April 7, 2016
It seemed like just another Wednesday evening. After the routine disagreements and struggles over homework, everyone sat down together to eat dinner and talk about their day. Afterwards, the twins (a boy and girl, age 9) settled in for a game of Uno while their 14-year-old sister went upstairs to finish her homework. When the twins headed upstairs an hour later to brush their teeth, they found their sister unconscious in the bathroom, an empty bottle of pills on the counter. Mom, panicked, called 911, and after what felt like an eternity, an ambulance comes. Dad stayed with the twins while Mom accompanied their oldest to the nearest emergency department.
While both parents had known about their daughter’s depression and cutting, they thought her therapy and medication were helping. They had not told the twins about any of it, and now, there was lots of fear, worry, and confusion to address.
Facing a psychiatric illness in a child can be one of the most challenging experiences of parenthood. Managing mood and behavioral symptoms and bearing a child’s suffering are compounded by navigating a healthcare system that treats psychiatric illness so differently than other serious illnesses that affect children and teens. What’s more, attempting this amid the stigma that still exists around psychiatric illness can leave parents feeling isolated in their struggle. On the other hand, unlike fixing a broken mental health system or diminishing stigma, addressing a child’s mental illness with his or her siblings is one challenge that parents are fully equipped to handle.
It’s normal for parents to want to protect their children from news that might seem scary or confusing. And, parents may feel that they ought to protect the privacy of the child managing the illness, especially (but not only) if that child is a teenager. However, a significant illness usually affects everyone in the family, and choosing not to discuss it can leave siblings feeling bewildered, confused, scared, or frustrated. Moreover, treating a mental illness as a secret may promote stigma, shame, and isolation. If parents can find a way to speak honestly about what siblings may be noticing or managing at home—while at the same time setting a tone of compassion, patience, and respect—they will create an environment that supports healing and resilience in all of their children.
Here are things to keep in mind as you approach conversations with children about a sibling who has a psychiatric illness:
Depression: In describing depression, for example, parents might explain that children sometimes develop illnesses that affect how they feel. Doctors don’t fully understand how these illnesses happen, but we do know that you can’t catch them like you could a cold. And, while it’s called “depression,” it’s different from just feeling sad; it’s actually more like losing almost all of your energy, interest, and motivation for things. This means that food doesn’t taste as good, games and friends aren’t as enjoyable, and jokes don’t seem as funny. While you can cheer up someone who is sad, someone who has depression needs to see a doctor to feel better. And, with the right treatment, he or she will feel better.
Anxiety: Similarly, if parents wanted to describe an anxiety disorder that is making it very difficult for one child to get to school, they might introduce the idea that while anxiety or worry is a normal part of life, there are some illnesses that can make that anxiety level much higher than usual. So, for their sibling, going to school may feel like he or she is facing a charging lion! Explaining that this isn’t an excuse to get out of school, but rather, a problem that needs special treatment, is very important for children who might find it unfair that their sibling is resisting school, and receiving attention instead of being disciplined.
Other psychiatric illnesses: Some illnesses can cause bizarre, disturbing, or self-destructive behaviors, be it mania, psychosis, repetitive self-injury, or even restrictive eating. With younger children, it’s important to speak in broad terms about how these behaviors are symptoms of an underlying illness that a whole team of doctors will treat. With older children, allow for time to discuss how sad or scary it can feel to watch their sibling go through something like this. Remind your children that some illnesses might affect how we breathe, and some might affect how we move; in their sibling’s case it’s the brain being affected, so his or her symptoms are coming out in his or her thoughts, feelings, and actions. It’s reasonable to acknowledge that while doctors don’t understand everything about these illnesses yet, they do know that they’re not contagious, and that they improve with treatment. This can be very helpful and reassuring for your children to hear.
Next, consider your children’s styles. Is one a talker? He may benefit from more frequent check-ins during times that he is likely to be talking with you anyway, such as during a car ride, or while getting ready for bed. Is one a doer? If so, she will want to think of ways she can be helpful; you can help her channel her feelings into constructive action, such as letting her assist with chores, or giving her permission to do what she loves (more soccer!) Is one a feeler? A child who is focused on how this illness makes him feel, or the sadness and worry he feels for his sibling, will also need extra time with parents. He’ll need you to listen, acknowledge, and bear his strong feelings—as he, too, learns to bear them himself. Is one a philosopher? She may get stuck on how unfair this situation is, or how her sibling suddenly seems like such a different person. She will also need you to listen and talk with her as she begins to make meaning of how life can be full of both terrible heartaches and wonderful gifts.