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Question
Posted by: Patricia | 2011/06/23

Difficult situation with brother

My youngest brother (14 years old) worries me. Around Christmas, during the holidays, he started playing computer games all the time, then he lost his appetite, got insomnia and things went downhill. After the holidays, he went back to school but still missed weeks at a time because he couldn''t sleep or eat. He got aggressive towards my parents whenever they tried to make him eat something. Teachers finally decided to do something and basically called an ambulance and sent my brother to hospital, which ended in his spending a month and a half in a mental institution. (You may remember this story because I asked for your advice at the time.)

So my brother went back home about a month ago and went back to school just in time to save the school year. He''s on medication (I don''t know which but it''s a very expensive injection he takes twice a month, if that helps.) He''s eating well and sleeping again.

However, things are very bad. I''m abroad, so I always call on msn. And when I do, his behaviour worries me a lot. He makes a lot of noise. Even when I''m talking with my parents, I hear him hit something constantly. And when he talks to me, he mostly answers my questions with things he finds funny like hitting the microfone, saying jokes etc, and rarely even answers a question properly. I already asked him to stop hitting the microfone because it makes a very loud noise that hurts my ears but he does it even more now.

He is very smart, he has never missed a year and his marks are usually A- to A+. He''s also learned to play the guitar in the last two years, which he loves, and his school has a band for the first time, which he and the music teacher formed together. The fact that he chooses to behave like a very mentally disabled person at home is hard to take and both my parents (86, 56), 3 other sibblings (25, 23, 17) and I (26) don''t know what to do. Our 17-year-old brother and the youngest brother are the only ones who still live with my parents (we move out at age 18 to go to university) but the one who''s 17 is totally fine and happy (probably the only happy person in the family, even though the had the same treatment as everyone else.)

My parents are very controlling but they finally allowed him to play soccer with friends and go biking with them almost everyday when they saw he needed a change. (For comparison, I was never allowed to get out of our property even when I was already 18).

One would think now that he can play with his friends, things would slowly get better. But they aren''t. He truly hits everything like a 1-year-old who hits a table with a spoon repetedly because he is discovering the new sound he can make. My father tries to ask as kindly as possible to see if he would stop but he doesn''t. I know living with my dad is very difficult, but disobeying him seems very scary to me. I''m scared my brother and my dad might lose control one day and hurt each other, especially since my brother is provoking my dad constantly.

Still on the same note, my sibblings and I all have a few ugly habits that range from mild to, in the case of my youngest brother, more severe. One is rubbing hands together when we succeed in something, the same way a " normal"  person would shout " Yay!" . I also apply a lot of pressure when washing my hands, washing something or brushing my teeth. We are have something like this to a certain degree. Is it a sign of inner aggressiveness? I wish I could stop and relax my muscles but it''s hard because I LIKE to do it. I think it has to do with anger/ happiness management. And maybe my brother is the same? How do we stop this? What''s the best way to help him with this and possibly help the whole family as well?

We''d all be much happier far from our dad but it''s impossible because of financial reasons and because our mom would be very sad too.

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Our expert says:
Expert ImageCyberShrink

It really is essential that the doctors who have been in charge of caring for him, discuss frankly with the family what diagnosis they have made, what the treatment is, and what the outlook is for him in the future. There are too many possibilities for me to want to guess. There are some medications, usually used for psychotic illnesses such as schizophrenia, but also with other uses, which are given by monthly or 2-weekly injections, which save the person from needing to remember to take the tablets daily. Some of this sort of medication by injection should be available through a state / privincial hospital or clinic, if the expense is a problem ; some of the newest varieties may not be available at such clinics.
Its probably significant that he is still managing to get really good marks in his studies, despite his otherwise odd behaviour, so there are a number of possible diagnoses including Autism and a range of similar disorders. In these conditions, a person may be highly intelligent and very skilled at some things which interest him, but may have severe problems in relating to other people and in conforming his behaviour to what other people expect of him. Physical aggression is usually not part of the problem, though their lack of concern for what other people think may seem like deliberate povocation when it isn't intended that way.
With several of these possible diagnoses, though one person may show marked anomalies in how they behave, its fairly common for other people in the family, maybe including brothers / sister, maybe even your dad, to share some of the features.
But above all, it is ESSENTIAL for the doctors responsible for caring for your brother to frankly discuss all of these issues with his parents and family, so they can know how best to deal with him - that is an inescapable duty of any doctor in this sort of situation, and part of basic good patient care

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2
Our users say:
Posted by: Tony | 2011/06/23

It sounds like your brother is Autistic  i.e.: he is on the high functioning side of Autism - you do need to find a doctor that understands this  where is he located?

Reply to Tony
Posted by: cybershrink | 2011/06/23

It really is essential that the doctors who have been in charge of caring for him, discuss frankly with the family what diagnosis they have made, what the treatment is, and what the outlook is for him in the future. There are too many possibilities for me to want to guess. There are some medications, usually used for psychotic illnesses such as schizophrenia, but also with other uses, which are given by monthly or 2-weekly injections, which save the person from needing to remember to take the tablets daily. Some of this sort of medication by injection should be available through a state / privincial hospital or clinic, if the expense is a problem ; some of the newest varieties may not be available at such clinics.
Its probably significant that he is still managing to get really good marks in his studies, despite his otherwise odd behaviour, so there are a number of possible diagnoses including Autism and a range of similar disorders. In these conditions, a person may be highly intelligent and very skilled at some things which interest him, but may have severe problems in relating to other people and in conforming his behaviour to what other people expect of him. Physical aggression is usually not part of the problem, though their lack of concern for what other people think may seem like deliberate povocation when it isn't intended that way.
With several of these possible diagnoses, though one person may show marked anomalies in how they behave, its fairly common for other people in the family, maybe including brothers / sister, maybe even your dad, to share some of the features.
But above all, it is ESSENTIAL for the doctors responsible for caring for your brother to frankly discuss all of these issues with his parents and family, so they can know how best to deal with him - that is an inescapable duty of any doctor in this sort of situation, and part of basic good patient care

Reply to cybershrink

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