Please help give me hope that downward spirals sometimes end.
April 9, 2015 7:49 PM Subscribe
I have a situation with a sibling who has been in trouble with mental health issues and general life stagnation for the past several years, and this year things have taken an ominous turn. Have you ever had a close friend or family member get into a really low functioning state/suffer from treatment resistant depression for a similarly long period of time and emerge from it successfully? If so, was there any particular trigger or thing that helped, or was it basically that they just decided not to live like that anymore? Can you give me anecdotes that might help me have hope for the future?
The snowflakes - this is really long, so skip to the questions at the end if you'd like. My sibling had a relatively normal childhood and teenage years, went to college and graduated with a good degree and got a job. Sibling suffered from depression during college, but definitely nothing very unusual. Sibling got a good job afterwards and worked it for a few years, but stopped working (in the context of changing careers)... and has never started again. For the first year or so the rest of the family would just ask how things were going and leave it at that, or send along job opportunities we saw.
It's now been I think about 4 years since Sibling last had this job, but things in their life have grown slowly more scary and anxiety provoking. At first, they were keeping busy with hobbies and volunteer work and doing some cool things, that lasted about two years. The next year, there started to be periods where Sibling was too depressed to do hobbies or volunteer work, and Sibling started dating a person who was incredibly mentally ill (severe borderline personality disorder, bipolar with psychosis, incredibly dysfunctional, on disability) and getting completely wrapped up in caring for that person and this person's very warped reality.
This past year has been when things have really started to get concerning. The significant other started Sibling on a heavy pot smoking habit, and I suspect that has played a role in worsening some of their psychiatric issues, as Sibling has been increasingly paranoid and borderline delusional. Before this point, you could definitely meet Sibling on the street and think they were a cool, very smart, pretty normal person. But during this time of things getting worse, it has become harder for my sibling to cover up their mental health issues, and they have started to lose control of personal hygiene (i.e. no showers/toothbrushing, even stopped with shaving and hair cuts now as far as I can tell), and have become irritable and very difficult to interact with at times. We can still go out sometimes or play games or hang out at family gatherings and have things be cool as long as we don't talk about certain topics, but if we get anywhere close to any of my sibling's pet controversies (let's say they are obsessed with 9/11 truth conspiracy, even though that's not it, it's something more common that unfortunately comes up in conversation a lot with current events). Once the controversy talk gets started, Sibling gets incredibly worked up and starts accusing everyone of being against them, becomes very condescending and mean and not like the Sibling I know and love. So it can be really hard to hang out at all because if this thing comes up, Sibling is a loose cannon and can say terrible things.
Sibling also does not answer emails, phone calls, or text messages regularly. Sibling has pretty much lost all their friends - there are still people who care, but Sibling has pushed them away. My family is very close knit, and we all live very close to one another, so family support has been extremely strong, but now is starting to break down, because one of my parents doesn't understand mental health issues very well (and can be stubborn) and has tried to talk about Controversial Issue with Sibling recently, with disastrous results. Sibling acted like a tantruming teenager (Sibling is in their early 30s), shouting "I hate you!" at our parent and now refusing to see or talk to them for a few months, which has caused both parents to be very sad. Sibling has also picked up a number of behaviors that are extremely different from how they used to act - lots of random casual sex, for example, or going out and getting arrested for stupid stuff (minor offenses), or and picking up a personal viewpoint that they never held before that many find offensive and getting in people's faces about it all the time for no particular reason. This person for whom I care about deeply and love very much is now so angry, so me-against-the-world, so difficult to reach. Yet underneath all the prickly exterior I can still see the sensitive, lovable, wonderful sibling I have always known before the mental health issues set in.
Sibling has been in therapy this entire time and has seen multiple therapists. Has tried many different medications and they clearly haven't worked - to the point where pretty much the only treatment left for their depression is ECT. Also, I think it's clear that my sibling is suffering from more than just depression at this point, I've seen many times on AskMe that people say depression doesn't mean you have to act like a jerk. I have a hard time telling if the rest is just pot-related paranoia/delusions and lack of motivation, or a personality disorder, or other mental health diagnosis like ADHD... or what.
This situation is terrifying to me for many reasons. I hate seeing my sibling suffer like this and turn into this other person who I don't know any more. I am constantly worrying about what my sibling might do because they are so unpredictable and suddenly can do something wild that gets them into big trouble and upsets my parents to no end. My parents are aging and won't be able to help support and take care of sibling forever - I fear this task will fall to me in coming years. Sibling wants to apply for disability, and I get scared that this means they will give up on ever getting better and just lie around on the couch smoking pot for the next 50 years. I have intrusive thoughts about Sibling committing suicide (although there has never been a suicide attempt or threat, it just seems a little too real a possibility after this continued downwards slide and unrelenting, treatment-resistant depression). I do see a therapist myself to talk about these fears and feelings, but I come to you, AskMe, with the following questions (as noted above and further elaborated):
- Have you ever seen someone fall deep into a mental health chasm in their 30s and then make a comeback? Stories of hope please. What caused the turnaround?
- How do I deal with the guilt and pain I'm having over this situation aside from the therapy I already get? I already regularly tell myself I cannot change my sibling, only my reactions to them, but I still frequently wish there was something I could do to help, or feel bad that I haven't been able to spend more time with them/feel like I should be able to say or do some magic thing to make them see the light and become rational and normal again. I also have times where I'm actually just really angry at Sibling, despite rationally knowing that they suffer from serious mental health issues, when they say cruel things that hurt me or my parents. There probably is no answer to dealing with this anger other than therapy, I presume.
- Does anyone know someone who succeeded in overcoming treatment-resistant depression, either with ECT or with ketamine or some other novel treatment?
Final notes: in case you are thinking my sibling is on other drugs aside from pot, I'm nearly certain that is not the case. I monitor my sibling's accounts in online forums that they shared with me many years ago, where they share all kinds of extremely personal information and I'm pretty sure they have no idea I'm online-following them. It's just the only way I get to see my sibling act like a normal person anymore (they pretend to be a normal person in their online forum persona), and I have a fear that at some point Sibling would discuss suicide concerns or plans for suicide online and somehow I will pick it up by following their posts. I am aware this might sound crazy but I want to be honest about how I feel confident there are no other drugs involved, just serious serious mental health issues. Also, if you comment that I ought to just stop communicating with my Sibling and hanging out with them, you'll be wasting your keystrokes, because that's never going to happen. That just isn't the way my family works. Cutting Sibling off is not an option for me. So I'd appreciate other types of answers if you've got them.
The snowflakes - this is really long, so skip to the questions at the end if you'd like. My sibling had a relatively normal childhood and teenage years, went to college and graduated with a good degree and got a job. Sibling suffered from depression during college, but definitely nothing very unusual. Sibling got a good job afterwards and worked it for a few years, but stopped working (in the context of changing careers)... and has never started again. For the first year or so the rest of the family would just ask how things were going and leave it at that, or send along job opportunities we saw.
It's now been I think about 4 years since Sibling last had this job, but things in their life have grown slowly more scary and anxiety provoking. At first, they were keeping busy with hobbies and volunteer work and doing some cool things, that lasted about two years. The next year, there started to be periods where Sibling was too depressed to do hobbies or volunteer work, and Sibling started dating a person who was incredibly mentally ill (severe borderline personality disorder, bipolar with psychosis, incredibly dysfunctional, on disability) and getting completely wrapped up in caring for that person and this person's very warped reality.
This past year has been when things have really started to get concerning. The significant other started Sibling on a heavy pot smoking habit, and I suspect that has played a role in worsening some of their psychiatric issues, as Sibling has been increasingly paranoid and borderline delusional. Before this point, you could definitely meet Sibling on the street and think they were a cool, very smart, pretty normal person. But during this time of things getting worse, it has become harder for my sibling to cover up their mental health issues, and they have started to lose control of personal hygiene (i.e. no showers/toothbrushing, even stopped with shaving and hair cuts now as far as I can tell), and have become irritable and very difficult to interact with at times. We can still go out sometimes or play games or hang out at family gatherings and have things be cool as long as we don't talk about certain topics, but if we get anywhere close to any of my sibling's pet controversies (let's say they are obsessed with 9/11 truth conspiracy, even though that's not it, it's something more common that unfortunately comes up in conversation a lot with current events). Once the controversy talk gets started, Sibling gets incredibly worked up and starts accusing everyone of being against them, becomes very condescending and mean and not like the Sibling I know and love. So it can be really hard to hang out at all because if this thing comes up, Sibling is a loose cannon and can say terrible things.
Sibling also does not answer emails, phone calls, or text messages regularly. Sibling has pretty much lost all their friends - there are still people who care, but Sibling has pushed them away. My family is very close knit, and we all live very close to one another, so family support has been extremely strong, but now is starting to break down, because one of my parents doesn't understand mental health issues very well (and can be stubborn) and has tried to talk about Controversial Issue with Sibling recently, with disastrous results. Sibling acted like a tantruming teenager (Sibling is in their early 30s), shouting "I hate you!" at our parent and now refusing to see or talk to them for a few months, which has caused both parents to be very sad. Sibling has also picked up a number of behaviors that are extremely different from how they used to act - lots of random casual sex, for example, or going out and getting arrested for stupid stuff (minor offenses), or and picking up a personal viewpoint that they never held before that many find offensive and getting in people's faces about it all the time for no particular reason. This person for whom I care about deeply and love very much is now so angry, so me-against-the-world, so difficult to reach. Yet underneath all the prickly exterior I can still see the sensitive, lovable, wonderful sibling I have always known before the mental health issues set in.
Sibling has been in therapy this entire time and has seen multiple therapists. Has tried many different medications and they clearly haven't worked - to the point where pretty much the only treatment left for their depression is ECT. Also, I think it's clear that my sibling is suffering from more than just depression at this point, I've seen many times on AskMe that people say depression doesn't mean you have to act like a jerk. I have a hard time telling if the rest is just pot-related paranoia/delusions and lack of motivation, or a personality disorder, or other mental health diagnosis like ADHD... or what.
This situation is terrifying to me for many reasons. I hate seeing my sibling suffer like this and turn into this other person who I don't know any more. I am constantly worrying about what my sibling might do because they are so unpredictable and suddenly can do something wild that gets them into big trouble and upsets my parents to no end. My parents are aging and won't be able to help support and take care of sibling forever - I fear this task will fall to me in coming years. Sibling wants to apply for disability, and I get scared that this means they will give up on ever getting better and just lie around on the couch smoking pot for the next 50 years. I have intrusive thoughts about Sibling committing suicide (although there has never been a suicide attempt or threat, it just seems a little too real a possibility after this continued downwards slide and unrelenting, treatment-resistant depression). I do see a therapist myself to talk about these fears and feelings, but I come to you, AskMe, with the following questions (as noted above and further elaborated):
- Have you ever seen someone fall deep into a mental health chasm in their 30s and then make a comeback? Stories of hope please. What caused the turnaround?
- How do I deal with the guilt and pain I'm having over this situation aside from the therapy I already get? I already regularly tell myself I cannot change my sibling, only my reactions to them, but I still frequently wish there was something I could do to help, or feel bad that I haven't been able to spend more time with them/feel like I should be able to say or do some magic thing to make them see the light and become rational and normal again. I also have times where I'm actually just really angry at Sibling, despite rationally knowing that they suffer from serious mental health issues, when they say cruel things that hurt me or my parents. There probably is no answer to dealing with this anger other than therapy, I presume.
- Does anyone know someone who succeeded in overcoming treatment-resistant depression, either with ECT or with ketamine or some other novel treatment?
Final notes: in case you are thinking my sibling is on other drugs aside from pot, I'm nearly certain that is not the case. I monitor my sibling's accounts in online forums that they shared with me many years ago, where they share all kinds of extremely personal information and I'm pretty sure they have no idea I'm online-following them. It's just the only way I get to see my sibling act like a normal person anymore (they pretend to be a normal person in their online forum persona), and I have a fear that at some point Sibling would discuss suicide concerns or plans for suicide online and somehow I will pick it up by following their posts. I am aware this might sound crazy but I want to be honest about how I feel confident there are no other drugs involved, just serious serious mental health issues. Also, if you comment that I ought to just stop communicating with my Sibling and hanging out with them, you'll be wasting your keystrokes, because that's never going to happen. That just isn't the way my family works. Cutting Sibling off is not an option for me. So I'd appreciate other types of answers if you've got them.
And yes, I know of someone who went through a dark period for a few years. They left college with no degree and were supported by their family, and due to lack of boundaries from parents they ended up living at home, becoming mostly a recluse, and gaining over 250 pounds. This was followed by drug addiction. They are doing somewhat better now - did a drug treatment program, finished the degree, and has a job now.
People are healthiest when they have to push against limits. Look at athletes (limits of diet and training) vs. obese people (no limits), or Marines (limits of behavior and duty) vs. homeless people (no limits), or business executives (limits of ruthless competition) vs. incompetent but un-fire-able employees (no limits). It sounds like someone's providing for your Sibling so that they don't have any limits. With no limits, the Sibling is going to look for different limits to push against. Unfortunately, these won't be the limits you want them to find. It sounds like Sibling is pushing the limits of civil behavior, and you'd prefer them to push against the limits of employment and self-improvement.
So: stop enabling Sibling. Stop paying for their apartment, food, etc. Once they've decided they want to make a change and are grateful for the support, give them help only as long as they try to improve. If they start taking the family's support for granted again, stop supporting them. Repeat as necessary.
posted by sninctown at 8:39 PM on April 9, 2015 [4 favorites]
People are healthiest when they have to push against limits. Look at athletes (limits of diet and training) vs. obese people (no limits), or Marines (limits of behavior and duty) vs. homeless people (no limits), or business executives (limits of ruthless competition) vs. incompetent but un-fire-able employees (no limits). It sounds like someone's providing for your Sibling so that they don't have any limits. With no limits, the Sibling is going to look for different limits to push against. Unfortunately, these won't be the limits you want them to find. It sounds like Sibling is pushing the limits of civil behavior, and you'd prefer them to push against the limits of employment and self-improvement.
So: stop enabling Sibling. Stop paying for their apartment, food, etc. Once they've decided they want to make a change and are grateful for the support, give them help only as long as they try to improve. If they start taking the family's support for granted again, stop supporting them. Repeat as necessary.
posted by sninctown at 8:39 PM on April 9, 2015 [4 favorites]
I'd be happy to share a story but not so much publicly. If you'd like, you can me-mail or e-mail (in profile). I'll honor your anonymity.
posted by Ufez Jones at 8:41 PM on April 9, 2015 [1 favorite]
posted by Ufez Jones at 8:41 PM on April 9, 2015 [1 favorite]
What Ufez Jones said.
posted by wonton endangerment at 9:26 PM on April 9, 2015 [1 favorite]
posted by wonton endangerment at 9:26 PM on April 9, 2015 [1 favorite]
I am not a psychiatrist, but this does not sound like depression to me. Getting arrested, random casual sex, getting in people's faces? Sounds like there may be something else going on. Perhaps bipolar disorder, or maybe something else.
Sometimes when someone has a diagnosis of treatment resistant depression, they have been misdiagnosed, and they really have bipolar disorder. People with bipolar disorder tend to experience more depression than mania, so this misdiagnosis is quite common. The sad thing is that antidepressants usually don't work for bipolar depression, and they can, in fact, make things worse.
One possibility is a new psychiatrist. Could you or a parent go with your sibling? Sometimes people with bipolar disorder have poor insight and aren't good at describing their symptoms and history. Friends and family can provide information that might help the psychiatrist arrive at an accurate diagnosis. If this really is bipolar disorder, proper treatment could make a big difference.
posted by islandeady at 10:06 PM on April 9, 2015 [8 favorites]
Sometimes when someone has a diagnosis of treatment resistant depression, they have been misdiagnosed, and they really have bipolar disorder. People with bipolar disorder tend to experience more depression than mania, so this misdiagnosis is quite common. The sad thing is that antidepressants usually don't work for bipolar depression, and they can, in fact, make things worse.
One possibility is a new psychiatrist. Could you or a parent go with your sibling? Sometimes people with bipolar disorder have poor insight and aren't good at describing their symptoms and history. Friends and family can provide information that might help the psychiatrist arrive at an accurate diagnosis. If this really is bipolar disorder, proper treatment could make a big difference.
posted by islandeady at 10:06 PM on April 9, 2015 [8 favorites]
I went through a time like this when I was in my late teens until my mid-twenties, so a bit different than your sibling but I can weigh in.
First of all, I DON'T agree with the idea that your sibling is some sort of spoiled malingerer who just needs limits. It's never that simple. No grown adult wants to be living the way your sibling does. It's not some sweet free ride in life. Being unable to support oneself as an adult because of mental health or addiction issues created profound feelings of shame for everyone I've known who has experienced this. But outside support is what kept them alive and able to recover. OP, I know you're identifying this as a mental health issue and you seem very caring but I just want to stress this point.
Re: Does anyone know someone who succeeded in overcoming treatment-resistant depression, either with ECT or with ketamine or some other novel treatment?
My experience with mainstream psychiatry in the U.S. (don't know where you're located) was that doctors just pile on the prescriptions for "treatment resistant" people. The extreme sedation, emotional volatility, and lack of motivation that had disabled me by my mid-twenties turned out to have been primarily a side effect of the prescription drugs I was taking. Weaning myself COMPLETELY off drugs was my "novel" treatment. You didn't mention what prescription drugs your sibling takes but it's worth looking at closely and I would be particularly concerned if they're taking any type of anti-psychotic (which have terrible side effects and are often given very casually for a myriad of issues that have nothing to do with psychosis.)
Finally, I know you're really worried about your sibling but secretly stalking their online communication is really violating. Again, I know you're concerned, but people with disabilities or difficult personalities deserve privacy too.
Feel free to memail me if you'd like to talk further.
posted by horizons at 10:28 PM on April 9, 2015 [14 favorites]
First of all, I DON'T agree with the idea that your sibling is some sort of spoiled malingerer who just needs limits. It's never that simple. No grown adult wants to be living the way your sibling does. It's not some sweet free ride in life. Being unable to support oneself as an adult because of mental health or addiction issues created profound feelings of shame for everyone I've known who has experienced this. But outside support is what kept them alive and able to recover. OP, I know you're identifying this as a mental health issue and you seem very caring but I just want to stress this point.
Re: Does anyone know someone who succeeded in overcoming treatment-resistant depression, either with ECT or with ketamine or some other novel treatment?
My experience with mainstream psychiatry in the U.S. (don't know where you're located) was that doctors just pile on the prescriptions for "treatment resistant" people. The extreme sedation, emotional volatility, and lack of motivation that had disabled me by my mid-twenties turned out to have been primarily a side effect of the prescription drugs I was taking. Weaning myself COMPLETELY off drugs was my "novel" treatment. You didn't mention what prescription drugs your sibling takes but it's worth looking at closely and I would be particularly concerned if they're taking any type of anti-psychotic (which have terrible side effects and are often given very casually for a myriad of issues that have nothing to do with psychosis.)
Finally, I know you're really worried about your sibling but secretly stalking their online communication is really violating. Again, I know you're concerned, but people with disabilities or difficult personalities deserve privacy too.
Feel free to memail me if you'd like to talk further.
posted by horizons at 10:28 PM on April 9, 2015 [14 favorites]
THERE IS NOT A MAGIC THING YOU CAN DO OR SAY TO MAKE YOUR SIBLING BETTER.
But of course you have to hope, and you have to try. And yes, sometimes people get better. I do agree with islandeady that your sibling sounds much more like someone with bipolar disorder than some who is depressed. Here are my specific experiences, for what they're worth:
My son became more and more obsessive and paranoid in his late 30's. He was able to hold a job (a very particular job with an unusual skill set, where he did not have to interact all that much with people), but he spent all of his free time on the internet, on crazy sites (really crazy sites) and smoking huge amounts of marijuana. Finally, one night at 3 a.m. he burst into our bedroom, saying people were trying to kill him, he had just paid two hitmen $100 each to not kill him, but he had to leave town. Two weeks of torture followed. He moved into our house, he was terrified, I could not find a psychiatrist who could see him in less than a month .... and then he tried to kill himself. Seriously tried to kill himself, using a Leatherman tool to slash his throat, his arms, his thighs. We found him, and were told in the ER that 30 minutes later and he would have bled out. We found him because I was in the middle of talking to a psychologist to see if she might help him when I found myself standing up and saying "I have to go," and going straight home. It was a miracle, but having a miracle happen did not make things one bit easier.
He spent three weeks in a locked mental ward in a hospital. He came home to stay with us. Like horizons, he decided he had to get better without drugs; that was his "novel" treatment. After a couple of months, he moved to a friend's farm -- still paranoid, still delusional, but less desperate. The farm was isolated, so he felt safe, and working with growing things and animals for two years helped bring the healing he needed. It's been eight years since the suicide attempt, and he's solid and steady and loving. He also spends a lot of time mountain biking, particularly when there are difficult issues in his life. Any exercise would work, I think, especially if it's outside.
And my second story, perhaps not as close to your situation. My ex-brother-in-law had a breakdown at the age of 17 (taking off clothes, going to park, screaming at the trees). He was put on anti-psychotic medications. He spent the rest of his life going off his meds, acting out, back in a hospital, back out, back off his meds.... He never held a job, or had much of a life. In his late 50's he met a woman he had known in his 20's, during one of his on-his-meds periods. She was divorced, with grown children, successful and wealthy. They got together, a bit at a time, and now live together by the water; she works (and keeps him on his meds, I'm guessing) and he takes care of her and their home. My daughter saw him at his father's funeral. He confided in her, "I can't believe my life. I never thought this could happen. I love her. She loves me. And the sex is so great!"
So there you are. Things change. People can heal. People do heal. What you can do -- all you can do, actually -- is continue to love them. No one ever explained to a mentally ill person that if they acted differently they would be well, and they listened and then they were well. No one ever tried being strict with a mentally ill person and that straightened them right out.
I really recommend two books by Mark Vonnegut (yes, Kurt's son); they're about his struggles with mental illness, and they're brilliant. "The Eden Express" and "Just Like Someone Without Mental Illness Only More So."
It's so much pain to see a sibling in distress, but my brother was in a crash that left him a quad, and then he died, and live suffering sibling is much much better than gone for good sibling. Wishing you well, and offering a virtual hug.
posted by kestralwing at 2:21 AM on April 10, 2015 [14 favorites]
But of course you have to hope, and you have to try. And yes, sometimes people get better. I do agree with islandeady that your sibling sounds much more like someone with bipolar disorder than some who is depressed. Here are my specific experiences, for what they're worth:
My son became more and more obsessive and paranoid in his late 30's. He was able to hold a job (a very particular job with an unusual skill set, where he did not have to interact all that much with people), but he spent all of his free time on the internet, on crazy sites (really crazy sites) and smoking huge amounts of marijuana. Finally, one night at 3 a.m. he burst into our bedroom, saying people were trying to kill him, he had just paid two hitmen $100 each to not kill him, but he had to leave town. Two weeks of torture followed. He moved into our house, he was terrified, I could not find a psychiatrist who could see him in less than a month .... and then he tried to kill himself. Seriously tried to kill himself, using a Leatherman tool to slash his throat, his arms, his thighs. We found him, and were told in the ER that 30 minutes later and he would have bled out. We found him because I was in the middle of talking to a psychologist to see if she might help him when I found myself standing up and saying "I have to go," and going straight home. It was a miracle, but having a miracle happen did not make things one bit easier.
He spent three weeks in a locked mental ward in a hospital. He came home to stay with us. Like horizons, he decided he had to get better without drugs; that was his "novel" treatment. After a couple of months, he moved to a friend's farm -- still paranoid, still delusional, but less desperate. The farm was isolated, so he felt safe, and working with growing things and animals for two years helped bring the healing he needed. It's been eight years since the suicide attempt, and he's solid and steady and loving. He also spends a lot of time mountain biking, particularly when there are difficult issues in his life. Any exercise would work, I think, especially if it's outside.
And my second story, perhaps not as close to your situation. My ex-brother-in-law had a breakdown at the age of 17 (taking off clothes, going to park, screaming at the trees). He was put on anti-psychotic medications. He spent the rest of his life going off his meds, acting out, back in a hospital, back out, back off his meds.... He never held a job, or had much of a life. In his late 50's he met a woman he had known in his 20's, during one of his on-his-meds periods. She was divorced, with grown children, successful and wealthy. They got together, a bit at a time, and now live together by the water; she works (and keeps him on his meds, I'm guessing) and he takes care of her and their home. My daughter saw him at his father's funeral. He confided in her, "I can't believe my life. I never thought this could happen. I love her. She loves me. And the sex is so great!"
So there you are. Things change. People can heal. People do heal. What you can do -- all you can do, actually -- is continue to love them. No one ever explained to a mentally ill person that if they acted differently they would be well, and they listened and then they were well. No one ever tried being strict with a mentally ill person and that straightened them right out.
I really recommend two books by Mark Vonnegut (yes, Kurt's son); they're about his struggles with mental illness, and they're brilliant. "The Eden Express" and "Just Like Someone Without Mental Illness Only More So."
It's so much pain to see a sibling in distress, but my brother was in a crash that left him a quad, and then he died, and live suffering sibling is much much better than gone for good sibling. Wishing you well, and offering a virtual hug.
posted by kestralwing at 2:21 AM on April 10, 2015 [14 favorites]
It sounds to me like your family is enabling your sibling's behavioral pattern by allowing them to continue ignoring their own well-being.
posted by deathpanels at 4:48 AM on April 10, 2015 [1 favorite]
posted by deathpanels at 4:48 AM on April 10, 2015 [1 favorite]
Just jumping in to say that major depressive disorder can induce psychosis. It sounds as if your family is in a lot of pain. I'm so sorry.
posted by batbat at 5:59 AM on April 10, 2015
posted by batbat at 5:59 AM on April 10, 2015
I have seen someone in their 50's go on a downward spiral and get treatment (ECT, followed by meds, when regular meds like SSRI's did not work). They had several misdiagnosis's, like depression and ADHD, when it was really more like a bipolar thing, non-stop talking, following people down the road who cut them off (luckily, did not engage in any violence, but following someone for several miles out of their way to yell at them, stopping in intersections and getting out and yelling), smoking lots of pot, and yes, there are people who will take advantage of someone who is mentally ill.
Now this person is working full time and has a stable relationship. Their new partner is a nurse so maybe makes sure they take meds. The ECT was at least two rounds, a year apart.
Also another person who did have ECT at least twice, several years apart, along with another series of misdiagnoses and going off meds because they didn't think they needed them.
Does your town have anything like a mental health crisis team? Like, can they be taken to the ER for evaluation if they do something off the wall?
Also, mental illness is an illness. If your sibling needs disability to survive, help them get it. It can take a long time to be approved. I know someone on disability and while this person gets unstable from time to time, their parents do not have to pay for their medical bills or apartment. Why would you want to financially burden your parents or your future self like this, because you seem to think it's a moral failing to be mentally ill? Which is it? Mental illness or laziness? Trust me, the government won't give disability to someone if they do not qualify, and it can involve a few years of lawyers going back and forth, or it can be faster if it is very clear cut.
A lot of times, if someone is on disability for a mental illness, they have to have someone else manage their money. That could be a family member or someone else, if no one is willing. They also have a caseworker. And once someone is able to work, they don't get it anymore. Tho' you are allowed to work limited hours.
I also encourage you to talk to someone at NAMI. And see if your state has a warm line, either for you or your sibling to talk to when things get rough.
At this point, it's not up to your parents, or even you. It's up to your sibling if they want to apply for disability. At least that is a choice to do something. It's better than picking up a needle. And the doctors and treatment facilities know that people with mental illness tend to smoke pot, drink, and do drugs. Sometimes the patients have to go through illegal drug testing.
I would keep looking at doctors, not just therapists, although therapy can be helpful. It sounds like something is not right with his/her brain. Make sure they tell the doctor about the paranoia and anger. I guess pot could be a part of it, but no one will know unless they stop it for a while.
And it's okay to step back and take a break. Limit your contact, set some boundaries ("hey, I won't be sticking around for this, call me when you've calmed down"). Take it one step at a time, this could be a long haul thing for you and your family. The first step is getting a proper diagnosis or a revisit of the current one, because drugs for depression can really mess up say, someone with bipolar. And ADHD drugs can do the same thing (triggered one of the ECT episodes with a 6 week hospital stay, so don't wish that on them either). Good luck to you and your sibling and your family. I know it's rough.
posted by Marie Mon Dieu at 8:01 AM on April 10, 2015 [1 favorite]
Now this person is working full time and has a stable relationship. Their new partner is a nurse so maybe makes sure they take meds. The ECT was at least two rounds, a year apart.
Also another person who did have ECT at least twice, several years apart, along with another series of misdiagnoses and going off meds because they didn't think they needed them.
Does your town have anything like a mental health crisis team? Like, can they be taken to the ER for evaluation if they do something off the wall?
Also, mental illness is an illness. If your sibling needs disability to survive, help them get it. It can take a long time to be approved. I know someone on disability and while this person gets unstable from time to time, their parents do not have to pay for their medical bills or apartment. Why would you want to financially burden your parents or your future self like this, because you seem to think it's a moral failing to be mentally ill? Which is it? Mental illness or laziness? Trust me, the government won't give disability to someone if they do not qualify, and it can involve a few years of lawyers going back and forth, or it can be faster if it is very clear cut.
A lot of times, if someone is on disability for a mental illness, they have to have someone else manage their money. That could be a family member or someone else, if no one is willing. They also have a caseworker. And once someone is able to work, they don't get it anymore. Tho' you are allowed to work limited hours.
I also encourage you to talk to someone at NAMI. And see if your state has a warm line, either for you or your sibling to talk to when things get rough.
At this point, it's not up to your parents, or even you. It's up to your sibling if they want to apply for disability. At least that is a choice to do something. It's better than picking up a needle. And the doctors and treatment facilities know that people with mental illness tend to smoke pot, drink, and do drugs. Sometimes the patients have to go through illegal drug testing.
I would keep looking at doctors, not just therapists, although therapy can be helpful. It sounds like something is not right with his/her brain. Make sure they tell the doctor about the paranoia and anger. I guess pot could be a part of it, but no one will know unless they stop it for a while.
And it's okay to step back and take a break. Limit your contact, set some boundaries ("hey, I won't be sticking around for this, call me when you've calmed down"). Take it one step at a time, this could be a long haul thing for you and your family. The first step is getting a proper diagnosis or a revisit of the current one, because drugs for depression can really mess up say, someone with bipolar. And ADHD drugs can do the same thing (triggered one of the ECT episodes with a 6 week hospital stay, so don't wish that on them either). Good luck to you and your sibling and your family. I know it's rough.
posted by Marie Mon Dieu at 8:01 AM on April 10, 2015 [1 favorite]
Sorry, meant to say the 2nd person finally started taking their meds regularly when family members said, "look, not going through this again. Take your meds or we're outta here." And this was after many years of the same thing, repeated over and over. Stopping meds, mania or psychotic depression, arrests, hospitalizations, ECT or redoing meds, before they finally realized, "hey, I have to take my pills every day or something bad will happen." Not that meds are always some miracle, but they can be the difference between someone being non-functional to being mostly functional.
posted by Marie Mon Dieu at 8:36 AM on April 10, 2015
posted by Marie Mon Dieu at 8:36 AM on April 10, 2015
As someone with pretty severe bipolar disorder (with psychosis, medicated and doing ok now) and with other family members who have struggled with mental illnesses I probably cannot express enough how much I disagree with sninctown. It is absolutely not as black and white as the term 'enabling' is suggesting. I think you are aware of this, though, and it sounds like you are making a lot of decisions very carefully in the way that you're trying to help.
If you want to send me a memail I'd be happy to talk to you about my own experiences as someone with a mental illness, but it would maybe be more helpful to talk about my relative with schizophrenia, who I have seen struggle with it her entire life. The super brief summary is that she was in a very dark place that has definitely gotten brighter, but if the details might help you shoot me a message, I will respect your anonymity.
I'm not your sibling but you have no idea how much I appreciate how much you care about them to try to help so much.
posted by nogoodverybad at 9:24 AM on April 10, 2015 [4 favorites]
If you want to send me a memail I'd be happy to talk to you about my own experiences as someone with a mental illness, but it would maybe be more helpful to talk about my relative with schizophrenia, who I have seen struggle with it her entire life. The super brief summary is that she was in a very dark place that has definitely gotten brighter, but if the details might help you shoot me a message, I will respect your anonymity.
I'm not your sibling but you have no idea how much I appreciate how much you care about them to try to help so much.
posted by nogoodverybad at 9:24 AM on April 10, 2015 [4 favorites]
It sounds to me like your sibling has bipolar or schizoaffective disorder. I'm not a doctor; I'm just a person who had a brother who was similarly affected.
You can me-mail me if you like. I'd just like to add that encouraging a person in the throes of mental illness to go off their medication is dangerous. I know it works for some people. But it does not work for everyone and it can have disastrous consequences.
I encourage you to get your own therapy. You cannot allow your sibling's illness to consume you, but you can learn how to set reasonable boundaries for yourself and also be compassionate toward your sibling. They have a disease. The disease is not rational. It is no one's fault. It's sad, horrible and unfair for everyone, most especially your sibling.
Good luck.
posted by TryTheTilapia at 9:32 AM on April 10, 2015 [2 favorites]
You can me-mail me if you like. I'd just like to add that encouraging a person in the throes of mental illness to go off their medication is dangerous. I know it works for some people. But it does not work for everyone and it can have disastrous consequences.
I encourage you to get your own therapy. You cannot allow your sibling's illness to consume you, but you can learn how to set reasonable boundaries for yourself and also be compassionate toward your sibling. They have a disease. The disease is not rational. It is no one's fault. It's sad, horrible and unfair for everyone, most especially your sibling.
Good luck.
posted by TryTheTilapia at 9:32 AM on April 10, 2015 [2 favorites]
The severity of the situation makes me wonder whether your sibling would benefit from inpatient treatment. I have witnessed my friend's 40-something sibling with BPD suffer a breakdown (psychosis) and improve greatly from several months of inpatient treatment.
I am glad cutting them off isn't an option for you and I'm sad this is so hard for you. I wonder if there is any way you can work, in therapy, on compartmentalizing this problem? It is so much bigger than you, so beyond your control, that you might be damaging your own mental health by taking it on so fully, though of course I unsderstand your love and concern for your sibling means you'll always want to fix it.
posted by kapers at 10:23 AM on April 10, 2015 [1 favorite]
I am glad cutting them off isn't an option for you and I'm sad this is so hard for you. I wonder if there is any way you can work, in therapy, on compartmentalizing this problem? It is so much bigger than you, so beyond your control, that you might be damaging your own mental health by taking it on so fully, though of course I unsderstand your love and concern for your sibling means you'll always want to fix it.
posted by kapers at 10:23 AM on April 10, 2015 [1 favorite]
I don't have a story of hope for you (20+ years of on and off stability, some of those stable periods lasting for years), but I do want to encourage you to find a way forward that includes taking care of yourself. Especially in those times when you have no idea what your sibling might do and sibling is behaving aggressively towards family members. That shit is overwhelming and can send stress fractures in every aspect of familial relations. I think it's great that you're already addressing this in therapy. I might come across as detached in the rest of my answer, but I identify with all of the complicated feelings you put forth in your question.
In my family I'm pretty sure I'm the only one who has lost hope for my sibling. Everyone else is convinced that sibling just hasn't had the right treatment/diagnosis/support/medical insurance (we're in the US)/pick your theory. I sort of see us all at different points in a grieving process as we let go of the idea of who sibling was going to be.
As difficult as it is for my parents, after the most recent episode, we are all stepping back. The pattern with sibling is that if you help during the down times, you are first in the line of fire of paranoid accusations during the up times. It seems like your situation is a little different.
The way I see it, the best situation for sibling at this point in life is to figure out a way to function as an adult without my parents' help because they won't be around forever. Also, I suspect my parents help is a trigger of sorts in the bad times. Realistically this probably means hoping that sibling is able to get on disability (not sure where sibling is at with that). Sibling is not going to have the middleclass-ish life that the rest of us have and that my parents were previously providing. One of my parents grew up poor and this is a really difficult thing to accept about their child.
With respect to drug use, do you think it's possible your sibling is self-medicating to some extent rather than the drugs causing the situation? My sibling will drink during the up times and I just sort of assume that is to slow down their racing brain.
posted by mandymanwasregistered at 1:15 PM on April 10, 2015 [1 favorite]
In my family I'm pretty sure I'm the only one who has lost hope for my sibling. Everyone else is convinced that sibling just hasn't had the right treatment/diagnosis/support/medical insurance (we're in the US)/pick your theory. I sort of see us all at different points in a grieving process as we let go of the idea of who sibling was going to be.
As difficult as it is for my parents, after the most recent episode, we are all stepping back. The pattern with sibling is that if you help during the down times, you are first in the line of fire of paranoid accusations during the up times. It seems like your situation is a little different.
The way I see it, the best situation for sibling at this point in life is to figure out a way to function as an adult without my parents' help because they won't be around forever. Also, I suspect my parents help is a trigger of sorts in the bad times. Realistically this probably means hoping that sibling is able to get on disability (not sure where sibling is at with that). Sibling is not going to have the middleclass-ish life that the rest of us have and that my parents were previously providing. One of my parents grew up poor and this is a really difficult thing to accept about their child.
With respect to drug use, do you think it's possible your sibling is self-medicating to some extent rather than the drugs causing the situation? My sibling will drink during the up times and I just sort of assume that is to slow down their racing brain.
posted by mandymanwasregistered at 1:15 PM on April 10, 2015 [1 favorite]
You could be my sister. Almost. I'm not sure if my sister would describe me as paranoid or delusional, but the rest is certainly the same -including the fears of my impending death. Did I reach a 'low functioning state'? Yes. Did I emerge successfully from it? Yes.
Was *my* (younger) sister able to see this? No. We no longer talk, because when I was in a 'low functioning state' some weird power dynamics took place. While that doesn't answer your question - and I want to be very clear that I am in no way ascribing this dynamic to your situation - I want to talk about this loss, in the context of emerging from a very dark place and time. It's a part of the larger story and it makes me very sad. Maybe it can serve as a warning.
Here's what I feel happened with her. Her fear of my impending death caused her to pull away from me, and keeps her from getting close to me now. My 'low functioning' also created a stronger sense of superiority and a very paternalistic attitude related to my choices. (She's not mentally ill, so she knows what my life should be like better than I do, and gets angry when I do my own thing. This includes her thoughts on my marriage, choices in where my wife and I live, our decision to procreate, and my friendships).
As for your question:
Some people get better, some people get worse. While people are basically the same, we are also recognized as individuals. Mental well-being is included in that variation. There are a ton of similarities, and some treatments work more reliably for some issues than others.
Like Horizons, my 'novel' treatment was to get off all meds. I would never have done so, if I didn't have a life-threatening reaction, because doctors had explained that I'd need meds for the rest of my life. This proved to be very untrue. But medication or lack there of, is only part of the story, and not the solution for everyone.
In my mid-20's, I hit a brick wall in terms of 'adulting'. Like I said before, my sister's description of me of me was much like yours. And it's a fair description.
So I sought help. When one medication didn't work, the doctors added another and another. Each one affected my brain and created side-effects. In my specific case, medications were like giving stronger antibiotics for the flu, they simply didn't work, and in many ways, I feel that they made me worse.
When the meds were discontinued, I began to improve. I wasn't muddled by the chemicals, and returned to my 'normal' before I sought help. Only, I'd learned a bunch of therapeutic skills along the way.
These skills helped me realized how my struggles kept coming back to issues I had as a kid. Things that- despite a gifted classification- I had an IEP and intensive special education for. It never occurred to me that these issues could impact my daily life and psychiatry doesn't do LD well. I demanded retesting, and while my mental health was fairly standard but my cognitive scores were all over the spectrum.
Today, I'm still considered disabled. I take medication for adhd and received skills training for learning disabilities. The stuff I needed to cope with life on a daily basis. The other differences, how I think and process information, I learned accept as part of me, just different, not disordered.
I'm married, I have a good life. I finished college. I'm happy and fairly stable. I'm looking forward to what's next.
Unfortunately, like I said in the beginning, my sister sees that I'm not working, believes I found an excuse, and is angry that I "won't live life right". While she generally avoids me, occasionally she gets angry enough to try to take me to task, often involving 'interventions' (triangulation) w/other family members.
For me, part of being healthy, involves not tolerating relationships where people demean or speak down to me. So, I called her on it. We both reacted poorly, hurling accusations at each other, and haven't spoken sense. She says she refuses to "enable my sick behavior" and that I need "consequences for not living right" and I think she needs to acknowledge my competency, even if I am on "welfare". I hope that this will one day we will move past this, but am not holding my breath.
posted by bindr at 3:58 PM on April 10, 2015 [2 favorites]
Was *my* (younger) sister able to see this? No. We no longer talk, because when I was in a 'low functioning state' some weird power dynamics took place. While that doesn't answer your question - and I want to be very clear that I am in no way ascribing this dynamic to your situation - I want to talk about this loss, in the context of emerging from a very dark place and time. It's a part of the larger story and it makes me very sad. Maybe it can serve as a warning.
Here's what I feel happened with her. Her fear of my impending death caused her to pull away from me, and keeps her from getting close to me now. My 'low functioning' also created a stronger sense of superiority and a very paternalistic attitude related to my choices. (She's not mentally ill, so she knows what my life should be like better than I do, and gets angry when I do my own thing. This includes her thoughts on my marriage, choices in where my wife and I live, our decision to procreate, and my friendships).
As for your question:
Some people get better, some people get worse. While people are basically the same, we are also recognized as individuals. Mental well-being is included in that variation. There are a ton of similarities, and some treatments work more reliably for some issues than others.
Like Horizons, my 'novel' treatment was to get off all meds. I would never have done so, if I didn't have a life-threatening reaction, because doctors had explained that I'd need meds for the rest of my life. This proved to be very untrue. But medication or lack there of, is only part of the story, and not the solution for everyone.
In my mid-20's, I hit a brick wall in terms of 'adulting'. Like I said before, my sister's description of me of me was much like yours. And it's a fair description.
So I sought help. When one medication didn't work, the doctors added another and another. Each one affected my brain and created side-effects. In my specific case, medications were like giving stronger antibiotics for the flu, they simply didn't work, and in many ways, I feel that they made me worse.
When the meds were discontinued, I began to improve. I wasn't muddled by the chemicals, and returned to my 'normal' before I sought help. Only, I'd learned a bunch of therapeutic skills along the way.
These skills helped me realized how my struggles kept coming back to issues I had as a kid. Things that- despite a gifted classification- I had an IEP and intensive special education for. It never occurred to me that these issues could impact my daily life and psychiatry doesn't do LD well. I demanded retesting, and while my mental health was fairly standard but my cognitive scores were all over the spectrum.
Today, I'm still considered disabled. I take medication for adhd and received skills training for learning disabilities. The stuff I needed to cope with life on a daily basis. The other differences, how I think and process information, I learned accept as part of me, just different, not disordered.
I'm married, I have a good life. I finished college. I'm happy and fairly stable. I'm looking forward to what's next.
Unfortunately, like I said in the beginning, my sister sees that I'm not working, believes I found an excuse, and is angry that I "won't live life right". While she generally avoids me, occasionally she gets angry enough to try to take me to task, often involving 'interventions' (triangulation) w/other family members.
For me, part of being healthy, involves not tolerating relationships where people demean or speak down to me. So, I called her on it. We both reacted poorly, hurling accusations at each other, and haven't spoken sense. She says she refuses to "enable my sick behavior" and that I need "consequences for not living right" and I think she needs to acknowledge my competency, even if I am on "welfare". I hope that this will one day we will move past this, but am not holding my breath.
posted by bindr at 3:58 PM on April 10, 2015 [2 favorites]
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posted by sninctown at 8:19 PM on April 9, 2015