A reader emails: “Dear Dr. Hurd, my brother is 32. He doesn’t work. He, his wife and daughter live with our mother. They scrape by on disability, food stamps and our Mom’s generosity. I believe that his 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 wonder if he’s legit or faking to collect disability. My feelings notwithstanding, do you think it’s possible to fake a diagnosis of that kind?”
Dear Reader, you wonder if your brother is mentally ill or just faking it. The answer is that it really doesn’t matter. You can acknowledge his problems if you so desire, but you should still hold him responsible for allowing his life get to this point.
Some health professionals will assert that your brother’s problems are entirely physical – that a “chemical imbalance” impacts his choices and his actions. But if that were true, then pills would easily cure all that ails us emotionally. No such miracle drug exists.
In trying to understand your brother, ask yourself, “What mistakes in his thinking make him act in self-defeating ways?” That’s how we hold people responsible. If his attitude is, “I can’t help it. I’m not responsible and everybody else owes me a living,” then you should indeed take issue with the way he thinks. If 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 at least attempting to take responsibility for himself.
One takes responsibility by taking charge of his or her mind. That’s the goal of cognitive psychotherapy. If someone isn’t willing to take charge, then they have, in effect, given up. Some 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. Because he’s overly emotional, he believes that there’s something wrong with him that he can’t be expected to fix. No wonder he’s angry and bitter. His erroneous conclusions led to his choice to mooch off your mother and be generally unpleasant.
Your mother and late grandmother helped facilitate the problem by buying into the same line of thinking. They viewed it as a false choice: Either he’s lying, or he’s physically ill. The truth is that we are the product of more than just brain chemistry. We’re the product of the way we view life, people and events. Anyone who’s even minimally intelligent can 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.
Going on what you told me, I doubt that he’s faking. More likely he’s sad, angry and bitter. He has it easy by mooching off family and then attacking them verbally. He likely believes he has no choice but to be that way. Nobody ever challenged him to rise to a higher standard. This is his biggest problem, although he’ll 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 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. Health professionals, significant others and family who encourage this helplessness are doing them an injustice.
If he’s 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.