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Intense depression can sometimes be a distorted expression of love rather than signs of a mental disorder.

When one assumes impossible responsibility for tragic events, suffering can become a form of self-punishment.

Challenging the belief that one should control the uncontrollable can rapidly reduce shame.

Several years ago, I met a man named Jim at a social gathering. When he found out I was a psychiatrist, he told me he had been severely depressed for nine years.

Nothing had helped. Not antidepressants. Not therapy. Not encouragement from friends.

“Is my depression hopeless?” he asked.

I told him I’d been developing a new approach to treating depression. Although I could not promise anything, I invited him to come to my home that Saturday.

When we sat down together, I asked what had happened nine years earlier.

He looked at me quietly and said, “I killed my stepson.”

I was stunned, and he told me the backstory.

Before getting married, Jim had been a successful businessman and a happy bachelor. His girlfriend had a teenage son who was struggling—trouble at school, trouble with the police, low self-esteem. Jim decided to step in and try to be a father figure and help the boy.

They bonded quickly. They skied together, and the boy turned out to be exceptionally talented. They began doing extreme skiing and became well-known. Their story was even featured in Sports Illustrated. When Jim got married, the boy stood beside him as his best man.

One afternoon, after hours on the slopes, they were about to head home. It was Jim’s wife’s birthday, and it was getting late.

But the boy begged him. “Jim, just one more run. There’s this really tough slope, but I know I can do it. Please, just this one last time.”

Jim hesitated,........

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