How to Love a Sibling With Mental Illness

It's the most difficult love of all.

By

Nicole Schwartz

 
Published June 18, 2026
Illustration of a surreal coastal landscape featuring shallow water with scattered rocks, an open green door filled with textured elements, a standing figure holding a lantern, and a glowing candle on a rock
Eva Vasquez

What we saw cannot be unseen — the small, dark room where my 61-year-old sister had been living in squalor. Her life had come unmoored. Hygiene, safety, self-awareness and the ability to make sound decisions had all slipped away.

Yet something remained.

A hint of knowing.

A hint of shame.

Dozens of products to kill the unbearable stench were scattered across the room: air fresheners, disinfectants, fragrances, scented candles and dryer sheets. They were under and over the wreckage of a life once contained, now emptied out.

The contents of a closet. Dresser drawers. Kitchen cabinets. All mingling on the stained, moldy carpet.

But it was the single shoes that struck me most. A left shoe, but no right. A right, but no left.

The bedroom door was finally opened after she was hospitalized for a broken leg that had gone untreated for months. Now she’s living temporarily in a rehabilitation facility to help her recover, thousands of miles away from the rest of the family. At her request, and because of privacy laws, no one is permitted to talk to us. We have no idea if they’ve diagnosed her mental health condition as well.

It wasn’t unexpected. Still, seeing it like this? Gut-wrenching. The room testified.

In the years leading up to that day, we didn’t agree on the best approach to manage her state, which had become a ticking time bomb — only that entering the room was a line no one wanted to cross. My sister’s handwritten sign on the door forbade it, and we honored that boundary, with my mother, who had become housemates with my sister, holding that line.

It’s doubtful my father would have been as open to that stance had he lived to see the direction my sister’s life had taken, but he died nearly 30 years ago. They were similar in temperament and shared a language all their own. A light went out in her life when he passed.

Not a day went by that I didn’t wish I could call him, fill him in on what was happening and ask him to help me make sense of it all. Seeing that living space screaming with neglect made it impossible not to question whether our optimism and patience were really just permission to look the other way.

The pressure placed on families of the emotionally unstable to do whatever it takes to make it all better is crushing. When does hope become harmful?

This isn’t the person we thought we knew. The one we grew up with. This is some alternate-universe version who moved in and stole her away.

Over the years, our language about our circumstance has shifted from “It’s going to be okay — we’ll figure it out” to “Why won’t she share information?”

The result has been pain. The kind that finds you in your dreams, making sure you’re paying attention. After the trauma of clearing out her room and facing the reality of my sister’s circumstances, my mother’s health deteriorated and she moved in with me across the country.

When there’s powerful, graphic evidence of self-neglect, of mental and physical instability, your frantic question becomes: What do I do to fix this? Quickly followed by:

Should I fix this? What happens if I don’t? I’ve imagined every possible scenario. We’re trying to help someone who doesn’t believe she needs help. Now we’re coming to terms with not being in charge.

My sister’s behavior began decades earlier with her slow disappearance from our lives and reality. There were multiple housing situations that required cleanup. Not showing up for our mom’s 90th birthday dinner while she spent the evening looking at the restaurant entrance, waiting for her to arrive. Telling us she was employed when she wasn’t. Money messes. Lapses in judgment followed by periods of relative calm.

Yet the family remained under the illusion that we'd always be connected. It’s who we are — an imperfect family bound by love and history.

We came together frequently. Our voices healed each other. Our laughter spurred us on. Now my phone dings nonstop with calls from family members and it means only one thing: another crisis is unfolding. It might have been lessened if my sister communicated with us, but she has chosen not to for reasons only she understands.

The one person she still speaks to is our mother, though their relationship is strained. When they talk, and the conversation turns to my sister’s health, she gives my mother her well-rehearsed line: “My team is taking care of me.”

I’m told by a social worker who may be familiar with the case — but who, because of privacy laws, could only listen and offer general advice — that there’s nothing left to do but wait. The choice about where to live when she’s no longer under care for her physical condition is hers. We only know my sister can’t return to where she was living because she was evicted and the lease, paid for by a family member, has ended.

The social worker says they will offer her housing options, but to be prepared — she may not accept those options or tell us where she ends up.

Hope, once my default, is out of the question. It’s like a death, except the person is still alive.

Will we cave and break our joint resolve not to rescue her again? Can we overcome our pain and salvage what remains of “us”?

I don’t know.

Privacy laws protect the patient until they don’t. Our family can’t relay to professionals what we’ve witnessed in that room or over the years, and she can only relay her own truth. Even if we could be part of the conversation, she can say she’s fine and the system has to go along with that unless she threatens to harm herself or others.

The sign on her door said, “Stay Out.” The moment we finally opened it, I understood why.

I cannot control her choices.

Walking away is not abandonment. It is survival for all of us.

And sometimes, when one door closes, it just closes.

(The author’s name has been changed due to the sensitivity of this piece.)