I’ve battled most of my life with depression, the causes of which are probably not of very much importance (absent alcoholic father, frequent moving, mentorless young adulthood, spotty employment, fear of commitment, and the crowning insult, a miscarriage and the end of a relationship). Perhaps these things, along with hopefully some joys and accomplishments, are just things that make up life. Unfortunately, I have been short on joys and long on disappointment, which has led me to become a very negative person.

After my miscarriage last year, I decided to give therapy yet another chance. Despite going into it with an open mind, I have come to the realization that no one can help me. Not a therapist, not my mom, not any friends, not my astrologer. Sure, people will listen for a while. They will give well-meaning advice and pep talks. They may even tell me that I am full of good things and that the world is a better place with me in it. I have even tried things like pharmaceuticals, acupuncture and the like. I’ve done all the things that are suggested to people like me. Volunteer! Exercise! Take up a hobby! Do some yoga! Meditate! None of it helps, and all I want to do is end the pain in the only way I know how. I know that this will cause those around me to suffer, but I cannot hang around and be miserable indefinitely just so three or four people don’t have to deal with my loss and be sad for what, two or three weeks, plus maybe around the holidays?

I would like to know your thoughts about someone like me. I’m sure that there are many others for whom therapy was not helpful and who continue to suffer every day.

Miserable in Paris

Dear Miserable in Paris,

You will get over this depression.

A significant number of women remain depressed almost three years after a miscarriage.

But they come out of it. You will, too.

One study showed that 13 percent of women who had a miscarriage remained depressed 33 months after. That’s almost three years.

The fact that you are still depressed does not mean therapy didn’t work. It means you’re not there yet.

While you’re getting well, when thoughts such as “Therapy doesn’t work” and “No one can help me” arise, tell yourself what bipolar author Terri Cheney tells herself: “That’s my depression talking.”

Of course, let’s be intellectually honest and admit that life has a tragic dimension. People will die unhappy. Some of us will not be able to rise out of whatever it is we are stuck in. Some of us will die senselessly in automobile accidents, others will be tortured by madmen, others will commit unspeakable crimes and get away with it, others will put guns to our heads and the trigger will jam …

To be equally honest, life has a miraculous dimension, and some of us will wake up one day and realize it’s not so bad after all, and our hormones will balance out or our neurotransmitters will start transmitting after being jammed, or we will eat the right carrot or see the right television infomercial and buy a juicer or get a crystal that cures us, and we will walk barefoot on the sunny streets of Santa Barbara believing that a fortune teller in Venice read our palm and everything is settled now, nothing to worry about, everyone is fine.

While we’re at it, let’s admit that no one really knows. But I want to be one of the ones who says, I want you to make it. I believe you will come out of this depression. I have been depressed myself, and I have read about depression and followed treatment regimes and read many letters from depressed people and talked to depressed people, and my experience has been that most people come out of it if they don’t kill themselves. So don’t kill yourself. Give your body time to heal. If you need to crawl into bed and stay there for a few days, do it. But also do the things that will eventually bring you out of it.

Maybe no one thing you do will cure you of depression. But each thing you do will help a little bit: eating well, exercising, talking about your experience with other women who have experienced the same thing, doing yoga, meditating, sleeping well, walking in fresh air, reading books with hopeful messages, studying “Feeling Good” by David Burns and doing the exercises in it, continuing therapy or finding a new therapist who will be more engaged, taking time off, getting a massage, doing breathing exercises, taking vitamins, getting your hair cut, doing one nice thing for your body every day, staying out of situations that make you depressed, seeking out laughter, seeing funny movies, staying away from alcohol and caffeine, taking a sauna, swimming, sailing, riding a ferry, being in the mountains, taking a long drive to a resort, seeing a great chamber orchestra, hearing jazz, giving money to street musicians, riding the Metro, buying some clothes, talking on the phone to people who really love you, petting a dog, going to a museum, standing on the Seine watching the tourists go by in boats, walking by Cathedral Notre Dame, taking the Eurostar to London, eating a croissant, checking your adrenal glands, remembering to laugh every hour … all these things together may help.

Still, you may remain depressed for a while. And it’s not easy to do what you need to do to get over depression when you are depressed. That’s the maddening thing about it. It’s hard to think well. It’s hard to form an intention and carry it out. I know. Yet we do what we can. We eke out a little life while waiting for rescue, while waiting in our shipwreck in our floating misery being eaten by the tides and pecked at by birds, while waiting to reach some kind of land and eventual comfort and bliss.

What happens when therapy doesn’t work is you keep trying. You try different things. You try cognitive therapy. You try everything. You try nutritional supplements, and you don’t stop any one thing. You keep doing all the things that could possibly work. You keep an open mind. You try antidepressants. You read and learn everything you can. You use your intelligence to tell yourself the truth, which is that you are going to come out of this, and then you try to believe yourself when you’re talking to yourself.

You tell yourself what happened: You had a miscarriage and a relationship ended and your support system fell apart, and you acquired a serious depression which you are eventually going to emerge from.

Here are some other things you can do. They may work and they may not. You might as well give them a try, while you’re waiting. Write down all the accomplishments you have ever had. Include things that happened in school and things that happened when you were a child. How were you able to take care of yourself and others in your household? Write down all the things you are proud of. Visualize the things you would like to have in the future. Visualize happiness. Visualize pleasure and exhilaration. How were you able to save others from abuse? How were you able to recover from trauma? What were the high points of your relationship? Envision them. Envision your happy moments.

Write down even all the little accomplishments you have had. Make a list of all the times you have felt happy. Look at them. See what elements they had. See if you can re-create some of those moments. Post this list on the wall where you can see it several times a day.

It can’t hurt.

As long as you are alive, you have a chance. Life, if you don’t die, is long. One or two years is not so long a time. I first visited a psychotherapist about 20 years ago, and I have seen several since then — four total. Four different practitioners of different healing arts, well, more actually, if you count others; and then there’s all the help I have gotten from individuals, and chance encounters, and all the meditation and exercise and walking and talking and traveling and reading and working.

I’m not depressed today. I’m listening to Bach, looking out over the garden, where there are purple flowers.

I would try everything. I would try fish oil supplements and exercise and vitamin B. I know for me nutrition is extremely important; I cannot have alcohol and only rarely can I drink coffee, and I must eat plenty of fish and vegetables and take vitamins. I must. I don’t care what the science says. That’s what I have to do.

Attitude also makes a difference.

We have this friend who thinks she is the luckiest woman in the world. She was walking across the street right in front of her house and a truck ran a stop sign and crushed her. She was dragged under the truck because the driver didn’t see her. But people saw her being dragged and screamed, and the truck stopped and she survived.

She’s in a wheelchair now but considers herself lucky because she survived. She was lucky enough to get an elevator put into her house so she could travel between floors more easily and not have to be carried. The thing is, with her roommate, they have to always remember to keep the elevator at the correct floor. Well, so her roommate’s friend comes over and leaves the elevator at the wrong floor. And she backs her wheelchair into the elevator and falls to the bottom.

But she survives! She considers herself the luckiest woman in the world because she survived.

See also:

• How cognitive therapy works
• Nutritional supplements for adrenal fatigue

I saw “Oslo, August 31st” last year at Cannes and found it powerfully affecting, but I never would have guessed that this small movie from a small country would have touched an international nerve the way it apparently has. In the wake of a breathless profile of doctor-turned-actor Lie and his supermodel wife, Iselin Steiro, in the New York Times’ style magazine — which made the film sound rather like a fashion accessory, or a handbook to Oslo architecture — I almost feel the need to dial back expectations a little. Yes, there are drugs and dance clubs and traveling shots but, honest to Pete, we’re not talking stylish, scenic, lovable hipster romp here, people. While “Oslo, August 31st” definitely has the dynamism and street-level energy of, say, an early Godard picture, and may indeed leave you eager to visit Norway, it’s first and foremost an intimate tragedy about a likable young man who has wandered off the path of life into some very dark woods, and isn’t necessarily finding his way back.

As in Trier’s equally wonderful first film, the 2006 “Reprise” — I’m pretty much the president of the cult on that one — the director is interested in exploring the existential dark side of Scandinavian social democracy, with its largely homogeneous character and devotion to equal opportunity. When I talked to Trier about that film, which featured Lie and Espen Klouman-Hoiner as a pair of arrogant, doomed aspiring novelists, he observed that in Norway “there are a lot of people with a lot of choices. It sounds wonderful but there’s a darker side to that. Lots of people are not dealing with those choices very well.” Anders in “Oslo, August 31st” is something like the worst-case outcome for Lie’s character in “Reprise”; he’s a guy from a loving, middle-class family who’s got looks, health, intelligence and education, but for unknowable reasons finds himself on the edge of middle age as a penniless, unemployable, supposedly recovering junkie.

Trier and co-writer Eskil Vogt adapted their central premise from “Le Feu Follet,” a 1930s novella about alcoholism by Pierre Drieu La Rochelle, but “Oslo, August 31st” could really be set anywhere at any time. It’s about the painful necessity of adapting to change, every single day that we’re alive, and if we identify with Anders even as we rage against his despair, it’s because every living human has at some point considered the possibility that it’s just too much and the struggle isn’t worth it. Anders is doing well in drug rehab, and has cautiously been granted a one-day leave to visit Oslo friends and apply for a job. But we can tell from the first moments of the film that his agenda is more complicated than that; Anders is in the position of a certain Danish prince, evaluating the reasons for being against the reasons for ceasing to be. (Trier, by the way, is cousin to another famous Dane, “Melancholia” director Lars von Trier, and one could argue their visions of the world are related as well.)

“Oslo, August 31st” runs a lean, mean 95 minutes, and not one second seems unimportant. Anders moves through the streets of Oslo looking for reasons to live and reasons to die, and even though we don’t know those streets as he does, we can tell that they’re haunted with memories and private agonies. The city is dotted with construction cranes and demolition sites, remorselessly regenerating itself while he appears to stand still. Indeed, Anders’ family home will soon be sold, and one of his personal missions is to pay a final visit. (The fluid, poetic cinematography is by Jakob Ihre.) He insults a prospective employer, refuses to make peace with his alienated sister, falls off the wagon — at first tentatively, and then enthusiastically — and leaves increasingly pathetic messages for his lost love, a woman who’s now in New York. (It’s the voice of Steiro, Lie’s real-life spouse.) On the other hand, he flirts with a younger girl who seems affectionate and charming, and who seems to open for him the promise of a new beginning. Their scene together at an Oslo swimming pool that has just closed for the season, so suggestive of both death and rebirth (and, literally, of baptism) is so gorgeous I wanted to cry. OK, I did cry, and that wasn’t the only time.

But none of that, not even the scenes where we feel that Anders is in imminent danger of taking his own life, are quite as painful as his visit with Thomas (Hans Olav Brenner), an old friend and veteran of long literary discussions and booze-and-drug sessions. Thomas has a wife and a kid now, and his vices involve an occasional bottle of beer. In the manner of one-time bohemians who’ve more or less grown up, he’s kind of an ostentatious jerk about it — but then admits to Anders, when they’re alone, that he’s desperately unhappy. Perhaps that’s the “ordinary unhappiness” Freud wrote about, the unhappiness we all have to accept to get from the last day of August into the first day of September, in Oslo or anywhere else. But is that enough? Is that ever enough, for anybody? And can we forgive those who decide that it isn’t?

“Oslo, August 31st” opens this week at the IFC Center in New York, and June 1 at Laemmle’s Playhouse 7 and Laemmle’s NoHo 7 in Los Angeles, with more cities and DVD release to follow.

From an evolutionary standpoint, it’s not hard to find sense in these suicide missions — the salmon are passing on and multiplying their genes in a habitat that has already been proven (by the adult salmon’s own experience) to produce strong and reproductively fit salmon. People tend to admire the determination of the salmon. At the very least, we generally don’t call the salmon “irrational” or “crazy” for their journey. We do, however, freely launch those pseudo-psychological assessments on human suicide bombers. Yet salmon and suicide bombers are not as different as their outward appearance would indicate. The most important difference between them is neither fins versus arms, nor gills versus lungs, but that the salmon (despite the dams choking up the rivers) still lives in the environment its ancestors evolved in for thousands of generations, while the suicide bomber does not. Suicide bombing is just an extreme case at the far end of a spectrum of behaviors related to establishing and reinforcing self-identity that impart survival to organisms.

The naturalist’s view on security doesn’t allow us to simply label something “irrational” and then dismiss it. Just as a biologist wants to get to the root of what makes a peacock grow such outlandish feathers or an immune system suddenly turn on its own host’s body, a natural-security approach tries to get inside these behaviors that compromise our security, tracing their roots back as deep in evolutionary time as possible and figuring out what they mean in today’s society.

Evolutionary psychologists, who study the ancient roots of modern human behavior, argue that religious fervor didn’t develop in the modern world but in a world completely unlike the one we have briefly inhabited now. In this early world, humans lived in small close groups that struggled constantly to obtain enough resources to survive. Only rarely did they encounter small groups of other humans, and if their interaction wasn’t about trading resources, it was likely because one group was trying to take the other group’s resources by force.

Yet almost all political analysis of human behavior tries to explain it within the narrow confines of the immediate sociopolitical environment. Some public commentators try to get us to broaden our thinking. Journalists try to remind the most short-sighted among us that there were clear signs of terrorist activity against Western targets years before 9/11. Historians admonish us to open our eyes and look at the thousands of years of history in places like Iraq and Afghanistan. Political scientists urge us to look at individual security crises within their global context. I fully support these viewpoints, but I suggest that analyses digging back ten, a hundred, or even a thousand years must be nested within a perspective that goes back orders of magnitude deeper into human, and biological, evolution.

Oddly, a virologist, Dr. Luis Villarreal of the University of California–Irvine, has made some key discoveries about human belief systems. The evolution and development of viruses, it turns out, is inextricably tied to almost every major evolutionary advance, including the rise of modern humans, in Earth’s history.

What Villarreal emerged with is a synthesis that traces the origins of human belief systems back to the earliest life forms, such as bacteria. The exact forms of these belief systems obviously differ between, say, a bacterium, a salmon, a chimpanzee, and a suicide bomber, but the mechanism is the same. In Villarreal’s theory, belief, as we know it in humans, is a form of addiction. And addiction in its pure form, according to Villarreal, is one of the oldest processes of self-preservation on the Earth, traceable to the earliest invasions of bacteria’s genetic material by viruses.

Although viruses seem to cause chaos in our daily lives—at the least, they cause sick days and frantic parents rearranging day care schedules, at worst they lead to epidemics that kill millions — the virus itself wants stability more than anything. In this sense, a virus is like a businessman trying to maintain a steady clientele. More particularly, the virus is like a drug dealer trying to develop a clientele of hardcore addicts. It does this by offering protection to its clients, something like a safe place to shoot up, shielded from the police or other junkies. This safe place is created by paired genes—called an addiction module by Villarreal — that the virus inserts in the bacterial genome.

One part of this pair (called the toxic gene) is destructive, killing all entering foreign bodies at will. If this gene was left to its own devices, it would destroy everything, including the host bacterium’s genome itself. So it is paired with a counterpart (the antitoxic gene) that confers immunity to the host. This simple opposing pair—aggressor and protector — provides a way to distinguish, even in the most basic organisms, self from nonself. If something is “self,” coming from the host’s own body or genome, the antitoxic gene allows it to reproduce. If something is nonself, a foreign invader, the toxic side destroys it. It’s easy to see why the bacterium, or indeed any other organism, would get addicted to this product pushed on it by the viral parasite — without it, any number of invaders, including the virus itself, could destroy the bacterium.

The story would end there with bacterial addicts if it wasn’t such a good system these viral pushers set up. When biological systems emerge with an idea that works, it gets made again and again. Sometimes the idea is replicated exactly; thus we humans have major components of our genome (especially those vital to survival) that are nearly identical to goats and fiddler crabs and even those earliest viral parasites. But often times, good ideas are merely mimicked, taking on different forms for different organisms in different environments, even as they maintain the same basic function.

A way to detect self from nonself is one such really good idea in biology. Nearly all organisms benefit from such a system. It allows them to identify who is likely to share their interest in producing common offspring and who is likely to disrupt that chain of genetic descent. It allows them to distinguish who to school with and who to swim from, who to eat and who to eat with. Even below the level of organisms, self–nonself identification is essential. In species where females mate with multiple males, the seminal fluid around the males’ sperm has evolved to protect its own sperm and destroy the sperm of a rival male.

As organisms get more complex in their behaviors, they need ways to identify potential mates and potential enemies. They need ways to assess a competitor’s intentions. They need ways to make friends and influence others. Villarreal argues that the same basic addiction system — a system that confers simultaneously both protective and destructive powers — fulfills all these complex needs of biological organisms.

Take the suicidal salmon. Young salmon cue into the precise chemical cues in their home stream. Then they make their way out to sea, traveling thousands of miles over two years or more, before returning to the precise part of the same stream in which they were born, in order to mate. While they may navigate by ocean currents and stars and magnetism in their open water phase, what gets them back to that precise stream riffle where they were born is the smell. Salmon possess a remarkably effective chemical-sensing organ called a vomeronasal organ (VNO). Villarreal argues that the VNO system is the same type of addiction module as the toxic/antitoxic gene pairs in viral-bacterial interactions. Indeed, a VNO system is another one of those evolutionary success stories that gets replicated in animals as different as salmon, snakes, and shrews.

For salmon, a sense of self and a sense of place are inexorably linked. Any particular salmon is literally defined by its home stretch of stream. In the salmon’s VNO system, home-like smells are intensified in the system and honed in upon, and non-home-like smells are rejected and effectively ignored. As a result, the salmon will relentlessly target their home spot, past anglers’ hooks and gaping sea lion jaws and enormous concrete dams with their artificial fish ladders as a small (and only partially effective) concession to the salmons’ unyielding will. What we admire as the incredible determination of the salmon is exactly the nature of self-identity addiction. The high threshold of acceptance into the “self ” category ensures that only the most fit will survive and reproduce. This addictive system, by the time it appeared in its particular form in salmon, already survived billions of years of relentless natural selection. What are some scattered predators or concrete barriers in relation to that track record?

Like the salmon VNO, our own behaviors have driven us to do remarkable things. Our behaviors allowed us to cooperate in complex ways and form strong groups, bonded for life. In small, clever groups whose members had a deep intimacy and mutual understanding and specialized in different tasks, we pulled through any number of forces—predation, bad weather, changing climates— that could have easily wiped out our weak and nearly naked bodies.

For salmon, group survival comes in part from a common set of olfactory cues that urge the fish to simultaneously migrate to natal rivers and spawn. But humans don’t have such a great sense of smell. The popularly bandied idea that invisible pheromones control our behavior, not to mention the endless iterations of supposed pheromone products purported to “drive women wild with desire,” appears to have little backing in olfactory science. While smell plays a subtle and not completely understood role in human mating, smells don’t play the dominant outward role in human identity. That is because higher primates and humans essentially turned our VNO systems off. The genes that form the VNO system are still there, but they don’t get activated. Those genetic changes have obvious outward manifestations. Have you noticed, perhaps while walking your dog, that we humans don’t scent mark or eagerly sniff one another’s nether regions when we run into a friend on the sidewalk?

But we do mark territory; just look at the graffiti scrawled across the walls in the tough neighborhood where Luis Villarreal grew up. That written marks were substituted for scent marks is a clue to the force behind our current sense of identity. Written symbolic language, which recent reexamination of the earliest cave paintings suggests may date back, not three or four thousand years, but perhaps as long as 30,000 years, is a uniquely human attribute and one that codifies our identities—especially our group identities.

Written language has a key role in codifying religious beliefs. As Villarreal points out, the word literate originally meant “one who can read holy scripts.” Not only are religious beliefs often spelled out in written tomes, but religious myths also contain curious references to written materials. God doesn’t just tell Moses the Ten Commandments; he gives them to Moses in written form on stone tablets. And when Moses grows angry with the Israelites for their idolatry, he smashes the tablets as a symbol of the broken bond between the Israelites and their one true God. The deference to written scripture goes beyond Judeo-Christian religions as well. A well-respected Japanese Shinto group, Oomoto, was codified in the late nineteenth century when Deguchi Nao, a supposedly illiterate housewife, suddenly had a vision that she transmitted into calligraphy that she scrawled across the walls of her cottage. This is not to say that nonliterate cultures can’t develop religious beliefs, but rather that written language provides a powerful symbolic shorthand for ideas that defy observable natural phenomena.

Defiance in the face of observable evidence is something that continually baffles outsiders trying to understand behaviors of individuals in tightly bound human groups—be they scientists trying to debate creationists or CIA agents trying to understand why someone would blow himself up for a cause. The rationalist-evolutionist deftly dismantles the structure of creationist theory with a few pieces of devastatingly incontrovertible evidence, but then can’t understand why the school board (freshly stocked with evangelical Christians) votes to “teach the controversy” in her daughter’s public school. People coming from this rationalist perspective tend to think that the resistance to rational testing of ideas is a weakness of religion — when in fact the opposite is true. Religious beliefs, perhaps more than other human belief systems, function well as a strongly addictive system because they substitute symbolic group identification for any type of rational-based test of group fidelity. The core ideas of religious conviction are universally true to believers and will remain so as long as adherence to religious laws is maintained, regardless of what some egghead scientist or analyst says.

Indeed, the high bar of irrational thought associated with most religions is a selective force that increases the strength of the belief system through time. Stream reaches that require salmon to make large leaps of gravity to get home and religions that require large leaps of faith for acceptance into the sect both enrich their populations with individuals that are especially capable of making these leaps. In part, this is an example of “honest” or “costly” signaling — there is no bluffing your commitment to the group if you will injure or kill yourself on its behalf.

Just because they are deep-rooted does not mean belief systems are necessarily locked in forever. Certainly, we’re able to trade more primal evolutionary signals for modern ones. That is why a short, nearsighted, balding weakling, who would have been an evolutionary dead end in our hunter-gathering days, may still find a fine mate, especially so if he drives a Ferrari. If a modern human female can calculate that the resource-gathering ability of the Ferrari driver may make up for his obvious physical weaknesses, so too can a modern Israeli or Palestinian realize that coming to the negotiating table with an eye to the future rather than to the insults of the past will lead to a much better future than engaging in escalating acts of violence. A modern jihadist can recognize that continuing his education, learning new skills, and getting a
mainstream job will give him a far better chance of propagating his genetic code than committing an act of martyrdom. Still, many do not, and it would help to understand why they do not.

Adapted with permission from “Learning From the Octopus: How Secrets from Nature Can Help Us Fight Terrorist Attacks, Natural Disasters, and Disease” by Rafe Sagarin (Basic Books, 2012).

How much longer can I have, with these feelings rocking inside me?  I can hardly look people in the eye and I rarely make I contact with people. My life is spinning out of control and there’s nothing I can do about it. I overdose regularly and soon I shall start taking magic mushrooms. I’m addicted to any tablet that comes my way and from there I shall move on to drugs.

Usually I take paracetamols [aka acetaminophen, Tylenol, Panadol, Thomapyrin, etc.--ed.] as a way of coping. Also I take aspirin to cope but a lot more than the recommended dose.

I’ve been holding on for quite some time but I can’t  now.

I need to eat household products just to balance myself out so why don’t my feelings stop?   

Can’t Hold On  

Dear Can’t Hold On,

You’ve got to hold on. You have to.

I am writing to you and to all others who feel that things are out of control and that the only ways to cope are to ingest substances, self-mutilate, or strike out at others.

You have to hold on.

What you feel now will change. You will come out of this. Meanwhile it is important not to do anything that will cause your death.  Overdose with paracetamol, or acetaminophen, is, “by far, the most common cause of acute liver failure in both the United States and the United Kingdom.”

Death by such an overdose would be a slow and painful affair. It would be messy and ugly. It would not be pretty and glamorous.

If you have already taken too many paracetamols, go to the emergency room of your nearest hospital now.

Otherwise, since it sounds like you are in the U.K., contact the Samaritans, either through their website or by phone.

Ask for help. Talk it through. Find solutions. Stay alive.

What you are going through will pass. You have to hang on through this. You have to tough it out. I know you have gotten a raw deal. I know you have been abused. It is painful and nobody knows how much pain it caused except you. It is an existential pain. It is not simple. But you have to survive through this because it will get better.

You may want to do many things so that you can be whole. You may have a sex change, or you may want to find your own practice that allows you to integrate pain and power into your life. That is OK. Those are routes you can take that will not destroy your body. Those may be routes to wholeness for you.

But do not destroy your body. Then there is no hope.

If you have ever had any dreams of doing anything, keep those dreams in your mind. Think of those dreams. Remember those dreams. Remember the things you have wanted to do. Remember the times when you have felt good. Visualize times you have been happy. Just sit and be there.  You can be happy again like you were before all this happened to you. That person you were before you were damaged is still there. You can contact that person you were, that young and innocent child. That young and innocent child you once were is ready to come back.

You are scared and uncomfortable. That is OK. You can be scared and uncomfortable and tough it out. Please understand: What your head is telling you is wrong. Your head was damaged by the abuse. Do not believe what your head is telling you. You cannot solve this on your own. But if you survive and get help, you can be fine.

So get somewhere safe where you can stay while this passes. That means stay away from websites that encourage you to overdose and mutilate yourself. You are too fragile for those things. You need to be around strong people who know what you have been through and can help you.

Sit in a waiting room until help comes. Tough it out. It will pass.

It gets better. You don’t have to die.

A friend of mine called just yesterday to say a friend of his died from alcohol and drugs. His friend didn’t really mean to die. He was just doing things to numb the pain. But that’s what happens. Then you lose your chance to do whatever it is that’s going to make you happy.

So this is a time to be careful and conserve your life. Whatever emotional pain you are feeling, it may seem intolerable but it is not. You can bear it. It will pass. You can survive. We are animals, all of us. We will do anything to survive. We can survive this and much more.

So find some place where you can be safe. Find someone you can trust, a doctor or teacher or therapist.

There is hope. What you feel now will change.

You can get through this. You will see. Trust me. You will see.

The districts made use of a mutual aid pact they’d set up, like those employed by firefighters and police from the same region. On the morning after each death, school nurses and counselors trained in suicide response, along with a team of therapists from Valley Community Counseling, a local mental health agency, descended on the school the student had attended. They spent days, sometimes weeks, meeting with pupils and parents, focusing on kids who knew the victims or seemed at particular risk.

The spirit of cooperation helped the team fashion an effective crisis response and ease the pain of some survivors, said David Love, executive director of Valley Community Counseling. But, by definition, it came too late, he said. “We’re doing everything we can to partner and develop these mutual aid plans,’’ Love said. “But we’re still band-aiding. When you’re doing crisis work, you’re at the back end. The tragedy is that we don’t have the resources early in the process.”

As the U.S. economy struggles to pull out of the worst funk since the 1930s, public services for the country’s most vulnerable populations—children, the elderly, the mentally ill—are being cut or disappearing at a time when the need for them is greater than ever. Faced with gaping deficits, states have slashed $1.6 billion from mental health programs over the past four years, according to a report by the National Alliance on Mental Illness.  The pain is being felt everywhere.

• Illinois has slashed $187 million from its mental health budget and plans to close three of nine psychiatric hospitals. A budget passed in November by the Chicago City Council will close half the city’s 12 mental health clinics.

• In Detroit, the county mental health program has lost $30 million in state funding over the past three years, forcing numerous cuts to the agencies it supports. Detroit Central City Community Mental Health, which provides outpatient treatment and reentry programs for people leaving jails and psychiatric hospitals, lost a quarter of its funding and cut its staff by a third. Charlotte House, a transitional housing program for people with psychiatric disorders discharged from the county hospital, closed its doors.

• California has cut mental health funding by $765 million, or 21 percent, since 2009. In Oakland, the number of children waiting to see a counselor at West Coast Children’s Center, a community mental health clinic, has swollen to 50.  “It’s not a good feeling that there are kids on a waiting list and you can’t hire more clinicians,” said Stacey Katz, the center’s director. “It stresses everybody out. How do we triage? How do we decide who needs services the most without violating our mission that kids should have mental health services when they need it?”

Meanwhile, homelessness, domestic violence, and child abuse are rising. Nationally, nearly 1 million schoolchildren were homeless in the 2009-2010 school year, a 38 percent increase in four years, according to the U.S. Department of Education.

University of Pittsburgh researchers reviewing hospital records from parts of Washington, Pennsylvania, Ohio, and Kentucky found that the rate of children younger than five brought to emergency rooms with abusive head trauma—brain injuries from being shaken or struck— was 65 percent higher during the 19 months of official economic recession that began in December 2007 than in the previous four years. Sixteen percent of the children died.

“Families are losing their jobs, they’re losing their housing, they’re on the street,’’ said Amy Weiss, director of Parents Place, a San Francisco program that offers counseling and support services to children and families. “We’re seeing more domestic violence, more complicated cases, more poverty. Our caseloads are bigger because there are fewer people and resources. We’re trying to do more with less.”

The economic misery that has swept the nation has savaged places like San Joaquin County, a place of long-standing poverty, large numbers of children and large tracts of homes purchased for little money down by people with scant savings and insecure jobs. To that mix, add years of declining investment in schools and social services.

The 900 students at Ripon High, where the suicide cluster started, have just two guidance counselors to help them. There was a third but the district laid her off before the start of the 2009-2010 school year after losing $6 million in state funding over three years. The cutback hinders the remaining counselors’ ability to address both mental health and academic needs, said Superintendent Louise Johnson.

Ripon High’s student-counselor ratio is better than the California average of one counselor for every 810 students—the second worst of any state. Neighboring Manteca Unified School District has no counselors in its elementary schools and has gone from four counselors at each of its seven high schools to two, said Caroline Thibodeau, the district’s director of health services. The number of school administrators and nurses has also declined, Thibodeau said.

While the number of adults attending to students has been falling, students needs keep rising. The number of homeless children in Manteca has more than doubled in the past five years to 700, Thibodeau said. Rates of alcoholism, drug abuse and child abuse are up, putting families under enormous stress, said Love. And over the past three years, he and his colleagues at Valley Community Counseling treated 60 percent more children who’d been exposed to domestic violence and 50 percent more whose parents were substance abusers.

“It’s a big circle,” he said.  “Family stress, community stress, student stress equals higher levels of depression and related issues among caretakers and children. With school cuts, counselor cuts and classroom sizes going up, the schools are seeing more mental health issues and have fewer resources. We’re getting more kids sent to us with clinical depression, PTSD or behavioral acting-out issues. And all this increases the possibility of suicide.”

Cities across the country are grappling with the same issues. In St. Louis, the number of homeless children in the city’s public schools has almost doubled in the past three years to 3,000. Until a few months ago, Elizabeth Snowden, 17, was one of them.

Elizabeth (her middle name) spent her high school years coping with headaches, fear and anxiety as she slept on streets and in overcrowded shelters, searching for quiet places to do homework and escape the stress that has engulfed her family of six since her mother Audrey lost her customer-service job at a St. Louis department four years ago.

“The stress affected me at school emotionally and physically,” she says. “I had a headache every day. I’d argue with my sisters and brothers and take everything out on them. It was tough keeping my grades up. I’d get them up, then fall back down and then I’d get stressed out. I got to the point I couldn’t take it any more.”

Audrey (who asked that her last name be withheld) moved the family to Mississippi, where a promised job evaporated in a region reeling from two hurricanes. When the family returned to St. Louis, they couldn’t regain their housing subsidy and had no money to rent a home. They ended up on the street.

Elizabeth and Audrey have been helped enormously by a social worker whose know their pain firsthand. Deidra Thomas-Murray, now director of homeless services for the St. Louis schools, spent years in her native New Orleans working in schools and with juvenile offenders, then became a refugee after Hurricane Katrina destroyed her home. She and her five daughters and foster daughters spent two weeks sleeping on the floor of a friend’s house in Baton Rouge, then went to Missouri, drawn by a relative’s offer of help. For a while, she said, five families crowded into a two-bedroom apartment while Thomas-Murray collected food stamps and hunted for work.

She found a job as a drug counselor, then a family therapist, and in 2006 was hired as a school social worker. Since 2009 she has coordinated the program for homeless students, networking constantly to solicit donations of clothing and sleeping bags for families. Her main focus: getting teachers and principals to know their kids so they can identify those who are homeless and make sure they get the services they’re entitled to by law.

“A lot of times we’ll see stuff happening with kids, but never ask what’s going on,” she says. “We just assume they’re some BAKs (bad-ass kids), which in many instances, isn’t the case. We, the educators, play a major role in how we embrace this population.”

Her advocacy has helped the district identify more homeless children, one reason their numbers have grown. The other reason is obvious. “More and more families are becoming unemployed and losing their homes,” she says.

Thompson-Murray is painfully aware of the damage being homeless inflicts on kids. “They worry about where they’re going to sleep at night,” she says. “They have difficulty separating from parents. If there’s been violence in the family, they’re preoccupied with whether the parent is safe. They have difficulty focusing. They stare off into space. They can be invisible in a crowd of kids. Or they can be the most disruptive in the class.”

The stress of economic uncertainty isn’t confined to the jobless, or people who have lost homes or services. Therapists working in government-funded agencies are under intense pressure as they absorb the distress of their clients, handle heavier caseloads and fret about their own flat salaries and job security.

Places for People, a St. Louis agency serving the city’s mentally ill, opened a drop-in center in April that offers assistance to anyone in need. The number of help-seekers climbed from 248 in May to 509 in August. “It’s off the charts,’’ admits executive director Joe Yancey.  The spike in demand has been so intense that the agency is grappling with whether it has the capacity to continue helping all comers.

The ability to meet the needs of the poor and distressed depends increasingly on extraordinary efforts. Megan Heeney, 26, is an outreach specialist with Places for People by day, helping people being released from psychiatric hospitals. At night, she’s part of a Catholic Worker community that provides housing for homeless women and children. She helped organize volunteers to bring homeless people off the streets when the temperature dips below 20 degrees and recruited local churches to provide shelter.

“We try as hard as we can to help people manage their crises,” she said. “We want to aid people in moving toward recovery yet because of economic conditions, we’re constantly doing crisis management.”

In a time of austerity, superhuman social workers can only do so much.

As you can imagine, she will never be OK.  For the first couple of months, I stayed awake 24 hours a day with two mobile phones in my hands in case she needed me.  At the suggestion of my psychiatrist, I told her she needed to see a professional, as I am not skilled in counseling and the strain was too great for me.  Since then, we somehow launched into a downward spiral of shutting each other out, then hurting each other, and now lying as well.

She spends her time with her parents and 18-year-old son from her first marriage.  We live in such a small town that we cannot go out for dinner, spend time with friends, or see each other much at all.  When she first returned to work after the tragedy, I would come by her cubicle on bad days and give her a small gift or trinket and a hug, until one of her colleagues warned me that he would cause trouble.  A week ago she left her job because she needs more time to heal.  I’ve tried to continue finding creative ways to distract her, make her feel normal, and be together.

I am convinced I will never work through this guilt.  When I see her old spot at work where her family pictures were, when she spends holidays with her husband’s family, when I go on a social networking site and see pictures of her and her husband, my world gets shaken like a snow globe.  Nearly every time I am left alone I break into tears.  I am overtaken by the irrefutable fact that my actions led to the extinguishing of a living flame and now it is snuffed forever despite what I would give to change things.

My parents got word of what happened and no longer speak to me.  My roommate is moving out tomorrow because he’s grown angry and hateful after unsuccessfully helping me through this.  I am nearly completely isolated and I clearly need to dedicate more time to work on myself.  Almost everyone I speak to insists that I need to leave her, especially my psychiatrist, but how do you break up with the woman you love after she’s endured such a traumatic loss?

Sincerely,

Overcome with Guilt

Dear Overcome with Guilt,

Your actions did not cause this suicide. They did not lead to it. You were not central to it.

You did not advocate for this person to commit suicide, or provide the means for this person to commit suicide. You knew nothing of any suicidal inclinations he might have had. You did not know him. He did not know you. Presumably, if he knew of your existence, he knew of you only as one of his wife’s co-workers. You did not sleep with his wife. Nor did you know that, after kissing you, his wife was going to go home and tell him she was leaving him.

The one thing you did was that you broke a well-understood obligation not to kiss his wife. That is a real obligation, not to kiss his wife, which you broke. You are not supposed to kiss other men’s wives. You knew that. You did it anyway. That is something to feel remorse about. That is something you did that was wrong.

If it were possible to make amends, that would be something to make amends to him about. Unfortunately, because he chose to take his own life, you cannot make amends to him for that.

So you will have to live with that.

That’s your situation. You committed no crime. It’s not a nice place to be. But it’s not eternal damnation. It is the wretched confliction of feelings that arise when we are tangential to a tragedy.

You are tangential here. You were not central to the suicide and you are not central to this woman’s life.

I think your psychiatrist, who has more knowledge about your situation and more understanding of you as a person than I do, and is professionally trained and licensed to guide people in their affairs, probably should be listened to.

You should leave her alone.

We don’t refrain from kissing other men’s wives because we fear the husband will commit suicide. But there are certain things we might expect a husband to do if he finds out that we kissed his wife. In the movies, a good punch in the jaw is the agreed-upon right action. It’s a non-fatal expression of contempt and serves to reassert the husband’s dominant role in the wife’s affections. Seeing the man she kissed lying unconscious on the ground, she will either run to him, thus affirming that her affections have shifted, or she will run back to her husband, affirming that she recognizes her best bet is to stick with the one who is good at punching. That is how the movies portray these things. We know that real life is different. But we still like going to the movies.

Your response is sort of like a movie. You are all histrionic. You are all saying things will never be the same; you are staying up all night with two cellphones. This is a little overdoing it.

So how exactly did you harm him, and did you harm him in any material way, or only by way of your attitude toward him? You didn’t sleep with his wife, but, knowing that he existed, you did disregard him as a person. You disregarded his status as the husband. You in a sense depersonalized him; you disregarded his existence. That is what we do when we fool around with someone’s spouses; we depersonalize a stranger, or a person known to us; we do things that we know would hurt that person if he or she were to find out. This is not a good thing to do. It probably makes it easier when we do not know the person, but whether we have met or not met, we still know that some person exists whom our actions would hurt if they were to be found out.

This is why we refrain from such things — because we know that they can hurt other people. Generally speaking, our actions do not lead to other people’s suicides, especially the suicides of people we do not even know. Rather, suicidal people make choices over which we have no control. If we could reliably cause the suicides of others, rest assured it would be against the law.

In certain cases advocating for another person to commit suicide has been prosecuted.  This man sought out depressed people, “posed as a female nurse, feigned compassion and offered step-by-step instructions on how they could kill themselves.”

That’s a little different, I think you’ll agree. “While it is illegal in Minnesota to encourage suicide, there is no such federal law,” according to an ABC News account of the matter.

Out of another situation in which a person’s suicide was aided by information and interaction on the Web, H.R. 1183 has been proposed, which would  “make it a crime to use the Internet to help someone commit suicide.”

I find that interesting, personally, because my 2006 column titled “What’s the best method for painless suicide?” continues to get many hits every month from people some of whom are expecting to get practical, how-to advice. Some of them even write to me angrily or disappointed that I don’t show them where to buy poison or name the best bridges to jump off of.

People do get over the suicides of loved ones. They meet in groups and talk on the phone with hotline counselors and go through their lives. The pain and shock abate. And there is evidence to show that how we talk about such things affects how we will feel. So I would guard against saying such things as she will never get over it. It isn’t helpful. One who has been through such an event may feel outraged that others do not seem to understand its power; they do not seem to understand how deeply we have been hurt or how long the hurt persists or the many small ways in which our day-to-day functioning is impaired afterward. This is true. So it is hard to go through life grieving. It is hard to grieve among strangers who do not know the cause of our halting responses and occasional lapses into blank emotion-filled silences when we are tugged violently by the anchor of the underworld.

That is what it is like to go through life grieving.  It causes one to wonder if it might not be better to wear a black armband for a while, so others, even strangers, know to tread lightly. It is hard to go through life with a burden like that.

But it does not change the philosophical or logical problem. You did not cause this suicide. You played a part in this suicidal person’s personal drama. Or, that is, not even you played the part, but your image; this person’s image of you played a part in his own drama.

When you say, “I am convinced I will never work through this guilt,” you do yourself a disservice. Why not instead tell yourself, “I will work through this guilt.”

A part of us, of course, likes the sound of “never.” A part of us clings to it. And inasmuch as it allows us to feel the complete depth of the shock, it serves a purpose; it is poetic language. It is dramatic language. It indicates severity, or degree.

But beware the effect of such pronouncements, because they also work as prophecy. So find more poetic language, if you can; say that the depth of it is tearing you apart, that you feel devastated. You may need some kind of catharsis. Catharsis means working through. In fact, come to think of it, catharsis may be exactly what you need.

And, despite what you say, she will be OK. And you will be OK, too. But it will take time. for now, I suggest you listen to your psychiatrist. Leave this woman alone. Give it time. Back off.