The impact of having a sibling with severe mental illness

Having an adult sibling with a diagnosis of severe mental illness such as schizophrenia or bipolar disorder is something that affects many people, yet it's rarely openly discussed. Adult sibling relationships are amongst the most important and lasting relationships we can experience and, whilst not always harmonious, many people find great joy in their relationships with siblings. Emotional support at times of crisis, family celebrations, delighting in the birth of nieces and nephews and sharing the responsibility for ageing parents are just some of the positive aspects of sibling relationships. However, when a sibling develops a severe mental illness, these experiences can be very different.

Illness is often diagnosed after a period of confusing and distressing behaviours in the ill sibling. Watching a brother or sister experience frightening delusions, hallucinations and paranoia, for example, can be devastating. Previously loving and close relationships change very quickly and may become frightening and distressing. The brother or sister you were once close to appears to be a completely different person and may be unwilling to accept that there is, in fact, anything wrong.

The emotional toll on families

Witnessing the distress of parents can be one of the most upsetting things. Their child may be unreachable emotionally, living in a reality that's far removed from that of the rest of the family. Their behaviours may be risky or self-harming in nature. As time goes on, unaffected siblings may experience a range of difficult feelings towards their ill sibling, including grief, pity, anger, guilt and helplessness.

Later, practical arrangements such as supporting the ill sibling with day-to-day life, maintaining a tenancy, providing support to pay bills and manage benefits, monitoring medication and many other things fall onto the elderly parents' shoulders and those of the other sibling. If there is reluctance from the affected sibling to accept support, or even to acknowledge that they require it, isolation and quality of life on both sides may be further diminished.

Navigating social interactions and stigma

Feelings of shame at the behaviour and lifestyle of the ill sibling may be common. Navigating innocent questions like, “How's your brother, I've not seen him for a long time?” or “What's your sister doing now?” may feel humiliating and awkward. Some siblings feel the need to hide the truth of their situation, feeling shame and guilt in doing so.

Moreover, it's not uncommon for unaffected siblings to feel a sense of responsibility for their sibling's condition. They may fear that they did something hurtful or damaging to them as a child or that they somehow should be able to 'fix' their sibling.

Feelings of intense anger can arise towards the ill sibling for the disruption and devastation caused to the wider family. There is grief in accepting the 'unlived' life, the absence of family occasions with everyone present, the loss of a supportive brother or sister alongside whom experiences and memories can be shared. This conflict between relief, anger and guilt for being the 'well' sibling can contribute to feelings of anxiety, grief and depression.

Siblings may also fear for their own mental health. Research indicates that there is both a genetic and environmental component in developing conditions like schizophrenia. Siblings, of course, share genes and have grown up in the same environment, meaning that risk factors must be higher than in the general population. Unaffected siblings can fear for their own children's mental health as they grow into adolescence and early adulthood when many illnesses begin to emerge.

Finding strength in adversity

Despite the challenges, having a sibling with a severe mental illness can result in a greater capacity for compassion, empathy and open-mindedness. Some people find comfort in becoming advocates and allies in the mental health field, raising awareness and educating others thanks to their own deep and nuanced understanding and lived experience.

Seeking support as a sibling of a person with severe mental illness may not be straightforward. Well siblings may fear being judged as lacking in compassion if they share some of their more difficult feelings about their ill sibling. They may be concerned about the ongoing stigma of mental illness, especially with conditions such as schizophrenia or bipolar disorder, which are often portrayed in an unhelpful way in the media.

Support groups, therapy groups and family or individual therapy may provide an opportunity to explore the impact of mental illness on the whole family in a safe and containing way. This can improve sibling relationships and offer hope for a happier relationship in the future.