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Section 12 ?

Sep 16, 1999

Dear Dr . Shernoff , My brother is HIV positive and he was doing great on the crixivan and combivir ( viral load undetectable and 430 cd4 ) for two and a half years . About six months ago he and his partner of 4 years split up and my brother stopped taking his medication , refused to go to the infectious disease Dr for his viral load tests , and picked up drinking again .Everyone in my family was very upset at first but we thought he would get over his partner and start his treatment over again ...Needless to say this never happened . He has developed pcp and STILL refuses to take his meds .We called his ex and asked him just to reason with my brother and this seemed to have the opposite effect ..We are just at a loss here ..He is depressed and outraged , and this is the ultimate act of rebellion. He actually seems pleased by his familys and friends growing desperation .I need to ask you how do we go about getting him the psychiatric treatment he needs with or without his permission . I wont let him kill himself .How do we get him committed ? Do we go before a judge ? Take him to a private therapist for evaluation ? Please help with this life threatening situation . Thanks in Advance , Mike C.

Response from Mr. Shernoff

I think that the problem here is two fold. Yes, your brother is behaving in very self destructive ways. But literally all you can do is to tell him that you love him very much and that it hurts you a great deal to see him not taking care of himself and thereby shortening his life. You can not force him to or pressure him into receiving medical treatment.

I do not think that there is any way that you or your family can make him see a therapist or get him committed. A person can only be committed against their will when they are an IMMEDIATE threat to others or themself. From what you say, your brother is not actively suicidal, but rather passively self destructive. I doubt that there is a psychiatrist in the US who could ethically justify committing him on this basis.

What's more, even if he were to be committed, no one can force him to take his meds against his will. It would be virtually impossible for a medicial or psychiatric institution to make him take oral medication that he does not want to take.

As sad and distressing as this situation is, I think that it is crucial that you realize that you and your family are actually powerless to change the outcome or intervene other than by telling him that you are angry at him and sad that he is not taking care of himself since you love him so much. You can and should also tell him that if he dies as a result of this it would be a tragedy and you would be angry at him as well as sad and miss him.

I know how frustrating this must be for you, but as a mentally competent adult he has the right to act this way if it is his choice as irrational as it seems to you,your family or even to me. Michael SHernoff, MSW

manic-depressive, fears .
Bipolar Disorder, hiv and ethyl use

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