Despite our best efforts to dissuade you, many of you have still decided to write to us with your problems, complaints and crises of the moment. We don't have a trained therapist on staff, and this isn't "Dear F*ckin' Abbey", but we DO have Bonnie, who has graciously volunteered her time and heartless perspectives in order to minister to (or macerate) the misguided, with "Dear Fuckin' Bon..."

May 8, 2003

Dear fucking Bon,

I need a heartless perspective and I’m hoping you can help. My kid sister is a functioning delusional sociopath . I don’t mean this in the derogatory sense, but in the literal medical sense. She has major episodes which destroy her live and the lives of those around her. But she is functional, in that she can hold a job for brief periods of time, she is raising her daughter on her own and has managed to create a semblance of life for herself.

She needs help, professional help but her brain tells her that all doctors are out to get her and she refuses to seek the attention she needs. In the past, I’ve taken her in, paid her bills, baby-sat my niece and done what I could. I only asked that she go back on her medication while living with me. She does and her life gets better, so she moves out on her own, then decides that she’s strong enough to go off the meds which puts her back where she started.

Its a horrible vicious cycle. One that hurts her so much. She’s basically fallen into this "one step forward, two steps back" rut that now defines her life.

5 years ago, she came to me for help again but refused the meds. I told her that I could not have her living with me under those conditions. (There’s a very good reason for this. She gets very physically violent. Broke my mom’s arm once while raging that my mother was a satanist who had try to sell her off to be sacrificed. Which is the reason my mom wont take care of her anymore.) When I refused her she moved out of town and I didn’t hear from her for 5 years.

I’d be lying if I said I wasn’t relieved to have my life back. In these last 5 years, I managed to set myself up with a great job, good friends, a place I really like and a strong supportive relationship. I’m pretty happy where I am.

But she’s back. She seems better. Has a new job, a little place. My nephew seems to be OK, he’s a B student who makes friends easily. My sister is very proud of the fact that she "doesn’t need any medication". I hope she’s right, I really do, but the fact that she’s already mentioned that I was just trying to persecute her and keep her down kinda worries me. And, of course, she just needs a little help while she gets back on her feet. She’s already determined that her current boss is a rapist and that she’s his next target.

Here’s the problem. I don’t want to help her any more. It’s exhausting, expensive and time-consuming. I’m so very tired of trading my life for hers. I can’t make her take her meds. And I can’t make her life better. If she was a stranger, I’d have nothing to do with her. But she’s my sister. You don’t get to choose your family but you are responsible for them. Other people have their own families to worry about.

What the hell would you do?

Torn Sister

Dear Torn,

I think that you should basically stick by your guns and let her know that you really can't help her unless she's committed to getting help, including obtaining and taking her medication. This is one of the heartbreaking things about having a family member who is severely affected by mental illness. Incidentally, I know she is avoiding therapists, but I would question her diagnosis as well. An improper diagnosis can mean that the meds in question are obviously going to be inadequate, possibly even worsening the situation. Her delusions may be making her paranoid, but you may also be dealing with more than one mental/emotional disorder, and to properly address her needs you need to know all of what you're dealing with.

Another possibility is for all involved members of the family (you only mention your mom and yourself) get together and help to situate her but not living with either (any) of you. If she really wants and needs the help and is dedicated to getting better and getting "back on her feet", then she will be grateful for whatever you do. This could mean helping her get into a small apartment (I don't know what kind of help she's requesting, which is part of the problem). I would encourage you, to the best of your abilities and energy, to help out with your niece or nephew (I'm guessing you changed gender to protect privacy, but you said one thing one place and another in another place. My guess is that she has only one child, and she's raising that one? Gender doesn't matter). The child can use the stability that you can offer if you are babysitting or caring for him/her on a regular basis.

Unfortunately, there comes a point at which you really can't help even family members if they won't take care of themselves. If your sister refuses to get and stick with help and maintain her mental health there really isn't much you can do (and based on her paranoia as of late, it sounds as though she's degenerating into an episode right now). Since one of her symptoms is paranoia, there's not much you can do or say without her getting more so. It's a terrible situation, and I really feel for you. But there is a point at which you are not responsible for an adult who refuses to get help. If it becomes necessary, you may have to make the difficult decision to report her and attempt to get custody of your niece/nephew. I know that sounds dreadful, but the only other option is to go through the cycle again and again, and as you say, it has the potential to ruin your life and finances. At the very least, as his/her aunt, you can talk to him/her and find out what mom says about people "out to get her" or whatever, and attempt to help the child sort through truth and fears based on what Mom is saying.

The bottom-line advice I can offer here is this;

1) Try to get your sister to see reason. I don't think this will work, and I'm saying it only so YOU can feel sure in your own mind and for yourself that she is utterly refusing to help herself, and that therefore you have given her every opportunity. (I think you're there already, I'm just saying be sure you feel this way).

2) Decide what you can offer as a family to help her back on her feet and decide what the minimum requirements are for that. She will not respond well to it, but make sure you and your mom and whoever is really sure of what you have to offer and what she must do (ie; see her therapist and take her meds, and you can do whatever level of assisting her with living arrangements or babysitting or whatever) or the offer is automatically withdrawn.

3) If you can't get her to see a counselor, find support groups for yourselves. You're on the net and I'm sure that at the very least there are newsgroups for families with mentally ill members. In fact, I have a Google search right here by entering "support" and "families with mentally ill members", if that will help you start off. Using different words, phrases, or search engines (ie. AltaVista search), you may get more and different sites with information. In any case, contacting them will get you some more direct advice than I can give, since that's their specialty and they can work with you to find resources in your area. If you're not in the boonies, there should be a city or town nearby where you can find resources for support for yourselves, and actually meeting people with the same stuff you're dealing with can be invaluable. You may even want to see a counselor yourselves for a session or two just to find out what your options may be.

I really hope things work out and I so hope that she chooses family and stability over "not needing meds" and paranoia. It's possible that she may be influenced by the fact that if she continues to lose it on a cyclical basis that her child can be taken away, I don't know. I wish you the best of luck though, and really hope that you and your mom can find some supports and information so that you know that you're not alone in this situation, and that it isn't on you to keep picking up broken pieces with no end in sight. Your feelings, from sadness to rage, are absolutely normal in this particular no-win type of situation, so I hope that you can work through them and come out stronger. Feel free to drop me an update, I'll be thinking of you.

bon