The Well Sibling: Challenges and Possibilities

The impact on the family of a child with serious mental illness or some other form of disability has been well documented by many authors. Contributing to this impact is society's attitude to mental disabilities, which has been ambivalent and marginalizing at best and shunning at worst. Because of this, individuals and families dealing with mental disabilities tend to become isolated. Further, onset of mental illness often causes disruption of the family's life cycle and profoundly affects the sibling relationship. This paper will consider the nature of the impact of the ill child on the siblings and propose some ways to address and manage the powerful reactions of well siblings in fostering a more satisfying individual and family adjustment and in preventing problems for the well sibling and future generations. KEYWORDS: family dynamics; sibling relationships; mentally ill child; well sibling The impact on the family of having a child with serious mental illness or some other form of disability has been well documented by many authors, including Torrey (1983), Marsh (1992), and Hatfield (1994). Society's attitude toward mental disabilities has been, at best, ambivalent and marginalizing, and, at worst, fearful, stigmatizing, and blaming, shunning afflicted individuals as well as their families. Nancy Andreasen (1994) suggests that the mind/body dichotomy is at the root of the attitude. A physical problem may be seen, but mental suffering seems not to be real because the cause is not visible because the mind is considered the executive of the individual, and that somehow mind functions are "under the person's control," the individual is seen as responsible for behavior. Thus, individuals and families dealing with mental disabilities tend to become isolated and feel shamed. Further, depending upon the timing of the onset of the problem, the life cycle of the family is disrupted (Carter and McGoldrick, 1989). Communication problems tend to develop and information about the disorder may not be openly discussed. There are many reasons for this, some are intrinsic to the problem and some are built into the family. Sometimes, for example, the problem has not been defined or explained clearly, leading to confusion. In some families, because of the pain and stigma attached to the disorder, there is denial and a wish for things to appear normal so that discussion about the problem is discouraged. Interventions have been designed to address this serious problem on the individual level through family therapy and psychoeducation, on the group level through multiple family groups, and on the advocacy level through such organizations as the National Association for the Mentally 111. Still, interventions with families have long been resisted, as many treatment modalities emphasize the primacy of the individual and view families as standing in the way of individuation. Mental health professionals have considered confidentiality, particularly with adolescents but with children as well, to be essential in developing trust in the therapeutic relationship. Further, because families have historically been seen as the cause of some problems, there has been a wish to save the child or adolescent from the destructive influences of the family. In recent years, some family members have been better integrated into treatment, but siblings continue to be forgotten (Marsh, 1992). While the sibling relationship has a profound impact on development, its significance is acknowledged far less than the parent-child relationship. The sibling relationship is the connection in which the child learns to interact with peers, tries on different roles, manages disagreements, handles rivalry, and learns to share secrets as well as belongings, laughs, cries, loves, hates. The ability to negotiate this/these relationship(s) serves as one of the models for the quality of future relationships. In The Sibling Bond (1982), Bank and Kahn describe different kinds of attachments that form between siblings, noting three predictable conditions that allow strong bonds to develop. …