Help me get my little brother into Dialectical Behavioural Therapy.
March 2, 2012 8:42 AM   Subscribe

Help me get my little brother into Dialectical Behavioural Therapy. Or into anything.

My baby brother is 21 years old and suffers from borderline personality disorder. His life is an absolute nightmare. When in control he's a sweet, generous, nerdy kid, but he literally can't go more than a few hours without being sent spiralling into hysterical rage. Every day of his life is the worst day of mine.

He was officially diagnosed about five years ago, but is still recieving no treatment at all. Early on, he and his parents made sincere efforts. I had just assumed that for the last three years he had been held up in waiting lists and red tape. It now seems like the truth is, everyone has kind of given up. It's just too painful to try to help him. Particularly since he's given up on himself and will respond to any efforts with blind rage.

Help me. Give me something, anything I can do to help him into a proper treatment program. Dialectical Behavioral Therapy is, I've always understood, the treatment that actually works, the thing he should have started five years ago, but I know there are other tacts with positive track records. I don't care. Just a real program, not the generic talk therapy+zoloft package that is as close as he's ever gotten to help.


A) We are in Toronto, but going somewhere else... I mean, it won't be easy but it's not like any part of this will be. I can just wait until he inevitably gets kicked out of his apartment again.

B) I need to stress again that not only will he definitely not take any steps to help himself, but he'll actively be angry that I am trying - acknowleding that he is sick, as obvious at it is, makes him feel bad and anything that makes him feel bad makes his brain chemicals baking-soda-volcano. I understand that the onus is ultimately on him to help himself. But he is not well enough to do so, and is in pain. There's got to be something I can do.

Sorry to be anonymous, if there's any relevant data I'm missing, I'll post it or ask a mod to update depending on how courageous I'm feeling, but he reads Metafilter sometimes, and, you know. Brain volcano.
posted by anonymous to Health & Fitness (5 answers total) 1 user marked this as a favorite
Unless Canada is really different in this respect, I think the only way you'll be able to get him into treatment if he doesn't want to be is to have him legally declared incompetent, with you or other family acting for him. I know that in the U.S. this can be a long process, especially if the person hasn't done anything that causes physical harm to themselves or someone else. I'm sorry this is happening. Good luck.
posted by rtha at 9:50 AM on March 2, 2012 [2 favorites]

One piece of the solution might be to frame DBT (or similar mindfulness/CBT program) not as something for sick people, but as something that makes people MORE enlightened, super-powered, etc. than regular people? Maybe as something that you could start doing, and invite him to join you?

If you need to frame the program as some kind of problem-fixer, perhaps the problem could be your shared childhood upbringing -- that way he as your sibling would also be in a position to benefit. DBT can include this framing (this workbook does), although it's not central to the work you end up doing.
posted by feral_goldfish at 9:57 AM on March 2, 2012 [2 favorites]

I have different issues, but for me the key was how the issue was framed. So I'll describe the ways of looking at it that helped me swallow my pride and help myself, maybe they will help you in approaching your brother.

Acknowledging that oneself is sick is a double-edged sword. I know how difficult it is to apply a label like 'sick' or use a phrase like 'psychiatric problems' in regard to yourself, because you feel like you should be smart enough or strong enough to just FIX it, to get over it. To admit sickness is to admit failure to overcome the sickness.

But man, the day I figured out that the reason I've always had so much trouble dealing with things that other people seem to be able to handle 'normally' was that I had psychiatric problems that made those things extremely difficult for me and NOT because I was failing at life was a pretty important day.

Every accomplishment he has made in his life he made in spite of having an unusual and heavy weight hung around his neck. The breakdowns, the failures, the things that make you feel like you are a weakling compared to the forces of your life, when viewed taking into account the fetters that strong psychiatric problems burden you with, actually attest to your STRENGTH. If he has ever had any success or progress in any aspect of his life, and if he is still trying to figure it out, still running up against that brick wall even though it hurts like hell to run into every time, then that means he is quite strong.

Here's a question I wish someone had asked me along time ago: "When you're having a fit/avoiding social situations like the plague/overwhelmed by unpleasant feelings/exhibiting erratic behavior in front of people whose respect you want, do you LIKE it? Or are they the parts of your life that, when you think about it, you dread and hate the most?"

The answer is obvious, and the follow up is: "Well, you absolutely do not have to let those things run your life, and there are a lot of very concrete and effective things that can be done to fix it."

And think about getting him a book on his condition. I got a non-self improvementy sort of business-like book about my own, and it was a huge help to read the context of the disease and its evolutionary origins. When I read the chapter about social anxiety it was almost hilarious to read such an uncanny description of my lifetime's problems, and that killed the illusion for me that all of this was just my fault.

Best to you and your brother.
posted by TheRedArmy at 10:32 AM on March 2, 2012 [9 favorites]

First, I think you should look into help for yourself to develop coping skills when he rages at you. That would be a good way to build a network of professionals that can help your brother. The Ontario mental health system is terribly fragmented and difficult for a layperson to navigate without a professional advocate. Two large systems you may want to contact are CAMH in Toronto and Homewood in Guelph. They may be able to direct you what is available now. To get him in the system find our the contact number for the mental health crisis team (sorry, I am outside Toronto so I only know the local number). The crisis team is a social worker and specially trained police officer. Don't think "oh, this isn't a REAL crisis", because they are the ones to decide that. Call when he is raging, have them come around and suggest resources for you BOTH. It is a way to get in the system.

He is lucky to have someone care about him do much. Good luck.
posted by saucysault at 10:51 AM on March 2, 2012 [4 favorites]

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