How to talk to my brother, who has mental health issues, about my frustrations with him?

Question

I live with my parents while I finish up my degree. A couple of months ago, my brother got out of a long, toxic relationship. He has since moved back in with my parents. The relationship ending caused him to seek therapy. Where he learned he is Bipolar(BP). My brother also has a history of ADHD but stopped taking his medication once he was unable to afford it. He is currently taking medication for his BP.

I've been very patient with my brother over the past several months, but I'm starting to get very frustrated at some of his habits. Both my parents are elderly, one being immunocompromised. With Covid going on, we've been trying as much as possible to mitigate exposure. However, my brother keeps going out to hang with his friends or out to eat. I've talked with him multiple times about my concerns for my parents. I recently confronted him about an incident where he self-admitted he "selfishly" hung out with a friend. He said he knew he shouldn't have done that. Then promised he'll stop until my parents are fully vaccinated. But a week later he ended up going out again to someone's house.

There are a number of habits that have been driving me to my limits. I ask him to help out around the house, but he very seldom does. The last couple of times I asked if he could help he said yes then left me to do all the work.

He also told me that his living with my parents has helped him save up some money. I've asked him to help out with the bills, but he only pays after repeatedly asking him each time. I've since stopped asking him due to the hassle it takes to get the money. He also is in medical debt but is ignoring the notices being sent to him. He frequently buys stuff online, calling it "retail therapy". My parents and I told him he should really be prioritizing his bills, but he gives us lip service. Saying he knows he should and he will, but continues to neglect them while buying indulgences.

My parents also explained to me they're also frustrated about these items, but they've also been wary about approaching him. They've asked me several times to be the middle-man, but I'm not comfortable about acting like a parental figure. Especially because he is my elder, and he is an adult.

I really want to confront him about this, but I do not know how to approach him. A couple of months ago when I got frustrated with him, he attempted to harm himself later on (he told me other contributions led to this, but I still wonder if I contributed to it). How can I approach him in order to help speak with him about my issues while minding his mental health?

Answer 1

I have bipolar disorder and it's been hell to my relatives the first few months when I came back from hospital. I'm not sure where this will shift from interpersonal to medical knowledge but here is a few things that I've learned along the way.

As someone with bipolarity, especially in the first year before medication kick in, you will do stupid things impulsively like buying with money you don't have, you will procrastinate about things, and certainly you will be a concern for your relatives whether its because you self-harm in regret or because you just act irresponsibly.

This is like the norm for us, and you can adjust expectations from that. To expect him to "behave normally" or responsibly; or in other words, to behave like you would want him to (for his own good, often) is in my own opinion unrealistic.

You can however encourage progress he does regarding stabilizing himself. The key I've found is to replace the "should"s by "want"s: I started to find appeal and satisfaction in doing things that sound boring and responsible. I started to acknowledge relief of doing things I long time knew I "should" do.

So, in order to help find this way, if you want to enable him to do something you think he should do, you can negotiate with him by "selling him" to do a task:

• Ask him if that's difficult to him to do something, offer help if you feel appropriate
• Project him in the "once its done" benefits e.g. "then you wouldn't have to think about it"
• Regularly give him a few kind words and encouragements about things he does well and responsibly.

I have experienced people communicating with me this way helped me fight anxiety and procrastination more than a direct order would. You may not have authority over him, but if your brother is like I was when I was in my twenties I'm inclined to think authority would be inefficient anyway.

Answer 2

First, let me start with an analogy. Have you ever had a sore knee? A really really sore knee, where you stop at the top of the stairs and take a really deep breath and have to steel yourself to make it down the stairs and you say ow with every step? I think most of us have, sometimes. Now, have you ever had a knee so sore you just couldn't face the stairs and asked someone else to go get you what you needed or got by without it? I have. I have recurring joint pain and there are days that stairs are just not an option for me. I have to ask someone else to help. Why am I telling you this? Because if someone I lived with were to tell me look, I'm going out, I put the laundry on, it will be done in an hour, I really need you to go down to the basement in an hour and get that laundry and take it up to the top floor and fold it, I would probably say ok, that makes sense, I will try to do that. I understand it needs to be done. But if my knee was bad when that dryer buzzer sounded, I wouldn't go down to the basement. I couldn't go down to the basement.

Bi Polar Disorder is not a sore knee. But it can keep people from doing things. From getting up off the couch and keeping their promises. From eating, or sleeping. And unlike my knee, when you feel terrible for not doing what you said you would do, you can make your BPD symptoms worse. I have a number of people in my life on anti-depressants and with problems with executive function. I also know, slightly less well, people on anti-depressants who have problems with impulse control.

What these people have in common is that explaining rights and wrongs to them will not help. It would be like lecturing me "when the buzzer sounds, the dryer has finished. And right then the clothes are warm. If you leave them there to get cold, they will get wrinkly. None of us wants to go out in wrinkly clothes. It's important to go to the basement as soon as the buzzer sounds." I know all that! It's not lack of knowledge that has kept me off the stairs! And the same often applies to people who are struggling with mental illness. They know they should do their share and help more, or clean up after themselves, or contribute towards bills, or keep their appointments, but when push comes to shove, they don't.

Now then, how can you talk to your brother about your issues with his behaviour? I recommend you stop explaining to him why he should not go out with friends, or should not spend money when he hasn't contributed to bills, or should help around the house more. He is an adult. He knows what he should and should not do, and why. I recommend you start being compassionate about his disease. For example, asking "do you think today is going to be a day where you could vacuum?" or "how much can you pitch in to the X bill this week?" lets him have more control than "could you X please" or "it's time for you to X." If he says he will do something but doesn't, you can explore with him what it was about the day and the task that kept him from being able to do it. Is the problem getting started? Perhaps we can start together. Is the problem a feeling of defiance that keeps him from doing something after you've told him to do it, even if he wants to do it? Is an optional part of the task (like driving himself to an appointment) keeping him from doing it, but if he got a ride he would do the rest? Does he have any understanding of what need he was filling, what itch he was scratching, by going out with friends or buying something? The phrase "retail therapy" is a natural opener to conversation about what sort of therapeutic needs he has. I have no idea what particular mental challenges your brother faces, and I don't think you do either.

If you are able to have compassion when he doesn't do things, or does things he shouldn't, and you are able to help him do things by meeting him where he is and helping him, things may get a lot better. That's what I've seen with my people. But I do remember an old acquaintance who was selfish, greedy, and lazy. He was diagnosed with depression and spent years in therapy and on medication. Eventually the psych said he was recovered, and what remained was just his own jerky, rude personality. Depression can make people act like horrible selfish jerks, but also some people are horrible and selfish underneath all that. I recommend you ignore that possibility for one simple reason: he is already behaving as horribly as you can tolerate. It seems very unlikely that compassion and helpfulness will make him do more unpleasant things, since he is doing so many already. But this approach may make him more productive, thoughtful, and helpful. It may enable him to control his impulses. It may make your life (and your parents') simpler and easier in addition to helping your brother.

One final thought: this is hard work. Depressed people are very frustrating. They don't argue, they say you're right, but then they don't do it. It looks like they are lazy and just enjoying you doing all the work. They rarely thank you for understanding or for helping. Other people tell you that you're letting them get away with stuff. It's a lot to take some days. But my experience is that people can get better, and when they are better, it's all worth it. No guarantees in your case of course. I'm just telling you my experience.