In commenting on my latest essay for “Good Letters,” a man “disabled from an odd condition” confided that, when his health crashed, he found himself abandoned by those he depended upon: “My family avoided me thinking that I repre­sented their destiny.” Years later “they still do,” he added.

Not everyone who lives with advancing death or a maladroit disability must live without his family’s succor and society. But I know exactly what this man is talking about, because my family too has avoided me since I was diagnosed with terminal cancer nearly seven years ago.

For five years my younger sister said nothing at all to me about the disease. My other sister will give a “like” to cancer updates on Facebook, but she never gets in touch with me. She doesn’t even leave a short encouraging comment. She clicks the “like” toggle and moves on. And, oh, oh, let me tell you about—but please stop me from tabulating grievances. Already I’m starting to remind myself of John McEnroe after a linesman’s bad call.

I also refuse to quote the first sentence of Anna Karenina, which is usually trotted out in these circumstances, principally because I think it is false. The truth is that unhappy families are more alike than happy families. Unhap­piness takes the universal forms of bitterness, resentment, and the symptom to which Kafka dedicated an entire novel—psychological arrest at an early stage, preventing emotional growth and development.

One of the best accounts of family dysfunction ever written is Joshua Henkin’s novel The World Without You. (My review is here.) Noelle, the prettiest of three daughters, was promiscuous in high school as a rebellion from the family strictures.

But now she has turned her life around. She is a baalat teshuvah (she has turned to Orthodox Judaism), made aliyah to Israel, married a religious Jew, gave birth to four sons whom she is raising as religious Jews, and enthusiastically sup­ports George W. Bush—casting an absentee ballot for him from 6,000 miles away, “and not just once, but twice!”

For the rest of her family, though, Noelle has merely brought her rebellious promiscuity up to date as rebellious religiosity and deplorable politics. In their eyes she has not grown and developed as a woman, but has settled down and spread out in her established family role: her adult choices are flagrant rejections of their public self-image. (The mother has written twenty-four anti-war op-ed columns and emphatically spurns President Bush’s invitation to the White House after her son is killed in Iraq.)

Like Josef K., Noelle is arrested without having done anything truly wrong. Her family of secular Jews angrily denies that they share her religion, sneering that it’s “delusional”; they condemn her home country, the Jewish state, dismissing it as “warmongering”; they blame President Bush and “all fifty million people who voted for him,” including her, for the death of her younger brother.

Noelle may be an extreme case—I too, as the only conservative, Orthodox Jew, and Zionist in my family, receive a cold shoulder while the anger is stored away in the freezer—but in every unhappy family the conditions are duplicated. Members of the family are arrested in roles that date from childhood. To escape these roles is to do wrong in the eyes of the family, even if it is not truly wrong. Growth and development are intolerable pressures on family ties.

Perhaps the most intense pressure is applied by disease. It splinters the family roles in ways that no one is prepared for. The dying find they have suddenly aged by a generation or more. Their brothers and sisters, without warning, are much younger than they