If I could write an action plan for you, it would go:
Get family members, you, and your brother on the same page
Get brother out of hospital (perhaps by convincing him to conform for a while, perhaps via a lawyer). Of course, don’t take this step unless you have a plan for his care. Can he live with you? Are you willing to be his caregiver? What happens if he attempte suicide again or does something else that would legally warrant commitment?
Is there a local Hearing Voices group? Or research Hearing Voices online. Lots of people have experience with living with the experience of hearing voices while managing the distress and disruption they can cause.
Thanks very much for your response. It is really helpful for me to have action items/relevant questions laid out, so again thanks very much. In answer to your points and questions:
1. My perception is that my other family members (other brother, mom, and dad) acknowledge that going through the same cycle of crises and downstream coercion that functions such that the outcomes then feed into the re-emergence of more crises, etc, is unhelpful (at best). I think though, that my family feels “at a loss” for how to move forward, given that a) my family is slightly fragmented and there are some persistent communication/power/ego issues, b) family lacks access to structural resources ($$ and time) c) some family members have personal demons of their own (not that this is different from fundamental human issues that we all face from time to time, but some of the problems can be pretty pervasive and it gets in the way of being able to support others in the family).
My brother is on the same page in terms of the general idea of a) not seeking to solve his problems via direct antagonization of neural processing networks in his brain. In the past, he regularly talks about not eradicating voices, but rather needing to re-relate to them..etc) b) achieving problem mitigation indirectly vis-a-vis increasing biophysical and cognitive “fitness”. He’s always been very pro-cognitive enhancement/cognitive liberty, and I’m right there with him. Also, right now, his individual issues are arising from more than just malevolent voices. There’s a big de-centralization/cognitive fragmentation aspect to it that I think it making it difficult to experinece any volition at all (which then makes dealing with commanding voices that much more complicated) I think that issues typically tend to arise during interactions with doctors who are uncomfortable with this and who may impose their own values and judgments onto a decision-making encounter...which then renders the whole interaction totally asymmetrical which is not productive
Over the years, many variables and iatrogenic interactions seem to have gotten us to a place where my brother regularly experiences the sort of cognitive disorganization that makes it really hard to coherently analyze and synthesize ideas, and to then verbally represent and communicate things to others...he also seems pretty primed to perceive incoming communications as antagonistic and hostile (understandably so, given his history), so it’s been difficult at times to overcome the hostility/aggression factor, but I think we have a connection where it’s possible to do that in the 9.5/10 cases when it comes up in a big way.
2. Yes—getting him out of the hospital right now, is, I think the limiting reactant..I’m trying to work with his doctor/social worker to start prescribing a low dose stimulant because I think that would really help with a)combatting the cognitive deficits that anti-psychotics give rise to for him and b) helping him to be more conceptually agile and to remember things that we discuss (strategies moving forward, etc).
He can live with me, but depending on where he’s at he’ll sometimes prefer to be at my Dad’s. Between the two of us, we can make it work, I think we just have to plan ahead more strategically in terms of having the time and resources that we need in order to de-escalate crises should they come up...Lately, I have observed that my brother seems to be explicitly more hostile toward women...not sure exactly if it’s a thing or not, but I get the sense that he’s s agitated by the threat of potential coercion because he’s experienced it so much, that maybe he thinks you either have “to overpower” or “be overpowered”. It doesn’t bother me because I honestly think the risk is low, and even if it’s higher than I think, I don’t particularly care. Neither my Dad nor myself have pushed guardianship out of the sense that it would be felt as offensive or infantilizing on my brother’s end, but I think that you’re right for legal reasons it could be in his best interest. I wonder if it were framed as “guardianship of personal freedom” if my brother would be more inclined to feel good about it. With respect to the legal implications of using psychopharmacological substances without a doctor’s prescription: ideally one would be able to find a licensed practitioner to collaborate with, but having tried to find this for a long time, I think it’s time to cut our losses and get things done. In my view, doctors are only relevant to this insofar as legality goes. In theory, they are not necessary or essential to acquiring, responsibly testing &carefully using high quality tools/methods. Yes, it might technically be ‘not legal’ at this time, but the legal system is far from ideal and at the end of the day, I would have more issues answering to myself if I failed to take the risk
3. I have some peripheral involvement with Hearing Voices communities in the area which I had moved towards in years prior because I thought it was/would be really relevant and useful—thank you for bringing it up. I think the ideas that underlie and are produced by the HV community are applicable to a lot of the existential issues that we all face. My brother has sort of engaged with the values and ideas of that community....I think in terms of engaging with people, he’s been wanting to re-connect with himself and old friends, so maybe it has something to do with his de-prioritization of this community? Regardless, I really agree with you that it can be really useful.
Thank you again for your input and sorry for the mini-novel. I really appreciate your ideas and your time and thank you for getting me to think.