How to Talk to Your Brother with Mental Illness
A brief pause can prevent you from opening more wounds

My little brother has been dealing with mental health problems for 14 years. Looking back, perhaps it’s been longer. But he experienced his first psychotic break, followed by his first hospitalization, 14 years ago, when he was just 18.
Over those years, we’ve developed a lot of baggage. He’s made trouble in the family a hundred times. So when my little brother calls and makes ambiguous statements or unreasonable requests, it’s easy to think the worst and jump to conclusions. In fact, whenever my little brother calls, my automatic thought process goes something like this: anxiety, confusion, assumption of the worst, anger.
On a good day, though, I don’t immediately act on that thought process. I wait a few moments before responding to him. I re-frame the statement or request in my mind, trying to understand it from his point of view: is there some way that what he’s saying could make sense? So that’s Step 1.
Step One: Pause to Consider Before Responding
Here’s an example that just happened this morning.
Yesterday, my brother had an appointment with a social worker. The goal was to secure a bed in a homeless shelter for the night. We had a text exchange at night that sounded like he’d been successful. Then at 6:30am, I got TEN TEXT BUBBLES which seem to say he didn’t get a bed but instead spent $500 on clothing at REI and thinks I previously promised to buy him a new phone.
They looked like this:
hey Sis!!!
I was just testing out my activity levels slash motivation
instead of following directions i got a lot done
including spending $500 at rei since that suitcase died immediately and i figured i would get the kind of clothes that fit into a backpack
soooo i also am ready to upgrade my phone / we talked about it a few times and you were enthusiastic about helping me at first and i was just biding my time but for real!
but at this point i’m practically moved in and know i already need help getting out and to stay off the computer except dedicated activities so so we should do it
i think you agreed initially because i asked when my bike got stolen
just to recoup losses
but yeah i was thinking about falling asleep near the apple store if you wanted to come by early and wake me up at 10 or 1030
backpack was $150 too -/ plus i stained my best pair of pants from goodwill -:/ eating a pizza.
My first impulse was to reply “I never promised to buy you a phone!!!” But after pausing to consider, I realized that wasn’t an important battle to fight. He can’t make me buy him a phone, so why bother trying to convince him that his memory is untrue? That I’m right and he’s wrong? That kind of argument is pointless and unproductive. He won’t agree with me. I won’t win. Better just to leave this thread alone.
My next impulse was to chastise him for spending money foolishly. My little brother has done this before. Spending sprees are a common symptom of mania. In fact, I was surprised he was even allowed to spend $500 at REI. There was a period of time when he was literally banned from the chain for buying so much stuff and then bringing it back to exchange for so much other stuff and then bringing that back to exchange, and on and on etc. etc. until REI just said, STOP! You aren’t allowed to shop here anymore.
But I guess they forgot.
So here’s a man who doesn’t have a place to sleep at night, and he’s spending all his money on expensive camping clothes and equipment. That’s not a good idea. Right? Not a good way to set his priorities? Perhaps not. But as I paused to consider, with my finger hovered over the phone, I realized once again that this was not a good place to take our conversation. I was not going to win this fight. He was not going to suddenly see the light. Besides, it’s his money. He’s allowed to spend it how he likes.
And considering it further, I had to admit there was some way his actions could make sense. I am not the expert on how to make my little brother’s life better. He is. He’s the one living it. After all, $500 could buy maybe a week and a day in a dirty, run-down, bug-infested SRO in San Francisco. Maybe it really IS better for him to have some durable clothing and a reasonable way to carry it around that will serve him for months on end (providing he doesn’t lose them). But even if it isn’t, shaming him will not make it better. It will not result in different behavior. It will not get his money back. It will only result in both of us feeling upset and angry. So I quashed that impulse, too.
Then I thought hard about what we should be talking about. That’s step two.
Step Two: Choose One Good Topic to Focus On
When conversing with people with mental health issues, it’s a good idea to focus on one topic at a time, to limit tangents. My next impulse was to ask about his housing situation; and that one, I realized, was good. Housing is the most important thing for my little brother. Does he have a place to sleep at night where he can be safe, warm, and clean? Once I’d identified the most important and least contentious topic, I was almost ready to respond.
Then it dawned on me, finally, that if he hadn’t slept in a shelter, he’d been outside all night, which must have been pretty stressful. If anyone else I knew had to sleep outside in San Francisco for a night, I would express sympathy. And that’s step three.
Step Three: Express Sympathy
Instead of blaming my little brother for making foolish choices and failing to show up for or otherwise reserve a bed in a shelter, I decided to treat him at least as well as I would treat a casual acquaintance by expressing sympathy for his plight. So after pausing to consider, choosing one good topic to focus on, and deciding to treat my little brother with kindness instead of blame, I wrote this:
What do you mean “instead of following directions?”
Sorry the bag broke. Lame.
Are you approved for a shelter?
The conversation went on and on, and it took awhile to get the facts straight. It turned out he had walked all night, racking up 30 miles on the fitness tracker on his phone. That’s probably what had broken his flimsy rolling bag, which I’d bought in Chinatown, and which wasn’t built for that kind of heavy duty. As a solution, he’d bought a new backpack and gotten rid of half his clothes, including some pretty good shoes I’d bought him recently, since they wouldn’t fit inside the pack. :(
At first, he told the story in a way that made me think he’d chosen to stay outside all night instead of accepting a bed at a shelter, which I automatically responded to with anger and upset. But the force was with me this morning, so I didn’t express those emotions. I waited, probed gently, expressed sympathy. And as a result, I eventually found out that he’d missed the call from the shelter while his phone was recharging, and they hadn’t answered when he tried to call back.
So it hadn’t really been a choice, after all. He’d just framed it that way to put a positive spin on it. And my initial assumption that his carelessness was costing me money (via the abandoned shoes) and putting him in unnecessary danger had been incorrect.
And considering it further, I had to admit he might even be right! I am not the expert on how to make my little brother’s life better. He is. He’s the one living it.
Over the course of the conversation, there were many more opportunities to fight. Over and over, it seemed, he was baiting me. And maybe he was. He certainly knows me well enough to know how to push my buttons, and getting reactions from people is a time-honored pastime for him. But he also just might have been failing to communicate clearly. And it took me pausing to consider before responding — creating that small space of non-judgement — for us to reach some understanding, to bridge our divide.
At the end of the conversation, I’d agreed to meet him a little earlier than scheduled to have breakfast. And at the end of the day, he’d pinned down a place to stay for the week.
Thinking about this story reminded me of a course I took a few years ago in mindfulness, where the key is in the delay. Instead of letting your emotions run you, you take a moment to observe them and consider what to do about them. The idea is to recognize that you have an essential self, an identity, that is separate from your emotions. Your emotions pass over you, like clouds passing over the sun, and like good or bad weather, emotions soon change.
This story also reminds me of a book I read long ago about how to talk to people with mental health problems: “I Am Not Sick, I Don’t Need Help! How to Help Someone With Mental Illness Accept Treatment” by Xavier Amador. That book uses the acronym LEAP to remind allies of people who are struggling to Listen, Empathize, Agree, and Plan together, which seems similar the the steps I listed above.
Of course, everybody is different. And if you love someone who has a mental illness, you’ll develop your own customized ways to help.
According to the Substance Abuse and Mental Health Association, one in five people in the United States will experience a mental health problem each year. But everyone on the planet, whether struggling or not, could use a little more patience, focus, and sympathy. So I’m going to try to treat everyone better, starting with my beloved little brother.
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