I want to help guide my roommate to a proper mental health care professional and I feel like having some list of possible diagnoses might help me get a list of possible options together for him.

A big event between us is the time he masturbated on my living room couch and forgot about it. He don’t clean it up. I did. I originally thought the cat threw up since it sleeps there and what I saw was his half-ass attempt at cleaning a mess. He was deeply ashamed for it and while I was mad, I was more worried his impulse control was THIS bad. I’ve noticed enough other behaviors and mannerisms that suggest this isn’t a respect issue. It’s a problem where he has terrible impulse control and cannot focus. His focus is so severe he cannot follow entire sentences. When he tries to join social conversations, he doesn’t have the attention span or focus to figure out the topic, he picks a random word he overhears and jumps in with some tangent about that word, even though it’s almost always irrelevant to the actual discussion. For example, if you were talking about the red shoe on the cover of the devil wears Prada, he would hear the word “red” and jump in talking about a red 1948 ford truck. He can follow a sentence, but if the thought spans multiple sentences or there multiple punctuation marks, he’s lost.

Heres the thing, he’s not stupid, he’s actually incredibly intelligent, but he’s processing things in a way that suggests he doesn’t have enough ram to follow along and learn, so he’s just been guessing at social behaviors all this time. Not a single thought he has can be pinned to any context so there’s lots of missing information and he has an incomplete understanding of the situation. It’s kind of like why I hate playing chess. I can’t think several moves ahead and plan for them. With him, he can’t keep track of what just happened in the last 30 seconds so he gets lost. There’s a desperate need to chase whatever thought pops into his head at any given moment. Any attempt at explaining or correcting a behavior does not last. I can’t even get him to chew with his mouth closed or close the door behind him when he leaves the house or close the bread bag before putting it away or flush the toilet every time. He looses track of whatever task he’s doing.

I don’t think this is autism, at least not entirely, but I’m not convinced this is ADHD either seeing as it is so cartoonishly severe. I’m quite worried.

He wants to improve so very badly but he just isn’t able to follow a thought long enough to do anything. He feels awful about the couch incident, but is also too ashamed to talk about it with his current counselor at the college he goes to.  That to me says it’s not a healthy fit if he can’t talk freely with them. I told him “if you are embarrassed to fart in front of them, it’s not a good fit. This happens all the time. Nobody’s the bad guy. You just have to find the right fit.”

He was apparently diagnosed with ADHD as a child but his father would not permit treatment. He tried getting help himself for the first time in college at 25. He’s so far behind developmentally I honestly believe there’s some form of brain damage.

He has a counselor and a psychologist at the university, but they rotate out every few months. There’s no continuity of care. He’s been on aderral for a couple years but it’s not very much and he’s never taken a holiday from taking his medication. The psychologist didn’t seem to know this based on what he’s told me. I told him to ask his psychologist about a mediation holiday to possibly reset his tolerance, CBT once they find a med and dosage that works, and a long term care option, not this. I made very clear these are suggestions, not mandates.  He can bring them up with his provider but should not consider a single thing I say actionable unless a medical professional hears it and agrees first. I repeated this warning multiple times every time I give him advice. The professionals can’t help you if they don’t know what’s going on. I can see what’s going on, THEY decide what to do about it.

The psychologist took him off his adhd meds for winter break. The only difference I’ve noticed is he’s already terrible sleep hygiene is far worse now. He’ll be up and active at 3AM doing nothing important. He doesn’t understand the idea of making a sleep schedule. He just falls asleep whenever he exhausts himself. He’s in him mid 20’s but has the life skills of a teenager.

Looking at other indicators, I don’t think he’s bipolar and going manic during his sleepless nights. Like, if we look at sexual impulsivity, he’s a gay man in his 20’s with access to grindr. That’s not going to be a reliable indicator. However he doesn’t seem to be ignoring consent and he isn’t a threat to anyone. He’s not using drugs, he doesn’t drink. His only vice is using his electronics as skinner boxes. He has been scammed on grindr before and has come running to me when someone tries to extort him with his nudes on grindr. I had to explain to him “you wanted someone to see you naked. He’s threatening to have other people see you naked. Sounds like he’s threatening you with what you wanted anyway.”  He thought about it for a second and just dropped the whole thing. I had to take that ridiculous shortcut to this because explaining the scam to him would exceed his attention span.

I also taught him some weird thing I figured out to calm my head as a child that DID have an impact on him. I told him to sit on the bathroom floor, lights out, no phone. Listen to the sound of the running shower. Focus really really hard on it. Make it the only thing you are thinking about right now. Everything else will still be there afterwards, we are doing this right now.

Then pull the sound apart. Find the layers. Don’t concern yourself with identifying what they are but focus on what they sound like. Attempt to pull the pieces of the sound apart and focus really hard. Once you master this, you will be able to willingly choose a specific part of the sound the analyze and it will be all you hear. Eventually, you will be able to summon that relaxed feeling on demand without the stimulus but that’s going to take time.

He did it. He started out incredibly frustrated but he did calm down a little as this attempt continued. He said he wasn’t able to pull it off but after he walked out he was much calmer. He just didn’t realize it. His ticks and urgency in speech dropped to the floor!  Like every now and then he will just look like he got electrocuted, jolting straight up and just resetting. Like a tiny seizure. He wasn’t doing that after this.

I told him he will get better at this with time and he can focus on any sound that isn’t music or has lyrics. It cannot have a pattern or his brain will try to process this differently and it’s harder to do. It needs to be an environmental sound to work.

That’s really all I have in my arsenal to help this kid. I don’t think I can help him but I can’t just kick him out. Dude needs help. It’s irresponsible not to help but I cannot do this myself. I need to get him to someone who can help him. The university that’s rotating out practitioners every 3 months is NOT working. The absence of continuity of care is frankly astonishing to me.

He’s also doing that insecure thing we’ve all seen over and over where he believes if he gets a boyfriend it will solve his problems. I’ve explained that’s not halving your emotional load, it’s doubling it. If you can’t meet your emotional needs you will not meet someone else’s. This kind of dependency makes people incredibly vulnerable to abusive relationships and he needs to work on his own needs FIRST. The world isn’t running out of gay men. There will be plenty ready for him when he’s ready. But he’s powered by instant-gratification. He’s scared of missing out because he’s so familiar with his own thoughts abandoning him. So being a horny 20-something is only compounding his issues.

I’ve introduced him to some people. I’ve taken him to a gay bar where there’s enough people who understand and keep an eye on him. (My 20s were a mess too and this community saved me in many ways) It’s not the wild and chaotic, drugged out party boy type of place but more mellow and calm. He can do some growing there. When I go, I get him to try some of my drinks. No, I’m not trying to get him to self medicate. He doesn’t have to finish anything. It’s more about trying new things and expanding the things he can feel comfortable with, like saying “I don’t like that.” He has no confidence and I try to praise him when he asserts himself, even if it is sometimes awkward.

I need to find him proper help. But I can’t do this shit myself. He has to do things on his own but he’s in a position where he doesn’t actually have that ability yet. He’s learning as best he can but he needs to develop some momentum.

What can I responsibly do?