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Siblings: Forgotten Family Members

By: Diane T. Marsh, Ph.D.
National Alliance for the Mentally Ill

Early onset mental illness has a catastrophic impact on all members of the family. Yet little attention has been paid to the needs of those who have a brother or sister with mental illness. In fact, siblings often feel like forgotten family members.

Parents, whose energy may be consumed in meeting the needs of their ill child, may have little sense of the turmoil that exists below the surface among their other children. Professionals are also likely to focus on the child with the illness, neglecting the cascading effects on other members of the family. Thus, it is essential that both parents and professionals become familiar with the experiences and needs of siblings so that they can reduce the negative consequences of the illness for well children.

Experiences of siblings

Young family members are especially vulnerable to disruptive or traumatic events, such as the mental illness of a close relative. Compared with adults, children have more limited coping skills and strategies, are more dependent on the other people in their lives, and have fewer psychological defenses.

In addition, early developmental accomplishments provide the foundation for later ones, and delays or disruptions in development may have long-term consequences, including a residue of "unfinished business" that reverberates through future years. In fact, the normal course of development may be disrupted for siblings from the moment that mental illness appears in their family.

During adolescence, for example, teenagers must establish their own sense of identity. The efforts of siblings to define who they are and how they fit into the world are likely to be complicated by concerns about their own mental health and by social stigma that may leave them feeling somehow "deviant" themselves.

Normal development may also be affected in other ways. For instance, siblings may strive to become "perfect" children who can compensate for their overburdened parents, perhaps denying themselves healthy opportunities for rebellion. They may also experience "survivor's guilt" for having been spared a similar fate, which may intensify the need to demonstrate their "invulnerability" and competence.

Internalizing the stigma that so often accompanies a diagnosis of mental illness, siblings may join with their entire family in unhealthy defensive maneuvers that result in a retreat from their anguish into a facade of normalcy. This denial undermines the family's ability to confront and resolve the inevitable problems that accompany the illness, thus increasing the amount of "unfinished business" that is carried by siblings into adulthood.

Siblings are likely to experience a range of powerful emotions in response to the mental illness of a brother or sister. Recalling her adolescence, one sibling wrote, "I was emotionally devastated. I felt guilt, anger, hopelessness, overwhelming responsibility." There is often a sense of loss, as siblings mourn for the family member they knew and loved before the onset of mental illness. They may also mourn for the loss of normal family life and wish for the opportunity to live out a normal adolescence or adulthood.

Frequently, siblings experience intense feelings of anger. The anger may be directed at God or at fate for this unanticipated family tragedy. Sometimes it is directed at parents whose energy is consumed by their efforts to cope with the mental illness. Anger may also be directed at their brother or sister for disrupting family life or for not getting better. And sometimes the anger is turned inward because of their inability to protect and rescue someone they love.

In addition to the emotional burden, siblings face many everyday problems. They must learn to cope with the symptoms of their relative¡¦s illness, possibly including hostile, abusive, or assaultive behavior; mood swings and unpredictability; socially offensive or embarrassing behavior; self-destructive behavior; and a lack of human relatedness.

Siblings often live with a high level of illness-related stress. Problems within the family may include household disruption, financial difficulties, and strained family relationships. Siblings may also find their social life restricted because it is sometimes impossible to take their brother or sister out in public¡Xto the mall, a movie, or a restaurant.

There is the risk that siblings will take on a "caregiver" role as they are growing up„o and then carry that caregiving role into adulthood, with adverse consequences for their adult relationships. On the other hand, some siblings may avoid intimate relationships to protect themselves from further vulnerability and pain. Either way, their adult relationships are negatively affected.

If they marry, siblings frequently have additional concerns about their own children in light of the genetic risks associated with mental illness. Throughout their lives, siblings typically struggle to achieve a balance that allows them to fulfill their family responsibilities without sacrificing their own lives. This is easier said than done.

Although the challenges faced by siblings are substantial, it¡¦s essential to recognize that siblings usually do manage to prevail over their challenging life circumstances. In my research at the University of Pennsylvania at Greensburg, most adult siblings said they had become better and stronger people as a result of their encounter with mental illness. They described increased empathy and compassion, more tolerance and understanding, healthier attitudes and priorities, and greater appreciation of life.

These positive qualities come at a high price, however, and are usually accompanied by intense feelings of anguish and loss. Although there is no way to protect siblings from this family tragedy, the negative impact of the illness may be diminished if there is open communication within the family and continuous attention to their needs.

Needs of siblings

At each stage of life, siblings share three central needs with other members of their family. First, they need information about mental illness and its effect on their brother or sister. Even the youngest sibling can understand that this is a real illness, with effective treatments„o and that they are not to blame.

Siblings need effective coping skills, including strategies for coping with illness-related behavior, with questions from peers, and with their own anxiety and stress. They also need support for themselves through special time with parents or involvement in a support group or personal counseling.

In addition to their needs for age-appropriate information, skills, and support, siblings need encouragement to ask questions and to share their feelings. They may need reassurance about their own mental health. Siblings may need encouragement to participate in satisfying activities and relationships outside the family and to develop constructive long-range plans. Finally, they often need reassurance that their needs matter„o and that they are not forgotten family members.