5

FEELINGS WITH NOWHERE TO GO

“I’m always being nice to people, even when I should be more demanding. It’s hard for me to show my feelings, and when I do and someone feels hurt, I’m overcome with guilt. I never get angry.”

—TARA

SIBLINGS OFTEN SENSE THAT IT IS NOT ACCEPTABLE for them to talk about their feelings in relation to their brother or sister. If left unexpressed, emotions such as anger, embarrassment, fear, and guilt can build up and contribute to ongoing anxiety, shame, low self-esteem, and possibly depression. Some of this distress can also show up as behavioral problems. The stories that follow show how the experiences of sibling children can manifest as emotional problems in adulthood.

ANGER

As a child I felt much anger: at my sister for being the way she was; at my parents for the special treatment they gave her; at everyone else for staring and not understanding. This anger had to be hidden; there was nowhere to direct it, so it turned in on me. I became self-doubting and frustrated at my perceived inadequacies.

If I did ever show anger toward my sister by lashing out physically, I was told that she couldn’t help hurting me and so I shouldn’t hurt her. I needed to have my own hurt acknowledged as well. Over time I had difficulty learning to stand up for myself.

There are several reasons why siblings find it difficult to express their anger and frustration. For instance, if you feel sorry for someone, it can be difficult to show anger toward him or her.

As well as feeling sorrow for a sibling with a disability, children often feel sorry for their parents and want so much to make things right for them. It can be difficult for children to express anger toward parents whom they see as dealing with enough stress already. Many adult siblings say that they still struggle with anger and need counseling to help them learn to express it and deal with it.

In his book What About Me? Growing Up with a Developmentally Disabled Sibling, Stuart Silverstein writes about denial.

In reading through the essays and stories written by other siblings of handicapped children, I see a similar tendency toward a denial of their feelings. Instead, they acknowledge the more positive emotions and experiences. They talk about their “special” brother, how he has brought the family closer together, makes them laugh, and makes them so much more compassionate. Everyone then steps back and says, “Now, isn’t that nice. His sister has adjusted so well to the situation.” I see very little acknowledgment of the darker emotions. What about the hurt, anger, frustration, and resentment that I know exists? . . . We siblings are not supposed to feel angry and resentful. Such feelings imply selfishness and insensitivity. But in not acknowledging these feelings, we only feed into denial. . . .

In the beginning, my denial was so strong that, when asked what impact Marc has had on my life, I proudly claimed, “Since Marc was around all my life, and as I have never known any different: no impact!” I then explained how much more sensitive to others I am because of Marc. I think that, as a child, I was perceptive enough to realize that this was what others were comfortable hearing. An expression of my true feelings would have been too overwhelming for all concerned.

He goes on to say:

Denial leaves you out of touch with your true feelings, incapable of finding the necessary energy to deal with the situation at hand. You end up mistrusting your own intuition in important situations and heading down the path to insecurity, low self-esteem, and depression. You are left a legacy of helplessness.

Rachel now understands the difficulty she had in talking about negative feelings in her family and the long-term consequence of that isolation.

It is hard for me to say that my parents “neglected” me because I don’t want to add to their burden, but I know in my heart it is true. I often feel that if I had happy things or positive things to express, that was okay, but if I was negative, that wasn’t okay.

I remember in eighth grade I wrote a poem entitled “My Name Is Rachel and I’m Always Happy.” It was about how everyone always thought I was so happy and told me all their troubles, but I could never tell anyone mine, and I always did everything with a smile, which masked everything.

Renee expresses similar sentiments:

Parents are involved totally with a seriously ill or disabled child. They also get a chance to talk to each other. Especially if you are the only other child, there is no one to talk to. It would have been difficult to get me to articulate my feelings. I was trying so hard to be the “good” child. It seems that the child who appears to be unaffected by what is happening around her is perhaps the most profoundly affected.

She was also afraid to show her own vulnerability.

By the time I was a teenager, I could have discussed it, but to me it seemed too difficult. Why would I suddenly want to appear so vulnerable, where maybe I’d cry or whatever?

Gina is one of six children. Her sister, older by fourteen months, is deaf. Even though she had younger siblings, she still had no one to talk to.

I had many negative feelings but could not tell anybody else. I would think a lot and it was difficult to express my feelings. I suppressed my feelings for my sister. I couldn’t express anger or frustration, except by bursts of fury. Learning to express anger as an adult has taken a long time.

I’m also very private because so much of what we did was visible to everyone else. Every time she spoke, everyone focused, and we were always the center of everyone else’s attention. When she wasn’t there, I was left very much to my own thoughts and feelings, and went inside myself for support.

I had learned from a young age not to react, not to show emotion on my face. It taught me a lot of control. I could mask everything if I wanted to. You should be able to acknowledge what you are thinking and feeling, verbalize and deal with it. But I couldn’t do that. You sacrifice all your thoughts and feelings to the needs of the other person.

Tara also felt isolated.

I felt totally alone at times in my family. My mother protected my brother from the world with a ferociousness that scared me. I was conscious that my father’s attempts to nurture me caused conflict between him and Mom. By the time I was twelve I was bulimic; fourteen, anorexic; nineteen, clinically depressed. I turned my feelings of anger, hurt, isolation, and loneliness upon myself. At twenty-eight I can finally recognize this—it feels like a long road ahead.

Carly describes her own spiral toward an eating disorder and depression.

I grew up in an isolated part of the country. My sister is five years older and my brother, who has severe epilepsy and a mild intellectual disability, is three years older than me. As a child, he spent many months of every year hospitalized, which meant he and my mother were not home for extended periods of time.

I felt I had to be the perfect child and not cause my family any problems. I was expected to be the child who would make something of my life and go on to university. My sister acted out and rebelled as a teenager, but I was told not to turn out like her. I never felt good enough.

In addition to the pressure to be perfect, I grew up with a lack of attention. I felt my life was put on hold until my brother left home at sixteen to attend a special school. Suddenly my life started again. Attention was poured on me as though I were a five-year-old child; but I was thirteen and the attention was too late. I needed it when I was younger. In some ways, I wanted to stay a child.

I held a lot of resentment for all my family, including constant thoughts as a child of wishing my brother was dead.

At the age of fifteen, I developed an eating disorder—anorexia nervosa—and severe depression. I have no doubt, looking back, that a major contributing factor was the feelings that developed around having a disabled brother.

Looking at what contributes to an eating disorder is complex. For Tara and Carly, it seemed to spring from internalizing feelings, a lack of nurturing, and self-abuse. Others might develop an eating disorder as a way of gaining some control over their lives, where as a sibling they have grown up with little control over their external environment. For others, symptoms can be related to the pressure of trying to be perfect.

Many siblings talk of their concern for parents and how this inhibits their expression of feelings. Renee explains:

One of my hesitations with talking to you for this book was that you might identify me and I would be worried about the effect on my parents. It’s a protective thing. Anger, et cetera, can’t spill out onto your parents. In the overall scheme of things, the much greater loss was theirs.

Ever since my brother died, we’ve had Christmas at our place. I have had anger about that. Why do I always have to be the parent? I went away a couple of times. I felt it was cruel, but I needed to.

There is so much to work through at a later age. You need to do it all at an accelerated rate. In some ways you have to be a child again at forty. You can say that it’s ridiculous to be jealous of your sibling, but you are. And you say to yourself, “Gee, I’m not like this in any other area of my life.”

Julie, also in her forties, commented that any effects on her were nothing compared with what her parents went through.

I think there is a lot of repressed anger. With my mother in particular, I have always been too afraid to show too much anger, because I think she’s had enough to deal with. So I don’t think you ever get it out. It probably never gets resolved.

Josie also continues to feel anger toward her parents into adulthood.

I have spent twenty-four years as a parent pleaser. It used to be that I felt guilty if I ever thought something negative about my parents, let alone said it out loud! I would think, “How dare I say something bad about my mom and dad when they have had to deal with all this stuff.” When my friends complained about their moms, I never said a word. Whenever I say something negative, I feel like I need to also say, “But they are wonderful parents and I’m very close to them,” “I couldn’t ask for better parents,” and so on. All of this is true, but I can never say a negative without adding a positive.

I am finally being honest about my feelings in regard to my mom and dad. Now that I am older, I am starting to realize that I can love someone with all of my heart and sometimes still be frustrated or angry with them! What a relief that has been for me.

For Rachel, marriage was the catalyst for understanding and change.

Being in a marriage forced me to deal with things. In most other relationships, if something bothers me, I can just leave for a time, or extricate myself from the situation, but with a spouse, it isn’t that easy. I recognized that I couldn’t fight with my spouse properly and was holding a lot of anger and resentment toward him for that. Counseling helped a lot.

There can be anger at others, especially those who stare and tease. As a child I would often stare back, and I remember wanting to do something like poke my tongue out at them. I’m not sure if I actually did. It was another situation where I couldn’t direct my anger specifically at someone. I had to keep it hidden.

Renee had similar reactions.

I can remember walking down the street and people crossing to the other side to avoid us. I remember poking out my tongue at people. One stare and they’d get it from me. Of course, if my parents saw me I’d be in trouble. But it must have been very hard for my parents.

Again, the concern for parents appears to be the overriding factor here.

DEPRESSION

Siblings talk about the periods of depression they suffer throughout their lives. Depression often arises in the context of unexpressed anger or other feelings that have been repressed. One definition of depression is “anger turned inward,” so it’s not surprising that siblings can experience depression and low self-esteem. This often goes unnoticed, and if young persons feel depressed, they may hesitate to express it to their family because their problems feel insignificant alongside the problems of others. They may not be able to talk to people outside the family either, if they are trying to hide the reality of their home life. For some siblings, a sense of helplessness can build up.

Everyone has ups and downs, with periods of feeling flat or unhappy. There can be pressures (both external and internal) on siblings to deny these quite normal down times. Constantly trying to be perfect and keeping negative feelings hidden can eventually take their toll.

Rachel recognizes the source of her depression.

I realize now that if I was ever mad or hurt or angry (especially at my disabled sib), my parents and I just didn’t know how to deal with it, so we didn’t. All that “emotion stuffing” has taken a big toll, and I have been on antidepressants and in counseling and group therapy for several years.

Tara’s inbuilt anger has led to ongoing depression.

I am angry so much of the time. Angry at the world for making my life like this, angry at my brother for his disability and health problems. Mostly I am angry at myself for not coping, for not being the perfect daughter, for failing to make life easier and better for everyone.

Siblings can reach crisis point at varying times. Like me, many siblings talk of it all coming unstuck during their teen years, when emotions can ordinarily seem difficult and confusing. Add to the mix all the issues related to a brother or sister with disabilities and the pressures can become overwhelming. Seventeen-year-old Vera, whose sister has cerebral palsy, describes her struggles with depression.

I had bouts of depression for various reasons, mainly through being in a family with a disabled sister—the stress that is present, the feelings that are never mentioned. Recently this depression has grown. It is something that I have to deal with on a daily basis. I get shaky, scared, emotional, withdrawn. It is pretty scary but I am sure it will get better. I used to use schoolwork, real work, organizing, planning my life, to withdraw myself. Now I have a lot more fun, I have more of a life, a wonderful boyfriend I love and respect. But sometimes I just can’t sleep. I feel like there is this black hole.

For children who have no other brothers or sisters apart from the child with a disability, the difficulties can be exacerbated. In most families, sisters and brothers provide children with their first social contact. Through this they learn to give and take, to share and to stick up for themselves and for each other. In families where there is more than one sibling without a disability, there are more opportunities to learn these skills. These children also have more opportunities to share some of their feelings instead of internalizing them. For single siblings, the isolation and self-doubt can be immense.

Lenore highlights a common feeling among siblings who ask, “Why did this happen to my brother?” (or sister) but at the same time know there is no answer to the question and nowhere to direct their angst.

I keep telling myself that asking “Why?” is pointless at this time in my life; that my energies are better devoted to coping. But there’s always that little voice locked away in the back of my mind that wants to rage at the sky.

Many siblings are able, as adults, to work through the negative feelings and experience relief from depression or other symptoms. Strategies that may help siblings are explored in chapter 9.

EMBARRASSMENT

Embarrassment is something siblings can begin to experience as they grow older. Preschool children may accept a disabled brother or sister completely and not feel any discomfort. However, embarrassment may come during school years when siblings become more aware of others’ reactions.

Victoria saw her classmates making fun of another child with intellectual disabilities.

That is when I became ashamed that my brother too was retarded, and I didn’t want anyone to know, for fear they would make fun of me. I already had enough going against me. I wore glasses, I was chubby, and I was smart; three things that easily kill popularity when you are a child. I didn’t need a retarded brother too.

Embarrassment is what I remember most as a child, and after all these years, it is still there. Wherever we went people stared. Part of me felt protective of Helen and concerned about how she felt. But most of all, I felt extremely embarrassed. I was terrified that people would think I was like her, that I too was disabled in some way. I wanted to yell at them that I was okay. I always sensed that I was being judged.

My teen years were full of uncertainty. So much of adolescence is about creating an identity. I seemed to be pulled in so many directions. I knew I couldn’t use my older sister as my model in trying to form my own identity. I felt a heightened sense of guilt and sorrow when I compared her life with mine. My self-consciousness seemed to blow out of control. Again, I had no one with whom to share my thoughts and feelings. Many siblings say that it was during their teen years in particular that they felt acute embarrassment. Some go through a stage where they don’t want to be seen with their brother or sister.

I felt uncomfortable when friends came to dinner. I tried to act cool, but my stomach was churning. Helen always struggled with her eating. She had to eat by pushing one mouthful of mashed food down with the next. She would also belch and laugh loudly. And in spite of my mother’s efforts, she always smelt of dribble.

I dreaded bringing boyfriends home. I was sure they would feel uncomfortable when they met my sister and that they would lose interest in me. I talked recently to an old boyfriend from my early twenties. He remarked that he wasn’t at all disturbed by Helen’s behavior but could see that I was deeply concerned by it. He said he could never quite understand why.

As soon as I finished university studies I moved into an apartment with friends. I needed to get away, to show myself that I could cope on my own. I didn’t stay away long, but it was important to have some space away for a while.

When I was about twenty I decided to do something nice for my sister on my own. I took her to the musical Godspell, starring John Farnham. Helen was, and still is, a real fan of his. She made her usual noises, and I spent the whole show grabbing her arm, pinching it, anything to try to stop her from attracting attention to her and to me. I hated the whole outing, and then felt terribly guilty afterward for not allowing her to enjoy the show.

Renee also felt this heightened sense of conspicuousness.

There was embarrassment of the wheelchair, the confinement, the obviousness of it all. My brother was quite large. If he needed to urinate, a huge metal bottle would be brought out. I found it mortifying and didn’t know whether to explain or go away.

For Julie, whose sister suffered mild intellectual disabilities, the embarrassment wasn’t huge but was still there.

I used to feel embarrassed when people came home. I would introduce her briefly and then run off to play. I did nothing to include her in our play.

Nance, like others, avoided bringing friends home.

While I was never ashamed of my brother, and most of my friends knew about him, I look back now and realize I rarely took friends home. I always tried to find a way I could go to their place instead. It was only the people I felt I could trust the most that came into my house.

Gina also felt uncomfortable and feared others would think there was something wrong with her.

I can remember being in the shops, and my sister was trying to talk to my mother and she couldn’t modulate her volume. When deaf children learned to speak, they would look in the mirror, feel their throat, and try to mouth the words in the right way.

She was calling out “Mum.” If you look at the way your lips form, she was crying out “bum, bum” very loudly, and everyone was looking at this child who looked perfectly normal but who, in those days, was being extremely rude. But no one knew. I felt like saying, “She’s deaf, she doesn’t know what she’s saying.”

I had to excuse her all the time, explain why she didn’t respond to people.

People would stare at her all the time if they couldn’t understand her. It made me feel important translating for her. I felt very needed, but she had such a loud voice, and when we were out people would stare. I felt like saying, “It’s not me; I might be using my fingers, but I’m not deaf, I’m not talking like that.” So as well as using my fingers to sign, I would make sure I was talking so people would know I was okay, I was normal. I wasn’t the one with the problem.

There were amusing incidents too. One time, as adults, we were at the hairdressers together and we signed. The girls working in the shop presumed we were both deaf and so were talking about us. I was so embarrassed and didn’t know what to do. I didn’t say a word, though I should have. They chatted away about all sorts of things—not only about us but also about their everyday lives, what they did with boyfriends in the backseat of the car. When we left I thanked them and said I hoped they had a good day. One of them replied, “Can you hear?” When I replied that I could, her face dropped. Though part of me was amused, I felt very guilty.

FEAR

Another emotion experienced by many siblings is fear. Earlier I mentioned the fear of also developing a disability, but other fears are possible as well.

If the child with a disability has extreme behavioral difficulties, siblings may fear for their own safety. Consider the child who locks herself in her room every time her older brother with autism goes “ballistic,” afraid that he will hurt her, break something, or at the very least upset her mother. This child is learning to withdraw from stressful situations. This might result in her withdrawing from other aspects of her life.

Another sibling, an adult woman, is still unable to be in the same room as her brother without feeling panic. As a child, she had been on the receiving end of much of her brother’s aggressive behavior. Some children with disabilities can be quite destructive, and this can create anxiety in siblings who may be younger and smaller. Living with such anxiety on a day-to-day basis can lead to longer-term problems with anxiety.

Some siblings have talked of parents not protecting them, even dismissing their fears and placing the blame back on the sibling. Some parents’ level of denial of the situation is so strong they don’t recognize the dangers. Denial is a coping mechanism, but it can put both the child with special needs and siblings at risk. Of course, some siblings will physically hurt a child with special needs. In some cases, this can add to the guilt they might be feeling already. They need to learn more appropriate ways of dealing with their feelings.

Even parents can experience fear, especially when children reach adolescence and become bigger and stronger. These parents may feel tremendous guilt about feeling such fear and find it difficult to share the emotion with anyone.

In addition to fears for their own safety, siblings often worry about the safety of a brother or sister with special needs and feel powerless to help him or her. Renee talks of a fear that her brother would die.

People with muscular dystrophy can die of something minor, like a cold. Several times a year my brother would be rushed to the hospital and have his lungs pumped. I remember sitting and waiting, not knowing if he would die. Everyone else was so worried, there was no energy to give to me. There was no chance to talk about my fear or anxiety.

A lot of feelings reflected an effort to gain control. I can remember my father telling me that my brother lifting his arm off the table would be as difficult as my trying to lift the piano with a little finger. I had such a sense of absolute powerlessness. When children are growing up, I think you give them a sense of all the things they can do, but suddenly, at a very early age, I found there was something absolutely overwhelming about which I could do nothing. It’s not a nice thing, either.

My husband says that when he first met me I was very pessimistic. If there were two outcomes, I’d always anticipate the worst. My explanation was that something terrible had happened before, so why not again?

In lots of different ways my childhood situation has had adverse effects on me. It still comes back and takes a while to work through and deal with.

Other siblings have talked of having an awareness at a very young age of the fragility of life. These children are more conscious of what can go wrong, and in the process, they miss out on some of the innocence of childhood. They may find it difficult to develop optimism. For some the fear and anxiety can continue through life, and not talking about it adds to the ongoing stress.

GUILT

As a child, if I felt anger or resentment, if I upset my parents, or if I was having too good a time, I felt guilty. If I wanted my parents’ attention, I felt guilty, knowing that my sister needed it more. If I felt embarrassed by her, I also felt guilty.

Helen missed out on so much. I could go to friends’ houses, play sports, do ballet. I remember going to birthday parties as a child, leaving my sister crying in the driveway because she could not go too. It was difficult to really enjoy myself. I started to feel guilty about having too much, for living a normal life. It is a kind of “survivor guilt.” I still find that guilt is an issue. I wonder if Helen thinks I have everything—job, husband, children—and she has so little. I doubt that she does, given her intellectual disability, but it tears me apart to think that she might.

Other siblings have said they can’t allow themselves to enjoy good things, that they feel they don’t deserve pleasure. They always feel the pain of others: their brother or sister, their parents. Deep down they don’t feel they deserve happiness. Rachel has a lot of happiness in her life—a satisfying career, a much-loved husband, and a young son—but still struggles with guilt.

I struggle with depression and guilt and anger and grief every single day of my life, to the extent that I am on medication. I abuse my body by overeating and not exercising because somewhere deep down in the middle of my being, I know I feel terrible that my siblings have mental retardation and I don’t. I still have to work quite a bit on the concept that “it’s okay that I’m okay.”

American pediatrician Stuart Silverstein writes in his book What About Me? about his ambivalence at visiting his brother’s group home.

To see him in the home, I will have to face up to the fact that his life is severely limited, and that he will always be dependent on others. How could I then turn around and enjoy my life, after leaving him behind? As long as I don’t have an image of his real world, I can envision it as being as pleasant as I want.

“Survivor guilt” can rob survivors of their future. There is always someone whose pain seems worse. Rachel, who works as an occupational therapist, says:

I used to have such a hard time dealing with my depression. I would think, “How can I feel so bad when I work with people with real problems?” Or I would think about what my sisters have to deal with, and it would just make me feel worse! I have to learn that even though I have a good life and am thankful, I may still feel bad or sad or rotten and it is important to be okay with it.

Renee expresses the desire to be able to feel down at times without feeling bad about it and to be able to complain without guilt.

I remember that whenever I’d grumble about anything to my parents, they’d say, “Well, you’ve got your health and you can run around. Be grateful, and that (whatever I was grumbling about) is a trivial thing in life.”

Guilt is a very large thing here. I didn’t understand it as guilt until I saw the film Ordinary People. A brother realizes that he feels guilty for surviving when his brother drowns. Once you acknowledge that, it helps.

That guilt carries through in many ways, and for me, it’s still there. My son recently had his twenty-first birthday. Not long before that, he had moved out of home and I was missing him terribly. At the birthday party an aunt asked me how I felt about his leaving home and I replied that it was a real trauma adjusting to his absence, that it felt like he’d died. My mother heard me and said, “Well, you shouldn’t feel like that; my son did die and I never got to see his twenty-first.”

I felt angry. I wanted to say that, for once, I’m just talking about how I feel. I wanted her to understand that there are other losses in the world besides her great loss as a mother, and that mine didn’t need to be compared with hers all the time.

I felt angry, and guilty for enjoying my son’s twenty-first, and I shouldn’t have had to feel that way. I can now talk with my husband and work through it, but I’m not going to have it out with my mother—it’s too difficult.

The guilt can carry through a lifetime. Siblings can struggle with the conflicting feelings of wanting to leave home and gain independence but also wanting to support their families. Often they need a reason, like going away to college, getting married, or traveling. Without that, the guilt about leaving home would be even greater. Sometimes the weight of domestic responsibility can be huge, but there is the dilemma of knowing that while they may be needed at home, they also need to forge a separate identity.

Eliza, who has a brother with intellectual disabilities, talks of the guilt she feels.

For a long time I always carried a sad torch for him, in the form of a constant inner sadness, not allowing myself to enjoy real happiness without always being sure to remind myself of his misfortune. Finally I accepted that my guilt does not make him feel any better. And when I hold myself back from fully feeling joy, he neither knows about it nor benefits from it. This sounds obvious, but ideas forged as children are difficult to dismiss.

My guilt makes me feel responsible for him, and yet makes me want to run away—because, according to my inner child’s reasoning, no amount of sacrifice could ever be enough. And at any time that I may say I don’t have or want to give any more time or energy . . . well, then I’m the bad person again.

Julie, whose sister has some intellectual disabilities, says:

I feel guilty that I don’t spend more time with her. Guilt is a big thing. I have my life with four normal kids. She comes to dinner once a fortnight. She has lived in different housing situations—some not very nice—and when I would drop her off I’d feel very guilty. I just hope she doesn’t feel too envious of my family and children. She goes off alone to her flat.

Many siblings go on to develop very successful lives, through high academic and sporting achievements. However, it can be a two-edged sword. At a young age, these children can also feel guilty when they do achieve success if, at the same time, they see their brother or sister struggling over the most basic of activities. As Rachel said, she still needs to convince herself that it is okay to be okay. There can be constant dissonance between needing to be perfect but feeling guilty when success follows.

If a brother or sister is sent to an institution, it is easy for young siblings to believe they might be to blame for their parents’ decision. The guilt can stay with them forever, even if explanations are given at a later stage. For other siblings, the immense relief about the child’s departure may cause guilt.

Some siblings adopt certain behavior in an attempt to appease their guilt. Helping out with a brother or sister with special needs can be positive in that a child can feel he is contributing to the family. Such activities can contribute to the development of healthy self-esteem. However, overdoing the caring in an effort to deal with guilt can be unhealthy. Siblings can become used to always putting the needs of another before their own. This can be particularly unhealthy if the sibling has also adopted the role of “people pleaser.” Such roles can continue into adulthood and be played out in relationships, inhibiting equality and growth. Siblings might become compulsive helpers, not knowing other ways to act. They might define themselves as carers and not know when to stop. They may never have learned how to look after their own needs. Sometimes this leads to burnout. Alternatively, the responsibility can be too onerous, causing siblings to distance themselves from the family as they move into adulthood. This can also add to guilt and isolation.

SUMMARY

KEY STRATEGIES TO DEAL WITH THESE ISSUES