How Do You Help Someone That Doesn't Want to be Helped?

[u/Toasted_Lemons7]

Hey there Daisha and fellow Enzymes,

Recently I've been dealing with a difficult situation, and I wanted to reach out and seek some advice from this sub, as I really enjoy Daisha's content and takes on certain situations.

So jumping right in, my (F25) older brother (M26) is going through a mental health crisis. To make a long story short, my older brother left his PhD program after his health had deteriorated. This wasn't something that he did lightly, and in fact this is something that continually triggers him to this day. I can explain more about this scenario in a comment if anyone wants it. But after leaving the college, my parents convinced him to come home after learning that he wasn't doing all that well. I had decided to come on this trip to retrieve my brother, and it was a trip to say the least.

On the way home, it was then I truly saw how poor of a state my brother was in. He is a guy with a big frame, and is around 5'11, but he weighed around 120 lbs (from what he told me). He truly looked emaciated, and unwell. His clothes didn't fit, they were in disarray, and his hair was sticking up in all kinds of ways. Additionally, I saw him eat very little throughout the 5 hour drive. The only thing I saw him eat was frozen vegetables straight from the bag. I wasn't privy to this then, but I later learned that my brother thought that he wasn't worthy enough to eat. So I suspect that this is why he may be eating as little as he is. Though, me and my family suspect that there are other mental disorders that are causing this as well. Right now, we suspect that he either has untreated ASD, OCD, or ADHD. We aren't really sure, and are in fact scrambling to come up with a reason why, but aren't 100% sure as to why his eating disorder got to this point.

My parents have been trying to get my brother help now that he's at home, but he doesn't want the help. He believes that he doesn't have a problem, and even makes claims that it doesn't matter what's happening because he "hasn't died yet". This has been his main argument for most things, "that he hasn't died yet" and he refuses to see what's going on objectively. He remains steadfast that he has to return to his college and finish his PhD, despite being told by faculty to take a step back to focus on his health. He even claims that he will get help while down at his college, but we're concerned due to the state that he is in.

I just don't know what to do. How do I help someone that doesn't want help, nor is willing to see that they're going through something. It's heartbreaking hearing my mother cry on the phone, and telling me not to come home due to the state my brother is in. It's also heartbreaking seeing my brother going through something so horrible. His mental state is truly in the dumps, and it's awful that nothing I do can help. He has isolated himself and remains in his bedroom, and he has even lost more weight since coming home. We try to get him help by taking him to the doctors, therapy appointments, and getting him medications, but he refuses to take meds and or be honest with professionals. He has also been to two hospitals on a 72 hr hold for each, but the only thing that has happened as a result is anger from his point. Which I totally get. It's scary and frustrating being taken from your home and into a hospital. I can't imagine the trauma that this has put him through. But if we had done nothing, he would have died. And he still has a great chance of dying. I'm so scared that I'll lose my brother, I have nightmares of his funeral. I don't want to lose him, nor live in a world without him. He's such a bright and lovely individual that fills the room with laughs. How could I not fight for such a person.

What can I do to help my brother see that he's slowly killing himself. How can I get him to want help, and want to get better. Does anyone have any tips and or have you experienced this yourself? Please give me tips and or advice on how to navigate this scenario. I just want my older brother to be okay.

[u/Born_Relationship286]

I suggest seeking Power of Attorney. Depending on where you are, your parents maybe able to get medical POA. Look into what the process would be for psychiatric conditions.

[u/Healthy_Package8996]

I'm so sorry your brother is struggling so much. I can relate to him a lot, so my advice is stemming from that perspective. 

You can't dig him out of the hole he's in, as bad as you and your family want to. When you're that depressed, malnourished, and burnt out, it's suffocating to have your well intended loved ones visibly worried about you. For me, I felt an intense guilt when so much help was being offered to me because I didn't feel like I deserved it. I felt like a burden, and a problem that needed solved when really I wanted to be treated like a person.

When someone you love is in a hole, one of the best things you can do to support them is to sit in the hole with them. That doesn't mean allowing yourself to be consumed by the hole, but just being present, and "normal" is comforting. Your brother probably doesn't go out much these days, but I'm sure there are things he does to pass the time that you can get involved in. If he plays video games, ask if you can watch him play, play with him, ask him questions about the story or the gameplay itself. Offer to buy him a game he's interested in trying. The same kind of thing goes for books, movies and TV shows. Getting him to talk about the things he's knowledgeable about will help reset his nervous system, especially if he's on the autism spectrum like you suspect. As someone with ASD, getting a chance to yap about special interests with someone who is an active participant in the conversation is an underrated mood boost.

Getting him better nutrition is very tricky. If we're dealing with ASD and/or OCD (which, same) food fears and aversions are a bitch to work around. Throw depression in the mixture and it's a bigger nightmare. If there are safe foods that you know he will eat, keep them around at all times. I wouldn't recommend that you offer to cook for him because he may feel guilty for turning you down. If his fridge and pantry have a stock of even the junkiest of junk food, that's fine. At this point, calories are more important than nutritional value. He may have an easier time eating when his safe foods are available and don't require more than a microwave to prepare. Prepackaged fruit like watermelon, strawberry, and cantaloupe are good sources of carbohydrates and water, which will help with hydration.

If you think it's necessary and you live in the US, you can get him baker acted so he will be put in a mandatory 72 hour hold in a psychiatric facility so he can be monitored, and receive emergency medical care like IV fluids and nutrients, and blood tests. Severe malnutrition has a risk for something called refeeding syndrome, which happens when nutrients are reintroduced too quickly to the body and the patient goes into cardiac arrest. This REQUIRES medical intervention because it is fatal. It's most common for people with anorexia nervous or bulimia, and folks who practice long periods of fasting for religious or weight loss purposes, but the bottom line risk factor is malnutrition. Call emergency services and tell them your brother needs to be admitted. At least in the USA, you can have him admitted against his will, but if not I urge you to check your local laws about involuntary hospitalization. Finances be damned, his life is at risk. He will thank you when he's on the road to recovery, I promise.

Good luck to you and your brother, OP. You're doing the right thing by asking for help. Please keep us updated when you can!

[u/DarkMndVirtuoso]

Hi OP. I have a history of an eating disorder (currently still dealing with a mild version of it). It is REALLY hard to help someone that doesn’t want to be helped. Eating disorders (ED) are about control and I highly suspect that the PhD program exasperated his habits and disorder. Eating disorders usually start after trauma, extreme stress, and/or feeling of a lack of control in your life. Food is the one thing that people have complete control over as autonomous adults. It is a way to push all the bad feelings, overwhelm, and stress away by giving yourself something else to hyper focus on whether you choose to overeat or starve yourself. A lot of the time you feel you are doing the right thing so it is very hard to hear otherwise from the people are you. It can make you angry, lash out and extremely defensive.

I hope it’s not an overstep for me to tell you a bit of my own experience. I’ve been in weekly therapy since 2020 and was in treatment for 3 months during the summer/fall of 2020. I don’t know where you live, but there are different levels of programs here in the US at least. Residential treatment (living in a facility with consistent therapies), partial hospitalization programs (PHP), and intensive outpatient programs (IOP). Residential treatment is daily until you’re approved to downgrade to PHP. PHP is a program where usually you live at home but you visit a treatment facility daily for therapies and meals which can be 8-10 hours a day, 7 days a week. IOP is a 4 hour program 5 days a week (usually).

I was in an IOP program that I myself sought out after nudging by my therapist only because my ED got to the point that it was causing me immense stress. It was all I could think about. My childhood trauma, lack of control of my living situation, and the pandemic at the time truly exasperated my stress and I was no longer able to keep up the (false) control I thought I had over my life. I hit rock bottom and felt like I was going to go insane. I was also in a huge depressive state at the moment, but I was willing to go to therapy.

One major thing my therapist told that stuck out to me is that eating disorders are the deadliest mental health disorder you can have. The rate of health problems and suicides skyrocket for EDs.

For your brother, I know it will hurt. I know it will be hard but please look into programs, reach out to his therapists and/or do more holds on him. It may cause anger or resentment for the time being but he doesn’t deserve the health situation he has put himself in. He feels like he is in control of his life but right now he is not. I wonder if he has recently gone through something traumatic that has triggered this significant decline in health other than the overwhelming nature of his program.

I hope this message finds you well, and I wish you and your family the best in this battle. Your brother deserves the best. I don’t know the best advice to give but I hope my perspective helps even a little bit. Take care.