Reader’s Question

I desperately need advice on what the next step is to take for my youngest brother. This all began with his lying about graduating from college, were he was 2 classes shy. He lived with my parents for a year with no job and isolated himself in his room.

He ended up stealing money from everyone in the household and eventually moved out to live with an old friend’s uncle who is dying of cancer and 70 years old. He did not take anything with him, including clothes. He has no job and has been living this way for almost a year.

The hardest part of this is not knowing what is wrong with him. Drugs? Gay? Mental disorder? All options are very likely, but how are we to help if we do not know what is causing this behavior? He completely shut out his family, and I have tried on many occasions to open our relationship and reach out. He wants no part of it.

This subject is very painful for my family and my parents enable him by going to this house and dropping off money every week. He is usually wearing the same clothes and looks like a bum.

We are all at a loss as to what to do. Can we forcibly commit him to save him from himself? I’m afraid for his life as he is clearly depressed/mentally disturbed in some way.

Any advice you can give is appreciated! Thank you for your time.

Our Clinical Psychologist’s Reply

From your description, this is likely to be a significant psychiatric disorder. Drugs or sexual issues are not likely. Let’s look at the pattern:

1. onset during college,
2. rapid deterioration in lifestyle,
3. loss of concern for appearance,
4. social isolation,
5. hostile detachment from family and friends,
6. living in his room for about a year,
7. hostility and suspiciousness, and
8. total loss of concern for his future.

When this happens to an intellectually bright college student, this isn’t good. Sad to say, the most likely psychiatric disorder is Schizophrenia or a Chronic Major Depression.

Schizophrenia typically surfaces between the ages of 18 and 25, so it’s not uncommon for the stress of college, military, or our first job to prompt the first psychotic break. The first signs are slow and gradual but over many months we realize the individual has lost the ability to function normally in all areas of their life. In drugs and other situations, only certain aspects of their life are involved. Your brother has gone from a college student to a deteriorated lifestyle and appears apathetic and unmotivated to change. While the social withdrawal and dropping out of college might support a diagnosis of severe depression, you’re not reporting a significant mood component here.

As a family, what can we do? The laws in many countries limit our ability to intervene. Some suggestions:

• Read my article entitled Chemical Imbalance on my website at www.drjoecarver.com. Also review information on this website about Schizophrenia. Your brother may have a significant neurobiological illness so his behavior is not related to attitude, being a problem child, disliking family, etc.
• Your parents are taking the correct approach. It’s not actually enabling him — it’s monitoring him. By dropping off money each week, they are obtaining a status report on your brother and can use those contacts to guage his health, his deterioration, etc. I would recommend that they maintain a log of their visits describing his emotional, behavioral, physical, and hygiene conditions.
• Contact the local mental health center and discuss your options. Forced interventions are unlikely unless he is a danger to himself or others. Local agencies may have outreach teams that can accompany your parents when they visit, although this is risky and may prompt him to reject future visits from the parents.
• Remember that your brother doesn’t hate you, the family, friends, etc. If Schizophrenia is present, he is totally overwhelmed by his own thoughts of paranoia, suspiciousness, and fantasy beliefs. He’s not rejecting you or others — he’s become severely withdrawn to detach and protect himself from what he perceives is a highly threatening community/outside environment.
• During those monitoring visits, parents should observe and inquire about his medical health. People will often seek medical treatment for physical issues before mental health treatment. If he participates in a few medical consultations, we may be able to convince him to seek psychiatric consultation.
• Maintain your contact with your brother. Send him small notes, cards, etc. Music CDs are OK, but don’t send him anything electronic (with circuits, chips, electric devices, etc.) as most Schizophrenic adults feel they are being electronically monitored or controlled.
• If he is living away from home, slowly return his personal items to him. These items often help “ground” the individual by reminding them of their previous life and lifestyle.
• After reading the information on Schizophrenia, he may be helpful for the family members to consult with a psychologist or psychiatrist to not only answer questions, but to obtain additional suggestions and guidelines.
• You and your parents should study the local community for mental health resources. Have information about hospitals, psychiatrists, costs, etc. of treatment. Why? If your brother calls and says “I think I need help” — you want to be able to act within 24 hours. Many intervention opportunities are lost when it requires 4 to 6 weeks to see a professional for a first visit. Have a family intervention plan developed.

In such situations, the family needs to hover overhead like guardian angels and monitor the situation. Use each contact as a type of assessment of his current status. At some point, he may actually deteriorate to the point that he can’t care for himself. At that time, you might legally intervene under the “danger to self” or “inability to care for self” criteria. Do your homework and be prepared. I wish your family the best of luck during this difficult time.