Parents, whose energy may be consumed in meeting the needs of their ill child, may have little sense of the turmoil that exists below the surface among their
other children. Professionals are also likely to focus on the child with the illness, neglecting the cascading effects on other members of the family. It is essential that both parents and
professionals become familiar with the experiences and needs of siblings so that they can reduce the negative consequences of the illness for well children.
Young family members are especially vulnerable to disruptive or traumatic events, such as the mental illness of a close relative. Compared with adults, children have more limited coping skills and
strategies, are more dependent on the other people in their lives, and have fewer psychological defenses.
During adolescence, teenagers must establish their own sense of identity. The efforts of
siblings to define who they are and how they fit into the world are likely to be complicated by concerns about their own mental health and by social stigma that may leave them feeling somehow "abnormal"
themselves.
Normal development may also be affected in other ways. For instance, siblings may strive to become "perfect" children who can compensate for their overburdened
parents. There is often a sense of loss, as siblings mourn for the family member they knew and loved before the onset of mental illness. They may also mourn for the loss of normal family life and
wish for the opportunity to live out a normal adolescence or adulthood.
In addition to the emotional burden, siblings face many everyday problems. They must learn to cope with the
symptoms of their relative's illness, possibly including hostile, abusive, or assaultive behavior; mood swings, and unpredictability; socially offensive or embarrassing behavior; self-destructive behavior.
There is the risk that siblings will take on a "caregiver" role as they are growing up – and then carry that caregiver role into adulthood, with adverse consequences for their adult
relationships.
