Dear Prudence: Coping with a very demanding, self-absorbed cancer patient.

Help! A Very Demanding, Self-Absorbed Acquaintance Has Cancer. Should I Help Her?

Help! A Very Demanding, Self-Absorbed Acquaintance Has Cancer. Should I Help Her?

Advice on manners and morals.
July 24 2017 4:44 PM

Nobody Else Stepped Up to the Plate

Prudie counsels a letter writer on how to support a difficult cancer patient when everyone else refuses to get involved.

Photo illustration by Slate. Photo by Thinkstock.

Photo illustration by Slate. Photo by Thinkstock.

Mallory Ortberg
Mallory Ortberg

Sam Breach

Mallory Ortberg, aka Dear Prudence, is online weekly to chat live with readers. An edited transcript of the chat is below. (Sign up below to get Dear Prudence delivered to your inbox each week. Read Prudie’s Slate columns here. Send questions to Prudence at prudence@slate.com.)

Readers! Ask me your questions on the voice mail of the Dear Prudence podcast. Just leave a message at 401-371-DEAR (3327), and you may hear your question answered on a future episode of the show.

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Mallory Ortberg: Good morning, advice-seekers and -dispensers alike! Let’s chat.

Q. Cancer hasn’t changed her personality: There’s a young woman, “April,” in my social circle. We’re not close, but we were involved in the same community volunteer project for a couple of years. A wife and mother of two small children, April is 26 years old but acts much younger. She’s not vicious but very self-absorbed and demanding. She talks way too much (always about herself) and has a big sense of entitlement, and when she had kids, no one else could match the experience. Recently she got a late-stage cancer diagnosis and has been unabashed in demanding—not requesting—assistance from everyone. The reality is that her prognosis isn’t good, and she really does need help with meals and child care. But she’s not very well-liked, and—surprise—very few people are stepping up to the plate.

What is my obligation here? My sense of compassion makes me want to step up, especially to help her children, but I’d rather not spend that much time around her, and I know that once I start dropping off meals or picking up kids from day care, she’ll demand that it be a regular service.

A: I’m impressed with your compassion toward someone you dislike, and I think your inclination to care for her kids despite how difficult their mother may be is commendable. If you have a general sense of what she needs, you might try approaching her with a specific offer of something you consider manageable: “I’ve got time on Wednesday afternoons between 3 and 5, and I’d be happy to pick up the kids from school and bring them home for you. Does that work?” If she starts pushing for more and you genuinely can’t spare the time, go ahead and say, “I’m sorry, but you’ll have to ask someone else.” But don’t let the fear of being asked to do more keep you from doing anything.

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Q. Mental health or something else?: I live in a small town where many of the twenty- to thirtysomethings are part of the same social circle. Many people in that circle, including myself, have some form of depression, anxiety, etc.—basically, high-functioning mental illness. My question is: What types of behavior does having a mental illness excuse?

A lot of my friends engage in poor social behaviors, such as bailing on plans last minute, waiting weeks or months to return texts, snapping at people, ignoring house cleaning in shared living situations, drunk driving, or getting incredibly drunk and causing scenes. All of which inevitably gets excused by having anxiety or depression. One acquaintance even went so far as to blame his (multiple) attempted sexual assaults on his having depression. Yet all these people maintain jobs, attend community college, have social lives and hobbies, which makes me think their illnesses can’t be that bad.

Am I unfair to think these behaviors are being assigned to the mental illness category just so people can escape personal responsibility? Since I was a child, I have suffered from severe depression, anxiety, and OCD. I was hospitalized once yet was able to start a career and am about to start grad school. I come from a family that prefers to ignore mental illnesses, so mine were mainly untreated until I could help myself, so I’m not sure if I’m projecting onto my friends and acquaintances. If not, what is a proper response to someone who treats you poorly then blames it on anxiety or depression? I don’t want to enable anyone yet also don’t want to be callous or presumptive.

A: Rather than scrutinizing your friends and acquaintances for signs that their ongoing employment or active social lives mean their mental health conditions can’t be “that bad”—whatever “that bad” means—focus on how they treat you. The behaviors you list above, from drunk driving to periodic isolation, vary so wildly that I can’t possibly offer you a one-size-fits-all piece of advice. They may very well love their friends but feel so overwhelmed by their own depression that it’s all they can do to get through the day. When it comes to things like drunkenly lashing out, drunk driving, or attempted assault, you absolutely can and should call out the bad behavior and reconsider the friendship in question. When it comes to something like wishing your friends would reply to your texts more often or feeling frustrated when they cancel plans at the last minute, you should speak up. You can be kind and acknowledge what your friends may be going through while also suggesting alternative, low-pressure plans for getting together.

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There is no mental health issue that excuses attempted sexual assault or drunk driving. Not even a little bit, not even close. Moreover, having a mental health diagnosis does not mean that no one else can ever disagree with or criticize you. If someone treats you badly, you can absolutely say, “It hurts me when you [yell at me/ignore me/don’t help keep the house clean], and I want to talk to you about it.” Those are totally appropriate topics for discussion! A person’s depression might inform the conversation and might be a reason for broaching a topic with compassion and understanding, but it is by no means an excuse to behave badly without criticism or feedback.

Q. My brother hits my girlfriend: I’ve been dating my girlfriend, “Emily,” for three years, and I want to marry her. We recently moved back to my hometown, and she’s spent a lot more time with my brother, “Tom,” who’s developmentally disabled. For reasons unknown, Tom behaves violently toward Emily, hitting, slapping, even biting her. My parents and I have worked hard to help Tom accept Emily, but it’s not happening.

My parents always told me they expected me to care for Tom after they died (he lives with them), and I accepted that. Now, as it has become clear Emily isn’t safe around Tom, I find myself resenting this expectation that I first agreed to when I was 8 or 9. I love Tom so much, but if he continues to hurt Emily, I can’t foresee a way I could marry her and have him live with us.

I know my parents would flip if I told them this is how I feel, and I can see their point. I’m choosing a woman over blood. Am I being selfish?

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A: This isn’t a matter of “choosing” someone else over your family. The situation your parents envision—one where your brother is in such distress and under the inexpert care of a nonprofessional that he is constantly lashing out violently—is not healthy or safe for either Tom nor Emily.

It is completely unfair and inappropriate to ask a 9-year-old child to commit to caring full-time for a developmentally disabled sibling. You could neither fully comprehend nor consent to what was being asked of you, and your parents are wrong to try to hold a childhood commitment over your head now. Luckily for all of you, your parents are not on the verge of death and have time to make a plan for Tom’s care after they’re gone. The level of care and supervision your brother requires in order to stay safe, toward himself as well as others, is well beyond what you are capable of providing. Think of this as being asked to be your brother’s pilot or his lawyer—you’re not necessarily qualified just because you’re related to him. Whether you and Emily stay together, you’ve got to tell your parents that they need to figure out a better plan for your brother’s long-term care, and there’s no better time to start planning than the present.

Q. Wannabe mom: I’ve been dating a wonderful guy for eight years now, and I’ve been an integral part of his son’s life since he was a toddler. Recently, “T” has asked if he can call me Mom. I’m all for it, and his bio mom is completely out of the picture. My boyfriend is absolutely against it. When I asked him why, he started talking about how T’s mom would feel if she decided to come back and he was calling me mom. I don’t get why this woman, who has not been here for at least eight years, gets more consideration in regard to feelings than T, who had a full-on fit when I told him he couldn’t call me Mom, or me, who desperately wants him to call me Mom.

I’ve tried to talk to him about it, but he shuts conversations down, and then I get insecure. I know there’s something else going on, but he won’t talk about it. How do I get him to talk about it so that we can move forward?

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A: I’d welcome suggestions from any readers who have experience step-parenting!

It seems like your boyfriend is having trouble prioritizing his son’s real-time, in-person needs over a pretty unlikely hypothetical. Surely, if your son’s—and he is your son in a very real sense, as you are the only mother he has ever known—biological mother came back in the picture, even if it were tomorrow, you would still be one of his parents. Kids have room in their minds, and hearts, for nuanced understandings of family. I’d guess your son is anywhere between the ages of 9 and 12—surely he understands the difference between biological and adoptive parents, as do many kids with complicated or blended families.

When it comes to your boyfriend, I think you should continue to gently insist that he have a calm, rational conversation with you, even if it’s difficult for him at first. If it helps to have a mediator or a few sessions with a couples counselor, that’s fine. If his goal is to make sure his son views his biological mother with compassion and understanding, whatever the reasons that make it impossible for her to be a part of his life, then there are other ways to do that than forbidding him to call you, the only mother he has ever known, Mom. If some part of your boyfriend is holding out hope that his ex will return—well, it’s better that the two of you acknowledge and talk that out together now rather than trying to ignore it. Whatever the cause for your boyfriend’s reluctance to acknowledge reality, continue to advocate for your son’s best interests. You are his mother. You’re just not his only mother.

Q. Am I just an evil stepmother?: My husband has two children, ages 20 and 22, who live with their mother. Both dropped out of high school; the elder has obtained a GED but dropped out of three college programs without completing a single credit. Neither has held a job for more than a few days.

The biggest problem is that they ask my husband—already their mom’s and their sole source of income—for everything they want, and they get it. We aren’t wealthy, and half my husband’s paycheck is going to them. Everything from new video games to huge dental bills are requested or demanded of him while we go further into debt supporting them. My husband puts off his own needed dental work and the luxuries he is expected to shell out for weekly for them.

When is enough enough? I’m at my wits’ end after the last dental visit, which was followed by a text with a price and instructions as to how my husband should apply for a dental credit program.

A: Is your husband paying any form of alimony or court-ordered child support? That seems unlikely, given his children’s ages. If he’s simply paying for his ex’s lifestyle, as well as his two now-adult kids because he’s used to it or feels guilty, with absolutely no plan for transitioning them off of the dad payment plan, then you two are probably overdue for a talk about how long he plans to keep this up.

Does he feel guilty about the end of his relationship with his kids’ mother? Does he believe them to be totally incapable of self-sufficiency? Does he set any financial limits with them, and if so, has he ever stuck to his word, or does he cave whenever they make new demands? Find the answers to those questions, and if he’s just as sick of the arrangement as you are, the two of you can figure out an appropriate, relatively fast-approaching date after which Dad Bank will close, and give his children a heads up. If he’s not sure what he wants or is happier with the situation than you are, at the very least you can set up your own private savings and checking accounts that only you can touch.

Q. Airport anxiety: The only time I went through the X-ray machine at the airport, I miscarried the only pregnancy I’ve ever had. Since then, I’ve “opted out” (so has my husband, in solidarity) as we’ve been continually trying to get pregnant in the years since. Last time I flew, the TSA agent roughly groped my vagina and labia, and I had a panic attack. I’ve avoided flying since.

Now I have to fly this upcoming weekend for a family obligation, and I’ve been a shaking, crying mess whenever I think about it. What can I do to protect my body, any potential pregnancy (we’re in the two-week wait), and my sanity?

A: Further research about what exactly you’re exposed to when you get an airport X-ray might help set your mind at ease if you’re balking at the thought of another invasive pat-down. The timing of your last miscarriage is terrible, and your reluctance at the thought of getting X-rayed again is understandable, but the energy of the X-ray beam of an airport scanner is very low and does not penetrate the skin. According to the Health Physics Society, an organization dedicated to radiation safety,

There is an American National Standards Institute/Health Physics Society (ANSI/HPS) consensus standard stating that people-scanning devices should expose an individual to no more than 0.25 microsievert per screening (one screening procedure generally consists of two scans). The two primary companies that sell people screeners say that their devices expose people to half that amount of radiation.
For perspective, 0.25 microsievert is also received by flying about a minute and a half (cosmic radiation during commercial flight exposes fliers to about 10 microsievert per hour). It is also received by living for 40 minutes (natural background radiation exposes people to about 0.35 microsievert per hour)...The American National Standards Institute/Health Physics Society (ANSI/HPS) consensus standard took into account the varying sensitivity of different groups of people who might be scanned. The authors first looked at a number of reports and published studies on the health effects of radiation. They then chose the 0.25 microsievert dose level to ensure that children and pregnant individuals can be safely scanned with these devices. The x-ray scanner uses a very low-energy and low-intensity radiation, so that an embryo/fetus is not exposed to any radiation that could possibly increase the developmental risks of radiation to the embryo.

Getting informed is always a helpful bulwark against panic, but as a nervous flyer myself, I know it’s not always helpful to know something is safe when your brain is convinced you’re in danger. Learn more about anxiety treatments—anything from deep-breathing exercises to cognitive behavioral therapy —that you can perform on yourself when you’re feeling cornered in the security line. You can also apply for TSA Pre-Check, which may only require you to go through an old-school metal detector. Good luck.

Q. Re: Wannabe mom: The boyfriend’s excuse is ridiculous. Lots of kids have more than one mom and come up with different names for them and don’t get them confused. The key to why boyfriend won’t let his son call the letter writer Mom is in the opening sentence: They’ve been dating for eight years. Sure, people can be committed to each other without getting married. But the combination of dating for eight years—with no marriage—and not allowing his son to call a woman he considers his mother Mom means there’s a huge probability that the boyfriend doesn’t plan on this relationship being till death do they part. The conversation to have now isn’t about whether the son calls her Mom. It’s about the future of the relationship. My bet is the boyfriend has always considered this relationship temporary, and this is just one more symptom. It’s time for the letter writer to realize that.

A: I’m not confident, based on the letter, that the boyfriend is definitely unwilling to commit to his girlfriend just because they aren’t married, but it’s certainly a possibility that I think the letter writer should consider. If there’s more going on here behind the scenes, if she thinks of their relationship as more serious than he does, then they should have an even bigger conversation than what their son should call her.

Q. Who can I hook up with?: My partner and I recently broke up. It was a full-on break up (not just a break), but we both recognize that it’s fairly likely we will get back together in the future. But for now, I’d like to casually date and sleep with other people (but I’m definitely not interested in another committed, emotional relationship).

Who is it OK to hook up with in this situation? Should I only be doing this with totally new people, or is it OK to get together with, for example, a mutual friend of ours or someone who is already in my life and knew the both of us? Under normal breakup conditions, I would just do whatever I wanted, but since there’s talk of getting back together at some point, I don’t want to do anything that could make that painful or more difficult (but I also don’t want to let him to inform my decisions too much). Also, he dumped me, if that’s useful information.

A: That depends on your goals, I think. If what you truly want is to eventually get back together with your ex (rather than simply having a sense of inevitability, as if the two of you were magnetized to each other), then it’s probably wise to steer clear of hookups with mutual friends, especially if one or both of you is especially close to the mutual friend in question. If, however, you consider yourself to be truly single and open to any and all possibilities, then you are free to date or sleep with anyone who’s available and interested. It doesn’t sound like you’re contemplating hooking up with one of your ex’s relatives or best friends, either. I suppose the deciding factor would be how uncomfortable you’d feel sharing that information with your ex if you two ever decide to get back together.

Q. Re: My brother hits my girlfriend: As someone who works in the field, dealing specifically with developmental disabilities, I want to reassure you that no, you’re not being “selfish” for taking into consideration your brother’s reactions to your girlfriend.

Taking care of an adult with a developmental disability is a monumentally challenging task, and even under the best of circumstances it can be draining on caregivers—emotionally, physically, and financially. Even in situations where developmentally disabled adults live in traditional home settings, caregivers often need respite care, where outside caregivers essentially take over duties and give them breaks.

At the moment it sounds like Tom is having some behavioral issues that need to be brought up with his care team (if he has one), a psychologist, and/or behavioral specialist with experience in this field. At the very least, there should probably be a plan in place for how to calm and redirect Tom when he does begin to behave violently against Emily or anyone else. It may be that Tom would benefit from some form of behavioral medicine, but again, all of this needs to be discussed with qualified professionals.

In terms of his future care arrangements, it is probably best if you and your parents have an honest and frank conversation about Tom’s future care. Aside from the question of whether you want Tom to live with you due to his aggressive behaviors, you also need to consider the possibility that any number of life events might occur that would make it impossible for Tom to live with you (not least of which is the possibility of you dying prior to your parents, who seem determined to keep Tom with them as long as possible).

Institutions for people with intellectual development disorders tend to get a bad rap that I suspect are more than a little egged on by one-sided negative depictions in popular media, but there are likely many types of institutional settings where Tom would not only be able to live a happy life but may even thrive and progress beyond where he is now. I recommend looking into things such as an intermediate care facility for individuals with intellectual disabilities group home or setting that focus on what is called “integrative care.” Essentially, these are group homes or other types of institutional settings where there is a care team that will look at all aspects of Tom’s health and well-being, including behavioral aspects, and will work to improve them. Upon your parents’ death you could gain guardianship of Tom, so you could still have contact with him and have a say in his care. This might be the best possibility for both you and your girlfriend, as well as Tom.

Furthermore, even if you found a woman to marry who your brother didn’t hit or slap, how could you be sure when you decided to start a family that he would behave safely and appropriately around your children? Your parents do not have the right to ask you to forgo having children of your own. Your parents cannot ask you to be a parent to your brother after they are gone. The most they can ask is that you be a good brother. After they are gone, you can ensure that he is well–looked after in a professional care setting and that he gets visits and knows he is loved.

A: This is such helpful and compassionate advice. Thank you so much for this reminder that seeking professional assistance in caring for Tom does not mean you do not love him or that you seek to abandon him.

And there’s more ...

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