Getting help for someone who won't help themselves?

August 11, 2009 6:18 AM

My sister-in-law is sick, threatening, and needs help So, my wife is the 2nd child, her brother is the youngest and her sister is the eldest. We have an ongoing situation with her elder sister, that we have no idea what to do about. How do we help someone who steadfastly refuses to do anything that will help herself? How do we get her to get treatment when she treats anything we say as an assault on her independence and her life choices?

To put it bluntly she needs help. Psychiatric help. However, every choice she makes in her life simply makes it harder and harder for her to take the necessary steps to seek help. She is stubborn beyond belief, and refuses to acknowledge anything in herself that has put herself in her situation.

There are many compounding factors.

A few years ago, having worn out all her friendships at home, she went to Europe and worked for a while in Scandinavia, then went to the UK and worked there for a couple of years. She had a couple of periods of unemployment, but she did find fulltime work in her chosen profession and used this to fund a lifestyle of constant travelling within Europe. However, during this time she basically made 0 friends. Those people who did become friendly she would inevitable burn and then she would be left alone again. (This is a pattern throughout her life - she doesn't understand that when you treat people badly - usually through emotional abuse and bullying - people tend not to forgive it.)

At some point during her stint in the UK she found work at another firm and it was fine for a while. However she began to suffer from depression (exacerbated by irregular sleep) and took a lot of sick leave. This didn't stop her from taking regular leave to go on holidays around Europe. Naturally her employers started to question all the leave (both sick and holiday) that she was taking. During this time she recognised the need to seek some kind of help for her depression, but refused to see anyone other than an NHS counsellor so as to save money. This meant that for extraordinarily long periods of time she didn't see anyone at all.

In the end the company she worked for managed to kind of fire her - it took them a long time as they were very careful not to expose themselves to a lawsuit for firing someone with a health problem, and actually they never quite fired her because she just refused to come to the meeting where they planned to let her go. She actually ended up working part time except she was too depressed to go to work so didn't even do those hours. Eventually she ran out of money and returned home (not in the U.K.). She now lives with her parents.

During this time we tried to help - we sent her money to see doctors, we paid for her to come and visit us a couple of times (we're living in a different country) and of course my wife spent a lot of time on the phone with her trying to be helpful and encouraging.

However at some point my wife's sister became angry at my wife and is now sending angry threatening messages. This has all been exacerbated by the birth of our first child - sister-in-law is in her mid-thirties, has never had a real boyfriend and is clearly feeling sad about not having her own family. She chooses to show her love for our child by criticising us for how we are raising our child - she has been saying some very toxic things.

The situation has gotten to the point where now my wife can't take communicating with her anymore. So now she has started sending me abusive text messages. She still lives at home, she has no friends, she has no job. Her parents don't know what to do - she abuses them all the time, takes no responsibility for herself.

(Apologies for the ridiculously long back story.)

posted by anonymous to human relations (11 comments total)

You have no obligation to put up with this. She is an abusive bitch. Unfortunately, it's your wife's call, but she pretty much needs to tell her sister the old line "If you can't say something nice, don't say it at all."

Some people, no matter how much it hurts, cannot be helped.
posted by notsnot at 6:31 AM on August 11 [1 favorite]

She isn't going to change until she has a reason... and she may not change at all.

Set expectations as to how she relates to you, if she doesn't respect those limits, stop interacting with her. If she is threatening in any manner, call the police. Stop providing her with money and trips.

Her parents are enabling her behavior.

You might also want to search for a support group for families of people with mental illness.
posted by HuronBob at 6:33 AM on August 11

Sounds like a possible case of BPD.

There is your family and then there are your friends. You wouldn't let your friends treat you this way because you choose your friends. But because they are our family, many people put up with abusive siblings/parents, even to the point of encouraging and/or supporting them. And whereas that's a good thing - everybody needs somebody to have their back when the going gets tough - the fact is, the obligation you have to raise your child in a supportive and loving environment supersedes any obligation you or your spouse has to supporting an abusive sibling. My advice would be to just stop communicating with her completely, get yourself a book on borderline personality, and concentrate on raising your child. That's easy for me to say, of course, because it's not my sister, but your wife needs to take a long look at her relationship with her sister and figure out just exactly what she is getting in return for being so supportive.
posted by billysumday at 6:45 AM on August 11 [1 favorite]

IANA Health care professional. I grew up with bipolar people. Sadly, people with diseases that affect their mental health may not seek treatment. Bipolar and borderline come to mind. In addition, it's my belief that our ability to adequately diagnose mental illnesses is rudimentary at best. Treatment has come a long way, but is still unreliable.

I think the kindest thing to do, in the long run, is to be honest. "X, I believe you need to be treated for mental illness. I've made an appt. with Dr. Shrink. I think you could be much happier. I hope you'll go." Psychiatrists often have long waiting lists, so start trying now. Do try to maintain any contact that indicates that you care about her, and tell her you love her. She needs serious help. Talk therapy is dandy to help people through life events, but she needs medication and monitoring.

Don't put up with any crap. Unless needed for documentation, delete the texts. Delete unpleasant emails. Hang up the phone if she gets abusive. If she is threatening to harm herself or others, call the police immediately. You absolutely must create good boundaries. She'll behave as badly as she's allowed to. It's not unkind; in fact, it's more compassionate in the long run. If she keeps it up, she could actually hurt someone and land in jail. Don't allow her to have any contact with your kids if her behavior is at all difficult. Support group is a great idea. She's lucky to have a family that will keep trying to help her. Good luck.
posted by theora55 at 6:49 AM on August 11 [1 favorite]

I can second boarder line personally disorder. My parents adopted my sister when she was 6. She seemed normal up until she hit her teens. She started lying, stealing, being verbally abusive, and very manipulative. No matter how hard my parents tried, how many doctors they took her to, she just did not want to get better or try anything. Sure she would act like she was trying but in the end she would do the same "burning bridges" routine. As soon as she was 18, she bolted. She calls every now and then but it broke my parents hearts. Now the whole family has just learned to accept the fact that there is nothing we can do for her. She does her own thing. Sometimes it seems that she does thing just to see how badly she can "shock and awe" the family. We love her but we know that we cannot help her anymore and if we try she will just manipulate us.

My advice to you is "never jump in the water to save a drowning victim." She will pull you down. You have children to think about. Do you really want anything from your sister in law to spread to them? I learned from my sister that there is love and there is duty. You have to love your family, because they are family BUT you have no duty or obligation to help or save them. They chose their path themselves. And only they can turn their asses around and save themselves. My sister was famous for the "you must not love me" line. Do not fall for a guilt trip. Like I said above you have your children and wife to worry about. Let your sister in law hit rock bottom. When she does she will seek help. At that point then you should feel free to help and support her.
posted by Mastercheddaar at 7:27 AM on August 11 [2 favorites]

If we're playing armchair diagnostician, I would go for narcissistic personality disorder over borderline personality disorder. But there's not really a point to that.

Why do you want to help her? She seems to be doing fine for herself. Seriously. She has the means and capability to get mental health treatment. It's up to her.

When I saw this question I assumed she would be schizophrenic or too depressed to get out of bed. Instead, she seems exploitative and mean.

Move on and feel no guilt about cutting her out of your life.
posted by kathrineg at 7:51 AM on August 11 [1 favorite]

You're not going to be able to make her get help.

Simply tell her you're not going to have any contact with her until she can prove she's gotten help, and run, do not walk away from her.
posted by kldickson at 9:14 AM on August 11

Wow.

It sounds like your family and your sister-in-law have been dealing with a lot of pain, and that the realization sister-in-law is mentally(?) ill sorta crept up on you all over the years...I'm sure the whole thing is devastating. I'm sorry.

I'm unclear from your post if the parents now know their daughter has developed a serious illness of some kind, or if they are just treading water in a volatile household? They are in a different country than you, right? It might be hard for you and your wife to really know what is going on. When you have resources lined up and more of a plan in place, you will probably have to visit and help the parents out.

First - yes, delete the messages and txt's. The drama is clouding the situation.

Have a talk with your wife regarding her sister's condition. Once you and your wife are in agreement, have the same talk with her parents. As a family, you need a plan.

Even though this crept up on all of you, I hope you all agree the sister is not well and she needs serious intervention. If one of the parents isn't onboard with seeking outside help, that might complicate efforts or outcome. My understanding is that, currently, the sister is unable to work or provide shelter for herself and she is very emotionally volatile. There is help and information out there for families going through this sort of thing.

During the first few talks, I think you might start to discuss how to deflect any attacks while you all seek help, how to process your emotions through this family crisis, and how to be most effective for yourselves, and for the daughter/sister.

It sounds to me like your sister-in-law might have Boderline Personality Disorder, but she could be manifesting anything, including a brain tumor. sadly, no one knows yet what the trouble is. I hope that you, your wife, and her parents can start to depersonalize the situation as you cope and seek medical intervention. I'm sure the outbursts are vicious and painful, but if you don't take the sister's outbursts seriously, and you start to see her vicious words as the result of some disease and not her.... that will help you all get to the bottom of things.

The parents, with the support of you and your wife, MUST talk to medical professionals and get advice. You probably need advice on how to get the sister to the doctor - get that! You might need advice on which professionals should evaluate the sister and in what order - get that! Good luck.

Since the sister-in-law sounds functional on some level, there is every possibility (as is the case with many BPD sufferers) that you might not be able to get her to care, or if she gets care, it might not be effective. The parents might have to kick the daughter out of their home to force her to get help. Or, the sister-in-law may recover just enough to live on her own again.... but she might never be OK. In this outcome, the sister will always be toxic to deal with, she probably won't develop the type of intimate supportive relationship you have with your wife, friendships and work might always be difficult for her to maintain, etc. etc. If it comes to that, I am sorry.

Here's is a link to another question on metafilter that was a revelation to me. We have a family member who has been estranged for many years due to mental illness. They function and support themselves, but they emotionally hurt those closest to them, so no one ever sticks around for long periods of time. It is sad, but it happens.

There are many other stories on metafilter where people have gotten help. Maintaining stability and monitoring meds, etc. can be an ongoing process, but people come out of stuff like this all the time.

Again, good luck!
posted by jbenben at 9:57 AM on August 11

i think you have three options.

1. you can do as kldickson said, and refuse to have contact with her until she's actively in treatment (therapy, meds, whatever).

2. you can stage an intervention.

3. just leave her alone.

i think in case 1 and 2, you need to be prepared for her to never speak to you all again. she either doesn't realize she has a problem, or she does and she refuses to own up to it. she will likely be furious with you for interfering and "accusing" her of being crazy. (mental disorders function a LOT like addiction)

in the last case, you at least get to maintain contact with her, however horrid she is. and can hopefully open the lines of communication enough to work some magic.

it sounds like she's pretty okay with the way her life is going, unfortunately, and until she's posing a physical threat to herself or others, there is nothing you can do. (if she IS posing a physical threat, you can usually have her greenwarranted, and she'll be held for 72 hours in psych -- which may or may not work out in your favor)
posted by unlucky.lisp at 10:08 AM on August 11

she doesn't understand that when you treat people badly - usually through emotional abuse and bullying - people tend not to forgive it.

Well then it's high time she learned. If she is unwilling to seek help and her parents are enablers, then she will not change. Which means you can either allow her to continue to spread her toxic goodness to your life or you can remove her. It's really that simple.

Along with your spouse, call the in-laws and tell them that sis is too much for you to deal with in addition to your own daughter. You are cutting off contact until your sister-in-law gets therapy consistently. Then block her emails and texts and don't respond to her.

I know it's harsh advice, but trips and money and cheer-up phone calls are all enabling this behavior. Mollycoddling her hasn't helped for the last 3 decades and it's not going to help now. In all likelihood your sister-in-law has another 40 or 50 years on this planet. Stop enabling behaviors that allow her to live unhappily.
posted by 26.2 at 2:57 PM on August 11 [3 favorites]

Nthing what 26.2 said and then some! No more enabling behaviour, at least from you and your wife. She has enough to think about with a new child and should be allowed to have peace to enjoy mother-child bonding and get over the exhaustion that looking after a new baby brings so she can get to the fun part. The family can't deal with your sil, and you shouldn't have to. She's an adult. You can't force her to get treatment. You can only protect yourself and your growing family. This is one problem you don't have to solve. Block her emails and get call screening. And don't open the door if she shows up unnanounced (we're sleeping, new baby and all.) Don't give her the opportunity to take out her spleen on you and your wife. Sounds cruel, but you do not have an obligation to her.
posted by x46 at 6:49 PM on August 11