Making peace with worst case scenario provides clarity

I'm absurdly optimistic. Which makes what I'm about to say surprising, perhaps. I often find it useful, freeing, even healing to argue backward from worst case scenarios.

Let's say I'm feeling uneasy about a patient who is severely depressed. Especially, say, a troubled adolescent. Even though the teen has never threatened suicide, something about her seems so vulnerable. Adolescents can be so impulsive, so dramatically emotional and so naive. There's a reason that suicide is the second leading cause of death for adolescents.

So, I do my job. I ask all the questions I know to ask. I secure as much confidence as I can from the patient's family and other available support. Then, at the end of the day, when I notice that the youth is still much on my mind, I argue backward from the worst case scenario. I journey into an alternative future. I make myself imagine learning of the patient's death. Getting "that" phone call. Seeing it on the news. It's awful to do, because I have a really good imagination.

But, the exercise forces clarity. It makes me ask and answer an important question: If, indeed, this tragedy happened, would I be able to say I had done every due diligence? Or, is there something I've missed? If the worst happens, will I at least have the solace of saying I did all that was in my power to do?

I invite parents of troubled young people into this same exercise when the parents are considering establishing a dramatic boundary in response to egregious behavior. Let's say you have a 20-year-old, still living at home, living a derelict life. Irresponsible. No job, or consistent efforts to find one. Nonparticipating in household duties. Bitter, combative, contemptuous and entitled in relationship with the parents. A marijuana dependent. He has threatened to kill himself if the parents evict him.

The parents consider evicting him from the house. But Mom says: "How will he survive out there? What would I do if he dies?"

These parents are in a terrible dilemma. Right now, they are veritable hostages in their own home, their love abused daily by a boy-man refusing to grow up. Doing nothing means participating in the boy-man's dereliction. On the other hand, withdrawing from the boy-man's choices and throwing him out is a huge risk. Anything could happen. He could turn to crime. Drugs. He could be homeless in two blinks. He could die.

And so I invite them to imagine the unimaginable. Close your eyes, and see yourself at your son's funeral. And, if such a dreadful thing should happen, could you at least say to yourself that you did everything that was yours to do? That you opened every door that was yours to open to the end that he would choose a responsible, productive and meaningful life? Your heart would be forever broken, yes, but could you bear that broken heart without the added hell of self-recrimination? Without saying that you were to blame for his suffering?

It might sound like a terrible, insensitive question to ask. But I ask it because I think the question forces an important clarity, and from that clarity, choices and hope. Yes, hope. Authentic hope is not the same as wishful thinking. The only authentic hope comes from embracing life as life is. The only hope worth having emerges from an abject surrender to immutable reality. And surely one such reality is that no one, in the end, can be responsible for another's life choices. Not the good ones, or the bad. Said another way, I can't be useful to anyone until and unless I'm clear about that which I'm helpless. Being clear about what I can't do sets me free to turn my energies to what I can do.

Let's say you're in a terrible fight with a loved one -- friend, family, mate. You're not on speaking terms. It feels right to shun the loved one. It feels like justice, not to mention self-protection. So, imagine: The last conversation you had with this person is the last one you'll ever have. See how a clarity of values suddenly sharpens focus? However painful is this conflict, would it be worth that? It better be, because forever is a long, long time.

When I can make peace with the worst case scenario, it seems more likely I have done due diligence. And perhaps more likely that I might have even done the right thing.

Steven Kalas is a behavioral health consultant and counselor at Las Vegas Psychiatry and the author of "Human Matters: Wise and Witty Counsel on Relationships, Parenting, Grief and Doing the Right Thing" (Stephens Press). His columns appear on Sundays. Contact him at 227-4165 or skalas@ reviewjournal.com.