How can I best help my brother?

I’ll try to make the back story as concise as possible. My 49 year-old brother has very recently been diagnosed with Major Depression and Paranoid Compulsive Personality Traits.

He is married and has two children (11 and 13). His business (which he inherited from my father) is failing badly and its the only work he’s known, but he doesn’t want to let go because he doesn’t think he can anything else. We had a ten-year estrangement so I have not had a bird’s eye view of his problems/behaviours, but I have known he tended to be overly suspicious (mostly of his wife) and could be difficult to reason with. I have only recently learned that he had a ‘break down’ and was diagnosed with OCD in 1998.

His wife is a wonderful woman. As his behaviours have been difficult to bear, but to all the world they seemed a happy enough and solid couple. Apparently not. She has spent years trying to follow his ‘rules’ and didn’t invite friends into the house, didn’t spend time emailing, basically trying to prove to him over and over again that he is worthy, lovable, intelligent, and so on. She had also tried several times to help him get help: told a doctor he was very ill, took him to the appointment, waited for him, only to have him tell the doctor that he was fine.

So on Valentine’s he asked his wife why she seemed distant. She told him she’d been unhappy for some time and was thinking perhaps they should separate. That sent him into a total tailspin and he walked 27 miles in the middle of the night to my home. He was mess when he arrived.

I drove him home that evening and checked on him every day - things seemed to get better. A week later (on the eve of his and his son’s birthday) he walked 15 miles to the hospital to see if they would give him something to feel better and they admitted him to the psychiatric department. He was there for five days during which time I was his only visitor. I got his clothes and toiletries, picked up whatever he needed and spoke with his doctor.

He was given two medications: one antidepressant (the dosage is to increase by double this evening) and the other an anti-psychotic, that apparently can take up to six weeks to become effective. His next psychiatric appointment isn’t until March 31st and he has an assessment to join a cognitive therapy group on March 23rd. That seems a very long time from now given the circumstances.

Since his release I have taken him to my home (where frankly, he is driving us crazy, although we realize he can’t help it - but he is clearly unbalanced and repeats paranoid thoughts, or poorly thought out ideas over and over). I drop him off at his home in the morning on my way to work as he has to take care of what little business there is left with his company and ostensibly prepare their home for sale (they can’t afford the big house and would be moving together or apart).

I pick him back up in the evening and so on. He is not responding to the medication in a way that makes me feel comfortable that he won’t be in another crisis - and I don’t want to put his wife back under that pressure as she figures out how to move forward in her own life.

I suppose what I am asking the Dopers for is a sense of to what extent they would feel responsible for their sick sibling and what sort of concessions they would make to care for them. I have two other sisters but one lives across the country and the other one, apart from ‘supportive phone calls’ is too self-centred to pitch in.

My husband is fabulous and knows that we need to help right now - but I think caring for him too completely (including living long term with us) would be neither helpful to my brother or fair to my husband.

I’m a bit lost about knowing how to help going forward, knowing that without my constant input he’ll get nothing accomplished - what would you do in these circumstances?

thanks - heckity

Wow. That’s a tough situation to be in for all of you. Is there any chance the wife can hang around for a couple of months until he stabilizes? I know it’s hard for you but you’re definitely doing the right thing, and it shouldn’t be for too long. As your brother’s doctor pointed out, the medication can take a while to kick in, so this is really the time when he needs your support most. It’s extremely trying and frustrating, but at least you have some sort of overview. For your brother it probably feels like nothing will ever change. But once he responds to the medication he’ll be able to think more clearly, although the work and relationship problems will still be there. Hang in there, and definitely look for other message boards where you can vent because what you’re doing is emotionally draining and sometimes it helps to scream.

I know you’re trying to give his wife some breathing room too, which is nice. But maybe you could trade off with her. She obviously cares for him and wants to see him get better. You could maybe trade off every three days or something. That way he gets intensive care and you each get a break, every 3 days, to get back to the other things that need attending. Just a suggestion.

Perhaps you need to call his doctor and discuss some other meds, pointing out the delay until he gets into therapy, and the difficulties he’s facing in the mean time.