Dear Dr. Hurd: My brother is 32. He has never held a job a job for longer than a couple of weeks and he, his wife and daughter live with our mother. They scrape by on disability checks, food stamps and our Mom’s largesse. In fact, I believe that his long-standing disrespect and mooching off our mother and late grandmother actually hastened our grandmother’s death.
About a year ago he was diagnosed with schizoaffective disorder, bipolar type. Since then I’ve wavered between thinking that he’s faking his symptoms (to collect ‘disability’ from the state) and thinking he’s legit and that I ought to cut him some slack. Irrespective of my feelings, I want to be fair. Do you think it’s possible to fake a diagnosis of that kind?
Dr. Hurd replies: Your question assumes that one of two things is true: Either your brother is ‘mentally ill’ and has no control over his actions, or he’s faking it. The most likely answer is that it really doesn’t matter. You can acknowledge his problems if you so desire, but you should also hold him responsible for allowing his life get to the point that it has.
Many mental health and medical professionals will assert that your brother’s problems are exclusively physical, i.e., in his brain. They will claim that a ‘chemical imbalance’ causes everything: his values, his choices, his beliefs and his actions. But if brain chemistry were the only thing that determined what makes us human, then pills would easily change all that ails our characters. If any such miracle cure existed, we’d certainly know about it by now.
In trying to understand your brother, you have to ask yourself, ‘How does he think?’ And, ‘What mistakes in his thinking lead him to act in self-defeating ways?’ That’s how we hold people responsible. If your brother’s attitude is, ‘I can’t help it. I’m not responsible for my actions, and everybody else owes me a living,’ then you should indeed take issue with the way that he thinks. If on the other hand he says, ‘I know I think in irrational ways. I want to change so I can live a better life,’ then he deserves credit for attempting to take responsibility for himself.
One takes responsibility by taking charge of his or her mind. That’s the whole point of mental health treatment, counseling and so forth. If someone is unwilling to take charge of themselves, then they have, in effect, given up. Some people give up passively (‘I’m beyond help’) and others in a more angry way (‘I’m helpless and you had better take care of me!’). It sounds like your brother falls into the latter category. He’s concluded that because he’s moody or overly emotional at times, that there’s automatically something wrong with him that he cannot be expected to fix. Naturally, he became angry and bitter. This thinking pattern and the resulting erroneous conclusions led to his choice to mooch off your mother and be generally unpleasant.
Your mother and grandmother probably facilitated the problem by buying into the same line of thinking. Like you, they view it as a false choice: Either he’s lying, or he’s physically ill, like a cancer patient, and therefore helpless. The truth is that we are the product of more than just brain chemistry and randomly firing synapses. We’re the product of the way we view life, people and events. Anyone who’s conscious and even minimally intelligent can be expected to evaluate his or her own thinking. Sometimes it’s hard to do that alone. The psychiatrist who prescribed the medicine should have told your brother that he needed cognitive psychotherapy to figure out how to improve his thinking.
I doubt that he’s faking anything. What’s more likely is that he’s sad, angry and bitter. Maybe he ‘has it easy’ in that he mooches off his family and attacks them verbally while doing so. He likely believes he has no choice other than to be the way he is. Nobody ever challenged him to be different and he never challenged himself to rise to a higher standard. This remains his biggest problem, although he might never see it that way.
Of course, not every person labeled with a mental disorder is like your brother. There are as many different types of emotional disorder labels as there are those without them. However, people with emotional issues often suffer from significant self-esteem problems and will tend to underestimate themselves. Medical and mental health professionals (and significant others, including family) who encourage them to feel helpless have done them no favors. If your brother is a victim of anything, he’s a victim of that insidious social trend. He has the power to liberate himself from that. If you want to help him — and hold him responsible— that’s the way to do it. Tell your mother too.