brother w/ BPD who has exhausted all treatment options, help pls

[Our abuse recovery guide]

Hi everyone,

I am writing regarding my brother who has multiple mental health issues. He is 39 years old and lives north of Los Angeles. Since childhood, he has had multiple psychiatric diagnoses including ADHD, OCD, depression. He's seen many psychiatrists and psychologists and been on countless medication regimens. He has been on and off abusing substance like adderall, benzos, marijuana, alcohol. He plays video games all night since his early 20s and avoiding other pursuits like employment, dating, friendships, and family. He has episodes of becoming aggressive at times and cutting himself. Based on all his behaviors, I believe he has borderline personality disorder.

He is a smart guy in a lot of ways. He earned a bachelors in english, and is well read. However over the last 10-15 years he has progressively struggled with finding stability and independence in his life and is becoming less functional. He was recently living in a subsidized apartment and could barely keep it clean or cook for himself.

Our family doesn’t know how to help him succeed.  He has been in and out of many sober living homes over the past 10 yrs.  Last year he started working full time after 10 yrs of refusing to work and living off my parents. Every time they tried to establish boundaries, or cut him off, he would say that he’s feeling suicidal, goto the ER, or cut himself. They were scared so they continued their financial support. He quit his last job because his anxiety worsened. He thought that his co-workers were all talking about him and conspiring against him.

For the last 3 months, he has been in a residential mental health program and living at their affiliated sober living home. Many of the patients who went there had been in horrible shape before and ended up benefiting tremendously, going on to do well afterwards. However, he seems to be getting worse. His therapist there told him he’s the most resistant to treatment patient she has seen in 20 years! He doesn’t want to work. My parents won’t totally withdraw support because they feel like he will be homeless, do drugs, and end up actually killing himself. The social worker says he doesn’t qualify for disability. The psychiatrist says he could write a letter for disability but it would be doing him a big disservice. It seems like almost everyone involved in his care says he can work.

We are trying to figure out where he can go after this. He refuses to go to sober living. We are trying to get him into a group home but the one’s we visited have people who can barely talk and have serious cognitive issues. My parents are getting older, more tired, stressed and don't have the mental strength to set boundaries or cut him off as so many people recommend.

I would be extremely grateful for any advise.

Sincerely,

Bob

[gratefulbob]

Hi everyone,

I am writing regarding my brother who has multiple mental health issues. He is 39 years old and lives north of Los Angeles. Since childhood, he has had multiple psychiatric diagnoses including ADHD, OCD, depression. He's seen many psychiatrists and psychologists and been on countless medication regimens. He has been on and off abusing substance like adderall, benzos, marijuana, alcohol. He plays video games all night since his early 20s and avoiding other pursuits like employment, dating, friendships, and family. He has episodes of becoming aggressive at times and cutting himself. Based on all his behaviors, I believe he has borderline personality disorder.

He is a smart guy in a lot of ways. He earned a bachelors in english, and is well read. However over the last 10-15 years he has progressively struggled with finding stability and independence in his life and is becoming less functional. He was recently living in a subsidized apartment and could barely keep it clean or cook for himself.

Our family doesn’t know how to help him succeed.  He has been in and out of many sober living homes over the past 10 yrs.  Last year he started working full time after 10 yrs of refusing to work and living off my parents. Every time they tried to establish boundaries, or cut him off, he would say that he’s feeling suicidal, goto the ER, or cut himself. They were scared so they continued their financial support. He quit his last job because his anxiety worsened. He thought that his co-workers were all talking about him and conspiring against him.

For the last 3 months, he has been in a residential mental health program and living at their affiliated sober living home. Many of the patients who went there had been in horrible shape before and ended up benefiting tremendously, going on to do well afterwards. However, he seems to be getting worse. His therapist there told him he’s the most resistant to treatment patient she has seen in 20 years! He doesn’t want to work. My parents won’t totally withdraw support because they feel like he will be homeless, do drugs, and end up actually killing himself. The social worker says he doesn’t qualify for disability. The psychiatrist says he could write a letter for disability but it would be doing him a big disservice. It seems like almost everyone involved in his care says he can work.

We are trying to figure out where he can go after this. He refuses to go to sober living. We are trying to get him into a group home but the one’s we visited have people who can barely talk and have serious cognitive issues. My parents are getting older, more tired, stressed and don't have the mental strength to set boundaries or cut him off as so many people recommend.

I would be extremely grateful for any advise.

Sincerely,

Bob

[formflier]

I want to assure you that you have found a group of people that "get it" and that this is a safe place to discuss all of this.

So..to be clear, is his medical treatment team recommending that he work?  How does he respond to them when they say this?

Hi everyone,

  Every time they tried to establish boundaries, or cut him off, he would say that he’s feeling suicidal, goto the ER, or cut himself. They were scared so they continued their financial support.  

To me this dynamic speaks volumes.  He understands what he must do in order to keep the finances flowing.

Best,

FF

[gratefulbob]

Thank you so much FF.

Yes multiple therapists and the residential program directors said he is fully capable of working. He replies saying he can't work, that his anxiety is too high, that he feels depressed, can't concentrate, no energy, fatigue, etc.

"To me this dynamic speaks volumes.  He understands what he must do in order to keep the finances flowing."

I believe you're 110% correct! It's so frustrating that every time he doesn't get what he wants or wants money, he basically throws the 'S' card at my parents. I wish I could get my parents to stop reacting to this dynamic!

[formflier]

So..what have you done so far to try and convince your parents?  What have they said in reply.

As I consider this, I kinda think that maybe you should shift focus.  What is it about your parents that have them listening to someone other than doctors about medical issues?

Stay away from the conclusion the doctors have come to...just stay with theory for a while.

What happens..what will you do if you parents and brother indicate they aren't ever going to change?  What is best for you?

Best,

FF