Living with a Family Mental Illness
February 15, 2014 6:43 AM   Subscribe

My younger brother has been living with a schizophrenia-like mental illness for about a year. It's hard for me to interact with him. I'm looking for perspectives from those who've had loved ones with mental illnesses, and books or other resources that will help me better relate to him.

My brother was an intensely moody teenager, and we grew distant while I was away in college and he was in High School. He stopped seeing most of his friends, barely graduated, and then dropped out of his first semester of college and was hospitalized. He was suffering from hearing voices and other delusions. That was a little more than a year ago. He didn't receive a specific diagnosis, but his symptoms are most similar to those of schizophrenia. He was originally prescribed a combination of anti-psychotic and anti-anxiety medications which he no longer takes. After a year of my parents trying to coax him to a psychiatrist he hated, he recently found one he gets along with better, and who is alright with him being unmedicated, though he still attends only rarely. I was away from home for a year, which was when he dropped out and was hospitalized..

I'm living at home between two different conservation corps jobs, and living with my brother is rough. There's a constant stream of domestic disputes and upsets - my brother refuses to go outside to smoke, he throws his trash outside the window, he cooks and leaves all the dishes out and burner on, he builds up laundry and old food in his room, and due to complicated family car logistics, his DUI arrest from a year ago landed a breathalyzer interlock in my car. None of these would be unbearably frustrating on their own, but recently they've been building up a bit on me. There's an endless series of dramas - last week he announced he wanted a one-way ticket to New Orleans (across the country; we went there once on a family vacation) where he said he would live on the streets till he found a job. When my parents told him they thought that was a bad idea, he got intensely frustrated and accused us of not having any faith in him. The idea seems dead, but there's a constant stream of family disputes that often involve my brother having unrealistic expectations or disordered thinking.

My brother is also very difficult to interact with - imagine a stereotypically surly teen turned up to eleven. He's terse, uncommunicative, and accusatory, and the few times I've had a longer conversation with him he's talked about his view of the world (which includes a lot of frightening religious delusions) and he got very upset that I didn't agree with him, though I was doing my best to engage him and be supportive. He gets very defensive and angry when you talk about his illness, or when you bring up something you'd like him to change. My mother talking to him about smoking in the house has made him start shouting on a number of occasions.

The situation is complicated a bit by our family business, which keeps our parents out for twelve hours of the day. When I'm away from home again in April, he'll be alone in the house again all day - which he has been before, but still makes me worried. I might come back for a few months this fall, but after that I might be leaving for the peace corps. I'm currently in the application process. I've been tempted to not go because of my brother, but I feel like I have to keep my own personal momentum going.

There's no immediate crisis that's prompted this question - my brother has been making gradual improvements, and recently started dishwashing at our family restaurant. He plays a lot of guitar. His psychiatrist is alright with him being unmedicated. His situation probably isn't going to change for a while. He's doing better but doesn't want to go back to school. We don't have enough money to send him to a residential program of some kind. Even though there's definitely been improvement since he was first hospitalized, and he is doing way better than a lot of people who have similar issues, but I still worry about him not being able to care for himself.

SO, metafilter, I'd love advice from people who've had loved ones with mental illnesses. How do you deal with the constant strain of someone who doesn't take care of themselves well? How do you relate to and support someone you love, but is consistently angry for reasons you don't understand? How do you deal with knowing that you won't always be able to support them? What books would educate me about mental health issues?

Thanks in advance for your thoughts and advice.
posted by anonymous to Human Relations (13 answers total) 6 users marked this as a favorite
I would suggest you get hooked up with NAMI, which is a great national organization for individuals with mental illness and their families. They have educational and support groups for families to learn how to help their loved ones and adjust to the idea of having mental illness in the family.

As a therapist, I thought the autobiographical book The Center Cannot Hold showed a good insight into the way hallucinations and delusions can affect somebody so strongly, and showed how one woman was able to persevere and have extremely good outcomes with help and medication.

Here are some links you might wish to check out for info on how to help your brother and support yourself:
Helping your family member
A Sibling's Guide to Psychosis
Helping a family member with schizophrenia
posted by gilsonal at 7:06 AM on February 15, 2014 [5 favorites]

Here's another recommendation for connecting with the local NAMI organization in your area. This organization was a godsend for my parents. The local NAMI will be able to give you and your family the kind of ongoing practical advice that you need, and have the resources to help you find the help you need. If there isn't a local NAMI group, there may be one nearby or as my parents did, you may want to consider starting a chapter where you are living (this is what my parents did along with a few other family members). my very best of luck to you in a very difficult situation.
posted by bluesky43 at 8:09 AM on February 15, 2014

My mom has bipolar.

How do you deal with the constant strain of someone who doesn't take care of themselves well? I wish there were an easy answer here. Mostly, I've gone on and lived my own life even when horrible shit was going down. I really advise you to do the same. So that peace core application? File it and go. Do not under and circumstances stay home because of your brother. You are not a psychiatrist and you are not equipped to help. Staying will not help him. It will only ruin your own life and make you resentful.

How do you relate to and support someone you love, but is consistently angry for reasons you don't understand? So basically I've been living with my mother's bd for 37 years in one form or another. The only thing that has helped is learning about her illness. Because when I understand it, I understand her behavior, and I can interact with her from a place of empathy rather than anger. In the darkest days, I didn't seek therapy for myself. I probably should have. I'll say this about shrinks: it's sort of nice to talk to them because they understand your family member's illness better than you do. Also there's no pity or shame in an interaction with a shrink. Which I feel with other people.


Also, it has taken me most of my life to figure this out: I give to my mother what I am able to give. And then I live my life. I try not feel guilty or angry about the things I couldn't give.
posted by bananafish at 8:31 AM on February 15, 2014 [1 favorite]

NAMI NAMI NAMI NAMI. I can't recommend them highly enough. I was part of an interesting group (possibly the first of its kind in NAMI) that had consumers and family members together. I don't know how common they are now, but it was a great help to me because I was both a consumer and a family member (my mother was bipolar and borderline). The Family to Family program is something you might be interested. It's more of an educational thing rather than an ongoing support group.

And the old phrase, put on your own oxygen mask first, really does apply here. You can't let your brother's illness stand in the way of your hopes and dreams.

Memail if you want to talk.
posted by kathrynm at 9:04 AM on February 15, 2014

As a professional in the field, I sort of hate your brother's psychiatrist at the moment.

The longer someone goes on without medication, the more intractable their positive symptoms become. And his wanting to move to NOLA and live on the streets? That right there is why the penal system is the biggest provider of mental health services in this country.

Your family can't stop him, and, depending on the judge you get, his frequently nearly burning the house down probably wouldn't meet the threshold of immediate threat (to him and the family) that would be necessary to legally intervene.

I know the laws are written so that people can't get locked up because their husbands say they won't do housework. But it's really hard to treat someone with a legit SPMI that has medication resistance and denial as part of their symptoms.

There is likely a medication or combo that would reduce his delusionals and paranoia and make life much, much safer for him and those around him. Don't give up on pushing for meds.
posted by The Noble Goofy Elk at 9:43 AM on February 15, 2014 [7 favorites]

One of the things bitter experience has taught me in dealing with mentally ill family members is always look after yourself first and police your boundaries religiously,
remember that though you may want to help there is possibly very little you can do, and sometimes the kindest thing you can do is let them be themselves away from you.
posted by Middlemarch at 9:45 AM on February 15, 2014 [4 favorites]

My uncle has schizophrenia, so while I have limited experience (I never lived with him for long periods), I would second the advice above. Concentrate on your own life and goals, don't make huge personal sacrifices for your brother, and do as much as you can while you are still living in the house to help get your brother on medication. Really the medication thing is your parent's responsibility, but if you feel like you want to help this is the factor that can help your brother manage his illness best and give him a shot at eventual independence. Perhaps it is time for your parents to speak with his therapist.

Taking legal action to have your brother "committed" or proscribed treatment is one option but would likely be very expensive and take months or years in the process. It would better to get the cooperation of your brother and his psychiatrist, if you can.

As far as being able to relate to your brother and continue to have a relationship with him, again agreeing with advice above about understanding his condition (via books, NAMI, etc). Your brother will probably never interact with you in the way a non-mentally-ill person would. Even with medication your brother may continue to be brusque, moody, and incapable of fully caring for himself. I know my uncle has never developed good personal hygiene or home-cleaning habits (he is now in his 60's and first diagnosed during college). Uncle has a housekeeper come in so that he has clean laundry and edible food in the fridge.

The biggest thing that has helped me to develop and maintain a relationship with my uncle is finding and cultivating a common interest. For us, it's reading: science fiction, and history of weird and unusual events and persons. Books give us conversational fodder, and give me an excuse to call him for a chat even when my objective is to check up and see how he's doing (Uncle has very little family and I will likely have to take on the role of caretaker when his step-mother dies). One great outcome of finding a mutual interest is that I discovered Uncle's sense of humor. He's incredibly smart and enjoys a good joke. It makes our otherwise-potentially-awkward conversations pleasant and has helped me to appreciate him.

Lastly, for your own mental heath and ongoing capacity to deal with the situation, you should move out as soon as you can. Either take the Peace Corps gig or if that falls through, move out and relocate in a different town if you can (or at least a different neighborhood if you live in a big city). It may sound callous of us to keep telling you to move out or move on, but it's the best possible way for you to be able to keep your life and goals intact, and also keep your head clear so you are able to help with the situation as much as you can. Living with your brother isn't going to help either of you.

Good luck, and best wishes.
posted by turtlegirl at 10:53 AM on February 15, 2014 [4 favorites]

Oh, and one more piece of advice: since he is an adult, can your brother file for disability benefits under social security? This will give him some income and may qualify him for other things like mental health services, housing, etc.
posted by turtlegirl at 10:56 AM on February 15, 2014 [2 favorites]

In addition to the recommendations above, it can be helpful to remember that your brother is doing horribly annoying things because he's mentally ill (rather than thinking that he's doing horribly annoying things and he's mentally ill).

Any chance he'd be willing to see a therapist, rather than or in addition to the psychiatrist? A new study has shown that therapy can be as effective as medication for managing schizophrenia symptoms.
posted by jaguar at 11:05 AM on February 15, 2014

I would not put your life on hold because of your brother's mental illness. The situation with his treatment doesn't sound like it's doing a lot toward helping him get better and you can't wait around for him to become cured when that most likely will never happen. I know he's your brother, but I would think about your own safety and your mental well-being. Your parents shouldn't be leaving you alone with him 12 hours a day (or him alone that long) but that is their problem and questionable decision-making. You don't explain how old you are, but I would definitely move out. Your parents are not handling this situation well and your brother is prone to fights and unpredictable behavior. You deserve to live in a home that is a safe sanctuary and you can't carry the burden of feeling like you need to fix this or take care of your brother. It's unfair and unreasonable.
posted by AppleTurnover at 1:09 PM on February 15, 2014 [1 favorite]

I'm sorry about your brother. I've had two very good friends with schizophrenia over the years and it's a terrible thing to deal with - for the person himself and everyone else.

By all means, get in touch with NAMI - they can help in ways you can't imagine.

But it's important to remember that your parents are undoubtedly doing the very best they can with an impossible situation. They have a restaurant business that keeps them busy all day every day - they can't just dump the business to stay home with your brother, after all. If they lose their business, they lose the only means of financial security they have - "they" including your brother.

Secondly, a person with schizophrenia who gets angry and doesn't want to be told what to do or to do things differently from what he's doing can be downright dangerous, especially when he's on no medications. What are his parents supposed to do, anyway? "Questionable decision-making"? What do your parents have to do with anything when he has the backing of his psychiatrist, who refuses to intervene even though your brother's illness is putting the whole family at risk?

If you're in your early 20s, you're not a little child and I'm sure your presence has been a great help to your parents since you've been home. I agree that you musn't even try to take responsibility for your brother's care over the long term and you musn't put your own life on hold indefinitely. But - he is your brother and he needs help, just as the folks you're intending to help with a stint in the Peace Corps do. I'd like to see you get busy right now, before you leave for the Peace Corps, and make an appointment with the psychiatrist, maybe for the whole family; it's time to push for some serious care or inpatient treatment rather than just expect this situation to do anything other than explode. You should also do all you can to help him get on Social Security Disability - and that's a BIG order, which will also involve his psychiatrist and a medical doctor. For his own safety, it would probably be helpful to have another physician's input as well as the psychiatrist's, anyway.

You're a fine brother, which shows in your desire to help him rather than just get away, and if you can help stabilize the situation before you leave, it will pay you back nicely later on when you can say (to yourself, even) that you did all YOU were able to do.

And hopefully, your brother will be in a safer situation. I wish you the best - all of you.
posted by aryma at 8:57 PM on February 15, 2014

Getting your brother committed may actually drive even more of a wedge between him and his family -- who, while not necessarily helping him manage his illness to perfection, are a sense of stability and connection. It's really, really important that he has someone who sees him on a regular basis (I'm talking during "normal" situations, not as a professional) who can casually note what's going on in his life from day to day. Is he better at certain times of the day? Do certain things or interactions come up more than others? That's why constancy is really critical.

If he gets committed, there's a good chance that -- like our friend with schizophrenia -- he will break that connection with his family because he no longer trusts them. And then our friend didn't even stay on medication for more than a couple of months.

I'm so sorry your family is part of this very difficult balancing act. NAMI and other groups like it can not only help you with strategies but help reduce the amount of hiding and stigma faced by those affected by mental illness. Then your family will hopefully be able to at least feel less of a burden by sharing your story with others.
posted by Madamina at 10:25 AM on February 16, 2014

Your situation is very familiar to me but I wasn't originally going to respond because I don't feel like I have great answers, but that's probably because there aren't any. However, on the off chance that it's at all helpful...

I do think that being unmedicated makes this more difficult than it might otherwise be. It's not always a magic bullet, my brother still has many of these issues and he does take medication, but there might be other factors at play such as initial misdiagnosis, taking the wrong meds, ruling out medications that might actually work because he wasn't taking them properly, etc. However, despite all of that, he would be worse without them. I also know many other people with mental illnesses who are fine when they are taking their meds, so it's frustrating that your brother's doctor is not concerned about medication being a goal.

Nth-ing what folks above said: NAMI is a good resource, signing up for benefits (disability, housing, social workers especially - sometimes they can be frustratingly incompetent but it can also reduce pressure about feeling like you have to worry about every little thing), and taking care of yourself. There's some guilt that comes with this, and for me, nowadays, it's more related to supporting my parents than it is about thinking my presence would have any big impact on my brother's treatment. I offer my support the best I can. It's tough enough that your brother's and parents' lives are basically dictated by the illness so don't underestimate the value for both you and your family of you living your life.

In regards to planning for the future, this was asked a little bit ago and might be helpful for you and your parents to think about:

As for your specific questions about how to deal with these things, maybe there are better answers, but for me, I kind of just don't. And I know that for the rest of my family, it's mostly a bunch of finger crossing that nothing _really_ terrible happens and dealing with the dramatic incidents as they happen the best you can. There are sleepless nights worrying about the future and a lot of imagining the worst. But, as with anything in life, there's not much that can be done worrying about the future. We try not to, but we do it anyway.

I have no good advice for dealing with someone who can be so volatile. I usually go with avoiding engaging on any topic too deeply and avoiding contentious topics (and of course, what comprises these is anyone's guess). Also, being able to walk away is helpful for your own sanity.

I don't have great suggestions for books to learn about the technical side of mental illness (I mostly learned this stuff on the internet and in psychology classes because I'm interested in it). I find that reading memoirs and even fiction relating to these issues is helpful for point of view and also for empathy. It can be extremely challenging to love someone with a mental illness. Also, I find it helpful for me to be involved in advocacy relating to mental health care and in eliminating the stigmatization of mental illness (even doing stuff like answering questions on MetaFilter).

Off the top of my head, I would recommend Crazy. It's part personal story about his son and part a look at WTF is wrong with mental health care in America.

Best of luck.
posted by wintrymix at 12:33 PM on February 18, 2014

« Older Does buying the Kindle Edition count towards...   |   How do I get these photos removed from the web? Newer »
This thread is closed to new comments.