My brother has struggled with depression for the past 14 years since our dad died. My family and I have become increasingly concerned about his well being. He is self-medicating with alcohol and resistant to any type of treatment. Do you have any advice as to how I can help him understand that treatment can be beneficial? Thank you.
First, I am sorry about the passing of your father. I can only imagine how difficult that must have been for your entire family, especially having to cope with brother and his poor choice of coping therapy.
Second, this is one of the most difficult questions for two reasons.
1) Are you asking for help for his depression, or his alcoholism?
2) It is nearly impossible to convince someone who does NOT want treatment that treatment is the best thing for them.
Though many with bipolar and/or depression have a tendency to self-medicate, those of us who don’t, do not always understand why they do. I mean, yes it is obvious … they are hurting and they want an escape from that pain, however, so are we, we just choose to properly treat that pain through medication and therapy. It’s hard for a person who has never turned to self-medicating to understand the resistance one has to getting the proper help.
I suppose you could start by answering that question. (Not by ASKING your brother the answer, but through observation and conversations you’ve had in the past.) WHY does your brother refuse to go to treatment?
Here are some possible answers you may end up with…
He does not believe he has a problem or needs treatment.
Denial can be a bipolar person’s best friend, sometimes for a very long period of time. Much the same, a substance abuser often refuses to admit they are ill. And they are ill. They are addicted, they are not in control of their own actions, and they are making improper decisions due to irrational thinking stemming from their illness, the illness being the addiction.
If a person is in denial of their illness, whether it be bipolar or an addiction or even something like cancer or aids, they are not going to accept that they need treatment. And a person can be in denial for ANY illness they do not wish to have. Cancer can go untreated for long periods of time before the patient inevitably becomes too ill to refuse the treatment. Likewise many of us with bipolar and/or addictions refuse to admit we need help until we are SO ill that we either hurt ourselves or someone whom we love.
It’s the breaking point, the moment where we surrender to the fact that we NEED HELP! It is not a moment that can be forced upon us. It is something that only that person can induce. It’s what I like to call, The Inevitable Crash! Without it, we can go on living in our precious world of denial for years. It’s cozy there. And when someone tries to force us into treatment if feels like they are taking away our fluffy pillows and fuzzy blankets and throwing us into a dark damp closet and saying, “THIS is how you are supposed to sleep!
Would you want to sleep without your fluffy pillow and fuzzy blanket?
So what can you do? I read an awesome article in regards to alcoholism called “How to help an Alcoholic.” It’s brilliant really, stating the three most effective actions you can do are; detach, don’t enable, and don’t react. Three VERY good pieces of advice for helping a person with any illness in which they are in denial over.
He sees he has a problem, it’s THAT obvious, but he doesn’t want help. He’s ashamed to get treatment. He’s not THAT bad. He can take care of it on his own.
Another form of denial really. Though there is one key word in there. Did you pick it up? It’s a Bipolar’s counter partner, that jack ass, Shame. (I’m going to call Shame a he … it just kinda seems like a man to me. No offense intended. Kinda like nature is mother nature…and so on and so forth.) Ok, so let’s talk about this jack rabbit Shame. Shame’s a jerk. He’s manipulative. He’s downright debilitating. And he is WRONG!
Shame can convince even the strongest of people that they are a piece of nothing with their illness. No one will love them if they admit to it. People will look down on them and laugh at them and scorn them, just for being ill.
The positive part about this? Shame is one step away from acceptance. IF you can convince your brother that there is NOTHING to be ashamed of, you may be able to convince him to get treatment.
It’s not an easy task. After all, you’re biased. You’re family. You have to love him. Of course you aren’t ashamed of him. He most likely needs to hear this from the person he is most afraid of turning against him if he is in fact a substance abuser. Unfortunately, unless you are in his mind or know him extremely well, you may have no clue who that person or persons is. But if you can find out who it is, it may just be the step to getting treatment underway.
He is so ill that, in fact, he has no idea he has a problem.
Though this is rare, it is possible. Depending on how much he drinks, he may not see it as a problem.
Maybe he only drinks a few (or what he thinks is a few) to take the edge off. That is obviously NOT a problem, at least to him. But it is. If he drinks regularly and drinks to stifle the pain, it’s a problem.
Or he only drinks on the weekend. Sure it’s never just two, usually more like twelve, but it’s not like it’s every day. So obviously it’s NOT a problem, to him. But it is a problem. Binge drinking is just as bad as drinking every day. And believe me, binge drinking is only one step away from becoming a daily drinker!
Then there is the worst case scenario. He is so drunk all the time that he doesn’t even know or remember what it’s like to be sober. He doesn’t know the difference between the flu and a hangover. He sleeps when he’s passed out, not when he’s tired. And every morning starts with a drink, then ends with a drink. He seriously, and literally does not KNOW he has a problem, because he doesn’t even know what time of the day it is.
The first two examples are actually a form of denial, but the last is just the illness having taken over to the point where your brother practically is the illness.And in that case, only a crash can save him, or unfortunately do the opposite. The only bright side to that is, if he is indeed this bad, you may be able to force hospitalization, though that may not help either.
I know I sound like a pessimist in this post. It’s hard not to be. In the end only we are in control of who we are and what we do. We decide what we want to believe about ourselves and we decide if we want to listen to what others think about us. We are in charge.
So my best advice … though not entirely perfect …
Be patient with him
And be there when he falls, because there is no doubt, that one day … he will inevitably crash. And if you can be there for him, hopefully it will not as scarey is it would be if no one is there.
Good luck, and my thoughts and prayers are with your family!