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Loser Siblings: Sound Like Anyone You Know?

The one you resent, that your parents enable and makes them sick.

I had some hesitation about using the word "loser" in the subject line, but then I figured, that such a person would never read this (#20 below).

Also, "loser" is not a word in my vocabulary -- I don't like it and I don't use it -- but it does appear to be a word thought frequently by a functioning sibling of such a troubled and troubling individual. Over time the functioning sibling learns to limit their involvement with this sibling, but is not infrequently drawn back in by their parents whose distress and anguish is nearly unbearable to the functioning sibling especially when it causes health problems in a parent.

I am writing this to check out the size of the unmet need to help a sibling or an adult child age 18+ with the following profile (according to the functioning sibling):

  1. Not doing anything productive in their life
  2. Unmotivated
  3. Makes excuses
  4. Blames others
  5. Feels sorry for self
  6. Acts like a victim
  7. Takes no responsibility for causing their situation
  8. Takes no responsibility for correcting it
  9. Has no plan for getting better
  10. Doesn't cooperate with plans provided by others
  11. Never made it through high school, college or beyond
  12. Sleeps most of the day
  13. Has psychiatric illness, but doesn't cooperate with treatment including appointments or medications
  14. Psychiatric, Drug or alcohol problems with at least one inpatient hospitalization, but either signs out, relapses or doesn't follow through
  15. Successful siblings view person as manipulative and can't stand them and believe parents are enabling them
  16. Responsible for more than 80% of their parents' stress
  17. Parents are besides themselves and even mentally and physically sick over this child
  18. Frequently threaten to end it all because there is nothing to live for
  19. The loser would never read this list, because it's too true
  20. The elephant in the room that no one will talk about is that when this person vehemently refuses all assistance it can cause the group to feel momentarily discouraged and think to themselves, maybe they would be better off dead (in truth when that happens the person is just trying to not feel so alone in their despair, because when you're there you can't even hear solutions and it just feels like people are lecturing you).

I don't like to bring up problems that merely make people more miserable and that there is no solution to.  However after spending two years of due diligence I have found that there exists in the mental health system a subspecialty called outpatient psychiatric and psychological rehabilitation that I was unaware of.

Outpatient psychiatric and psychological rehabilitation essentially provides a seamless team of individuals that work together on an outpatient basis that is the equivalent of the inpatient teams that do so in either psychiatric or drug and alcohol inpatient facilities.

One of the problems when patients are discharged from such inpatient facilities is that the patient and their family are on their own recognizance regarding following through.  Such inpatient facilities or for that matter appointments in doctors' and therapists' office provide stabilization of patients, but not treatment. Treatment needs to take place where and how patients live on the outside. Just as more and more people stick to exercise routines like spinning or cycling classes in groups at sports facilities the same is true with recently discharged psychiatric and substance abuse patients, but in the latter cases they often need someone to come and take them to doctor's and therapist appointments and other outpatient services and too often the patient/parent relationship is too emotionally charged.

The reason AA and other 12 Step Programs have a better record for helping alcoholics and other addicts is that sponsors meet them or even pick them up to take them to meetings in the community.  Outpatient psychiatric and psychological rehabilitation does the same except that the case managers (usually with Masters or higher level psychology degrees) serve as highly skilled psychologically trained companions that pick patients up and take them to their doctors' and therapists' appointments, defuse the relationship between patients and their often anxious and overcontrolling parents and even serve - with the patient's permission - as the eyes and ears of the treating psychiatrist or psychotherapist.  By doing this they are able to let that professional know of an acute deterioration of the patient's condition that the patient may not report to their doctor or therapist until the next appointment.  And that might be too late and not before a relapse has begun to happen.

The AA and other 12 Step support network is extensive and works well with cooperative alcoholics and substance abuse patients who need and accept help, but there are few coordinated and seamless outpatient programs for recently discharged uncooperative and non-compliant psychiatric and substance abusing patients who don't follow through on treatment. 

Sadly and tragically, the majority of the shooters we read about every couple months fall into the category of psychiatric patients who had seen mental health professionals, but then didn't follow through often because they didn't have a cooperative relationship with a family member nor a psychologically trained outpatient teacher/mentor/coach to treat them where they live.

If you have need for such services ask around in your community if and where there are outpatient psychiatric rehabilitation programs that work as closely together coordinating psychiatric and psychological rehabilitation similar to what is done on an inpatient basis.

Mark Goulston, MD, is the author of the new bestselling book Just Listen: Discover the Secret to Getting Through to Absolutely Anyone.

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