New here, with a question for the role of family in treatment

[1sister]

Hi, all. I'm very happy to have found an active forum that's Canadian - pleased to be here.

Wondered if I could start with a question. How much input can siblings and parents have on the diagnosis and treatment of a family member? My brother (early thirties) is currently on drug treatment for ADHD. He's not receiving adjunct counselling. He occasionally has raging episodes, often (but not uniquely) directed at myself and our other sibling (all of us are adults). I'm talking about full-on abusive rage. When raging he will say and do absolutely anything to dominate the other person. His logic is disordered; it's impossible to penetrate his thinking or calm him down. Usually, I just say things like 'Stop this now', or walk away, but it doesn't work. Sometimes the things he says are so perverse and horrible I can't help but react by yelling too.

When he is not raging, he can be loving, sweet, and funny. He would do anything for friends. All heart, really. But even when he's not angry, he sometimes seems unable and unwilling to be empathetic to people who violate his self-image, i.e., towards those he doesn't feel meet standards he's set for himself*, or who remind him of himself when he's been in a 'weaker' state. He's definitely got a superiority/inferiority thing going on and will admit to that.

I was in actual shock after the last episode. I am very concerned about him, but also can't tolerate much more of this for my own health. I've tried to set boundaries in the moment. Useless. We are close, but I am a particular target for his anger, for lots of reasons.

I suspect the stimulants might be contributing, but this explosive anger pattern existed from his teens on (with us, that is... He once kicked me out of a moving car.) I also suspect he may have indulged in some version of this abusive anger with his past girlfriends.

My bro knows he needs help, and shows awareness of his behaviour after the fact. He has other problems and tries to work on them. But in the moment, it's like a switch gets flipped, and he can't turn it off. (Right now, he is not speaking with me. My bro's relationship with our other sibling - they live together - has been seriously damaged by this ongoing verbal abuse.) I doubt my bro is communicating the full extent about this aspect of his problems in his 2-3 annual appointments. I think his doctor should know more about it to properly help him.

Given privacy laws, how much can my other sibling and I say? If the only approach is speaking to my brother directly, how might we go about it?


-----

*Our dad was only nominally present, and when he was in actuality, things were chaotic. My bro built up a personal ideology from self-help books (on 'winning' in life: 'you can be anything you want'), hyper-macho ideals from sports, and the family he created from friends as a teenager. I know that sounds condescending, but I think he'd even agree with that.

 

[AmZ]

Welcome to the forum

 

[forgetmenot]

Hi hun You brother needs someone to advocate help for him really. YOU are allowed to call his doctor relay what you are seeing and hearing okay that way his doctor can talk to him about it. If your brother becomes violent then call the police okay i know that one will be hard because you donot want to see your brother harmed but in doing so he will be put on a form and put into hospital. There he will also be assessed by a doctor and maybe new treatment will be started hugs to you

 

[Daniel E.]

Is your brother seeing a psychiatrist or just a general practioner?

In any case, do you even know who his doctor is?

 

[1sister]

Thanks for the welcome, AmZ.

Spirit - thank you for your advice and supportive thoughts. I guess that's good news, that I can offer my perspective... but I wouldn't want my brother to feel betrayed... he has moments in which he's a little mistrustful of people's intentions. I for sure don't want to have any part in institutionalizing him, oh man... I can't say he's got a habit of being physically violent, with the exception of the car thing, occasionally throwing things, and when he was a teenager, punching the odd hole in the wall. That last time, he did almost hit me, which is what freaked me out, but he stopped himself. (That, and I left.)

Maybe I should have a conversation with him, if/when we start speaking again. We've gone months not talking. Usually I'm the one holding out the olive branch. In the last episode, he said things like 'You're dead to me, I hate you, I don't want to even hear your name, don't you *ever* f***** talk to me again' among other things of course... I don't think he'll lose that feeling quickly...

---------- Post added at 12:11 PM ---------- Previous post was at 12:10 PM ----------

He is seeing a psychiatrist... I don't know his name, but can find out from my other sibling.

 

[forgetmenot]

If you can that would help hun just explain to his doctor you do not wish your brothers knows you called him because he does get paranoid I think if you can talk to your brothers doctor maybe med changes are needed to decrease the anger outburst some and maybe even some anger therapy would help I hope you can talk to his doctor hun and i hope his doctor is receptive hugs

 

[Andy]

Welcome to Psychlinks 1sister:2thumbs:

 

[Jazzey]

I'll play devil's advocate...just for a minute...sitting on the other side of the 'proverbial' couch...I do not want my family involved in my therapy unless they're invited in - by me. Therapy is a process. You've said yourself that your brother has moments of awareness. Give him the time and space he needs to process it all. it's heavy, and the reflection isn't always kind to us (reflection of therapy I mean).

If you want to support him, support him. By telling him that you're there for him when/if he needs to talk about anything. Support him in his decision to continue with therapy / search new avenues in therapy if need be. But don't stick your toe into his therapy unless he specifically invites you in there. Therapy is about trust too. And maybe for right now, he's not trusting too many people (not blaming anyone here).

If a sibling of mine tried to contact my therapist without my consent, I'd feel betrayed and it wouldn't help my relations with them. But I would be grateful if they could support my course of therapy. Support me in my efforts.

That's my two cents...

 

[Daniel E.]

But this is likely not therapy but just med checks? The brother seems unwilling to go to talk therapy in the first place, possibly due to low insight ("low insight is highly associated with ADHD") or other symptoms of his disorder. There's also the fact that men are much less likely to seek help in the first place. And two to three visits to a psychiatrist per year seems rather minimal even for maintenance treatment.

In addition to the possible need for more frequent med adjustments, another possible concern is that comorbid disorders like depression, anxiety, or substance abuse could go unnoticed by his psychiatrist since the visits are apparently infrequent:

In adults, it has been reported that almost 80% of ADHD patients present at least one lifetime psychiatric comorbidity, with major depressive disorder (MDD) as the most common condition (prevalence 24.4% to 31%).

Adult ADHD and its comorbidities

Does your brother have a history of suicide attempts or substance abuse that you know of?

BTW:

The way that men think about themselves can impede how they are identified and treated for depression, experts say. Compared with women, men tend to be far more concerned with being competitive, powerful, and successful. They often don’t like to admit that they feel fragile or vulnerable, so they’re less likely to talk about their feelings with their friends, loved ones, or even their doctors...

“Culturally, women have more words to describe their inner emotional world and men have fewer words to describe it...So, for guys there’s more of a tendency to try to distract themselves from the nagging from that emotional world.”

They may be grumpy or irritable, or lose their sense of humor. They might drink too much or abuse drugs. They might work all the time or compulsively seek thrills in high-risk behavior. Or, they may become isolated and no longer interested in the people or things they used to enjoy.

http://forum.psychlinks.ca/depression/17775-the-mask-of-male-depression.html

Can stimulants make a person irritable or depressed?

Sometimes, if the dose of stimulants is too high for a person, the stimulants can make the person irritable or depressed. In my [clinical] experience, irritability occurs somewhat more often with the methylphenidate stimulants (Ritalin, Concerta, Focalin) than it does with the amphetamine stimulants (Adderall, Vyvanse, Dexedrine).

More often, the irritability occurs when a long acting medication is wearing off, often in the late afternoon or in the early evening. One way of dealing with that is to take a dose of short acting medication in the mid or late afternoon so the medication will wear off around bed-time. I have not seen this problem with Vyvanse, which seems to wear off more smoothly.

Adult ADD | Stimulant Medication Questions and Answers

---------- Post added at 01:54 AM ---------- Previous post was at 12:28 AM ----------

Given privacy laws, how much can my other sibling and I say? If the only approach is speaking to my brother directly, how might we go about it?

Certainly, it would help if your brother could be encouraged to see his psychiatrist more often. Perhaps the sibling who lives with him is in the best position to do that given the physical proximity. Personally, I would have a low tolerance for living with someone who was verbally abusive, and so I would perhaps mandate that something needs to change.

Even if you talked to your brother's psychiatrist, the next psychiatry visit may be another 3+ months from now?

 

[H011yHawkJ311yBean]

Welcome to the Forum, Sister...

As an older sister with a younger brother with problems myself, I feel your pain. I'm not 100% sure what is wrong with my brother, but my parents haven't helped. Instead of trying to make him feel confident about being independent, they've made him totally dependent on them. "Coddled" comes to mind. He's 38 years old and pretty much all his life my parents have paid for his dental bills, debts he's amassed from calling 1-900-sex, paid for his car and its maintenance, paid for and bought his groceries, paid for his tobacco habit (because he'll get violent and anxious when he doesn't get his smokes), etc. As a child I wasn't allowed to compete with him, I wasn't allowed to do anything that would be seen as "better" than him. I was expected to be the example, and was given strict rules, and they would try to impose these rules and groundings on him, but he would just flagrantly disregard them and my parents decided he just "couldn't help it" because he was ill, mentally incapable, etc...

Soooo, that being said, he did some things that were violent. Not as much to me, as I tried to stay out of his way. My mom, strangely enough, would let him get away with things like holes in the wall, but our youngest brother did the same thing and she called the cops on HIM. Yeah.

Anyway, if he was ever violent to me, I would call the police. How is that betrayal? He betrayed me by pointing a knife at me. He apparently threatened and shoved my mom (mind you there were plenty of times I would have liked to do some serious damage to her, but instead inflicted it on myself or an inanimate object like my brothers would)... Isn't an act of violence against you or your loved ones an act of betrayal on his part? My brother ended up in a boys' home for a while, which was actually the best thing that I think ever happened to him. It was run by a mentor of his from Cadet school. He loved her, and she didn't let him get away with anything, and there were consequences for his aggressive behaviour. That's what he needed. That's why he loved that tough ol' lady.

Anyway, it sounds like he needs some serious scared-straight or consequences to realize that he needs help. Wouldn't it be better if it was a family member, rather than some stranger he punches in the mouth? If he is that threatening to his own family's safety and can barely hold back from hurting them, what has he done to other people? He might think of it as betrayal at first, but you could point out to him that threatening his family's safety is a betrayal in itself. Perhaps you could tell him, he wasn't doing anything else to try to prevent these outbursts of rage. Perhaps he needs some kind of judge's orders to seek the kind of help he needs whether it is community work, boot camp, psychotherapy, medication or some combination thereof. This is one of those things you could say with certainty could be considered as "tough love." It's one of those unpleasant things a family may have to stand together on and say "Enough is enough." I know it seems to be because of his cognitive/mental state, but I am not sure if he realizes how dangerous he has become to others (and possibly himself)... And as long as he thinks he can get away with that behaviour, how is that going to help him? It certainly doesn't help my own brother: he seeks employment to try to get out of my parents' control, and after his usual 3 months he will quit, blaming someone at work for being mean to him or playing mind games with him, or because some "ugly guy at work" who is "a complete loser" that he's got a raging case of inferiority/superiority over somehow lands a date with a girl he's been eyeing for weeks. He knows my parents will look after him each time he fails. He feels miserable about it and lashes out, but it's a pattern that has been going on for decades. I would never have gotten away with that kind of behaviour, so why should he?

But however you decide, I hope things go well for you and he eventually gets the help he needs.

 

[Daniel E.]

I would agree that the people who are in your brother's life, e.g. your mutual sibling who lives with him, may be enabling the behavior in some way. Not to "blame the victim," but eventually enough is enough. In other words, "it takes two to be in an abusive relationship." I realize that may be an overstatement, but the point is that family members can let themselves be manipulated by guilt, etc. Your sibling certainly has a choice in that he doesn't have to live with your brother. If your brother cannot function on his own, there are group homes, etc.

An example of "tough love" as a last resort:

Adult Children with ADD Living at Home ("As resentment and anger build, the household can become unbearable.")

Is "tough love" an acceptable approach for an adult child with ADD / ADHD? ​("When faced with the choice of receiving treatment or living on the street, he chose treatment")



In any case, the issue of telling the psychiatrist vs. not telling the psychiatrist may be secondary to other issues such as the frequency of the psychiatry visits or the fact that your brother is not getting therapy for his anger issues, etc.

From the author of Is It You, Me, or Adult A.D.D.? Stopping the Roller Coaster When Someone You Love Has Attention Deficit Disorder

ADHD can greatly affect "depression and anger issues."

Think of ADHD being, at its core, a challenge with self-regulation. For many people with ADHD, that includes challenges with regulating one's emotions, including anger and irritability.

Some people with late-diagnosis ADHD have even gotten into the habit of "self-medicating" with anger and provocation, because it "wakes up" their brain. This isn't intentional, but it can be an unconscious habit...

The fact that you might not see your anger and irritability can also be an ADHD-related challenge -- something called "low insight." The right medication often helps with this, too...

Sad to say, some doctors will just pick a "favorite" medication and hope it works for most of their patients. This isn't the way to find an effecting treatment regimen for ADHD, however.

"Adult ADHD and depression/anger"

More generally:

“Adult ADHD Symptoms Or Poor Coping Strategies?”

http://forum.psychlinks.ca/adhd-and-learning-disabilities/4234-parent-of-an-adhd-adult-child.html

---------- Post added at 04:33 PM ---------- Previous post was at 03:03 PM ----------

And an excerpt from the book mentioned above:

Know That Even Experts Can't Always Reach a Loved One

For some people, no matter what you do, denial remains impenetrable. It's not your fault.

Years ago, top ADHD expert Russell Barkley learned that his fraternal twin brother, Ron, had ADHD, but even he could not convince Ron to seek treatment. Finally, in 2006, Ron, 56, failed to negotiate a bend in the road and, not wearing a seatbelt, died at the scene. That Russell Barkley has contributed significantly to the research detailing ADHD-related impairments to driving safety only adds irony to this tragic course of events.

As he wrote in the October 2006 edition of his newsletter, The ADHD Report:

You can provide information on risk all you want to an adult with ADHD. You can even arrange inducements and mild coercions in an effort to get your suggestions adopted. But at the end of the day, it is entirely the adult's choice whether to adopt or ignore that advice. And we all know there is not a damn thing you can do about it if they opt to continue in their self-destructive ways.

​

Finally, Barkley realized that his good intentions were only enlarging the wedge between them. So, he adopted a supporting role, helping his brother when his actions created dire consequences (such as near homelessness, legal actions, and medical care). This approach isn't enabling bad behavior, he clarifies, "It is facing and accepting the reality of having a persistently disabled family member.... It is the only important role left to play if you wish to stay involved in your loved one's life."

Of course, the situation is different when the person with ADHD is a partner, not a sibling, parent, or child. The factors that determine your continued involvement in the person's life, including shared custody or a deep friendship, become very personal. It's up to each individual to navigate as safely as possible.

Is It You, Me, or Adult A.D.D.? Stopping the Roller Coaster When Someone You Love Has Attention Deficit Disorder

 

[1sister]

Wow! I'm overwhelmed with the quality of the responses you've all offered. Thanks, all!

In response to issues brought up by Displaced and Daniel: it's not that I wish to impose my own issues into my brother's therapy, though as his sister I'm biased, without question. I think he should work on whatever he needs and wants to.

It's more that I'm not confident the psychiatrist is getting a clear enough picture of what's happening. Because, as you say, Daniel, my bro's history is inflected with the ADHD itself; his macho ethos (this is very present, though punctured, as mentioned, by moments of insight. Which results in confusion, which my bro has on occasion talked to me about. As mentioned, we are actually close, when not in combat.)

My thinking is that - in line with systems theory, I think - between my brother's account of his behaviour, my sibling's, my mom's, and my own, we can triangulate to get at something like a fair idea of what is actually happening. I mean how reliable is the patient's account of his own behaviour, when he's so invested in it? Maybe I'm off-base, but I would have thought information from family might have been important in establishing the initial diagnosis. Not loads, you know. Just enough to counterbalance what I think is a slightly skewed version of events.

Just found the Utah diagnostic criteria for Adult ADHD. The bolded areas are ones I think might be glossed over, in my bro's interpretation of things.

[SIZE=+1]Utah Criteria for ADHD in Adults[/SIZE]

[SIZE=-1]I. Childhood history consistent with ADHD [/SIZE][SIZE=-1]II. Adult symptoms[/SIZE][SIZE=-1] [/SIZE][SIZE=-1]Hyperactivity and poor concentration[/SIZE][SIZE=-1] [/SIZE][SIZE=-1]Two of the following:[/SIZE][SIZE=-1] [/SIZE] [SIZE=-1]Affective lability[/SIZE][SIZE=-1] [/SIZE] [SIZE=-1]Hot temper [/SIZE] [SIZE=-1]Inability to complete tasks and disorganization[/SIZE][SIZE=-1] [/SIZE] [SIZE=-1]Stress intolerance [/SIZE] [SIZE=-1]Impulsivity[/SIZE] ​

[SIZE=-1]Adapted from Wender PH. Attention-deficit hyperactivity disorder in adults. New York: Oxford University Press, 1995:122-43.[/SIZE]​

I mean he's got the diagnosis, true. And he admits to feeling 'annoyed'. But he attributes it to other people's wrongdoing. And I think he underestimates the degree to which his anger and irritability compromise his ability to function in the world. Which means the headshrinker isn't getting it either, and can't (or maybe won't, idk) stress the importance of counselling.

Ok, forget about my other brother and myself. From what I can gather, he's gotten into disputes with business associates that have affected his work. According to his logic/interpretive scheme, those people 'screwed' him, or misrepresented themselves, etc. Also, two of his friends have approached me to say he has said some outrageously inappropriate things, and not 'been himself'. He doesn't see how his impulsivity might contribute to those interactions. Maybe that's where the 'paranoia' comes from... he's sensing people pulling back, but doesn't know how to parse it...

I wouldn't want to interfere in the actual therapy - just want to know he's getting *some*. And of course, that the drug regime is working, or that it can be amended, as Spirit and Daniel have mentioned.

Daniel: you're right, I think my bro *is* depressed. He's said he doesn't feel like going out anymore; old pleasures are now boring; he feels 'flat', discontent. "I'm not depressed or anything, but things just feel not right..." He absolutely self-medicates, with pot. I'm interested in the idea that anger could also be used as a modulating device. I do suspect he experiences what I've heard described as 'flooding', in which adrenaline and cortisol and whatever else rush in and overwhelm his ability to control himself. I think he's probably always at a fairly high state of arousal; that its effects are cumulative; and that it doesn't take much to trigger it.

I'm not aware of suicidal thoughts. Last time I asked him about his next appointment, yes, he said he couldn't get an appointment until close to Christmas. How is that possible??? He has no reason to lie to me. He wants some kind of assistance. Man, now I'm angry, with his headshrinker.

Re: my other sibling - he has strongly detached from my brother. Sibling minimizes contact to bare necessity and aims to move out asap. Brother feels bereft, abandoned, and doesn't get how 'just yelling' could have this effect. He's said he feels 'lost' in all his intimate relationships.

Really, I mean he's suffering, and doesn't know why. And we suffer from it too. And I'd like to help him but am not the person to do it, it seems, or not right now anyway.

He's actually said - this in a calm moment - 'Sometimes, sister, you say something normal, and because it's you, and whatever that is, it just makes me hate you'. When a few days before that, we'll have had a nice lunch, laughed, talked openly about, e.g., his treatment, his romantic life, career stuff... I'm certain he links me with some of the traumas we grew up with. I think I'm a trigger for him. I inspire contempt, disgust - this from his mouth. He sees me in some nightmarish light I can't change, and it saddens me - I don't feel that way about him. I miss him, you know?

That's my bit, fine. But I see him going off the rails and whatever's up with his doc isn't working.

---------- Post added at 11:33 PM ---------- Previous post was at 11:31 PM ----------

Sorry, that was a bit of a ramble. I have my own organizational issues...

---------- Post added at 11:54 PM ---------- Previous post was at 11:33 PM ----------

Welcome to the Forum, Sister...

As an older sister with a younger brother with problems myself, I feel your pain. I'm not 100% sure what is wrong with my brother, but my parents haven't helped. Instead of trying to make him feel confident about being independent, they've made him totally dependent on them. "Coddled" comes to mind. He's 38 years old and pretty much all his life my parents have paid for his dental bills, debts he's amassed from calling 1-900-sex, paid for his car and its maintenance, paid for and bought his groceries, paid for his tobacco habit (because he'll get violent and anxious when he doesn't get his smokes), etc. As a child I wasn't allowed to compete with him, I wasn't allowed to do anything that would be seen as "better" than him. I was expected to be the example, and was given strict rules, and they would try to impose these rules and groundings on him, but he would just flagrantly disregard them and my parents decided he just "couldn't help it" because he was ill, mentally incapable, etc...

Soooo, that being said, he did some things that were violent. Not as much to me, as I tried to stay out of his way. My mom, strangely enough, would let him get away with things like holes in the wall, but our youngest brother did the same thing and she called the cops on HIM. Yeah.

Anyway, if he was ever violent to me, I would call the police. How is that betrayal? He betrayed me by pointing a knife at me. He apparently threatened and shoved my mom (mind you there were plenty of times I would have liked to do some serious damage to her, but instead inflicted it on myself or an inanimate object like my brothers would)... Isn't an act of violence against you or your loved ones an act of betrayal on his part? My brother ended up in a boys' home for a while, which was actually the best thing that I think ever happened to him. It was run by a mentor of his from Cadet school. He loved her, and she didn't let him get away with anything, and there were consequences for his aggressive behaviour. That's what he needed. That's why he loved that tough ol' lady.

Anyway, it sounds like he needs some serious scared-straight or consequences to realize that he needs help. Wouldn't it be better if it was a family member, rather than some stranger he punches in the mouth? If he is that threatening to his own family's safety and can barely hold back from hurting them, what has he done to other people? He might think of it as betrayal at first, but you could point out to him that threatening his family's safety is a betrayal in itself. Perhaps you could tell him, he wasn't doing anything else to try to prevent these outbursts of rage. Perhaps he needs some kind of judge's orders to seek the kind of help he needs whether it is community work, boot camp, psychotherapy, medication or some combination thereof. This is one of those things you could say with certainty could be considered as "tough love." It's one of those unpleasant things a family may have to stand together on and say "Enough is enough." I know it seems to be because of his cognitive/mental state, but I am not sure if he realizes how dangerous he has become to others (and possibly himself)... And as long as he thinks he can get away with that behaviour, how is that going to help him? It certainly doesn't help my own brother: he seeks employment to try to get out of my parents' control, and after his usual 3 months he will quit, blaming someone at work for being mean to him or playing mind games with him, or because some "ugly guy at work" who is "a complete loser" that he's got a raging case of inferiority/superiority over somehow lands a date with a girl he's been eyeing for weeks. He knows my parents will look after him each time he fails. He feels miserable about it and lashes out, but it's a pattern that has been going on for decades. I would never have gotten away with that kind of behaviour, so why should he?

But however you decide, I hope things go well for you and he eventually gets the help he needs.

Jollygreenjellybean: It must be amazingly frustrating to have been forced into the role you've had to take, and to see this going on. I reckon a million accidents come together to make one child inspire that kind of (over) protection, and another not.

Don't know how I feel about 'tough love'.... I agree that structure, consistency, and sound expectations are what most people need. I'm sure it's not helping your brother to be bailed out constantly. I hope your parents come to see that...
Sounds like your bro's got to get some small wins here and there - ones that make sense to him, that he can accept - before he can expect bigger ones. Which feel more impossible, I'm sure, as the years roll on. It's that frustration/sense of entitlement that kills progress, and is probably the very thing that allows him to keep his sense of self-respect through these 'menial' jobs. Freaking ironies, eh.

With my brother, the temper thing is so sudden, so extreme... I don't think he's capable of controlling it given whatever chemical soup's driving it now... I don't see him having the tools to swim, if left to sink.

To this, though, yes: He betrayed me by pointing a knife at me. I've got to work out more clearly how to handle any violence directed at me. I don't know... I kind of see him as a hurting, rabid dog, in those moments.

Thank you for sharing your experience. I'm sorry we've got some of these things in common.

 

[Jazzey]

yes, I agree with what you're saying. I did not mean to come off too harsh..I think that only you can assess the situation. My post was more about guarding you about a possible backlash? If that makes sense?

I know that your intent is good, genuine.

There will always be "family dynamics". I guess my concern was more about balancing it? Making sure that whatever you decide is done with some view or balance to what you know your brother will be ok with?...

wishing you well. Just wanted you to know that my words were not meant to dissuade...just maybe words of caution towards a balance?

 

[Daniel E.]

Last time I asked him about his next appointment, yes, he said he couldn't get an appointment until close to Christmas. How is that possible??? He has no reason to lie to me. He wants some kind of assistance. Man, now I'm angry, with his headshrinker.

In any case, he could probably get on a waiting list for cancellations.

 

[locrian]

I'll play devil's advocate...just for a minute...sitting on the other side of the 'proverbial' couch...I do not want my family involved in my therapy unless they're invited in - by me. Therapy is a process. You've said yourself that your brother has moments of awareness. Give him the time and space he needs to process it all. it's heavy, and the reflection isn't always kind to us (reflection of therapy I mean).

If you want to support him, support him. By telling him that you're there for him when/if he needs to talk about anything. Support him in his decision to continue with therapy / search new avenues in therapy if need be. But don't stick your toe into his therapy unless he specifically invites you in there. Therapy is about trust too. And maybe for right now, he's not trusting too many people (not blaming anyone here).

If a sibling of mine tried to contact my therapist without my consent, I'd feel betrayed and it wouldn't help my relations with them. But I would be grateful if they could support my course of therapy. Support me in my efforts.

That's my two cents...

In general, I would agree with this. However, if her brother is a danger to himself or to others, then family members are legally and ethically entitled to intervene.

Another consideration: it's difficult for a family member to be completely objective. Even women who are abused by husbands or boyfriends will often make excuses for the abusers.

Suggestion: since this is an issue for you personally, why not consult with a therapist on your own? Explain the situation and see what observations and recommendations are made. In my opinion, someone with professional training and an objective outlook is in a much better position to assess the situation.

I hope it goes well for you and your family.

 

[H011yHawkJ311yBean]

Sister, I agree with locrian about seeking a therapist's advice. Who knows, maybe you could even meet as a family together. You could invite your brother, and tell him you want him to come but explain that the whole family is effected so why not all go together? You can explain that it is because you want support, but you also want to support him and the family wants support and wants to support him. If he refuses to accompany you, then it's not like you tried to do anything behind his back, you were open and honest. You could always keep inviting him, saying that the whole reason your family has these meetings is for him and since the therapist is helping you and your family understand him, it would only benefit him if he could also take part.

Either that, or go on your own, and see if you can find a therapist who knows a lot about ADD/ADHD... Perhaps the therapist can come up with some ideas or give you some objective insights as to what is going on.

I do understand to a certain point that you want to protect and support your brother, but sometimes there is a fine line between that and allowing him to continue his behaviour. Perhaps you could discuss some ways you could put down some healthy boundaries. It almost sounds like he needs someone to film his rages before he realizes exactly how hard it is to deal with him when he is like that. Have you ever been able to capture anything on your cell phone or anything, just so he can get a reality check? He almost has his own perceptions of reality, a disconnect between how he thinks other people see him, and how he is actually perceived. That kind of reminds me of both my mother and my brother. My mom, on the other hand, claims to have some kind of spectrum of ADD, but she's also claimed to have been physically abused, sexually abused, claimed to have cancer, etc (all lies - all those things happened to someone in her family or someone else, not her), but my therapist thinks she has something else completely. So maybe if your brother could see a 2nd therapist for a 2nd opinion with or without the family, the new therapist could shed some new light on things.

Even if he doesn't go, go on your own. I have gone for similar reasons: my parents and one of my brothers are "ill", and that and a combination of things made me "ill" as well. It's nice to have support from someone who can see things from the outside looking in for a change.

Hope you stay safe in the meantime, and your brother, too.

 

[battleworn]

A book suggestion for your brother

Change your Brain, Change your Life by Daniel Amen

The only thing you can control is your reaction to your brother. You might evaluate these and experiment or explore other reactions, keep safe and do what is healthy for YOU.

 

[1sister]

Hi all.

Many thanks again for all your support and suggestions. Just wanted to update...

Since I wrote, my brother chose to take himself off the medication he was prescribed. His aggression has diminished by a factor of 10.

He has been insightful about this process - which, annoyingly, could not be timed (or costed) to match available supports - and open towards efforts by me and other family members to reach out, as he is doing, in turn.

He is working actively to understand his ADHD (by reading), and to compensate for it in his life.

With regard to his explosive anger - he is trying to recognize his triggers better and to calm himself, or leave the situation, sooner. I think I am succeeding in helping a bit, when I witness the beginnings of things (and am not the target, those times are less easy, but far from as bad as what prompted my first message here). When I see him 'start', I mention, in a non confrontational way, that I am seeing signs of anger - we have talked about what those are - and ask him to 'pay attention'. He does.

I really can't believe it.

I should say that all this was initiated by a conversation prompted by a friend of his, independently of my input or knowledge. This friend - who my brother is lucky to have - also noticed that my brother was acting like an ass. (This friend is an unusually forthright and loyal person. I can't think of too many other people who'd both stick around, and tell the truth.)

More than ever, I am certain that care providers should take a wider view of the patient, to include - if not family - at least partners, or close friends. Where there is drug treatment especially, they should follow up as a matter of course, and not leave patients to slip away. I'm not sure where my brother would have found himself had he not a) had a trusted friend like X to begin with, and b) lucked into a moment of openness to the concern.

This is not to say that my brother's 'fixed', by any means. His inappropriate anger pre-dated his drug treatment, and will surely take years to really get at.

He will be going to his GP soon, to discuss all this.

In any case - thank you all. Your input has been valued.