A garden enclosed is my sister

July 4, 2008 2:49 PM

How can I help my sister come to terms with her mental health issues?

My sister and I have shared a home on and off for several years. She was at the top of her game for a long time, but has always been very volatile, with hairpin-turn mood swings and anxiety problems. This past winter she went into a tailspin; she broke up with a boyfriend who had been a constant disappointment, and that same week got fired from her job. Neither situation was black/white, but she immediately fabricated a mentality that allowed her to blame herself for all of it.

Since then she has had severe anxiety attacks, deep depressions, lost several more jobs, put on about ten pounds, and spends almost all her free time sleeping, smoking pot in her room, and watching movies. She's flat-broke most of the time, thanks to the job bouncing, and turns down invitations from almost everyone who offers. It's been 7 months of this.

This week I moved into a new place by myself, which resulted in days of crying jags from sis-- because of how much she will miss my cats. She called everyone we know to cry about losing them. I got a lot of embarrassing phone calls from concerned friends, wondering if she was okay.

I've tried to get her to seek treatment during a few substance-related nadirs, but no dice. She sees professional counseling as something she'll simply never be able to afford, and doesn't really listen to advice that says otherwise. She's on an antidepressant (Paxil, I think?) but I don't know how that interacts with alcohol and weed. I've been pretty supportive, so I don't think she has any idea how freaked out I am by her at this point.

I know it's impossible to diagnose her, but looking at descriptions of Borderline Personality Disorder, I am pretty astonished at the similarities. Looking at this list of symptoms, she is seriously afflicted with practically all of them:

* Manipulativeness
* Suicidal threats or gestures, and self-harming acts
* Impulsiveness, jumping into relationships quickly, and without knowing the other person
* Promiscuous sexual behavior
* Drug and alcohol abuse
* Eating disorders
* Unstable relationships
* Sensitivity to the reactions of others
* Tendency to idealize or devalue other people
* Fear of abandonment
* Shifting moods and emotional outbursts
* Engaging in reckless behavior
* Unstable self-image
* Strong dependency on others
* Paranoia and other delusional thinking

Almost everything I read about BPD reminds me of her. I think she's gotten so used to being miserable that she doesn't even remember what normal feels like; normally something changes by now and she gets moving in a new direction. I'm worried, and I don't know what to do to help her. I'm the only family member geographically close enough to see how serious this has gotten-- she's VERY good at only calling our parents when her outlook is temporarily brighter.

I've kept my suspicions about the seriousness of this to myself. But when I try to point things out to her, she just makes jokes or changes the subject. However, whenever disaster strikes (and it strikes several times a week) she calls me in tears wondering what to do. Now that I'm out of the house, I'd like to be a little more honest about how worried-- and often offended-- I am by her behavior.

I know that substance abuse programs say that a person has to fall far enough and land hard enough to decide to make changes on their own, and I'm prepared to allow her to do that. How do I deal with her in the interim? She's a lovely person who I adore, and who looks to me for support (despite never taking my advice). I've bailed her out so many times, financially and otherwise, but now I'm wary and fatigued. I'd like to know what I can or ought to do to help her take treatment options seriously and handle disasters in the interim.

posted by Julia F***ing Sugarbaker to health & fitness (17 comments total)

I would be very careful with the armchair diagnoses. A lot of the characteristics you've named can be related to various mood disorders, and I think you should leave the psychiatry to her psychiatrist. It sounds like you haven't really spoken with her seriously about the problem directly. If I were you I'd consider having an earnest talk with her saying that you don't believe her current treatment is effective and encouraging her to return to her doctor to tell him/her as much. Offer to go with her if necessary. But don't make this conversation all about "You're really sick, you obviously have a personality disorder." Whether or not you're right about it is irrelevant. It's about helping her get the treatment she needs, so your tone should be more along the lines of, "I see you suffering still, and I worry about you and all the time you're spending being so unhappy. I know that treatment helps a lot of people and I really want to help you get on the right track again."
posted by loiseau at 3:25 PM on July 4, 2008

Almost everything I read about BPD reminds me of her.

This is immediately what I thought of, and if it is then good luck. You may not be able to do much.

You may want to read this post.
posted by P.o.B. at 3:26 PM on July 4, 2008

If she doesn't want help, she'll just refuse it. Let her get to the point where she wants it, and then you can get her the help she needs. If you keep getting her out of fixes, she'll never learn what it is to get herself out of that fix, and still be dependent on you for years.

To hit rock bottom, she's going to have to have some kind of disaster. It's tough love, but I think you need to let that happen to her.
posted by Solomon at 3:32 PM on July 4, 2008

Wow. This sounds really, really tough. It must be exhausting for you. It can't be easy to have your sister calling you several times a week crying. It's hard to see our loved ones in pain. It hurts.

I think the most important thing to do is take care of yourself.

Get counseling on your own, or join a support group for the family members of people with mental health problems.

Long term, once you feel a little more energetic and able to cope, you might want to make a road map (or strategic guide) for how to handle various situations. This might look like this:

If Sister calls crying and there is no other problem:
Listen for ten minutes, then tell her you hope she feels better, and goodbye.

If Sister threatens suicide:
Keep sister on the line until help arrives
Call 911 on the other line
Stay with her until she speaks with a psychologist and is evaluated

If Sister asks for money:
Listen to her for ten minutes, then tell her you need to think about it, will tell her your decision tomorrow, and say goodbye.
Check your finances and see how much you can afford to give her. If she needs a specific item, consider buying it for her instead of giving her cash.
Call her the next day and tell her your decision. If she is upset, listen to her for ten minutes then say goodbye.


Your sister might or might not be able to give you input with this plan. I have bipolar and I sat down with my loved ones and created plans like this. It is really helpful for all of us to have plans in place pre-crisis.
posted by sondrialiac at 3:37 PM on July 4, 2008

I would be very careful with the armchair diagnoses. A lot of the characteristics you've named can be related to various mood disorders, and I think you should leave the psychiatry to her psychiatrist.

I cannot agree more.
posted by sondrialiac at 3:38 PM on July 4, 2008

There's a book, "Stop Walking On Eggshells" by Kreger and Mason, for family members of those with BPD. Regardless of whether that's an accurate diagnosis, it is helpful for determining how to best respond to that type of behaviour.
posted by winston at 3:39 PM on July 4, 2008

I don't mean to be cheesy, but this really reminds me of that excellent movie "In her shoes" with the successful sister and the falling apart sister who gets rescued. She'll fall hard if you stop rescuing her. I don't know if that's what she needs to pick herself up and get her stuff together, and I don't think there's a surefire way to make her do that.

>Now that I'm out of the house, I'd like to be a little more honest about how worried-- and often offended-- I am by her behavior.

So, it sounds like you're not living together at the moment, which is good. I think you should tell her what you think, try to have a caring but truthful conversation with her. You may lose your sister (I did) if you won't keep taking crap, but at least she will have some honesty and some adult input. For some reason she is not setting the right priorities and she's floundering. You are not sure why. Is she sure why? Is she even trying to make the right choices? All you can do is try to find out, and encourage her to do so. If you believe she can succeed, tell her so. But she is the only one who can make the essential changes and fixes necessary. Good luck with it -- this kind of communication is very, very difficult.

Paxil and alcohol together are a no-no. She's self-medicating because whatever help she's trying to get isn't doing the trick. I hope she realizes that, and can move on.
posted by Listener at 4:07 PM on July 4, 2008

Advice to drop her like a hot potato and let her hit bottom is irresponsible when the sister is suicidal. It is important to recognize the distinction between being caring and supportive and being an enabler and rescuer.
posted by loiseau at 4:12 PM on July 4, 2008

Bright people on this site; this whole 'hive mind' thing truly is great. I second most everything I've read thus far, had written a lot and threw it out, as it's been addressed better here already.

I love this site.
posted by dancestoblue at 4:15 PM on July 4, 2008

You should stop funding her pot habit. (I'm assuming if she spends lots of time smoking pot in her room alone, little time working and you've often bailed her out financially, that it's your money going up in smoke). It's fine to provide financial support if you're able to. But if she can afford to sustain a daily pot habit, she can almost certainly afford to get therapy.

It does sound like she has multiple issues, although it's probably unhelpful for you to think of this as a personality disorder. Anti-depressants can be great medications, but they don't fix poor coping mechanisms, or allow people to develop ways of dealing with life. So yeah, therapy sounds like a really good idea for her.

It doesn't sound like you want to withdraw your support for her, despite being understandably weary and tired of helping someone who's resistant to your advice (though not your money or your attention). You can't make her better, nor is it your job to force her to make herself better, but your support does, to an extent, enable her to continue to not address her problems. If you want to continue to support her, you really need to make your support contingent on a commitment from her to work towards getting some therapy, cutting down on the pot and generally addressing her problems.
posted by xchmp at 4:19 PM on July 4, 2008 [1 favorite]

My sister has a less serious mental illness, but still, I feel your pain. Depressed people wear out their support systems. You need to watch this.

Please don't cheapen the need to have your own life. Letting her drag you down won't help her. I'd get a good therapist to help you draw boundaries. What you're going through requires super-human strength. Helping yourself is the surest way to help her. Good luck. There's too much to say for a mefi post. I wish you and your sister the best.
posted by gesamtkunstwerk at 5:23 PM on July 4, 2008

The best way for you is to arm yourself with knowledge.

Previously
posted by mynameismandab at 7:33 PM on July 4, 2008

You mention that you've tried to get her into treatment in the past with no luck, because she says she can't afford it, and part of your question is how you can get her to take treatment options seriously. One thing you can tell her is that many therapists have sliding scales of payment and will see X number of patients at less than their full rate. You could even do some scouting with a few therapists to see what they charge and how low they'd be willing to go. They might not be able to tell you - sometimes they only really consider it once they've seen the person a bit and are familiar with their situation and see real need. It's worth a try though.

If she is already on anti-depressants, however, she ought to be taking them under the care of someone trained in mental health. I realize this can be even just a nurse practitioner at an HMO, but even they can help. Is it just her GP that has her on anti-depressants? Is she paying for them without insurance? If she can do that, and you can find a therapist to cut their rate down, could she not pay for that once every week or two as well? If you're tired of giving her money, and you really want to help her get treatment, perhaps you could offer to pay for half if she'll stick with it.

She needs to lay off the pot though. Alcohol is bad enough for depression, and worse mixed with antidepressants, but pot can have very different and even more potentially dangerous effects on depressed people, especially ones on medication. Even without the dangerous effects, it can sink her deeper into depression. Jesus, she needs to quit all that shit, and you shouldn't give her money if she's jobless and broke but smoking weed. What a tough situation. I swear this sounds like intervention time. I wish you the best of luck and agree with the suggestion that you seek your own support group for help coping with this and so you can get advice on solutions.
posted by kookoobirdz at 7:37 PM on July 4, 2008

Get this book.

And this companion workbook.

They saved my life.
posted by Fuzzy Skinner at 8:23 PM on July 4, 2008

I'd be more blunt about your concerns and really consistently urge therapy. In fact, get some referrals for really good therapists. Many therapists are not prepared to handle someone with a significant diagnosis, so even if she gets therapy, she may not get the right therapist. If you can, offer to help pay for therapy. She's lucky to have you. Good luck.
posted by theora55 at 4:51 AM on July 5, 2008

I can't say enough that she really has to want it. It took me 15 years and having the same problems reoccur over and over and over and over, until I finally recognised a pattern and realised I really couldn't fix it myself. It's not like I didn't know there was a problem all that time, I just thought I was smart enough to deal with it on my own.

I definitely knew that I was terrible at attending school, awful at keeping a job and had more and more trouble just seeing people I supposedly 'cared' about. I knew that I would adapt my personality to those around me. I knew that I was afraid of rejection and criticism. The school psychologist told my mother when I was twelve that I had identity issues and didn't seem totally in touch with reality. I have actually been afraid of weighing above 100lbs. One day I learned that cutting could relieve a little pain, but it was a lot harder to hide than I had hoped. What I didn't understand is how I could keep on hurting myself in these ways, seemingly so subconsciously. I didn't see at all how these things were so intrinsically related. I really thought I could handle it, when really these were all symptoms of me not being able to really 'handle' anything.

I didn't know a lick about BDP before my diagnosis. I kind of wish I had, but I'm not sure I would have listened. When my doctor opened up the DSM-IV and showed me the criteria, it was like reading the story of my life, in bullet points. Still, it may not be the whole picture for me, but it was relieving knowing there was a name for this, a reason and a respected non-medical treatment, DBT. Fortunately, I'm in Canada, so this won't cost me an arm and a leg. I get the impression that therapy can be costly and difficult to find in the US, hopefully I'm wrong.

She's probably going to have to fall a few more times, and harder, to realise what's going on. It really took an epiphany for me to go seek help. She needs moment where she's seen something in herself enough times to be fucking sick of it.

Best of luck, you are certainly not alone in this!
posted by sunshinesky at 12:34 PM on July 5, 2008

I would find a support group for people in your situation. It cannot be easy.
posted by salvia at 3:06 PM on July 5, 2008