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Dr John B
Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience:  PhD in Clinical Psychology, registered clinical psychologist.
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A good friend of mine mutters loudly and unselfconsciously

Customer Question

A good friend of mine mutters loudly and unselfconsciously to himself, including obsenities and shouting. I've noticed, in only a few minutes of searching online, that others have the same issue. It's become extreme and he is becoming increasingly alienated. Along with this has come in increasing disregard for his outward appearance and general acumen regarding eating and drinking hygine and accumulation of filth. I am very concerned about him and don't know where to start.


 


Also, I should mention, he is happy and driven to improve his life, he just can't accept that he's creating an obstacle with his behavior.

Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr John B replied 2 years ago.

Hi,

I'm sorry to hear of the situation. Just to clarify, do you consider the changes you are observing to be a departure from his previous condition/state? So, what would the comparison between now and 10 years ago be like? Also, have you noticed anything strange/unusual about his muttering (meaning the content not the fact that he is muttering)? Do you know if there is a family history of mental illness?

Customer: replied 2 years ago.

He's always been pretty loose with his behavior but it's gotten increasingly offensive. He's in total denial and considers it within the normal range of male behavior. He has transgendered leanings (since childhood) and becomes manic when offered an opportunity to act on his obsessive desire to dress behave like a woman openly. Ironic, huh? The muttering content is pretty standard for a mutterer, just way less selfconscious and offensively loud. As well, I think most people who mutter to themselves when alone aren't in denial about it, whereas he is.

 

His grandfather was a sexual deviant who, sadly, did molest him. His family is in denial yet, for the last few years of his grandfather's life, wouldn't allow any of the family children to be alone with him - thankfully. Too late for my friend...

 

I've wondered, lately, if the same condition that allowed his grandfather to behave so unacceptably and to create so much damage isn't the same condition that allows my friend to behave with such blindness toward the ramifications.

 

Other people in his life have suggested that he apply for disability but he is adamant that he can function productively. I believe this to be true but acknowledge that his behavioral barriers make it almost impossible. I believe that he can overcome them but I don't really know how to drive home the importance or help him create a regimine of self awareness and self-respect.

Expert:  Dr John B replied 2 years ago.

You raise an excellent point about the possible relationship between his grandfather's condition and his own.

Do you see any of his difficulties/problems occurring in areas that aren't social or relationship based? That is, are his difficulties limited to how he interacts with other people (poor hygiene would be included in this)?

Customer: replied 2 years ago.
Yes, they're prevasive. He's been studying auto-mechanics and, although his classmates receive him very well, his instructors have not. They've told him that he won't be employable due to the loud muttering, mostly, but also his appearance. I don't want him to become resigned to alienation. Btw, he's 60. One of his instructors suggested that he apply for disability and he was deeply hurt.
Expert:  Dr John B replied 2 years ago.
Has he ever seen film/video of himself in his current state? Often when we work with people who have impaired social skills (e.g. Asperger's Syndrome) we use real feedback (e.g. video or audio) to help a person understand how their behavior appearances to others.

My main query here would be whether you are observing a change in his psychological state (poor hygiene & deterioration in self care are often seen with the onset of some illnesses) or rather just a slowly developing behavior. I would recommend he undergo an assessment to at least rule out the former but I'm going to assume he might also find that suggestion offensive.

How did he respond when his instructors told him his muttering & appearance were inappropriate?
Customer: replied 2 years ago.

He was hurt/offended and chalked it up to eccentricity that they couldn't relate to. He often blames people for their negative responses to him, they're too macho and don't like him, they're flakey or stupid and are blaming him for something that's not his fault, etc. He recently stayed with me for a couple of days and I had to give him a laundry list of things that were unacceptable to my roommate, most prominently the muttering. I reminded him that we all share the sound environment and it's annoying when someone fills that environment with loud sounds, especially gutteral, raspy profanity.

 

He basically seems to be retreating further and further inside his own head. I'm warry of driving him to further introspection because he's already so blazingly neurotic. His neurotic tendencies are food for the withdrawl, an excuse for anti-social impulsive behaviors.

 

You mentioned that I might be right about a correlation between his and his grandfather's mental health, is there a particular disorder that fits both of those profiles?

 

What sort of disorder do you think he might have?

 

I don't think he would ever take med.s (although he smokes a great deal of marijuana). I'm not sure how to proceed with him.

Expert:  Dr John B replied 2 years ago.
It is very hard to say what might be going on without a proper assessment. Are you seeing any other changes at all in addition to the muttering and deteriorating self care?

Did he mutter 10 years ago? Was his self care poor 10 years ago?

If he didn't then my (very broad) areas of concern would be that he is deteriorating due to an organic problem (neuropsychological) or possibly Psychotic Illness. The Marijuana use is a huge concern. While there are rare exceptions long term heavy use usually ends up leading to Psychotic Illness. I have also seen the emergence of muttering in older males who develop a Psychotic Illness. Does he pace or is he unable to sit still?

It would be next to impossible to connect his father's condition with his own retrospectively. I was thinking perhaps something like Asperger's but it sounds like you are seeing a change in function rather then a life-long problem.

The really key thing here is whether you are seeing a significant change in behavior. At his age, with a family history of (possible) mental health problems and the heavy Marijuana use he is at high risk for becoming unwell.
Customer: replied 2 years ago.

The change is in severity only, he's always been unselfconscious, but only to a normal, tolerable degree. Now it's intolerable.

 

He doesn't pace, can sit still, but will migrate toward impulsive, transgender related internet surfing with muttering.

 

Are there any references, articles or sites you can share with me that discuss how to talk to someone about these sorts of behaviors, how to broach the subject with a friend, etc.?

Expert:  Dr John B replied 2 years ago.

I'm sure there are but I am not aware of any myself. I can opt out of this question and leave it open for another expert who may be able to direct you to the resources you are seeking?

I should stress again that he really needs to be assessed just in case he is becoming unwell. If the change you are seeing does reflect the onset of illness he may not be able to recognize symptoms in himself no matter how you broach the subject.

Let me know if you would like me to opt out.

Customer: replied 2 years ago.
Yeah, thanks, XXXXX XXXXX need some specific guidence. If you think someone else could help, I'd appreciate it! I hear what you're saying about getting assessed, in a perfect world he would agree to it.
Expert:  Suzanne replied 2 years ago.

I have to say I agree with Dr. John B. Your friend's behavior has all the earmarks of serious mental illness. Retreating into his own mind, anti-social behaviors, a lack of ability to control his muttering, and a disregard for hygiene-- combined with others being so concerned for his ability to function effectively in the world that they suggest disability means that this is not a choice he is making, but an illness he has no control over.

While I admire you determination to help your friend, this is truly past the point where your presenting him with logic and support is going to help. This is an illness. He needs to be evaluated and given medication. Until that happens, all you can do is continue to offer your friendship and support.

Customer: replied 2 years ago.

Hello Suzanne, I'm still in the dark here, I know that nobody will diagnose him without examining him, that's not what I'm after. I would like to know what sorts of disorders have symptoms like his, so that I will have something to back me up when I talk to him about the possibility of getting examined. Basically, I'm trying to build some medically relevant language around his behavior so I can make a kind, compelling argument toward treatment.

 

As I mentioned up the page a bit, impulse control is a large part of the problem. Do you have any questions for me that would help to make things more specific?

Expert:  Suzanne replied 2 years ago.
The thing is, this sounds like a mental illness, so I can't think of a kind, compelling argument that he won't take exception to. If he thinks it's other people's fault that they can't understand his eccentricity, I doubt he'll react well to a suggestion that he see a psychiatrist.

Honesty is the best policy. Tell him his behavior has changed over the past few years, and you're worried about him. Have some resources ready to give him in case he says he doesn't know where to get help.

The only medical conditions I'm aware of that cause behavioral/impulse control problems are forms of dementia, specifically Pick's Disease:
http://helpguide.org/elder/picks_disease.htm
Customer: replied 2 years ago.
The resources you mention are what I need, I have nothing. This is what I need your help with.
Expert:  Suzanne replied 2 years ago.

Here is a directory that will show the psychiatrists in his area. http://psychiatrists.psychologytoday.com/rms/

If you think he would be more receptive to going to a neurologist to be checked for Pick's Disease or other forms of dementia, here's a directory to find one locally: http://www.lifescript.com/doctor-directory/specialty/neurology.aspx?gclid=CPDgxoOft6wCFQ1X7AodwEAYXQ

and another:

http://www.bookofdoctors.com/tek9.asp?pg=search&category=22&location=all

Customer: replied 2 years ago.

Hello Suzanne, thanks for checking in. Sadly, I'm not any further along. I've looked at the lists of doctors that you sent, but I'm afraid I misinterpreted what you meant by 'resources' in our last communication. I'm looking for sugestions on how to talk to people about their mental health. I've heard the term 'intervention' tossed around but in conjunction with sucess stories.

 

Since you're in the field, I'm hoping you will be able to share methods and ideas with me about convincing people to get examined. He is the third person I've know, over the years, who is functional but mentally ill. Unwillingness to be examined or, after examination, unwillingness to accept the diagnosis, are common to all three of them.

Expert:  Suzanne replied 2 years ago.

The reason that all three responded the same way is that it is the nature of mental illness to not respond to logic. Mental illness means a person's thought process isn't working the same as others.

If there were a method or a technique I would be happy to share it with you. If such a thing existed, the mentally ill on the streets of major cities wouldn't be there. That's why so many people never get into treatment until they put themselves or someone else in danger, and the police step in and get them committed.

You're hoping for a logical solution to convincing people that their brains don't work like other's...but because their brains aren't working the same, what seems logical to us doesn't seem like a good idea to them. No one wants to be told,. by a doctor or a friend, that they're "not right." And if they are functional, as you mention, no one else has a right to force them into treatment. As functioning adults, even though they might not be functioning as you might wish, they have the right to refuse treatment and to refuse to accept a diagnosis...the same way a diabetic might choose to continue eating sweets. We may strongly disagree with their choices, but we have no right to try to force the issue.

Expert:  Dr John B replied 2 years ago.

Hi,

 

After some hunting around I think I have found the kind of resource you are looking for. Dr Xavier Amador publishes in the area of 'Anosognosia' - the technical term for a lack of insight into/awareness of being unwell. His work focuses mainly on assisting individuals suffering from Schizophrenia to accept and engage with treatment but I his book here http://www.amazon.com/Not-Sick-Dont-Need-Help/dp/0967718929 will be relevant to anybody trying to help someone recognize they need assistance. You can also watch a detailed presentation he has given here http://video.google.com/videoplay?docid=3157373037314023921# XXXXX I was really impressed by this presentation and I plan on using this as a resource in the future.

 

I hope this may be the kind of thing you have been looking for. Best of luck!

Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience: PhD in Clinical Psychology, registered clinical psychologist.
Dr John B and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.
Yes, THANK YOU!!
Expert:  Dr John B replied 2 years ago.
Great! I'm glad we finally got there! Good luck.

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