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Psychiatry & Psychology--General/How to handle my brother's anger management issues and other issues ?

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QUESTION: Hello...my parents and I are trying to decide the best plan for helping my brother, who is 31 years old and currently in jail because we pressed charges against him for threatening us over the phone when he was drunk a month ago. He called us in the middle of the night, asking that we come get him because he was stranded in the city and had no money or way home, where he stayed with a friend. We refused to come get him at 4AM in a place we aren't familiar with and we aren't comfortable being around him when he's drunk or high on drugs, which he has a history of...and he has been a drug dealer off and on since he was a young teenager. He has a criminal felony record for drug bust in the past. When he doesn't get his way, he threatens us (his own family) and also his son's mother in the past. He had just gotten out of jail a month before this incident. He had been in there from Thanksgiving morning until one month ago...for alleged armed robbery on an individual and his girlfriend. My brother and his friend stole $58.00 and a cell phone from those people, but he case was dropped because the victim was also put in jail for something while my brother was in jail for this crime against him. But, then this incident happened where my brother threatened me (said it was his main mission to make me dissapear) beause I wouldn't come pick him up that night. He also threatened my parents and said he'd kill us...and so we called the police. We had not pressed charges on him in the past, partly out of fear and partly because we had hope that he would change for the better on his own. Now, we are realizing that this may not be possible...probably isn't. He has had a history of anger management issues since he was about 7 years old. He used to easily get mad at his friends and chase them around or hit them and he also got mad and pitched fits when his ball team lost a game. Then he got into marijuana and then selling it. He then got into Xanax, Ecstasy, Cocaine, etc...and always drinks too much. He always gets back into his old lifestyle of trouble and selling drugs right after he gets out of jail. My parents used to bail him out but they stopped recently. They want to see if there is some kind of court-appointed rehab and mental evaluation that the state may pay for or help pay for. My brother has exhausted my parents funds over the years. We fear him, although he has always seemd to be "all talk" with his threats, but we are not comfortable being around him, and he doesn't even understand why. He says that we overreact. We are afraid for him to get back on the streets without some serious help this time. He seems to get worse with age...and we don't know if it's just the drugs/alcohol, or a mental condition like Bipolar disorder, or if he was born this way...or if a head injury he sustained to the forehead at the babysitter's when he was a few months old...had caused some sort of frontal lobe damage to his brain, in turn causing anger management and decision making problems. I personally saw a documentary on Dateline or a show like it...back in the year 2000, which discussed a survey that was done on some prison inmates who were incarcerated for violent crimes. They did MRI scans on these individuals and also psychotherapy and determined that 80% of those tested...had frontal lobe damage to their brain when they were young children, and it was caused by either physical trauma or emotional abuse. I am wondering if it's possible with my brother, since he did have a forehead injury when a baby ? And he had the anger issues as a young child and all his life. OR...is he just pure evil ? We don't want to believe that, but we need to find out for sure and know how to proceed...for our safety and for his best interest. Thanks for any advice...we are desperate for answers.

ANSWER: Jamie, the first question is your brother's willingness and sincere cooperation to accept help to change. Sadly, I can't say I read anything that suggested he has the insight and motivation to alter his path. If that is indeed the case, your own protection would lie with law enforcement and perhaps a lawyer who deals with remedies such as restraining orders and involuntary commitment.

If, however, there is the possibility of enlisting his "normal" self, I suggest that you and your parents find out what exists in your location and how to access it. Often the best source for this is a clinical social worker. Their time is not costly, they know the law, and most important they are familiar with what mental health resources are available and what programs exist to help with access. After a professional diagnosis, management might be any combination and type of medication, psychotherapy, and institutionalization.

As for the root cause of his antisocial and dangerous behavior, this might never be uncovered with clarity, but it is less important than a diagnosis that points to what will work in effecting a change.

I hope those ideas will be somewhat helpful in gradually improving the situation. In any case, all else I can offer is an invitation to send a follow-up if you have one.

Wishing you all the best of luck,
Alan

---------- FOLLOW-UP ----------

QUESTION: Hello Mr. Auerbach...thank you so much for the very informative and helpful response to my question. Do we contact the Dept. of Family and Children's Services to get a Social Worker assigned to our case for my brother ? We don't really know where to begin, but are speaking with an attorney who feels that my brother is more than likely Bipolar. We lack the money to have my brother put into an institution ourselves and don't even know if that's the route to take for him. He did have a steady job for a couple of years until he got into a heated argument with a woman co-worker and he was fired, but collected unemployment before he went to jail again recently. He is so socially awkward because of his temper and a little bit of paranoia. He has, however, always seemed to have lots of friends, but they have slowly dwindled down over the years. He can be quite comical and show a caring, loving side to himself when he wants to and when he's not under the influence of a substance, which is rare...he usually IS under the influence of something. He has always had insecurities about his size when younger, so he shot-up steroids to beef-up right out of high school. That probably added to his temper...or so I've heard. He used to constantly look at himself in the full-length mirror to see how his clothes fit him...he was almost obsessessed with the way he looked when younger. He is not that thin anymore, though. He is pretty irrational lots of the time when speaking with him on the phone when he calls from jail. He cries sometimes and admits how wrong he is about some things, but then he gets mad again or blames us for overreacting. He cusses (uses foul language)constantly and repeats himself a lot especially when drinking. He claims to love his 3.5 year old son, and wants to be part of his life but yet when he was out of jail before this last incident, he had his son for a few days and admitted to doing cocaine while his son was in his care. He was hallucinating and thankfully nothing happened before his son went back to his mother's home. The child's mother is now pregnant by another "thug" and so that worsens this whole situation. It's so much drama and we are literally at a loss as to how to handle this. I guess just start with a Social Worker in our town, and we do that by contacting DFACS ? Thanks for your help...

Answer
I was thinking more of the listing for Social Workers in your Yellow Pages, failing that, an internet search. And I was picturing your finding one who does private practice, and simply engage an hour or two of face-time. If you can access a SW, they may agree with your thought of the DFCS, and give suggestions of what points to make that they would respond to. Also, major hospitals often have a SW on staff or on call. Again, their specialty is resource management (like where a bedridden patient might go after discharge).

If you can't find one (there may be no such professional in your state), most police services have an officer or civilian on staff who know what's available, or where to find out. They could have various job titles, but typically counsel victims following interventions involving substance, spousal or child abuse.  Or, given that there is a local DFCS, it does seem sensible to contact them, although I can't say what the qualifications of the initial intake worker would be. Other mental-health practitioners (psychiatrists, clinical psychologists, some physicians) can also give you a rundown in short order, but they tend to charge more for their time, and may not know quite as much. Or it could be as simple as calling the local "Help Line," whose number might be in the front of your phone book or online.  

Once you start to get a handle on what's available in the way of help, more possibilities will flow quickly, and with a full picture you'll be in a position to get the services you need, your taxes have supported, and your brother needs. While I can't properly comment on specifics, typically in these cases the first priority is protection of those who might be vulnerable. The second is fixing your brother, about which I need to point out that sometimes there's a miraculous conversion with no further episodes, but often the response is poor, short-lived, or even a worsening. So even in the best of hands, I'm afraid you can't necessarily count on a magic cure but it's certainly worth a try. Let me know what happens.

A.  

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Alan Auerbach

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Taught psychology for 30 years, authored four textbooks. Specialize in introductory and industrial/organizational psychology, but will tackle wider range of areas.

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