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Approaching My Tightly Wound Depressed Attorney Brother

Question:

I have a question for you. How do I approach my brother and encourage him to open up to me about depression and possible alcohol abuse? His wife called me the other night. She is worried and thinks I am the only person he may confide in. He would not talk with her. He is a tightly wound high power attorney who lives an incredibly stressful life. He has his own practice and business is doing poorly. His wife is also an attorney, kids are in expensive private school, overscheduled, always on the run with tons of lessons of one sort or another. Kids are 14 and 11, good kids but going thru teen angst. Anyhow, he has been drinking a lot at night, alone, isolating himself. Won’t exercise anymore, gained a lot of weight. My husband is going to join a rock climbing gym and invite him to climb with him. They have a good relationship, always used to cycle together, but I know their conversations are usually fluff. I think I can get him to talk with me but am not sure how to approach it. You know, like a conversation starter. Any advice? I really could use it. Thanks sooooooooo much

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Answer:

The first thing that jumped into my mind in reading your letter was the Massachusetts based organization, “Lawyers Concerned for Lawyers”, (http://www.lclma.org/) which is a group offering mental health services to Massachusetts based lawyers. I’d start by giving them a call as they might have a perspective on the problem you’re facing that I don’t. Also – they might know of sister organizations in California.

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p> I’m not sure there is any slick way to have this conversation. You have to end up saying that you are concerned about him, that he seems to be depressed, he’s not taking care of himself and that he is drinking too much. How you get there is less important then that you get there. If your brother is as much of a ‘tightly wound high power attorney’ as you say, he’ll probably minimize the problem and try to through you off the scent by raising other issues or getting indignant or some tactic like that. You’ll have to find a way to not get distracted from your task and to hold your ground, at the time you first deliver the message, and in the future if he denies that his problem is significant enough to require help and resists your efforts to help him help himself.

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p> It would be best to go to him with a measurable plan of remediation, as his own thinking on this subject hasn’t been too successful. Your plan might be as simple as asking him to make an appointment to be evaluated for depression and alcohol abuse by a Psychiatrist and/or Psychologist, and asking him to stop drinking. If he agrees to the plan, find a way to measure his progress and call him on it (lovingly but firmly) when he doesn’t keep to what he agreed to do.

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p> There is generally an order to successful treatment of complex mood disorders involving substance abuse and that is to treat the substance abuse first – this is because substance abuse can contribute to the onset and maintenance of the mood disorder. It will be important for him to stop his drinking or at least cut it way down. Provided that a local doctor finds that he does have a problem, treatment for the mood problems and isolation should also occur. Antidepressant medication is good (but can have sexual side effects that are demoralizing), cognitive behavioral psychotherapy for depression is also very good (if more work) and longer lasting in its effects). Finally, exercise (and the socialization that comes with it) are extremely valuable mood enhancers and also help to ward off the effects of stress. Regular exercise (perhaps with your husband) is recommended as well. Good luck.

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