The surgery is exasperating the situation. He's slowly gone down hill since November (yes, we think he was sick by that time). He completely slid down about 3 weeks ago. Him and a friend got into a "fight". Miguel didn't want his friend to play with a toy. Instead they watched a movie. He felt bad later, so he didn't spend the night at his friends house, that night. It's just spun out of control with self-hatred/harm since then.