How to get my brother some help and stop my family from falling apart?
November 26, 2005 3:44 PM   Subscribe

The Does-My-Brother-Need-Psychological-Help and How-To-Persuade-Him-To-Get-Some filter.

The setting: I am 24, my brother is 20, we've both been studying so live at home with our dad (we have another brother who no longer lives at home), and until recently, our mum.

The back story: In May (ironically on Mother's day), our mother went to the doctor with what she believed was a stomach virus. To cut a long story (very) short: less than 5 weeks later she died of a very agressive cancer.

To me, the enormity of this alone would warrant seeking out at least a few hours from a therapist (dad and I have had various help in this area), but my brother never admits to needing help, and his situation is getting pretty hard to deal with:

He's always had some of these tendancies but they are getting extreme:

*His mood is pretty inconsistent, some weeks he's fine, other weeks extremely grumpy, and is totally unpredictable day to day.
*He stays in his bedroom almost 24/7 (he just sat his exams, and now university is on break here in New Zealand until late Feb or early March, and is pretty much point blank refusing to get a holiday job [my other brother offered him some work, which he turned down]), he usually spends his whole day on his computer. (there is one person who can get him out of the house, and that's mum's best friend - although I did manage to make him take a walk with me a few days ago [minor triumph])
*He only grudgingly (and only sometimes) helps with anything around the house, and his bedroom is usually knee deep in debris (maybe not that unusual for someone his age?)
*He sometimes only showers about once or twice a week
*If dad or I try to have a conversation with him that he didn't start he gets this glazed look in his eye that says "I really don't care"
*He claims that he can't sleep, and usually stays up till 5 or 6am before going to sleep, and will then sleep till early afternoon.
*He usually eats almost nothing before 8 or 9pm, and then practically eats the whole cupboard.
*He meets any suggestion with negativity or open hostility. He's not physically violent, but he is often easily frustrated and verbally abusive. His temper swings in a heartbeat.
*Friends that he used to see and talk to often now seem not to call as often, which I hypothesise to be indicative of the way he treats them when they do call (he says almost nothing and gets off the phone as soon as possible). Perhaps not, but given his mood changes it seems a fair assumption.
*He had been exercising every day before mum got sick (he's quite overweight, and was losing weight at a rate of knots), but now seems to almost never. He says "I'm going to go for a run today", but unless he goes after we've gone out (I work shift work so am often home during the day) he doesn't go.
*If someone comes over (say, a relative), he refuses to come out of his room and say hello. He also refuses to go out and see anyone with us.

I feel like his behaviour is all geared towards keeping everybody at bay. His attitude, his weight, his hygiene, sleeping when everyone is awake, staying in his room, etc: If he can convince everyone that he doesn't care about them, and that he's the kind of person that nobody should care about, then maybe everyone will leave him alone, and he'll never have to care about anyone ever again. But (even though he makes me hopping mad), I don't buy it. He's a sensitive guy who doesn't know how to deal with the fact that the most important person in his life is gone. I don't want him to be grumpy and alone when he's old, but he's so hard to deal with that he's on track.

I think it's also fair to note that he never talks about mum, and I'm not sure whether he cries about it, but I haven't seen him cry since the funeral.

I know he's hurt badly because he will talk sometimes with mum's best friend, and she passes some info back to me. She's trying to help him but can't always be there for him, she's often overseas for several months of the year, and even when she's home he only speaks to her when she calls him. And even with the help she can give him, I think he could still benefit from professional advice and a helpful ear outside of the situation.

So, after all of that, the question is: am I wrong to think that he's not grieving healthily? I know that people grieve differently, but isn't this extreme? and how do I convince someone who is tightly shut in his shell to seek help that I feel he needs?

(wow, that's a long post, I've done some tweaking to cut out unnecessary stuff... so what's here is all stuff I think is needed info to the issue of my brother's mental health.... thanks for getting this far! and thanks in advance for any advice offered)
posted by anonymous to Health & Fitness (18 answers total)
Can you get him to go to a grief/support group....with you? You can use the old, "I need to go, and need your support, would you please help me by going with me." Other than that, I applaud your concern (and obvious love) for him--but it has been less than 6 months and the holidays (don't know if you all celebrated Christmas/New Year's together before your mother died) are a terrible time--particularly the first EVERYTHING without the person (first christmas, first birthday, first Mother's Day, etc. after the death). He might indeed be grieving differently. You can point out (with love) behaviors that might be destructive (is the sleep schedule hurting his schooling, etc.) but I wouldn't pathologize it to him (i.e. "I'm worried about your mental health").

Also, you didn't ask this, but....make sure you are not focusing on his grief to the exclusion of taking care of yourself during this difficult time, and paying attention to your own needs.
posted by availablelight at 4:04 PM on November 26, 2005

Men don't cry in this country unless they're some kind of girl. You know that. Your brother knows that. I knew that when my my mother died (also of cancer) and the pain manifested to others in the form of attempts to numb it all.


Yes, he needs help. It will take years to be over this, but after six months the worst should be past. Instead he shows all the signs of someone who is still badly depressed and not coming out any time soon.

I'm afraid I can't see any better method for getting him to seek help than bailing him up and haranguing him. The harangue would be around the discourtesy to you and your father, the disappointment your mother would feel if she knew, and the fact that you love him to bits and are worried sick by his stupid behaviour. He doesn't need to be told to "snap out of it" (he probably can't anyway) but he needs to be told to reach for assistance. If he doesn't need any help ("I don't need any help!"), why is he behaving like such a reject?

This isn't guaranteed of success, but it sounds as though you're treating him with kid gloves, which is just making it easier for him to persist in this counterproductive effort to disengage from life. Anyway, that's what I would do.

Maybe it doesn't have to be professional help though. Are there any relatives or friends of his you can call on to drag him out of his room, or visit him?

Good luck to you and your brother.
posted by i_am_joe's_spleen at 4:06 PM on November 26, 2005

Have you ruled out drugs?

Assuming so, you mention running. That could give you an opening. Exercise generally helps people with depression (even if only slightly,) and if it's something you can do together, you may find opportunities to broach the broader issues.
posted by ParsonWreck at 4:08 PM on November 26, 2005

On preview--if "mum's best friend" is the one person who can get him out of the house, make her your ally. Talk to her about your concerns. He may be more receptive to hearing them (and seriously consider suggestions for help for grief counseling, depression, etc.) from her than from a brother.
posted by availablelight at 4:08 PM on November 26, 2005

I think men grieve for longer than women but your brother sounds very depressed and I'd guess he would benefit from professional help. Perhaps he is unwilling to discuss your mother with an outsider or feels it would be disrespectful? Could you ask him that and try to work something out, maybe witha counselor who knew your Mom? In the meantime maybe you could talk about the good things you both shared with your Mom to try and get him to remember them instead of just the pain of losing her. I've always heard that the worst thing about a family member dying is that no-one wants to talk about them (to avoid upsetting you) and you can feel they are being forgotten.
posted by fshgrl at 4:15 PM on November 26, 2005

Based on what you've said, it sounds like a pretty clear case of depression. Often, the stigma attached to mental illness prevents people from accepting that one of their loved ones needs help (medical help!). There's a simple question to ask yourself: is something disrupting your brother's ability to perform major life functions? (Hygiene, eating, relationships, employment all fall in this category). As long as you're answering yes, you can be pretty sure that he needs some help. It's no different than if he'd broken his arms and couldn't feed himself.

It very well might just go away... sometime. How long is the real question. Will it be after he's wasted a semester at school? After he's dropped out? Will it get better before it gets worse, possibly to the point that he becomes suicidal? Don't just be hopeful, it's too risky.

I don't know what to tell you about how to confront him. It's likely that getting him to get help will be even more painful than watching him suffer. Make sure you have some definite goal, and stick to it until its met. (Stay the course! Don't cut and run!) A good goal would be that he starts seeing a psychiatrist or psychologist, and continues to do so until they agree that his condition's improved. Make sure your whole family agrees on this and is intent on seeing that it gets done.

Also, just as a warning that hopefully won't be needed: if he happens to become violent at any point, or starts to hurt himself, don't hesitate to call the police and have them take him to a hospital. If he gets to that point, he needs to be hospitalized.
posted by dsword at 4:26 PM on November 26, 2005

Another couple of things to consider.

It sounds as though you and your dad are managing OK now (and good for you). Maybe little bro is feeling resentful and puzzled at your apparent lack of concern. Maybe there's a little bit of compensation going on there.

I'll tell you something else. It sounds as though Mum's best friend is a woman, yeah? Bit of a surrogate mother figure?

After my mother died, I realised that she had always brokered the communication between me and Dad. That's one of the things mothers do, they reduce the friction between the men in their care. Over a period of months and years my father and I have started to talk a great deal more about our family, our lives, and what's going on inside. It's neat that you're feeling such love and concern for your brother, but maybe this is something your Dad needs to take responsibility for, and your brother may respond better, whether it's marching him down to the pub, or seeking his assistance in painting the roof, or a blatant "time we had a talk, son."

Anyway, change the family dynamic, and there'll be a change in your brother.
posted by i_am_joe's_spleen at 4:27 PM on November 26, 2005 [1 favorite]

One last thought about his friends. If they are also 20 year old boys, he will find it hard to tell them that he misses his mother. And they will (quite wrongly) be respecting any perception that he wants to be left alone. Does he have a best mate? Someone who maybe needs a word in their ear that now is not longer the time to back off?
posted by i_am_joe's_spleen at 5:24 PM on November 26, 2005

The sleep alteration, appetite changes, isolation, irritability, and lack of interest in formerly pleasing activities all sound like unhealthy adjustment to me. I think he could benefit from seeing a therapist, just as you do; the trick will be to convince him too.

One of the problem with depressed states is they are characterized by a lack of insight, feelings of shame and guilt, and hopelessness (as though nothing could help). This combination can make it hard to convince someone that anything can help. Have the conversation with him, then when you get to an impasse, make him look at this thread.

He'll see that a lot of folks believe that he could benefit from professional help.

I agree with enlisting his friends, his religious person, his teachers, his doctor, anyone whom you think might be able to get through to him. Ounce of prevention is worth a pound of cure here.
posted by ikkyu2 at 6:18 PM on November 26, 2005

Your brother is exhibiting classic signs of depression. I've been there. Your brother's symptoms are "oh-so-familiar" to me. After the death of my partner, I became a shut-in. Food, friends, showers and shaving meant nothing to me. I rarely answered the telephone. I literally lived on my sofa for six months -- just lying there -- no reading, no television!

In my case it was a coalition of friends who intervened -- and their help was the start of a journey out of the darkness of my depression. They arranged for a vacation. I left the cold of Boston for the warmth of Playa Blanca, Mexico. On my return -- and only on my agreement and after much hesitation and doubt (hey, I come from an old New England, Puritanical background in which the idea of seeking help from strangers is anathema) I started a course of "talk therapy." A year later I found that antidepressants were also in line.

As has been said above, you might consider marshalling your father, your mother's best friend and/or any of your brother's best mates in an effort to demonstrate your concern and support. Consider having a plan-of-action that includes a break from his current physical circumstances, as well as professional counseling.

Everyone's descent into the abyss is personal. Likewise, the ascent out is just as likely unique.

The simple fact that you are seeking advice indicates your concern, care and love for your brother. It appears as if it is time to take action in order to help him out.
posted by ericb at 6:36 PM on November 26, 2005

The things you describe could be suggestive of Major Depression or other mood problem.

Question: How many psychiatrist does it take to change a light bulb?

Answer: Only one, but the light bulb has to want to change.

When he's ready, get him to a doctor- better yet, a psychiatrist and/or a therapist.

Advice for entertainment value only. Not medical advice, just my opinion.

Thomas Meacham, MD
posted by INFOHAZARD at 7:12 PM on November 26, 2005

You've pretty much summarized my experiences after my divorce a few years ago, and yes, you are describing depression perfectly. It's a massive generalization, but men are rarely equipped with coping skills adequate for large, traumatic changes in their lives. We are not socialized to naturally share our inner thoughts and fears and anguish, and we tend to withdraw into isolation instead of communicating.

Something you should very much prepare yourself for: whoever attempts to intervene in your brother's situation (and it sounds like you're the one performing that role at present) will almost certainly become the focus of a great deal of resentment. It might help to understand that when / if this happens, it's not about you, it's about the fight or flight instinct; and since he's already performed the flight part of the process (withdrawing from everything and everyone he can), all that's left is fight.

The important thing (or at least, this was incredibly important to me) is to help him understand not only that he has a problem, but that he has a problem that is shared by almost 1 in 10 people, and for which there is a great deal of help available.

Something I'd suggest is perhaps going back to your own therapist to specifically talk about positive steps you can take to help your brother. There is also a wealth of helpful material about depression available on the net, and probably many support groups for those attempting to help a loved one through a state of depression.

Lastly: take hope from the fact that many people do overcome their depression. It takes time, an immense amount of love and patience from those who care about the person going through the experience, but it doesn't have to be permanent.

My thoughts are with you, your family and your brother.
posted by planetthoughtful at 7:39 PM on November 26, 2005

This does sound like depression.

The book How You Can Survive When They're Depressed : Living and Coping with Depression Fallout by Anne Sheffield was indescribably helpful to me when in a similar situation to yours. I'm not a self-help book person in the least, but this was incredibly practical and useful to both me and the depressed person in my life.
posted by jennyb at 8:29 PM on November 26, 2005

"Men don't cry in this country unless they're some kind of girl."
joe's_spleen, this is spot-on.

anon, after having gone through something similar, I'll just say this: a trouble shared really is a trouble halved. Sounds trite, but it's true.

I think the key to this is your mothers' friend. She'll be the one to convince him to do something about it. Once he's taken that first step and found that he can deal with the stigma of needing professional help - and platitudes don't help here; rightly or wrongly there is a stigma - then he'll start to open back up again.

I learnt to deal and open up to people, but I did it the hard way, by myself. It took years - years that I knew then I was wasting but didn't care; years that I now regret wasting. All because of that bloody pride, and fear, and stigma...

Unless he comes to you, there's bugger-all you can do - except be there waiting for him.
posted by Pinback at 2:54 AM on November 27, 2005

I'm afraid I can't see any better method for getting him to seek help than bailing him up and haranguing him.

This is bad, bad advice. Men are taught to feel that their emotions make them less of a man and create problems for other people. For a lot of men, the word "depression" carries a heavy stigma that marks them as a weakling. They believe they are supposed to suck it up and deal with it alone. If you harangue him for not being able to deal, you're just reinforcing the shame he must feel for not being able to just get on with his life. It's shame, not grief, that's keeping him in his room.

Instead, try connecting with him. Don't start by talking to him about depression or about his current behavior. The most useful thing you can do is try to talk to him about your own grief. Let him know that sometimes you feel just as bad as he does, and communicate to him that it's normal for him to be very affected by his mother's death. His way of dealing with his pain may not be healthy, but he's got to be able to admit that he's hurting before you can even begin to talk to him about seeking help.

Make it safe for him to express what he feels, avoid making him feel like he's got a "problem" for feeling bad, and maybe you can get to the point where you can start to suggest things he can do to feel better.
posted by fuzz at 3:13 AM on November 27, 2005

I think you need allies in this. There are different kinds of things that different people around anyone can due - different types of communication that are appropriate, different levels of familiarity and different levels of tolerance for excuses.

For instance for many siblings (male or female) it is probably not a good idea to say, "hey man you're disgusting and you smell!" But for a buddy, saying something that insensitive might be the norm - esp if the friend is good enough that your brother will understand that behind such a blunt statement there is a kind of caring that isn't easy to express openly between guys of that age.

Likewise with the friend - there are things she can say that it would be very difficult for you or your father to say. You can talk soothingly about depression, knowing that it alone isn't going to have the effect you want - and you can enlist the friend and his buddies (one or two I guess) to pass the same message in their different ways.

The trick in all of this might be to make sure that a consistent, firm message is being passed along by all of the different channels that are open to you.
posted by mikel at 5:54 AM on November 27, 2005

On mature consideration, only follow my advice if fuzz's approach doesn't work :)
posted by i_am_joe's_spleen at 1:12 PM on November 27, 2005

I'll be showing this page to mum's friend and my dad

Given what you said about your Dad and his new girlfriend, maybe edited highlights would help focus on the issue at hand.
posted by i_am_joe's_spleen at 8:03 PM on November 27, 2005

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