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Hello, Dr. Saltzman,

I am very happy to find a place to come for advice on my little brother. He is very withdrawn from society and talks to hardly anyone except me and sometimes our other siblings and mother. He is closest to me because I have never made fun of him or treated him like he was different.

Recently, I talked him into writing an essay about himself to let us know what had happened to him from the time he was in kindergarten to the present. He finally wrote it. I wish I could let you read it, because I know you would find it interesting from the psychological standpoint. But I haven't asked him, so I won't. But in the essay, he writes about his obsessive thoughts and feelings that make him feel guilty, then dwells on it for hours on end. He is very different and he doesn't want help. He has self diagnosed himself with Pure Obsessive Disorder and says that if he sees a doctor it will lower his self esteem.

He has been depressed for a long time, and all of us knew there was something wrong, but we thought he was autistic. He can hardly ever laugh, he can't show emotion, his body language is nonexistent, except for when he is irritated. He can't talk to you, but he can write so eloquently. It's sad, because you can read that there is a "normal" person in there somewhere. He is an extremely complex case but here are some highlights:

1. Kindergarten: received an award for being so nice to the other children and everyone liked him.

2. 1st grade: started to feel guilty about being in a gifted class, but really he was in there because of a speech problem, they had told my mother at 4 years old, he was autistic and would never learn to talk or anything and would only read on a 1st grade level. At 7 yrs old, he read the book Jurassic Park from front to back.

3. 2nd --6th grade: he gradually got worse and feelings of being better than others made him feel guilty he started to pull away from society. He began thinking that everyone was making fun of him and paranoia set in. By 7th and 8th grade he didn't talk to anyone except a friend of his, Jeremy.

4. During high school people would make fun of him and call him "Serial Killer" because of his odd mannerisms and inability to talk to others or make eye contact. His depression became severe, and now instead of feeling sorry for people who were being made fun of or feeling guilty about being smart, he would feel guilty because he would think he was so much better than them, they were nothing, and so on. He also had very negative thoughts about my dad. He would look at something that daddy really liked and think of smashing it to pieces to hurt his feelings. Then he would run to his room and dwell on why he would think such things for hours on end. He likes to be alone and is obsessed with the computer. He goes on chat rooms and that's all he does. He can't drive or anything that most people his age can do. for

5. When I read his emails, he seems so normal and is happier now. But, he has such a problem with his mannerisms and body language and ability to communicate in person. I don't know what to do. He wants to lead a normal life and is trying to do it on his own (he's taking St. John's Wort). He can write to you and seem fine, but he is almost autistic at how he acts in front of you.

Please help us. I don't know what to do. He doesn't want to go to the doctor because of his self-esteem. He wants to do it alone, and I don't think he can. I don't know what to do, though. I know you are busy, but if you have any time at all, please let me know if there are any options for us. And what they may be.



Dear Melinda--

I imagine that you are correct in saying that your brother cannot work this out on his own. St. John's Wart is not a proper treatment for the very deep emotional difficulties in which your brother finds himself. And a long history of emotional withdrawal usually is not self-reversible--a special friend (the therapist) is almost always needed to bring such a person back into intimate contact with others. On the other hand, good psychotherapy with a compassionate and competent person might make a real difference in your brother's quality of life.

I do understand your brother's concerns about his self-esteem. Because personhood--or in your brother's case, manhood--is defined in American culture along the lines of self-reliance ("I don't need help, I'll do it myself") people, particularly people of the male gender, often wait much too long to seek the help they really need. This is as foolish--and unfortunately as common--as trying to find ones way around an unknown territory without asking directions from those who live there.

I know this is not much, but I suggest you show this communication--both your letter and my reply--to your brother in hopes that he might be inspired to drop his fear and resistance enough to be able to establish a therapeutic alliance with the right doctor. With the kind of problem from which your brother suffers, I have seen wonderful results from proper psychotherapy. I hope he will read this and believe me that life can be much happier when one is able to accept a helping hand.

Or, if your brother would like to write to me, I would be happy to read his letter and to reply to it personally.

Be well.

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