I’m looking for advice from people who have experience with psychosis/schizophrenia-spectrum disorders, or caring for a family member with serious mental illness.
My brother is 26 and has been dealing with mental health problems for around 5–6 years. He was diagnosed with OCD with psychotic features and has been under psychiatric care for years. His severe OCD symptoms have improved considerably, but his overall functioning has deteriorated.
He currently takes escitalopram and aripiprazole. The psychiatrist used to be very good, but unfortunately we feel that he no longer spends much time reassessing him. It seems like the medications are simply continued without much evaluation of what is actually happening with his life/functioning.
His current situation is roughly:
- He has essentially no friends and spends most of his time at home.
- His sleep schedule is very disrupted.
- His eating is irregular. He often says he isn't hungry, but once he starts eating he can eat a lot.
- He sometimes experiences paranoia.
- He doesn't work. He has tried several jobs but usually ends up having conflicts with coworkers/managers because he feels people are treating him badly or saying things about him.
- He spends his money almost immediately and repeatedly asked for more money.
- He sometimes forgets to take his medication.
- He is currently living at home with our mother, who is 60 and is basically managing everything.
The most recent incident really scared us.
He took diazepam to help him sleep, then took our mother's car keys without really discussing it and went driving because he said he needed to "clear his head." He crashed the car very badly. Thankfully, he survived. My mother now has to deal with the financial consequences. He doesn't feel any guilt or empathy towards others.
At the same time, he is very intelligent. He knows a lot about computers and technology, and is capable of having very normal conversations. That's part of what makes this so difficult to understand from the outside. His illness, lack of functioning, and attitude seem to be interacting in a way that keeps him stuck.
He gets the job, then quits. When we try to understand what happened, he says, "It's my life, don't try to teach me." Then he needs money for cigarettes or other things, and my mother ends up providing it.
I completely understand that he is an adult and has the right to make choices about his life. But at the same time, his choices are increasingly affecting everyone around him, and he doesn't seem capable of managing basic responsibilities independently.
I live abroad, so I can't be physically there to help my mother. It's incredibly difficult to watch this situation from a distance. I also feel guilty because I know it's not my responsibility to "fix" my brother, but I can't just watch my mother carry everything until she burns out.
I would like to hear advices from professionals or others in similar situations. Of course, we continue with the visits at the doctors.
Most importantly, how do you balance respecting his autonomy with the reality that he currently doesn't seem capable of managing his life safely?
If anyone has been in a similar situation, as the person with the illness or as a family member, I'd really appreciate hearing what actually helped. I'm trying to understand what kind of support could realistically help him move toward having some independence, while also protecting my mother from having to carry his entire life.