exacerbated their illness. As Pogrebin says, the last thing your friend needs to be doing is blaming themselves.

When thinking about how best to approach a sick friend, Pogrebin quotes Hillel’s famous words: “Do not say unto others what you would not have them say unto you. All the rest is commentary.”

Other countries have long had to deal with seemingly random bombings in urban areas; the U.S. is relatively late to this particular brand of horror. I’m not sure how one ever gets used to the idea that by just going shopping or watching a parade or sporting event, something really bad could happen.

But life carries on — we cannot stop living out of fear.

With the prevalence of always-on media, it’s tempting to keep updated when tragedies like this strike by monitoring the news 24/7. But that would be a mistake, as we become overwhelmed with the sheer magnitude of information (at first), and then the agonizingly slow trickle of new information (later on).

But there are some things you can do to help yourself — and others.

Elvira G. Aletta, Ph.D., for instance, had these helpful suggestions after the Newtown, CT shootings:

• Share in our humanity. Highly sensitive people (and who among us is not?) feel empathy profoundly. Just because it has not happened to us directly does not mean we do not grieve. Even from a great distance we are sensitive to the depth of loss. Cry, be sad. Allow grief to happen. Then wash your face, breathe deeply and allow life to happen, too.

• Turn off the radio, television, step away from the computer and put down the newspaper. Allow yourself the space to adjust to the news at your pace, not theirs.
• Do good. I do not mean make a donation or give blood. Although all that is good, there is more we can do. I mean what Chris said in a comment he left on my blog the day of the shooting, let us out-grace one another. Let us look for opportunities to act with kindness. Pay forward the kindness received from others. Let us breathe in the healing love and goodness in the universe and breathe out the poison.
• Stop the hate. Now that I’ve breathed out the hate I am hopeful I can let it go.

These are still helpful suggestions today. I would also add:

• Talk about it. Get together, face-to-face, with some friends or family members to share in your grief, or just the need to talk. Spending more time with others helps reinforce those emotional and social bonds that help us feel safe and secure.

• Engage in self-care. Now is not the time to challenge yourself to start a new diet, or challenge some habit or behavior you’ve been meaning to change. Instead, ensure you are getting your emotional needs met — ask for a hug, give a hug. Let others know what you need, and take the time you need to keep yourself together.
• Volunteer. While the Red Cross in Boston isn’t in need of blood donations right now, they will again in a few weeks. Commit to helping by giving blood, or donating in some other way that can help the victims of this tragedy (or even a recent tragedy closer to your own home or local community).

Our hearts and prayers go out to those who were injured or lost a loved one in the Boston Marathon bombings.

Even the word “survivor” uncovers stigma in the world of suicide prevention. Traditionally it’s been used by those bereaved by the suicide death of someone else, and does not refer to those who have survived suicide attempts.

A few savvy agencies, including the AAS and the American Foundation for Suicide Prevention, are careful to distinguish between “loss survivors” and “attempt survivors,” but more often organizations will simply refer to “survivors,” and they always mean the bereaved when they do.

This might seem like a quibble with language, but in fact illustrates structural stigma among suicide prevention agencies. Attempt survivors simply don’t exist in their language, or in their activities.

For many reasons suicide attempt survivors have been left out of suicide prevention efforts, beginning with stigma, but there are also clashes with the bereaved who can be angry at attempt survivors. This unfortunate situation means that those who have literally survived suicide are rarely able to contribute knowledge from lived experience to the field. Channels are closed.

In my hometown of Vancouver, BC, for example, not only are suicide attempt survivors explicitly banned from volunteering (for two years post-attempt), those with active mental illness are excluded from Crisis Centre BC. (As of the publication date, Crisis Centre BC hadn’t responded to a request to explain their rationale for this policy. I received an email later explaining that people with mental illness are welcome once they have a year of recovery, and the reason for not having attempt survivors volunteer for two years is to avoid triggering and give time for healing.)

As a suicide attempt survivor, I’ve used the knowledge I gained from my lived experience of pain and recovery to help others, through blogging, by creating the Unsuicide Online Suicide Help Wiki, and sharing links to resources and supports on @unsuicide. I have bipolar disorder, which is cyclical in nature, so I’ve fought many battles with suicidal thoughts. I’ve learned what works and what doesn’t, not only for me, but by talking with peers I’ve learned what works for them as well. Books (and apps) like Kate Bornstein’s “Hello Cruel World: 101 Alternatives to Suicide for Teens, Freaks, and Other Outlaws” and Susan Blauner’s “How I Stayed Alive When My Brain Was Trying To Kill Me” are two examples of peer knowledge that have helped many people.

Peers know that bombarding us with trite “inspirational” aphorisms doesn’t help, and can have the opposite effect because it demonstrates a profound lack of understanding and empathy. We know that intentionally guilting us about loved ones makes us feel worse about ourselves (this is one example of how loss survivors and attempt survivors can be at odds). We know all the clichés and why they’re unhelpful. And we know what does help. Not every tip helps every person, but by compiling knowledge we have a lot of powerful wisdom to share.

Why don’t suicide prevention professionals want this knowledge, then? Wouldn’t it provide a tremendous amount of insight, and useful feedback on services? Couldn’t it help save lives? Why are we being overlooked? Are we considered incompetent? Failures? Traitors to life? Contagious?

What Happens Now is a groundbreaking work that explores these themes and more. If you want to keep up with the cutting edge of suicide prevention, this is truly it.

If you are experiencing suicidal thoughts, read this first. Find help near you through the International Suicide Prevention Wiki, or the Unsuicide Online Suicide Help Wiki if you’re not comfortable using a phone. Also check out the Suicide Project, a place to share your suicide story with others.

Chen can only move her big toe. She writes emails and communicates with others using special technology. Composing an email with five short sentences takes her 20 minutes. But she continues to email with her family, friends and other ALS patients. She also visits patients in person with the help of her caregivers and relatives.

Chen’s remarkable story is featured in Richard Cheu’s empowering book Living Well With Chronic Illness: A Practical and Spiritual Guide. Cheu provides pastoral counseling to patients in New York City medical and hospice centers. He helps patients find peace with their illness and live their lives to the fullest.

Getting diagnosed with a chronic illness is overwhelming. It can unleash a range of reactions, from shock to fear to grief, said Cheu, also a stress management consultant, Catholic deacon and a caregiver himself. The diagnosis can shatter your self-image, he said. It’s as though you draw a line in the sand, one side representing you before the diagnosis, the other side representing you after.

While chronic illness changes your life, it doesn’t have to stop you from enjoying it. Chen is just one example of many individuals who’ve carved out meaningful, satisfying lives with a debilitating disease.

When she was first diagnosed with ALS, Chen was heartbroken and depressed. She isolated herself from her loved ones. But talking with another ALS patient at her monthly support group helped Chen start accepting her diagnosis and reach out for help.

Accepting your condition and asking your physicians about your options opens up a world of resources and support, Cheu said.

Taking Charge of Your Health Care

Cheu stressed the importance of taking charge of your health care with these three steps: Stop, look and listen. When you’re first diagnosed, stop, “and just sit down, and take some deep breaths.”

“Look at your disease, and learn everything you can about it, [such as] how it can affect you.” Think of it as learning a new language. If you were traveling to France, and wanted to make the most of your trip, you’d learn some French, he said.

Finally, “listen to your advisors,” or your health care team. Your doctors advise you on what to do, but you ultimately make your own decision on how to proceed, he said.

Taking charge of your health also includes: engaging in healthy behaviors, coping with your emotions and creating calm every day. For instance, you can meditate, journal or spend time with loved ones.

Focusing on Today

“Every person is unique, and has unique concerns that day in that moment,” Cheu said. That’s why he asks his patients to focus on today and consider: “What do you think is the most important thing to achieve today?”

Having a Hero

In addition to Ein-shei Chen, Cheu features other chronically ill individuals in Living Well With Chronic Illness. “Everyone needs a hero,” he said. Pick a hero who inspires you to keep going, someone who’s overcome major hurdles but is living life to the fullest.

Overcoming Loneliness

Loneliness is a common issue for chronically ill patients, Cheu said. After you’re diagnosed, the people in your life might stop calling and inviting you to social events. You also might distance yourself from others. The first step in overcoming loneliness is to recognize that it’s part of chronic illness, he said.

Next, in his book, Cheu encourages readers to “create peaceful and meaningful solitude.” As he explains, “Happiness starts within, and the best relationships happen when you are at peace with yourself regardless of your present condition or circumstances.” Choose activities you find restorative and that bring you joy, such as praying, spending time outdoors, reading or playing music.

Cheu also suggests considering how you’d like to improve your relationships. Would you like to enhance your current connections or make new friends? Would you like to hang out with people who share your religious beliefs or individuals who have the same illness? Then make a list of specific ways you’ll approach these relationships. Cheu also underscored volunteering and having face-to-face interactions.

Cultivating Spirituality

In his book, Cheu defines spirituality as “a way of thinking and living that uses the positive aspects of human thinking, feelings, and behavior to achieve meaning and purpose in life.” He suggests exploring your personal values and making a commitment to live them. Consider how you’re “going to live out this life, today and every day.”

Cultivating spirituality also includes regularly checking in with yourself and asking whether your current life reflects your values, Cheu writes. He also notes the importance of gratitude, and showing your appreciation for your caregivers.

Having a chronic illness can be devastating and make you feel incredibly helpless. While you have little control over your diagnosis, you can take charge of your responses and reactions. A chronic illness doesn’t have to stop you from leading a fulfilling life.

One of the hosts said that he dealt with a difficult personal issue a few years ago. He described conversations he had with friends who wanted to offer their support and condolences, and he said, “Most of them told me, ‘I’m so sorry. I don’t know what to say to you.’”

And then the host made a particularly interesting comment: “Then my friends opened their mouths anyway — and that’s when I wished they had never said anything in the first place.”

I’ve certainly been on both ends. When I attempt to give my grieving friends comfort or insight, too often I walk away feeling as if I’ve failed. My words are balloons that have come untied, or antiseptic on a burning wound. I long to help — and stumbling over my words, confused over what angle I should take, I feel a miserable failure.

How many of us have admitted that we have nothing comforting to say, and then turned right around and scraped together some kind of awkward, unhelpful comment? Why is it that we feel we must speak, and why do our words so often harm the mourner?

Whether our losses have been large or small, most of us understand how kind and comforting the presence of a friend feels in the midst of grief.

I remember when my grandfather died unexpectedly. I got the call from my parents while I was at my freshman college roommate’s house. My cell phone had no coverage in that tiny Michigan town, so my dad had called my roommate’s parents’ house. My roommate’s mother looked concerned as she handed me the phone. She didn’t walk away.

When I’d heard the news, my roommate’s mother immediately pushed a box of tissues my way and went to the stove to pan-fry French toast, handing me a plate with a fork ready to go. I remember as I cried and took bites of that syrup-drenched bread, she told me stories of when she lost her grandfather. The kindness was real; the words were well-intentioned. Yet I can’t remember anything she said, nor was I comforted by any of it. What lingers is that memory of the French toast, her maternal presence, her action in my grief.

Life’s tragic occurrences pop up more often than we would hope in the lives of the people we love. Yet few people have mastered the art of responding well to heavy news. We’re simply not all trained in the art of listening. Professional counselors and psychiatrists are the ones who know how to listen and what is most helpful to say in response. They understand what kinds of comments a grieving person will receive as helpful, and likewise, the type of comments that will sting, irritate, and fall flat.

I spend a lot of time in the car with nothing to do except steer and soak up radio waves. After I listened to the radio host say “I wish they had never said anything in the first place” so bluntly, I pondered his response. Was it too harsh to react to his friends this way? Did he have a right to request his friends’ silence, like the Biblical character of Job? Job endured endless words from his three unhelpful friends in the midst of losing everything.

A few days ago, I received news that a friend is dealing with deep, debilitating depression that has left her hospitalized. I haven’t talked to this friend in a long time, nor am I geographically close or able to do anything, really. Should I offer possibly unwanted words? What to say when there’s nothing to say?

There is a time to speak and a time to remain silent. The radio host needed that silence desperately. I cannot do anything else for my friend, thousands of miles away from her anguish. Speaking words into her grief is my only contribution when I have no physical presence to give. All else is the silence that lacks any presence at all.

Eventually, I sent a short email — words that I know won’t fix her problem. I’m aware that they’re not helpful. But when I cannot provide physical presence or French toast, I find myself needing to do something. Is that why we all are so prone to opening our mouths in these circumstances – because we have this human need to help the healing?

She may not even open it. She may not want or need to hear my attempts to be there for her. All my words will do is symbolize my love and my awareness of her sorrow and provide a type of presence.

I have hurt those who love me, squandered my savings, lost jobs, behaved very poorly, and even attempted suicide.

As episodes ended, the knowledge of what I had done made me feel so alone, so separate from those close to me. Isolated even from strangers. The worse I felt I behaved, the more I felt undesirable. Immoral acts left me feeling as if I had no one.

Mental illness and its associated behaviors can make one feel wrong without equal. A sense that only a very sick person would commit such transgressions can drive one inward and away from those who can help. We often push those who want to help away. Fear of hurting or disappointing others leads to strained and severed relationships.

But who hasn’t hurt someone? Who hasn’t lost money, stayed in bed, embarrassed himself in public or acted cruelly? No one is infallible — we all have flaws.

Could it be possible that our egregious behavior actually joins us to others? Love, grace, and honesty support humanity. But humanity screws up. Why should our failures leave us feeling so apart when everyone has failed?

Perhaps the very things that make us feel alone are the things we have most in common with others. Perhaps the acknowledgement that we share failure can make us more able to share success.

This does not give us license to continue to hurt others and ourselves. But it does allow us to forgive ourselves.

Just as we can forgive others for transgressions against us, we must forgive ourselves for our failings, rejoin humanity, and move on. We must see the behavior that most embarrasses us as an opportunity to practice self-compassion. We should hold ourselves gently and let guilt and regret go. Then, and only then, can we seek forgiveness from others. For how can we ask to be forgiven if we haven’t first forgiven ourselves?

Everyone who hurts, and everyone who has hurt someone else, has something very deep in common. This hurt is independent of any diagnosis. Hurt is not a symptom. It’s part of being human, something we all share.

With something so profound in common with everyone, why should we feel so alone?

Susan J. Elliot, author, relationship coach, counselor and speaker/ presenter, wrote an article on the subject that was featured last year on the Huffington Post. Elliot stresses that even after an amicable breakup, it’s extremely difficult to be friends, at least initially. The bond of the couple needs to break and sifting through the emotional aftermath takes time in order to efficiently heal.

“Each needs to deal with the breakup in their own way, apart from the scrutiny of the person they just broke up with,” she said.

“Most people cannot remain friends after a breakup, but if it will ever be, it will be later — much later. The atmosphere immediately following a breakup is too emotionally charged for it to happen right away, if at all.”

Elliot references a couple who had dinner together every now and then after they ended their relationship; two months into this new “friendship” routine, one of their meals turned into a heated fight. Both were moving on, which brought certain feelings to the surface.

If you’re the one pushing to be friends, Elliot suggests examining your motives. Perhaps you’re trying to avoid your grief or you want the benefits without the responsibility. If you’re on the receiving end of a “let’s be friends” agenda, she says to just be honest; there’s no long-winded explanations needed if you don’t want to venture into that realm.

“I think that maintaining a friendship with an ex or someone you previously dated is dependent on a few things,” Ashley Knox, who has her masters in social work, said.

“One, how the relationship ended, two, whether both parties have been able to move on successfully enough so that they can begin purely a friendship and three, whether any new boyfriends or girlfriends in the picture are accepting of you maintaining contact with your ex.”

Alex Karpovsky plays Ray, a witty, cynical 20-something on the award-winning HBO series, “Girls” (a show that’s entwined with relationship dilemmas). Karpovsky fielded questions on Rookie, a Web site for teenage girls. The second question that was asked in this quirky video-chat inquired about staying friends with an ex.

“I’m personally of the opinion that it’s hard,” he said. Karpovsky mused that the only way it’s likely is when you’re both completely over each other and have moved on.

Yet if someone still harbors a glimmer of hope, being platonic friends may prove to be difficult.

“Being friends with your ex can be a minefield,” Elliot noted. “Don’t try to cross it in the early stages of a breakup. The early stage is about taking care of you.”

What makes for adversity is different for each person. For example, while one person might see the loss of a job as an opportunity, many (if not most) would find it stressful.

These life-changing situations often happen when we experience a death, job loss, serious illness or other traumatic events.

How you act when faced with setbacks and hardships can be as unique as you are.  But according to the American Psychological Association (APA), what you have in common with anyone else facing adversity is “a flood of strong emotions and a sense of uncertainty.”

So how do we overcome adversity?

With resilience — the ability to overcome obstacles and deal with difficult, life-changing events. It is the capacity to make realistic plans and carry them out. It may require you to solve difficult problems, experience painful emotions or take action when you’d rather step back. But in order to overcome adversity, it is necessary to foster resilience.

The good news is that resilience is not a trait.  This means it is not something we’re either born with or without. It’s a skill everyone can learn.

You can develop resilience by following these strategies:

• Focus on building relationships.Studies have shown that strong, supportive relationships are one of the primary factors in resilience.  Whether it’s family, friends or co-workers, having role models, encouragement, support, love and trust is important to the ability to overcome adversity.
• Accept change.When change happens, especially if it brings pain or hardship, it’s natural to wish that it hadn’t occurred.  But once it’s happened, continuing to fight the change only keeps you stuck in difficult emotions.  Instead, try acknowledging that this change is hard, painful and unwanted. Then ask yourself how you want to live and what type of person you want to be going forward.
• Try to learn about your strengths.Ask yourself how you’ve dealt with adversity in the past. In what ways are you strong?  Are you a decision-maker, able to reach out and help others? Are you optimistic by nature? Able to make others laugh? Persistent?  Take time to reflect and build upon your strengths, then use them to your best advantage.
• Act.Overcoming difficult circumstances can require us to take difficult action.  Even if it’s a very small step, it’s important to move forward.

It may feel as if the obstacles you face are tougher to overcome than those of others. The reality is that every day, ordinary people are required to rise above their circumstances, dust themselves off and continue on. You can do it too.

While many people point to the cause of his death connected to the overzealous prosecution by U.S. District Attorney Carmen Ortiz, it’s unlikely that a single thing led to his decision. If Aaron Swartz was like most of the 100 people every day who take their own lives in this country, the biggest thing that likely led to his death was untreated or under-treated depression.

Which comes as no surprise to people who knew him and have written about him. Nor after reading his own struggles with depression earlier in his life.

His passing is indeed a tragedy. But it’s time to realize that he lived and thrived in a technology sub-culture that mostly doesn’t understand — or care much — about mental illness.

While loved ones often search for answers after someone they know takes their own life, the answers are never very satisfying. In Aaron Swartz’s case, it appears that the jump to the cause and effect conclusion that his legal troubles led to his decision is overly simplistic. Young adults get into legal troubles all the time — especially in certain disadvantaged parts of this country. The vast majority of them don’t take their own lives.

But we know that in most cases of suicide what is nearly always present is a history of clinical depression. And at the time the person has taken their life, it is depression that is either not being treated at all, or being treated inadequately. Swartz seemed to understand this, as he thought a great deal about depression, and linked to this description by George Scialabba:

Certainty that an acute episode [of depression] will last only a week, a month, even a year, would change everything. It would still be a ghastly ordeal, but the worst thing about it—the incessant yearning for death, the compulsion toward suicide—would drop away. But no, a limited depression, a depression with hope, is a contradiction. The experience of convulsive pain, along with the conviction that it will never end except in death—that is the definition of a severe depression.

Clinical depression — like all mental disorders — is exacerbated by stress. The more stress you have in your life, the worse the problem is usually going to get. Getting the book thrown at you by a federal prosecutor and facing the possibility of months (the last plea deal the U.S. Attorney was said to have offered was 6 months) or even years in jail is stressful. To a sensitive, brilliant person — as Aaron Swartz was reported to have been — it was probably beyond stressful.¹

Put those two together — depression and a huge stressor — and you have the recipe for a classic case of suicide.

And some people picked up on his down mood, as danah boyd said:

I knew he was struggling, but he was also a passionate activist and I genuinely thought that would see him through this dark period.

Which is a sentence we read time and time again from friends or family members after someone takes their own life. “I knew he was struggling…” and yet… I thought he would be okay.

Silicon Valley is a Culture of Denial & High Stress

Not surprising, for people who are predisposed to depression, some work environments are not ideal. Wall Street, for example, is not a good place to work for a person with depression. Neither is Silicon Valley or really in any startup.

Startups, by definition, are high-pressure work environments, where a small group of people (usually young, white males) work 18- or 20-hour days to produce a product or service they believe will be The Next Big Thing (ala Facebook).

But because startups don’t live in a protected bubble, they’re going to suffer from the same human problems any company comprised of ordinary humans is going to suffer — people with mental illness. After all, 1 in 10 people among us have one. Silicon Valley and tech startups are no different.

As investor Brad Feld notes,

“Many entrepreneurs don’t feel like they can talk openly about their depression, as they don’t want their investors, employees, or customers to know they are struggling with it,” he says. “For anyone who has been depressed, not being able to be open about it with the people around you makes depression even harder to deal with.”

Startups think they are “special” because they have some money and an idea. What they often don’t realize is that when it comes to the messy human things — like emotions or health problems — they are just like every one of us.

Fixing the Problem

Every tech startup, every VC firm, and indeed, every workplace has the power to help reduce future suicides. All they need do is to stop tolerating discrimination and prejudice against those who have a mental illness. If someone speaks up about their own depression or other mental illness, they should be met with the same open empathy you might give someone who was just diagnosed with cancer or diabetes. You make adjustments to help them make it through this period of their lives.

This sounds easy, but is harder than you might realize. Stigma still exists in many parts of our society, and often found among people who don’t think twice about health problems. There are still many — too many — who believe mental illness is a “made up” problem and that people can just help themselves out of the problem if they only put their mind to it.

There is hope — there is always hope. If anything good can come from a tragedy like this, perhaps it is helping others to better understand the vicious cycle of depression — one that can ultimately lead to suicide for some.

Remember Aaron Swartz

Activist Aaron Swartz’s suicide sparks talk about depression

1. Please don’t write me about how it’s inappropriate to discuss Aaron Swartz’s depression after his suicide — suicide is caused by untreated or under-treated depression. He was an activist, so he — of all people — would understand.

I live on the water at the Jersey shore and the reports about Hurricane Sandy were not to be taken lightly. I caught the last train out of Washington D.C. and headed back to the home. Everything on the dock had to be secured or removed and it was already raining.  From the Amtrak station I raced down the Garden State Parkway. 

The rain was relentless.

I went straight through the house to the back prepared to work in the rain to save my stuff.  I had only moved into my house months earlier, and since I travel a lot barely knew the neighbors.  The water was rapidly rising. Trees were already down and everyone had already been evacuated. The town was broadcasting a red alert. I had to get in and get out — fast.

I came in the front door and ran to the back to get out to the dock. But what I saw stopped me in my tracks. 

My neighbors, Tom and Eileen, had done an act of kindness above and beyond anything I might have expected. They had removed ALL of the furniture including tables, chairs, footstools, cushions and whatever else was lying around and brought them up to the house under the protective cover of the porch. Then they secured everything that needed to be tied down. 

This wasn’t a ten-minute job. If I had to have done it myself it would have taken nearly an hour to move and secure each piece.

I knew a flood of near-Biblical proportions was coming, but what I didn’t know was that the greater surge would be in the pervasive kindness, altruism and gratitude among people. Caring moves us to act.

Edward O. Wilson, sociobiologist and professor emeritus, Harvard University believes that our drive to survive favors altruism when our group, our community is involved.  In other words, we move from competing against others in our group (selfishness) toward helping them when it serves evolution.  We stop competing and begin helping when the chips are down. Or, in his words “individual selection promoted sin, while group selection promoted virtue.”

As a psychologist living in Monmouth County I was immediately immersed in trauma work.  The therapeutic community could not help but be inundated. Nothing, not even 9/11 matched the intense and prolonged pain people shared.  Monmouth had the greatest loss of people in the terrorist attack and many were directly affected.  But with the hurricane everyone you spoke to was distressed.

One of the people I spoke with was a first responder.  When the seawall broke in Sea Bright he left his home in Union Beach, the next town over, to respond.  During the surge he became part of a rescue team that saved four people trapped in their home. Nineteen hours later an Army vehicle was driving him back home — but they couldn’t find it. It was gone. Not just damaged.  Gone. So was his car.  Everything.  Gone. They could not even find the cement slab his home had been built on because it was buried under mounds of shifted sand.  Everything he owned was in the house.  Nothing survived.

How did he cope?  He said he was lucky he wasn’t in the house and asked them to turn around and let him go back and do what he could to help the people in Sea Bright.

Over the next several weeks I worked with about 50 people who were deeply affected by the storm.  No matter their story a collective chant arose:  “We were lucky,” they each said.  On occasion someone offered a variant:  “We were very lucky.” But the feeling of being lucky motivated each person to help others. Empathy drives altruism.

Jeremy Rifkin has written in Empathic Civilization that to empathize is to civilize, and to civilize is to empathize. He argues that there is no empathy in heaven or utopia because empathy is based on the commonness of human struggle and our shared fragility of life. Without the essential common bond of mortality and struggle there is no empathic awareness. Rather than narcissism, materialism and aggression he views empathy, compassion, and humanitarianism as the primary drives.

In the wake of the storm are endless stories of gratitude and thanks followed by stories of those feeling gratitude helping others. Those who had a little damage were thankful they didn’t have more and were willing to share their good fortune by donating their time or their money or their clothes for others. Those who lost their home and their business were thankful for their lives, and then donated their time to help the utility workers get fed, or the Army or National Guard get messages home. Gratitude in almost every instance gave way to altruism, which in turn inspired others.

As the power outage continued and the gasoline became scarce there was a shift toward greater sharing and unselfishness.  One man had a large freezer full of salmon burgers that were quickly thawing.  He texted the neighborhood and told everyone to bring some bread and their friends. He fired up his gas grill and spent the afternoon cooking for 30 people.

Some of the restaurants in the area pooled together their collective resources and started cooking for the people from the armed forces, the National Guard, and the utility workers. They could have easily banded together simply to preserve the food they had, but instead made a direct effort to cook and prepare it for others. Three meals a day were provided in many areas by a team of restaurateurs that made it all happen. Those with generators let their friends and neighbors move in.  Those with cash gave money to those who couldn’t use the ATM machines. Many hotels dropped their rates to let people stay longer. Verizon didn’t charge for domestic calls or texts during the storm or recovery period.   My local laundromat and dry cleaner hired extra people and stayed open late to make sure folks got clean clothes.

I’ve seen devastation on the news in other parts of the country from tornadoes, floods, hurricanes, earthquakes and the like. While I had sympathy, I never had true empathy. 

Now I will never see images of a natural disaster and not be moved. The most poignant moment for me was walking by a well-known hotel in the shore area that had hundreds of out-of-town utility workers staying in it. Plates from Ohio, Mississippi, Washington, Virginia, Pennsylvania, Delaware, Kentucky littered the parking lot.  On the night I walked by there were more out-of-town plates than those from New Jersey:  People coming to help us. That was unique. We were always the ones going to help others. Now they were able to return the favor.

The first responder mentioned above stayed in shelters until some of his friends put him up. He was staying with them when I spoke to him about his ordeal. After helping him begin the grief work to manage when a disaster pushes the reset button on your life –he offered me an expression I’ve heard many times in the last several weeks.

“I was lucky,” he said.  “I had a chance to help save someone’s life. Some of my coworkers were out of town when the storm hit and they didn’t get that chance. I was very lucky.”