Family and Caregiver Schizophrenia Discussion Forum

54 yo undiagnosed brother - How to get from LEAP to treatment?

After many years of denial and resistance in my family – and after the suicide of my oldest brother in 2016, due to depression…this year, I got my parents to participate in the NAMI Family to Family class (for most of it), and begrudgingly, I’ve gotten my father to participate in a family-coaching class on the LEAP method.

My remaining brother is 54 years old and has been living with our parents for the past 3 years. He had his first mega-psychotic break at age 28, which was a jumble of extraordinary delusions, channeling spirits, hallucinations, a rock-solid belief that he was psychic, and suicidal thoughts. He ultimately shoved our mom when she confronted him…but looking back, maybe this is what got him to go see a psychiatrist.

I’ve always felt that first psychiatrist visit was a tragedy of an insufficient diagnosis, for everybody. He was diagnosed with “major depression”, and he stopped taking the meds when he started to feel the effects. Even if we were to say he had bipolar disorder, it was a half-diagnosis, but my view then, and today, is that the answer is somewhere on the schizophrenia spectrum.

He’s cycled through multiple psychotic breaks in his life, involving the Illuminati, bug spray/weed killer, stock market manipulation, government surveillance, etc., and he has never been financially independent or consistently employed. We had him on a temporary hold in 2017 when he threatened suicide, but even then, to my knowledge, there was no diagnosis. My brother has never seen a psychiatrist in his life, other than that time when he was 28.

By doing LEAP, we are trying something different, other than loving, praying, reasoning, or telling him what to do. Asking/encouraging him directly to get psychological or psychiatric help leads to paranoid defenses and the wall between my brother and my father gets higher, every time it’s mentioned.

My father is not a patient, empathetic, or nurturing person. I see the long-term potential of the LEAP method, and I think my mother does, too, but my Dad is feeling exasperated by my brother’s negative symptoms: not talking, not coming out of the room, etc., while also not understanding that these (and other) symptoms indicate that my brother has schizophrenia. My mother, on the other hand, is sincerely worried that my brother is going to kill himself, by not eating, drinking water, or overdosing on sleeping pills. I live across the country, and it’s hard to verify what’s really going on, but my read of the situation is that we can’t have him committed until/unless he is a threat to himself or others.

Questions:

  • Assuming that my brother is in fact taking sleeping pills, how do we set boundaries on this, in a way that won’t disengage him further, or plunge him into paranoia?
  • Could we put him in a hold on account of taking sleeping pills? Or would he have to overdose (morbid thought) in order to do so?
  • If you have traveled a long road to diagnosis and treatment, what would you recommend in order to get your loved one and you to that point, mostly in one piece? With my brother’s profound lack of volition, I really don’t think homelessness will work.
  • What can I tell my Dad, to help him stay the course with LEAP?
  • What can we do, to help prevent this from becoming another suicide, between now and the hopeful day when he seeks treatment? His daughter turns 18 soon, and she will move out one day. We need to be ready for the crisis of transition….

You are asking some challenging questions. LEAP is only effective if the person starts with Listen and that takes a lot of effort on the person’s part not to be judgmental. I wonder if your Dad would be willing to get help by talking to a therapist himself?
Would your Mom and Dad be willing to do an involuntary hospitalization? They would need to have a record of his behavior to indicate he needs help. They could make a call for a Health Care evaluation. Again if they are willing to connect with someone from NAMI that would help them in this situation can make a huge difference. It must be quite difficult for me being so far away from the situation and watching things unfold. You mentioned his daughter but not a wife. Is he not married and the daughter lives with him? How is his daughter involved in all of this? Relationships sure are complicated. What is the best next step you can take?

I just reread my message and see I put “It must be difficult for me being so far away”. I guess I was thinking how hard it has been dealing with our daughter’s psychosis living miles from her. We actually moved back to the area where she was living to help. We are thankful that she has now recovered a second time and is functioning in her new job.

Thank you for your reply, @Julie1, I truly appreciate it. I do find it difficult to watch all of this from afar. The other difficulty is that I present resources to my parents, but they haven’t followed through on the NAMI links and phone numbers. It’s frustrating to see a plane, slowly crashing to the ground. I will need to be the one to do the work, it seems.

My brother is separated from his wife, and they are going through an extremely slow divorce. He and his daughter are living with my parents.

My father went to maybe 2 counseling sessions alone and then stopped, since he couldn’t get my brother to go, “who is the one with the problem,” as he said - though you do bring up a good point - if my mother and I could role play and reinforce more positive behavior amongst ourselves, perhaps this could help the LEAP transition process for him, and for us all. We are all guilty of not listening as well as we could, at times.

I am encouraged to hear that your daughter has recovered a second time–and I am curious, can you share how you got her to treatment and diagnosis? Did enough LEAP methodology get her to go into treatment? That is the piece we are missing.

Otherwise, I am concerned that we have to wait for my brother’s next violent psychotic break in order to have him committed, and that’s a sharp knife that I don’t want to catch when it falls. My brother’s positive schizophrenic symptoms are relatively mild right now; I don’t think his overwhelming negative symptoms are enough to put him into treatment involuntarily - or am I wrong about that?

Also - happy soon New Year! May this next year bring a break for everybody!

You are in a difficult situation and it must be extremely frustrating for you. You apparently have a deep love and concern for your brother. It sounds like you must or should take care of this situation with your brother and parents but how can you do this and take care of yourself? I know I desperately prayed for my daughter especially when in the last situation with her but realized she has to make her choices. Many others were praying as well. This second experience with our daughter I tried to use LEAP and it was a challenge. What worked for her was the therapist she trusted who encouraged her to be evaluated at a hospital. I was the one who drove her to the hospital. It was during her hospitalization that our older daughter hired a lawyer who helped us find an outpatient program for her to attend which she did before starting to work again. Remember LEAP is a process not a magical formula. Here is a quote from an article I’ll send to you: “LEAP stands for Listen, Empathize, Agree and Partner. As the author (Dr. Amador) writes, LEAP works because it is based on the strength of the relationship, not the strength of the argument.”
https://www.psychologytoday.com/us/blog/recovery-road/202102/the-leap-method-listening
I wish things were different for you and your parents and your brother and his daughter. May this next year be one of hope and renewed strength.

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