Two letters about families with kids who need mental health care

[conuly]

1. Dear Prudence,

My sister is three years younger than me and has crippling anxiety. She will not dip a toe out of her comfort zone, which is basically just our family. She has zero friends besides me. My male cousins were able to get out of babysitting her by the time they were in middle school. I was stuck until high school graduation. I couldn’t have friends over and not include her. I couldn’t go out with friends and not include her. My parents forced me to rearrange my lunches in high school when she started so she wouldn’t be alone. I went into 4H because my sister has an intense fear of animals and birds (she will have a panic attack if a chicken wanders up near her). Supposedly, she was in therapy and on medication, but she only got worse as she got older. She threw a fit when I went to community college near a relative rather than stay here. My parents threatened to not help me pay and only backed down after my grandmother got involved.

Now, I am 23 and in a serious relationship. My sister managed to graduate high school but she has never had a job and going to community college is too “hard.” I brought my boyfriend home for the first time, and my sister acted like a jealous ex. She wanted to be velcroed to my side and hated if my boyfriend even touched me. She cut him off in conversation and even told him to shut up when someone asked about our future plans. I finally pulled my sister aside and told to stop acting creepy and needy or we would be leaving. She had a very public fit, so we left. My parents are furious and accused me of deliberately triggering my sister. Honestly, at this point, I don’t know if I should cut my immediate family off. My sister is an adult even if she is dysfunctional. My parents refuse to hold her to any reasonable standards, and I am sick of my life being held subordinate to her whims. I am also scared of being alone and on my own. I just want normal here. What should I do?

—Sister’s Keeper

Dear Sister’s Keeper,

As you know, your sister is dealing with more than a difficult personality and parents who excuse it. She has a diagnosed mental health issue that isn’t being treated. She obviously loves you and feels very attached to you, so I wonder if you could leverage that relationship to nudge her toward the therapy and medication she desperately needs?

If she refuses, you’ll have to decide what kind of behavior you’re willing to tolerate from her, and in what contexts. She should definitely not be present for future new boyfriend intros or other sensitive events that she could totally derail with one of her fits. But you can probably stop short of cutting the entire immediate family off. There is a middle ground that includes brief, low-key family visits, one-on-one hangouts with your parents, and phone calls that you are free to end if you are attacked or become really frustrated.

Sadly, it may be that this is the life all of them choose: Your parents dedicating all their energy to your sister, your sister having regular breakdowns and dictating their day-to-day life, and all of them getting mad at anyone who upsets the balance. They’re comfortable with their dynamics and may not really want anything to change. For a while, they might continue to get really, really upset when you don’t participate in the way you were forced to when you were growing up. And things might be really rough. If you’re going to survive this without being deeply hurt or pulled back into the dysfunction of your childhood home, it will help a lot to have a solid chosen family: Your new boyfriend and friends you can count on to be there for you, spend holidays with you if necessary, and most important, treat you like you matter in ways that have nothing to do with what you tolerate from your sister.

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2. Dear Care and Feeding,

I have a fun, creative, and sensitive 5-year-old son. Earlier this month, he had a bad virus and was hospitalized for weeks. He’s (thankfully!) fine now, but one of the outcomes seems to be a lot of unprocessed rage. Two weeks out of the hospital and the most minor of things will set him off screaming and melting down. This behavior is completely new to us (previously he was prone to cry and take some space if he was upset). The sorts of things that set him off are: dinner not being ready, a play date coming to an end, a friend interrupting him while he’s talking. And even when I (his mother) am not the “cause” of his rage, it will often be directed at me.

I wonder if this is because I’m the safe harbor for his feelings or (more upsettingly) if it’s because he views me as complicit in some uncomfortable medical moments (e.g., holding him still for blood tests and the insertion of IVs). His meltdowns mostly (but not always) occur at home, and I don’t want to overreact to what may be a short-term problem as his emotions level out. But I also don’t want to just stand by if there’s something to be done that might help him. Currently, I’m trying to talk to him about his feelings, reiterating my unconditional love, and acknowledging how hard it’s been for him. When he does act out in school, his teachers are being understanding—but I fear that, as time passes, their sympathy will wane. Do you have any advice? Would a therapist be overkill? How long might this go on for? I don’t know any children who’ve had similar experiences so I feel a bit at sea!

—Relieved but Now A Scapegoat

Dear Relieved Scapegoat,

A therapist is never overkill. What would it hurt to have him see a (good, play-therapy-trained) therapist specializing in the treatment of children? Why let him struggle through this on his own, when professional help can offer him the support he needs to process what’s happened?

Sure, he will likely get through this with or without professional help, but bringing a therapist into the mix doesn’t need to be thought of as a drastic measure. At his age, a few weeks is a significant portion of his life. It’s not at all surprising that it’s left him distressed, feeling out of control, frightened, and enraged. And I’m sure he’s taking much of this out on you because he’s too young to fully understand what happened to him, and because even if he knows (because you’ve told him) that you were just trying to assist the doctors and nurses in helping him get better, he still feels that you were “supposed to” protect him from harm and “instead” held him down while needles were inserted. (I know this thought is upsetting for you! I promise, it’s even more upsetting for him.) I’m also sure you are indeed the safe repository for all his feelings.

I think showing him you love him—speaking gently, holding him, soothing him, demonstrating understanding and compassion—is even more important than telling him anything. Offering the space for him to talk about his feelings if he wants to and can, is great (but don’t push it; don’t ask him, again and again, how he’s feeling) and making it clear (not by saying it, but by not punishing or scolding him) that his anger is understandable, given his experience, will go a long way in this instance. But I’d get him some outside help, too, at least for the time being.

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Comments

[conuly]

1. If you're considering cutting off your parents entirely, you should take that seriously. However, if LW is still unsure then I'd suggest laying down the law as such: There will be no contact with Sister until and unless she is getting an appropriate course of treatment including medication and therapy and has been for at least three months. LW will call the parents X times per week/month, at scheduled times for a set duration, and will immediately end calls if parents do X, Y, or Z. LW will absolutely not come home to visit unless they are convinced both Sister and Parents are willing to behave better, and then LW will not stay in the family home at all. (I'd strongly recommend making therapy for the parents a requirement as well, honestly.) If they're not willing to do those things then, oh well, I guess they don't want to see their other child.

2. I went to the comments to see if other people had brought up post-viral illness and other people had done so. However, I had failed to consider that the topmost letter in the column was about fat-shaming grandparents and was smacked in the face with one dedicated jerk who seemed determined to spam "calories in, calories out" everywhere.

Still! Post-viral illness is a possibility! Good luck with that, it's probably easier to find somebody willing to diagnose PTSD in a preschooler.

[petrea_mitchell]

2. Post-viral conditions are exactly where my mind went too.

[topaz_eyes]

Re #1, LW can ask, but they can't force their parents and sister into therapy. They need to be prepared for no-contact. Imho LW should set up their support system before they present the boundaries for future contact with parents and sister.

Re #2, thirding the possibility of post-viral illness. Personality changes are a worrying sign. A visit to the son's paediatrician ASAP to rule that out should be LW's first step.

[melannen]

Not just post-viral illness; it's unfortunately common for severe illness in small children to come with high fevers that can cause brain damage. LW, if you haven't mentioned personality changes to your kid's doctors, do so now. I know someone who has had major impulse control issues since a severe fever as a small child. Post-viral illness in the way we talk about in adults lately might be a tough diagnosis to get but any pediatrician worth their salt will have their eyes out for the possibility of neurological damage after a severe illness in a toddler to kindergartner.

[full_metal_ox]

Seconding the sentiment; “brain fever” was the go-to among Victorian novelists wishing to disable a character to order.

[firecat]

I’m really surprised Prudence didn’t suggest that LW#1 talk to a therapist. Setting boundaries is important and necessary, but breaking off with your family and/or trying to defend multiple boundaries when you weren’t able to before are both hard. LW#1 should not be expected to do that without any professional guidance, never mind being responsible to “leverage that relationship to nudge her toward the therapy and medication she desperately needs.”

Also, LW#1 is understandably judgemental and resentful of sister because of being forced to be one of her primary caregivers, which is hard even when you chose the role voluntarily. When sister relies on LW#1 for all her social needs, she is experiencing further damage by being steeped in LW#1’s negativity toward her. They both need to be apart from each other, but no one in the family is likely to go along with that simply because LW#1 says so. LW#1 could use someone with authority to help.

BF and BF’s family can be part of LW#1’s support system, but being LW#1’s primary support system would put a lot of pressure on their relationship.

[minoanmiss]

All of this. The first line made me huff in rage -- if LW could possibly convince Sister to go to therapy, etc, I'm sure she'd've done so. Besides she's not actually supposed to be Sister's primary caregiver. And LW#1 ABSOLUTELY needs solid and professional help. She knows she doesn't exist solely for her sister's benefit, but it's hard to rememeber that when one's parents are screaming the opposite at one. Plus, while friends can do a lot for one, laying all of this on young people with no other supports may strain those relationships terribly.

I wish we could write to LWs sometimes.

[ashbet]

I’m surprised that the response to #1 includes putting more responsibility on LW’s plate — “Supposedly, she was in therapy and on medication, but she only got worse as she got older.” doesn’t actually state that Sister is *not* getting any treatment now, simply that it appears not to be working.

The parents bear a lot of responsibility here for creating a caregiving relationship between LW and Sister — it’s not appropriate to require that kind of responsibility from a highschooler.

I do think that some heavy boundary-setting is in order, and it would be good if LW could get some professional support in that.

[movingfinger]

I am also scared of being alone and on my own.

This closing remark, after the litany of awful parental behavior including threatening to cut off LW's financial support for college, hints at an incredibly toxic home. If LW isn't in therapy already, they need to do that, and they need to stop trying to parent their sister. If this means limiting calls with parents to an uninformative five minutes monthly, so be it.

Any information about friends, boyfriends, life, work, etc. that LW gives parents will be undermined by the parents and sister, so I would suggest that LW stop expecting normalcy or validation in any way from their family of origin and cultivate their family of choice.

[adrian_turtle]

I was reading the first letter and thinking, "you don't have a sister problem, you have a parent problem." Though of course she also has a sister problem. I wouldn't advise her to ask her parents to protect her, they have spent many years demonstrating how they value her (ie, primarily as a caregiver and not seeing her as somebody to be protected in her own right.) I completely agree that LW would benefit from supportive chosen family.