Brother in Law… mental health

[DamnitImTired]

This is not really a question but perhaps someone will engage in a discussion with me to help me understand better.
My brother in law has some sort of as yet undiagnosed mental health condition. We are in the process of getting him the help he (and we) need. Symptoms:

1. he has no insight into his problem. Ie he believes he is of sound mind
2. he has lost all his life earnings in various internet scams and then sold all his possessions in recovery scams trying to get his lost money back. He has razed his life to the ground, even sold his bed and has been sleeping on the floor of his rental
3. This has been going on for weeks. Everything we ask him what his plan is to get out of this mess he tells us confidently about another obvious scam which he believes in.
4. after all he has been through he still cannot identify a scam
5. he is planning on going here and there with people because there is ‘money’ due to him coming soon from these scams. The money is always coming ‘tomorrow’
6. he develops ‘relationships’ with strangers on the internet and trusts them (various of these people have proven to be the very people who have scammed him).
7. he takes great offense when you point out the facts which point to these schemes being scams
8. he seems delusional but possibly these are just overvalued ideas?
9. logic just does not seem to exist
10. we are providing basic food to him but he sees no problem with living with no furniture and no money (not even enough to buy a loaf of bread)
11. he says he will just get a job but he has no transport as he sold his car and we live in a country with no public transport and he doesn’t have the funds to pay for a taxi
12. he gets very offended even angry when you suggest that he may have a mental health problem

What are your thoughts?

He's 52. And apparently not been involved in a crisis of this magnitude before.

It would be exceptionally rare for bi-polar to have a sudden onset at this age or for it to not have been obvious before.

The diagnostic criteria for bipolar disorder involves many, many things that aren't just about making unwise decisions or being easily conned.

My initial thought was

1. gambling addiction and
2. learning disabilities.

He's become obsessed with get-rich-quick schemes which is basically the mentality that's behind gambling. The using (and losing) more money to try to recover losses, right upto the point of losing everything you own, is classic. Gamblers are addicted to the drama. They're not actually in it for the wins. They don't stop if they make lots or quit while they're ahead. There's no such thing as "enough" to them. They do it for the losing because, although it's consequences can be devestating, it also comes with the hope of things improving. They won't admit that even to themselves though.

If he genuinely believes these scams and people then it sounds like learning disabilities to me. Obviously I've no idea what he's been like the rest of his life, this trusting naivety could be very new.

Don't underestimate the power of denial though. All the while he tells himself these people are his friends, the schemes are legitimate and his time will come, he doesn't have to face reality and look at what he's done to himself. So the determined belief in it all could just be a coping mechanism to maintain the fantasy that everything is fine. A fantasy which in turn allows him to remain an addict and carry on gambling "because where's the harm in it?".

Thanks for all your responses.

I am aware of that… because I have it and relatives have it. I spent a great deal of time in my childhood sitting in hospitals because of other peoples episodes and I myself went through several assessments before a psychiatrist diagnosed me. But thank you for letting me know.

As I said earlier only a psychiatrist can say for sure. This is just speculation based on my experience. I just want to point out though that late onset bipolar is possible and from what OP said there might have been signs before. This is might be a worse episode and he might have had more subtle hypomania before. As OP herself has said they intend to go to experts.

The OP is in another country though, which may mean less interventions, less understanding etc. Many people go for years with people thinking its just what they're like. I've met people who were diagnosed late who had had it for years (sometimes something happens in life e.g. divorce, new baby, death, etc, to set off a bad episode). Others are actually diagnosed late into their 60's after a first episode. Men often present with more anger, irritability (just like getting annoyed with a boss and constantly leaving etc).

I have bipolar, and when I had my first manic episode, I had a brief moment where I thought I could be manic (I'm not a high-energy person at all). This then went, and I had no idea that my delusions, etc, were strange and don't even have a great memory of the episode. I have good insight out of an episode or at the start. Lots won't take medication, though, as they do not think they are ill.

If it was bipolar (which is obviously not possible for me to say for sure), some people first present with lesser hypomania (bipolar 2), which if untreated (and sometimes even if treated) progresses into a full on manic episode (bipolar 1) one day. It is quite possible that with lesser symptoms, no one noticed and thought things that were happening were just him.

How does a psych assessment work? Do they take into account what the family feel or have to say?
I fear that if it’s just him and a MH professional he will just say it’s all fine and he knows he has made a ‘mistake’.
For us it’s bigger than the mistake and more about the capacity of a human to just sit with the devastation their decisions have created and not do anything to resolve it and just say it’s all fine and ‘I will make a plan’ when it’s obvious to us that there are no real plans to made.

Latest development is that he is going to a Coldplay concert and will be flying there.

Coldplay are on a world tour but are not playing in our country, certainly not the city he says he is going to

If you have any influence over him I'd try to prevent him going to this or meeting anyone about it. I'd be worried that someone else will pay the flights, then coerce him into being a drugs mule because he "owes them". Of course there will be no concert on arrival.

He has always been a bit ‘off piste’ and it has been suggested to us that he perhaps has a spectrum disorder. But that is quite in contrast with his childhood where he seems to have been fairly normal and achieved quite well in school

That's not a contradiction at all. Some neurodiverse people don't cope with school. Others can mask while they're there and then it all falls apart at home. Some it suits them, the certainty of the class schedule, the daily routine, the being thrown together with others daily which can hide the fact they have no real friends, obsessive tendencies can be channelled into studying and passing exams. None of this is anything like normal adult life, so the problem may not become apparent until they reach adulthood.

I wonder how many homeless people have undiagnosed MH problems that have resulted in them being on the street?

Lots.

He has had a disagreement with every employer he has worked for.
He has not held down a relationship since I’ve known him

This points towards personality disorder, neurodiversity, learning disabilities maybe. Basically anything that causes him to think in a way that's different to most people's thought processes and to believe that he's right, even when it's obvious to others that he's not. Or that causes him to not be able to cope with things that others find easy to cope with. So someone asking him to do something or expecting something of him, they're assuming it is totally reasonable but he thinks they're an unreasonable arse because he can't cope with it (and don't realise it's not like that for others).

Does he own a property? Live with you? If he has no money he can't be paying rent, unless there's welfare benefits for that? You're buying him food but who's paying for the internet and phone?

You can't force him to get help. Sadly, for some people their problems don't become apparent until they're in trouble with the police multiple times and the pattern of behaviour is officially noticed. Even then, it's unlikely anyone can force them to engage with any help that's offered.

How does a psych assessment work

I have no idea in your country but honestly even in the UK it depends on what area you live in and how they do things there. It also depends on the individual doing the assessment, to a point, everyone has their own way of working and some are downright incompetent. Could even depend on how you, the family, appear. People can get judged as not worth listening to based on things like how they dress, regional accent, level of education or intelligence. It's wrong but it happens. Can also depend on who pays for it. If someone is paying privately I imagine anyone could get themselves booked into a private hospital for extended observation, thorough assessment etc. If the state is paying it might be a one off meeting, with someone who isn't even a doctor, for an hour and they decide whether you get to see a psychiatrist or not, and whether you get discharged from the service or helped by them.

In my assessment my psychiatrist wrote to my parent, my partner and a psychologist I had been seeing. They independently answered the questions he had and their statements were used to diagnose me. BUT I agreed to this, I’m not sure how it works abroad or if he doesn’t.

My heart goes out to you, it’s so hard on families regardless of the cause. If it is mental illness it will be a symptom on its own. In that relative case, it has been decades, and they genuinely can’t control it. I have minimal insight during hypomania so to help my psych worked with me to create a traffic light system. The moment I notice anything I get paranoid, run to the doctor and avoid everyone I know.

again, thank you for your thought out response.

he does not own property. He lost all his liquid wealth in a scam and subsequent recovery scams. He sold all his possessions too.

he is renting and he managed to get some friends (real ex school friends I believe) to do a bit of a sponsorship for this months rent. But I don’t think he will be able to rally enough for the next month.

we are buying him food as he needs it. But his requests are loaf of bread here and there. Nothing healthy or substantial.

the internet and cell phone will be cut shortly I’m sure. I’d imagine the providers are at the end of their grace period.

partly what the desperation is on our part as it’s unraveling before our eyes and can’t see the problem and just says he will work it out…

unless someone buys him a ticket, he can’t even get to an airport as he has no transport or money to pay for transport. This is not going to happen. The concert doesn’t even exist. Seems like a delusion to me.

That sounds so difficult, OP. This won’t solve the immediate problems, but as your DH is his next of kin, is there anything similar to a Power of Attorney where you live? Obviously, your BIL isn’t well enough to agree to this at present, but if your DH can persuade him to get help and he becomes more stable, it might be a good idea for the future.

Severe depression can cause this. My uncle when down will sell,buy literally anything to cheer himself up then end up in a deeper depression. It goes round same circles every time

That sounds so difficult, OP. This won’t solve the immediate problems, but as your DH is his next of kin, is there anything similar to a Power of Attorney where you live? Obviously, your BIL isn’t well enough to agree to this at present, but if your DH can persuade him to get help and he becomes more stable, it might be a good idea for the future.

we do have something like that here and in hindsight it would have been a worthwhile thing to do when he had assets to protect. Right now I think the best option is to get him to agree to a psych consult in exchange for the help we are giving him in terms of living needs and then hope for an admission into some sort of programme. After that I just don’t know.

All I can say OP is that you need to have a chat with DH about protecting yourselves. BIL is going to end up homeless, I can see no other outcome. If you take him in to live with you, or let him use your computer/phones, you'll be exposing yourselves to these criminal elements too, they'll have your address and your gadgets could get infected with viruses.

You can't help someone who doesn't want to be helped. Be aware this could be very complex. He may not have just one problem. For all we know, he could be neurodiverse with additional learning disabilities, have a mental illness too and be a gambling addict. There's not a limit on how many things a person can have wrong with them.

Rock bottom looks different for everyone. A friend's DH had problems with his health, the doctor ordered a liver function test because he was alcoholic. You'd think it would be a wake-up call, but when the test came back as fine, he came home with a bottle of wine to celebrate. She divorced him. Maybe your BIL needs to end up on the streets to make him realise he has to change his ways.

Perhaps you could look into charities that help the homeless, whether that's feeding them, providing clothes, somewhere warm to go for a few hours a day in winter or helping them get rehoused. In the UK, as part of their help they'll look into the barriers to being housed. Things like losing all your money to scams, failure to hold down a job or relationship, will be noted as red flags for possible addiction or mental health issues and if the homeless person was agreeable the charity would help them get investigation and help for whatever the issue turns out to be. Some people do self destruct though and spend their entire lives refusing help. If he does want help though, he may be eligible for more help if he's not staying with you.

@MariaAshley
youve touched on so many things. He has already put our lives in danger. He borrowed money from some unsavory characters who threatened his life when he couldn’t pay. We don’t live in the UK and so this is a very real threat here.

he will not live with us. We have already agreed on that. He will never leave and will drive my dh crazy.

I said the same thing about Rock Bottom. It’s crazy.

If he's done things already that could have a major negative impact on your life, I'd consider distancing yourselves further.

Has he shown remorse at all? He certainly hasn't had enough remorse to change his ways. However you want to look at it and whatever the reason, that boils down to him caring more about his chosen lifestyle than he does about you.

I'd consider moving home if possible and not giving him the address. You could still meet up with him somewhere neutral, taking care to ensure you're not followed home or talk on the phone when he has access to one. I'd consider getting a second phone number, giving the new one to everyone else and saving the old number just for him, because you don't know who he might give it to. Many phones have a dual SIM card facility these days.

It's one thing to not realize you're ill, to behave in strange ways whilst ill, to accidentally cause harm or problems for others. It's another thing entirely to refuse to listen when your loved ones repeatedly tell you you need help. If he's determined to self-destruct, it's ok for you to step aside so you don't accidentally become collateral damage in the explosion.

The lack of remorse is the thing that bugs me the most. One minute we are bailing him out of a dangerous situation and the next day he is phoning like nothing is wrong and trying to make plans to go to an event on the weekend. An event where he couldn’t buy a ticket or even a bloody soft drink if he wanted. It’s crazy.

We cannot move and we cannot change our phone numbers. We live in a small town with multiple business interests. He is the one who needs to be ringfenced.

Anyway, I’ll keep you posted.

He is the one who needs to be ringfenced

True. But you can't control another person's life/behaviour, only your own. Good luck.