Writer and broadcaster

My brother is a hypochondriac who believes he is dying but won’t see a doctor. The Guardian.

Dear Annalisa

My brother is 52. He has not been to a doctor in 20 years and has some health issues that he won’t address because he has convinced himself he will be given awful news.

Both of us have a degree of hypochondria, thanks to a mother who was so entrenched in catastrophised thinking that it had lasting effects on both of us. She had valid reasons as, when she was 14, her mother was hospitalised for many years. However, her message to us was that whatever we might want to do – from school trips to career choices – would be dangerous and probably kill us. Death was not always the final outcome, but she could see the negative potential in every daily activity and had to voice it out loud, leaving us with a degree of paralysis in making decisions or taking any kind of risk.

We have both experienced jobs and relationships that we were unhappy in but couldn’t change because of the terrible potential for things to go wrong or get worse. In fairness, we are both OK outwardly, always employed and solvent.

I have great children and a stable relationship (my brother has neither). We are very close, he is a frequent, welcome visitor, and in many respects we have relatively successful lives.

However, my brother is almost certainly an alcoholic – drink tempers his anxiety in social situations. He has an unhealthy, single man’s lifestyle: he eats junk food, is overweight, takes no exercise, smokes when drinking, has late nights, has high anxiety levels and always overreacts to everyday stresses.

He is convinced that seeing a doctor will tell him what he already “knows”: he is going blind, has a failing liver, type 2 diabetes and a host of other terminal conditions.

He has options to easily access mindfulness, counselling / coaching and offers of support to attend a doctor (from us and also his friends). Encouragement, nagging, acceptance and indifference all have no effect and he is trapped between the rational desire to see a doctor and the overwhelming and paralysing fear of what he will find out.

I love him dearly, understand that I do not have the skills to change his thinking, and can only stand by while he wrestles with it, but it is the unnecessary unhappiness it brings to him – and ultimately to all our family – that I want to stop. If he were happy ignoring his issues, I could sadly live with it, but his clear misery and inability to enjoy his life is distressing and probably unnecessary.

How can I best help him to help himself?

What struck me most in your letter was the inability to take individual responsibility and how much projection was going on. While I understand how parental influence can shape things, you are an adult now and you can make your own choices and change your behaviour. So your brother is projecting on to you, you are projecting on to your mother, and so it goes on and on. You are cross that your mother projected so much on to you, yet you carry on the cycle. You need to stop it.

You say, quite rightly that you cannot change your brother, so let’s concentrate on you. Before I move on however, there is a portion of your letter I cut, to preserve your identity, but I want to stress that if you think your brother is not safe to drive you should read this article on Age UK’s website. There is a legal imperative to report certain conditions.

I contacted Jan McGregor Hepburn from the British Psychoanalytic Council. She wondered if your brother was jealous of you and all you had. “He is projecting on to you his despair and discomfort. So you are now carrying it. But you can’t help him and so you need to look at why you want to help him,” she says.

There is, of course, a natural desire to help loved ones, but when they resist all aid, you do have to step back and look at things differently and wonder why you are persisting. McGregor Hepburn thought you were “feeling a lot of responsibility for him that he cannot feel for himself”.

I wondered where you were in the birth order, and if you feel some guilt? Perhaps guilt at having a successful life, or guilt at something to do with childhood? Sometimes, for example, younger children can carry guilt at having taken parental attention away from an older sibling by being born or adding to the “parental burden” and changing the family dynamics.

McGregor Hepburn felt you were, as a family, “communicating by projecting” – a very salient point.

So what to do, given that you seem to have tried everything else?

McGregor Hepburn suggested that you try saying a sweeter version of something like this to your brother: “Either you go to the doctor, or you stop telling me about it.”

It really is that simple. That is, if you want him to stop telling you.

I would also suggest letting your brother know what his pronouncements do to you, You could say something like: “You telling me about these illnesses and then doing nothing about them causes me lots of stress. If you continue to do that, then I’ll have to assume that you want to cause me upset.”

You mention at the end of your longer letter, a warning to mothers of how not to behave. I would add that a warning to siblings would also not go amiss here.

This article first appeared in The Guardian Family section on 6 August 2016.