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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4483
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I have a 28 year old brother who has gradually distanced himself

Resolved Question:

I have a 28 year old brother who has gradually distanced himself from all friends and family over the last 10 years. he has become very quiet, unsocial and views things very irrationally and differently from how he used to. For some reason, he stopped talking me and my parents a few years ago. When we tried talking to him about what is going on and what is bothering him, he says there's absolutely nothing wrong. Over a year ago, he would not come home on the weekends and would avoid us completely the course of a few months. This was highly unusual to us because he would never go out and do anything prior. We come home one day to find out he has left home and abandoned us. He took only a few belongings. A few days later, we found a card that he wrote and a few pictures of a new place he found in our mailbox. My mother and father are completely drained as they think he is suffering severe depression. He does not answer our calls, and NOBODY has heard from him in over a year. We know that he doesn't have a steady job. Both my parents would search all over the town he told us he is living in. A few times, my mother had actually ran into him and he would get very angry, not speak to her and speed off, and even run away. We know he needs help as this is concerning behavior. What should we do?
Submitted: 10 months ago.
Category: Mental Health
Expert:  Dr. Z replied 10 months ago.

Dr. Z. :

Hello I believe I can help you with your concern

Dr. Z. :

I am so sorry that your brother is exhibiting this type of behavior, I can imagine how distressing this is for you and your family

Dr. Z. :

Based on the symptoms and behavior you have described, this could possibly be a depressive disorder or it could paranoia as well. Symptoms of Paranoia frequently include isolation, anger, not talking to friends and family, etc...

Dr. Z. :

Paranoia are typically symptoms of a psychotic disorder, personality disorder, or it can be a symptom of a very severe depressive disorder (e.g. Depressive Disorder with Psychotic Features).

Dr. Z. :

It is obvious by his behavior that he needs treatment, but he is refusing to do so for his own personal reason, one of which is that he may not think he is ill. I would like to recommend this book as I believe it can provide insight on your brother's behavior for you and your family

Dr. Z. :

Now for what you can do, is the most difficult part because legally your options are limited. If the city that your brother is living in has a Crisis Stabilization Unit, you can call them to provide onsite counseling and assessment for your brother. Also the only way to get your brother treatment, unless he volunteers, would be if he made any threats to hurt himself, hurt others, or is gravely disabled (e.g. unable to provide for his basic needs like food, clothing, shelter, hygiene, etc...). If any of those three criteria are met then your brother can be involuntarily committed for 72 hours to get immediate treatment and an evaluation. If he still meets the criteria after the 72 hours, then a civil court judge can extend his involuntary commitment by 21-30 days depending on what jurisdiction he lives in.

Dr. Z. :

If he does not meet the criteria for involuntarily commitment, then he must seek treatment voluntarily. Since he has isolated himself from his family, then most likely he will have to do this on his own as he cannot be convinced. In fact, if you try to convince him and push him towards treatment then he may resist more. This is because if paranoia is the reason he is isolating himself, he will feel that you have an ulterior motive for pushing treatment on him that can include hurting him, controlling him, etc...Paranoia is a very serious symptom of mental illness where you distrust most people, organizations, government, so he isolates himself to not be exposed to those he thinks may harm him. This is why most individuals do not seek treatment because they do not trust them to the point where they think that the mental health professional treating him will cause him harm instead of helping him.

Customer:

We feel helpless because we have no way of contacting him. His phone is shut off, he refuses his mail from us, and he ran away when my parents came across him in town, even after my parents begged for him to stop. We do know where he lives however. Is it wise to go to his place and try to talk to him?

Dr. Z. :

I think if you try to go to his place to talk to him it will push him farther away. But there are two outside chances with going to see him 1) He will talk to you about what he is going through and why he wants to be left alone, at least giving you some sort of explanation 2) He will respond in rage and act very irrational to you when you see him, this is a paranoid reaction that can be violent or appear violent. If this happens you would have enough cause to initiate a 72 hour psychiatric hold on him if you call the police and explain the situation to them. But these are outside chances of these 2 scenarios to occur, most likely he will not answer the door if he is home or just run away again.

Dr. Z. :

I know that you and your family feel helpless right now and I am sorry, but the options are limited for forced treatment, even though your brother definitely needs treatment.

Customer:

I have thought about these very two scenarios. He lives in a house where the owner leases to a few different people. I think he wouldn't be able to avoid us because he would be worried of his landlord getting upset. Is there any other possibility other than paranoia?

Dr. Z. :

Well like you said it could be depression, but this very extreme behavior for a depressive disorder. In relation to depression, it could also be shame, where he feels guilt about something he did and this is why he is running away and choosing not to confront it or talk about it with his family.

Dr. Z. :

Does he live alone or not?

Customer:

I see. We have had a rough life. My little brother is severely autistic and self injurious. My parents are also immigrants and he always seems to hold things against them. But the things he would complain about were so irrational and almost made up in his head.

Customer:

He lives in a house where he rents a room alone.

Dr. Z. :

Can you give me an example of things he would complain about that were irrational?

Customer:

He would be upset at my mother for being depressed and not doing anything with her life because she is too busy with me and my brothers. He said that she would be happier taking english classes and she needs to learn the computer. But my mom would always say she is happier being there for her kids.

Customer:

He would complain that my father doesn't care about us, when in reality my dad works very hard and has been here for all of us. In comparison to my other friends, my parents are very loving and caring.

Dr. Z. :

And you mentioned that your brother was diagnosed with autism. Well depression is very common with individuals that are autistic and so is paranoia. These are usually caused by the cognitive deficits associated with autism.

Customer:

And when it came to me, it was like everything I did upset him. Going to the gym daily, getting my haircuts frequently (every 2 weeks), and my personality. He took these things as if they were the worst things in the world. He speaks very slowly and softly, and me and my parents naturally speak a bit faster and with emotion. This would upset him greatly.

Customer:

Are you suggesting that there is a possibility that he suffers from Autism?

Dr. Z. :

I thought mentioned that your little brother was diagnosed with autism, I thought your were talking about this brother who moved out, but I am guessing that you have another brother.

Customer:

I apologize for the confusion. My little brother is diagnosed with autism. My other, older brother is the one we are concerned with.

Dr. Z. :

No problem, miscommunications happen on the chat sometimes. But it is possible that your older brother may be diagnosed with Asperger's disorder as it appears he has trouble socially and that may be why he chooses to isolate himself. Here is a list of common symptoms of Asperger's Syndrome

Dr. Z. :

This is considered an Autism spectrum disorder, but a higher functioning one and there is a genetic link as well

Customer:

Ok, I am familiar with this as well. I have thought about everything you mentioned (paranoia, asperger's, guilt/shame, etc). I just wanted to see what the best course of action is. I was already aware that you can't force anybody into treatment against their will. We just see this going down a bad road. What makes things worse is that he had mentioned to us that he had suicidal thoughts back in high school and did talk to a counselor about it.

Dr. Z. :

It is difficult the situation you and your family are in with your brother, and the treatment options are limited. That book I provided does have some techniques that you may want to try with him and see if he responds to them. I agree, that if he continues to isolate he will be traveling down a bad road, but unless he voluntarily tries to seek help there is not much you can do unfortunately.

Dr. Z. :

The law is not as helpful with certain individuals with mental health disorders, which is very unfortunate for the individual and their loved ones.

Dr. Z. :

To me I think the best course of action would be to wait and see if he comes around, hopefully he will, but there is no guarantee.

Dr. Z. :

Because if you confront him, I believe he will react as he has in the past and just push you and your family away farther, but next time he may not tell you where he is living.

Customer:

I understand. I have thought about giving it some more time. He has always been very distraught over his massive student loans and trying to start his life on his own. He always got very upset when my parents would help him financially. My take on this is that he broke away from everything to start from scratch, to start his life on his own. He is trying to start a business or find a steady job, which unfortunately may not happen in the field he chose. He also didn't want to be a "burden" on my parents. I say this in quotations because he wasn't a burden on my parents in the slightest bit, but he viewed it that way. He thought they would be happier without him around so they can focus solely on my little brother and their own lives, which isn't true at all. He has made things much worse for us all. I have been torn over the last year or so because I don't know whether to give more time, or take action.

Customer:

He probably saw it as he would break away from everything, get on his feet and then may come around. But I don't think that will happen.

Dr. Z. :

Well from what you are describing it definitely does sound like guilt and depression are what is causing him to isolate from his family because he viewed himself as a burden, even though he was not. I would not push him to make contact with you since his goal is trying to make it on his own, but I would mention that when he wants to come home he can at anytime. So if he cannot establish himself on his own in the future and needs help, at least he will know that his family still loves him and will be there for him if he needs them. Hopefully he will strongly consider this.

Dr. Z. :

But I think giving him time to make this decision would the best choice for him for right now as he has expressed a desire to isolate from his family.

Customer:

I wish we can tell him this all. Again, he just won't give us the time to even say one word. And we support his decision of trying to make it on his own. But why can't he stay in contact with us and why did he isolate himself from EVERYBODY and EVERYTHING? That is the part that concerns us. We don't want him to keep getting worse because he is alone and end up on the streets, or even worse.

Dr. Z. :

Since you know where he lives you can mail a letter explaining this or just drop it off, explaining that you understand that he wants to be alone right now, but when he wants to come home or contact you and your family he can do so at anytime. There is no guarantee that he will read this letter as you mentioned his past behavior, but at least you can say you have tried. He most likely isolated himself because he felt like he was a burden as you mentioned and guilt is a very strong emotion. He is also prideful and that leads him to not want to ask for help from you or your family. I think he most likely will get worse, but I doubt that he would live on the streets before contacting you, since he knows in the back of his mind that you want to support him and help him

Dr. Z. :

Right now he wants to work on his issues and life on his own, which is probably a result of depression, guilt, and pride, but if you say that you respect this decision he would be more open to support in the future when he does ask for it

Customer:

I understand. I will speak to my parents about everything we discussed. Thank you so much!

Dr. Z. :

Anytime, I am always happy to help and I hope your brother gets treatment and reunites with you and your family soon. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

Customer:

Sounds good. Thanks and have a great day.

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 4483
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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