Also, my hairy legs mean that I have "failed at being a woman."

April 11, 2009 9:19 PM

How do you deal with a crazy person's total hostility?

My brother is in the psych ward again, which is good, and he's getting good care, which is good.

But he's acting like a caged animal and says a lot of nasty abusive shit to me. I KNOW that he doesn't really know what he's saying and that it's not his fault. But I'm having trouble not taking his bait and not being hurt by it. Like when he says that I must really love this (being here with him) because it's easier than holding down a job. Or that I lie to him. Or that I don't keep promises to him.

How do I react to him, and how do I react in my mind? It hurts.

posted by liketitanic to human relations (14 comments total)

If you talk to his caregivers, they'll probably tell you that you need to practice detachment from his verbal abuse. This article is a bullet-point rundown of detachment and how to start doing it; you'll need to procure more resources, and maybe look into a support group for families of patients under psychiatric care, to get good at not engaging his damage.

(I'm not a shrink. I grew up with crazy.)
posted by fairytale of los angeles at 9:37 PM on April 11 [5 favorites]

I'm not really sure how to react to him outwardly, but in your mind I think the best way to deal with it is to tell yourself over and over that it's not your brother saying these things, but his illness. I know that can't be an easy thing to do, but I think if you can put the person he is right now in one box, and the person he used to be and hopefully will be again in a different box, you can reduce the pain it's causing you.

Good luck!
posted by cerebus19 at 9:38 PM on April 11

The first thing you can do is try to find a qualified therapist, or talk to a trusted loved one or even whatever passes for a priest. You're going through something very stressful, and a reality check will help you hang onto the fact that you are not the crazy one.

If I were you, I'd both try to get some philosophical distance, and think of his comments as the barking and snarling as a dog at the vet. He doesn't want to be there, he's in pain and he'd probably bite you if he could, even if the whole process is actually for his benefit. But like the dog at the vet, getting bit will still hurt, so don't discount that it's reasonable to feel damaged when he attacks you

As for rising to his bait, why don't you think of a repetitive response to unreasonable behaviour? How about “Tell me again when you’re feeling better/sane”?

We both know that you can rock all the fuzz you want without handing in your ovaries, that being with him is a big sacrifice, and it isn't really material if you lie to or break promises with your brother. What you should focus on is that you are in control. You can choose to help your brother or not, and even if he is family, if he’s hurting you, you will leave.
posted by Phalene at 9:43 PM on April 11

You agree. "Yes. You're right about everything. I'm going to leave you to the care of your doctors and nurses now, and I hope you feel better soon." And then you leave him to the capable care of his doctors and nurses. His medication will kick in at some point and he will stop this abusive nonsense which is his way of controlling you by knocking you off balance and keeping you constantly on the defensive. It's classic bipolar behavior brought on by intense feelings of complete powerlessness, it's really fucking awful, you have my sympathies, and it will end. What you must do is agree and then minimize actual contact with him until he's stable.

This is the worst part. You can't take any of it personally and you must seek out a support system of your own. See if there isn't a support group for families of bipolar patients that meets in or near the hospital where he's staying. You can ask either his psychiatrist or one of the psych nurses for information. There should also be psychiatric social workers working in conjunction with the hospital you can talk to for information like this.

I'm really sorry. This is incredibly hard but it will end once he's properly medicated. Until then, it's natural to be hurt, it's natural to want to be as far away from him as possible, and it's totally acceptable to be nearby but not completely in the line of his fire. Whatever you do, do not argue with him or try to point out to him how wrong or hurtful he's being. It will only encourage him to continue, and what you want is to deflect, minimize and create a safe distance. I truly wish you the best of luck.
posted by TryTheTilapia at 9:52 PM on April 11 [2 favorites]

You already know that he doesn't mean that stuff (or wouldn't mean it if he were stable). When I'm in a similar situation (and I've been there a time or twenty), I try to react sympathetically to the person's emotional state, not their words.

Statement: "You're just lying to me. I can never trust you!"
Response: "I can tell that you're really upset right now."
"You just visit me because you don't want to get a job."
"You must feel kind of alone right now?"

This isn't guaranteed to work, of course, but it creates the possibility of getting him to talk about him, not you, and builds a little connection along the way.

You may discover when he's that irrational that it's just too hard to visit him, and it doesn't seem to do any good. It's certainly okay to check on him for a few minutes, say "I'll come back when you're up for a longer chat" and step back out.
posted by Pater Aletheias at 10:43 PM on April 11

I see that one of your tags is schizophrenia. I'm very sorry.

We had a post on the blue that might help you make sense of the hostility he's exhibiting, and accept it as not really him. One of the links is to a movie (scroll about 1/3 down the page), which requires RealPlayer to view it, but it is very good at showing how the world looks to a schizophrenic. I know you know it's not the real him who is talking, but it must be hard because he still looks (and maybe acts) like the real him sometimes, and you still remember how he was before this.

Maybe (surely?) his doctors or people at the ward can point you to support groups for families of schizophrenics, who are facing the same thing?
posted by Houstonian at 12:48 AM on April 12

Rehearse. Make a mental or actual list of everything he's said and everything he could say (this involves cataloging your own emotional soft-spots that he might be able to find). Throw in some things that make no sense at all ("I remember that time when you were 9 and you stole my cookie--that's when I knew you were a slut!").

Rehearse your reaction to these things over and over. Vividly recall the feeling you had when he said something unexpected and got a reaction from you, and rehearse your (new, level-headed) reaction to that feeling. Rehearse over and over again. If you can, try to distance yourself from the fact that he is your brother and it's a very big deal, and try to think of it as a job. Or a play you're in.
posted by K.P. at 3:27 AM on April 12

From going through something similar with a friend of mine, one thing that did not work for me was to take the approach of "it's not her saying these things" or "she doesn't mean it." No offense meant to those for whom these approaches did work. But at the time, to me it was pretty clear that it was her and that she did indeed mean all of it, so I couldn't convince myself otherwise.

What helped me was to try to look at why my friend was saying hurtful things and at times even becoming physically violent. What was her emotional state and what was she trying to achieve, and how was she perceiving the world around her, that caused her to act this way? Because it was all about weird emotional states, and later, complete disconnection from reality.

It came down to wanting the people who cared about her to go away, initially because she knew something was very wrong and was trying to spare us from it, then later because of paranoia about being forced into (and forced to stay in) treatment that she didn't believe she needed -- she saw us as the people who were forcing this on her and if we would just go away then she could leave.

In hindsight it was actually a good sign that she was still fairly well connected with reality, since she knew who we all were and what to say that would hurt the worst. Maybe it would help you to look at the silver lining in the cloud that way.

One thing I can think of to watch out for in the future is that your brother may remember everything he said and may end up feeling tremendous guilt once the reasons why he's saying these things have been fixed. So if you find some techniques that work for you, remember what they were so you can tell him about them later. He may need them too.
posted by FishBike at 6:54 AM on April 12

Step One: Empathy: "I think you must be angry to say those things to me," "I can tell that what you're going through is hard," "I know you're lonely and frightened."

Step Two: Don't argue or take the bait. This is so very vital. First of all, arguing with a schizophrenic is big fat waste of time. You'll never win because your brother's delusions are rooted too deeply in his illness for you to counter. Also, every time you engage in argument you require him to more fully prepare and justify his delusion. In effect, you're helping to ingrain them even more.

Step Three: Acknowledge that his verbal aggression is a behavior with purpose and meaning. Most behavior is an attempt to obtain or avoid something. In this case, I'd guess he's trying to avoid and alienate you. It's really impossible to know what's going on in the mind of someone with schizophrenia. Now, this isn't to say that you shouldn't visit - but when he gets really mean, it's probably time to end your visit (matter of factly, without showing him that his meanness has hurt you) and try again another day.

Step Four: Redirect: Talk about other things. Talk about mundane things.

Step Five: Boundaries: Don't share personal information, insights, feelings, or experiences with him until he gets better. In other words, don't give him fodder for more insults.

Step Six: Detach. See the first response to your OP. It includes a great link about detachment.

Step Seven: Get support. If you are your brothers most vital support, it is absolutely necessary that you get support yourself. You can't really do this alone and handle the emotional backlash healthfully without support. There's already been lots of advice in this thread about where you can get support.

Step Eight: Talk to his support team. If you notice any changes in the way he interacts with you, report these. These are interesting and useful bits of information that they are unlikely to get any other way.

I'm sorry you and your brother are going through this. It's probably not the first time and it probably won't be the last. You and he are both doing incredibly difficult and painful things. You're being a good sister and you deserve recognition for that. You're unlikely to get any recognition from him until his meds kick in, so you have mine.
posted by dchrssyr at 9:35 AM on April 12

Also, this: NAMI
posted by dchrssyr at 9:52 AM on April 12

Until his medication starts to work all bets are off - his brain isn't functioning normally and you have to take everything he says with a pinch of salt. I think also it's too early to expect some kind of dialog where you can make him see you how feel when he says this stuff. He's in a psych ward for a reason.

dchrssyr has some good advice, esp to detach. His comments are part of the illness. Speaking as someone with a sibling with a chronic mental illness, it's easy to fall into the trap of putting their welfare first, and letting yourself get beat down by the situation. If his comments get too hurtful, its okay to remove yourself - and certainly find a therapist that has dealt with this situation and start talking to them, taking care of your feelings, too.

It's hard right now, and I know this all too well - but he's in the best place and hopefully things can only get better for him once he has a sound diagnosis and is on an effective treatment regimen.
posted by poissonrouge at 10:09 AM on April 12

Many family members have found the book Surviving Schizophrenia to be extremely helpful in understanding how to get on with a loved one who has schizophrenia. The author (E. Fuller Torrey) is a well-known physician/researcher who has a sister with schizophrenia, so the book benefits from his clinical and personal knowledge.
posted by jasper411 at 11:23 AM on April 12

Since he was also abusing substances you may also want to look into how the alcohol and narcotics anonymous groups work. They've got a lot of good info and support for both those with the problems and those around them. A lot of how they approach things is useful for family in dealing with problems like this.
posted by wkearney99 at 6:55 PM on April 12

Also, short visits. When people are in a very volatile emotional state, it just builds. Visit, bring him music, tell him you love him and hope he's making progress, and leave. Sometimes music is a more useful communication tool with someone who is cognitively impaired by mental illness. You can pick up an inexpensive music player if he doesn't have one.
posted by theora55 at 6:45 AM on April 13