Have Mental Health Questions? Ask a Psychiatrist Online
Hello, I am Rafael. Thanks for asking your question - I'm here to support you. (Information posted here is not private or confidential but public).
I am truly sorry to know about your brother's situation. It is obvious you feel very frustrated and concerned about him.
I'd love to support you directly through this chat interface in order for you to benefit the most from this service. If you could join the chat we could dialogue and and get a response to your question. I will be here looking forward to meeting you. Thanks.
Hi Rafael, are you there
Yes, I am here. thank you for joining the chat.
Thank you for the promp response
the scenario you depicted in your question is very concerning and sadly not an uncommon one.
Your brother is an adult who has been able to keep functioning and taking care of some core needs while neglecting important areas, from close relationships to healthy sharing with other and a fulfilling life experience at home. Different issues seem to have led to it, and mental illness in family obviously are the root of it.
What is your biggest fear about this situation?
My parents are living with him. so he doenst have to worry about food or shopping. But i am worried what is going to happen in the long run as he doesnt cook or do any chores. I am a physician myself(cardiologist) he would not listen to me "saying you doctors follow pseudoscience i dont have any problem to see anyone"
he is open to reading about behavioural therapy i think
I see, then even when he has been able to keep his job he has never truly taken care of core daily life needs, and that is not good. I am afraid that the lack of need to take such responsibilities and the "support" he may have received by parents may have been enabling or perpetuating these serious issues.
Genetics are the core of it but it is life experience from infancy and childhood mainly and then how healthy or dysfunctional a person's support system works, what define how things evolve around personality and mental health.
he is an expert in computers, so he could understand about behaviors and how brain and mind work. But intellectual understanding could become useless when emotions, even more, when undermined by obsessions and compulsions get in the way. And from all obsessions, those of religious natures are the worst, and he has them plus the ones around cleanliness and purity, so it is very complex.
how do you classify this problem? he has features of OCD but he doent agree or realize its excessive? is it personality disorder? i think he is unhappy and probbaly depressed. his friends descibe as a brilliant programmer but has no communication skills that is why he is not advancing as he should. he changed 4 jobs in 10 years for various reasons
is it common to seek comfort in religion when depressed
OCD with poor insight type, is just like that, denial and poor understanding and acceptance of the disorder are pervasive. I would say he could have different personality traits fueling OCD and his life style. No doubt anxiety and depression are at the core of it too, as uses to be the case with OCD disorders.
Yes it is, and in his case it could be deeply affected by his own upbringing, the modeling he received from parents or significant people, life experiences and issues, based on the very predisposition to develop these disorders.
i dont think he gets any intrusive thoughts though
Different disorders like Aspergers do present poor social skills and many times outstanding performance and skills in specific areas.
if its your brother what would you do?
Obsessions mean fixed, powerful-overwhelming ideation about things, generating anxiety, where reason or logic get distorted and the person ends justifying his own rationales and performing compulsive actions to get some relief and sense of control, one that never happens in significant ways, but ends reinforcing the vicious cycle.
I would eradicate any form of and source of spoiling or enabling of whatever fuels lack of responsibility and awareness of reality, allowing him to afford consequences of his actions, since it is from there that he would have be find himself challenged by reality and the need to behold changes from beliefs to habits, even to consider other outlooks and support.
my worry in doing that he is going to quit his job and join some religious group.He says he cant take care of chores and job.
I would offer sound - empathic but not codependent support, in order to promote awareness or reality and mature understanding of it. Setting healthy and clear boundaries and never engaging into obsessive rituals or behaviors, like praying in excess, since that would enable his distortions even more.
my grand father who i was saying a loner had exceptional math skills. I remmeber him doing exhibitions in various high schools where he does calculations which are hard to do with out a computer.
That's a very good and valid point for sure, and the risk is real. then what I would do is to keep support but to refine it as much as possible in order for him to be more responsible, accountable and grateful about it. Anything that promotes his responsibility as an adult would help. and every behaviors or condition-support that could enable or allow distorted beliefs or practices must be eradicated.
how do I know if my brother has aspergers?
I believe you, many people with disorders from the autistic spectrum do have such special talents, could be genius at specific areas.
If he has clear obsession, intense one on one or more topics' if he presents uncommon nonverbal communication, from body language to unusual or no eye contact, if content and form of verbal communication is uncommon, like fast, monotonous or too rigid; if he gets stuck in one subject during conversations with one-sided approach, not showing much interest on what the other person thinks or how reacts; if he has problems with empathy, understanding other people, if he has some coordination problems, these are common symptoms of a person with Asperger's syndrome.
his body language is unusual he avoids eye contact. he does argue with out considering others point of view
Then I would say he could have Asperger's.
he is empathtic when you talk to him and make him think. but he is not empathtic by default
i mean as reflex his empathy is average or less.
I see. People with this disorder could learn to identify emotional tenor in language with time and effort but with big effort and never to the level we consider standard.
however i remeber as a 5 year old he used to say eating meat is unkind as its expoiting other animal. he is still a vegetarian. when i was a child i wanted to ride a horse i remember him saying stuff like if you cant carrry anyone why should a horse carry you ( he must have been7-8 years old) no one tought him that eating meat is bad. is that considered empathy?
Psychotherapy focuses on promoting and supporting awareness, learning and development of empathy to read people's verbal, non-verbal and emotional communication too.
I would say so, in that area it is and in his mind as a child it made perfect sense.
he is not very empathtic day to day that my mom and dad are still doing lot of stuff for him
but if you sat him down and ask him he feels sorry
he tried to go to a religious dorm earlier this year so that its closer to work and my parents dont have to cook for him.
he was there for couple of days and coudnt adjust and got back home
This is why I made a clear point about not spoiling an adult with such problems, it does enable dysfunction taking away his very chances to work on necessary improvements, and as you said, once they do not happen to be there for him, who would take care of him? He may be becoming disable because of being spoiled, and that shouldn't be that way.
deepdown he knows he is depending on parents and wants a solution but he feels there is no solution and i think that makes him even more depressed.
I truly believe that if at home you work on improving the quality of the support you provide it would concretely positively impact on his well-being. It would not be easy once he has adjusted to being spoiled, it would be hard and challenging, it would create conflict, but a constructive and necessary one.
I agree with you. he could not get better having these core unavoidable conditions limiting his abilities for a normal life, but he could get better with adequate support, then the responsibility family has on promoting his improvements is fundamental, and the power to undermine is is obvious and enormous.
since i cant get him to see nyone yet is there any book/selfhelp you would suggest. thats the only thing he is somewhat open to at the moment
If he is open to read about behavioral science, then invite him to read about Aspergers. i have had several adult clients with Asperger's Syndrome who had the chance to face challenges and learn from them looking for support and improving.
do you mean on the web or are there any books you personally like about OCD or aspergers?
Both, online you would find several websites focused on Aspergers just google for it and books too like using Amazon.com
Like this one: http://www.amazon.com/The-Complete-Guide-Aspergers-Syndrome/dp/1843106698/ref=pd_sim_b_1
Thank you. i looked in to it recently there are so many of them. do you have a favorite one? what do psycholgists read as a syllabus
when in school/masters
is ocd common in aspergers?
That depends on the very professor and institution, nothing official for every or most schools that i know. I am mostly a clinician, a psychotherapist and not a researcher, that's why I could not offer a better answer to that question.
is ocd common in aspergers? one last question do you think its helpful to share our dialogue with my brother or do you think its counterproductive
Yes, OCD patterns are common in Aspergers, like other comorbid disorders.
I would review the whole chat in order to decide if it would have more pros or cons to do it considering his personality and you are the one who knows him. What I do recommend is to be empathic, understanding and supportive but to eradicate any codependent form or sharing and support, since that could only undermine his well-being and path for improvement.
Thank you Rafael. Appreciate your help.
You're very welcome. Please feel free to contact me for any further support.
(Please do not forget to rate support for the chat session to be closed, thanks).
Thank you for the great service. If you can suggest a good book on behavioral therapy that would be very kind.
There are many good on therapy, most for clinicians-therapists, the benefits of CBT -cognitive behavioral therapies are in their implementation. Understanding is necessary but useless without the concrete application of its principles with adequate support. Let me review my lists of books.
This is a good one: Cognitive-Behavioral Therapy for Adult Asperger Syndrome (Guides to Indivdualized Evidence Based Treatment Series)
Have a great weekend Rafael.
You too. Take care.