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Doctor Rao
Doctor Rao, Doctor
Category: Mental Health
Satisfied Customers: 641
Experience:  MBBS,MD,DPM,MRCPsych
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My brother has an undiagnosed mental illness. He is

Customer Question

my brother has an undiagnosed mental illness. He is devastating everyone around him, ruining my parents marriage and ruining himself. He has terrible spurts of violence and hatred. He finds the negative in people and picks and picks and picks at people until he makes them feel violent towards him. He belittles others, but he is a 20 year old who quits everything he attempts. He had a serious drug problem with prescription drugs (mainly benzos) last year and went to a treatment facility for it. He came back and slowly manipulated all the rules my parents had placed on him. My dad and mom are at odss, my dad is successful and very dogmatic in his thinking ('old school'- raised by a Navy frogman) and my stay at home mom (once a nurse, co-dependent and enabling, easily manipulated). I am 23 and left the state where my family lived because my health was being seriously compromised on all facets. My brother has recently pushed me to the point, with two disgusting events, where I am ready to remove him from my life until he starts loving and caring for himself. He is violent and selfish. I know he is severely suffering and a very broken individual, but he will not help himself. He lied after the treatment program and said he was trying medication for his mental issues, when he was really abusing xanax again.. Its breaking my heart to see my family, especially my parents relationship being destroyed because he masterminds a game of deceit and destruction against them. I do not know how to handle this towards my brother, mom, or dad. I have tried so many modalities of communication and all have failed because everyone is in this sympathetic mode. My mom is enabling him, protecting him, and growing his behavior. My dad is harsh, fed-up and without any patience. I need help to handle this with the least amount of harm to my family and myself. I'm leaning towards writing letters to my mom and brother, and I hesitate because part of me thinks it may be best to just leave it be and allow them to play out their own lives.

Submitted: 4 years ago.
Category: Mental Health
Expert:  Doctor Rao replied 4 years ago.
Doctor Rao : Hi are you online?
Doctor Rao : It must have been difficult for you all
Expert:  Doctor Rao replied 4 years ago.
It must have been difficult for you and your family. I would concentrate briefly on the problem and then mention about interventions.
The prescription drug abuse(Benzos) is not uncommon but can equally problematic as the illicit substance abuse. The benzodiazepines have two main problems. 1. Tolerance (the person develops tolerance to the drug,means he needs more strength to get the same effect after using for longtime) 2.Dependence (The person becomes dependant on the drug,making the person addicted to tot he drug, making it difficult to come off ).This is more common for short acting medications like Xanax because of the short half life which means the drug would stay in the body for short period making the person to crave for it more.
Coming to the management issues--
1. It is atmost important for all members of the family to be consistent in the message that it is NOT acceptable and try not to ignore or allow him to split the family opinion.
Discuss rules, expectations, and consequences in advance.
If a rule is broken, be sure to enforce the consequences. This teaches him to take responsibility for his actions.
Give praise when he follow rules and meet expectations.
2.Short discussions go a long way. Engage him in a conversation. Ask what he know, how he feel, and what he think about the issue. If he has been to the rehab before,I am sure he might have learnt some good techniques but putting them in to practice is the most important thing.
3.It is important to find out the source of medications. If he is abusing Benzodiazepines, it might be unlikely to get these from PCP on a regular basis. So, it is important to ask him because if he is buying off street the quality and safety is important thing to consider.
4.It is also important for him to be seen by a Psychiatrist to look for any co morbid psychiatric illness if present as sometimes the person might choose to self medicate than accepting the problem and seeking help.
5.Please note that both your parents might have to change their styles of interaction(one being strict and other being too soft . But it is not easy because it might be ingrained in the, at least what they can do is have a discussion between them about this specific issue,agree for a common strategy of action and stick to the plan, Not allowing him to manipulate them as can happen sometimes)
6.The positive news is if he is keen to seek help,wanting to change his behavior or drug seeking habit, it can be done with the help of PCP,Drug counselor and Psychiatrist if necessary. The extent of the problem would be assessed first,then the doctors would discuss with him and decide whether it is safe to wean him off gradually in the community with the help of the family or needs admission.
I am sure by now you might have noticed that all I have mentioned above have some for of involvement from him which is a key.
For you to choose writing letters might be fine but try not to attack the personality but be factual in the content of the letters,how it is effecting him and the family,how he was before all this,why you thought he relapsed and you would love to see the old brother who was a completely different person Etc.
Please do not hesitate to contact me if you require more information.
I wish him all the best.
I hope you had a lovely Christmas and happy new year.
Please be mindful that you are doing what you can.
If you find the answer helpful,please provide positive feedback.
Thank you.
Customer: replied 4 years ago.

1. My parents are not consistent and their opinion has been split

2. My brother will no engage in conversions, or employ any of the techniques he has learned in treatment centers

3. He was buying them off the street. I do not think at this current moment he is abusing xanax again, his drug of choice is marijuana (which in our state has become "legal"). My brother is extremely unproductive and gets stoned daily.

4. My brother is self-medicating and refuses to get psychiatric help. When he did receive help, he lied and put on a show to act normal. He refuses to go to a doctor and admit that he needs help, and how do we force him?

5. As long as my brother is living in my parents house, their communicated is destroyed and they cannot talk without getting extremely emotional/ frustrated/ defensive etc. My brother has put himself between them and uses them against each other. He is manipulating

6. He will not get help for his mental illness. It is at a point where my parents need to practice tough love and force him out, that is the only way he will change his selfish/ spoiled/ narcissistic ways..

I just don't know what is best for me to do. I live multiple states away and I am physically away from the situation. My mom dad and brother have grown incapable of communicating and the situation is highly dysfunctional. I do not want to see my parents divorce, but I truly believe that they are coming to the point because of my brother's toxic behavior. How does a family convince/ insist someone to get help for a mental illness? (i am nearly positive that he is bipolar-- it runs heavily in our family)

Do I say nothing and let these people live their lives?

Do I verbally communicate what I see as an 'outsider' and risk offending them (I won't make personal or character attacks, only specific examples with words to what I believe the situation needs)?

Customer: replied 4 years ago.
Relist: Answer came too late.