Advice: My Sister's Keeper

My sister's son, now almost 30, has serious developmental problems. Despite the obvious fact that he can behave only at a 5-year-old level, she insists on treating him as a normal family participant, including him in holidays and family occasions. He is very aggressive and intrusive, constantly interrupting, unable to focus, understand conversation, or relate to others. This behavior leaves me (and others) exhausted and depressed. Over the years I've tried to endure, but nothing ever improves; our family tolerates his presence out of deference to our sister, but I think the time has come to set some boundaries and to question whether bad behavior should be allowed. I've now told her that I can no longer attend our family functions if they include him. He clearly needs very structured situations or a coach/therapist to intervene; his mother's efforts are largely ineffective. I wish parents of "special" children would wake up to the reality that they can easily dominate any social situation, making conditions difficult or impossible for others. Are there other options for me, the soft-spoken, introverted older sister who hates conflict?

If you think it's difficult being the aunt having occasional contact with a young man who has a developmental disorder, pause for a moment and imagine being the parent. The challenges never cease. It has to be exhausting and disappointing over and over again. Your sister's inclusion of her child in family events may be her only option, and it may be a measure of enormous optimism on her part. Still, research has shown that family members in such situations often become too emotionally reactive to each other, exacerbating negative patterns of behavior, even in disorders that are biologically based, so that interactions quickly spiral into ugly dynamics that are unpleasant for everyone. Those afflicted may have problems controlling emotions and especially inhibiting negative emotional reactions, often generated—unwittingly—by nonverbal communications. It may even be that your discomfort, or expectations of unpleasantness are contributing to a negative atmosphere that acts as kindling for your nephew.

Just as mental disorders affect family dynamics, so do family dynamics affect the course of mental disorders. And here's where you can help. A number of family-based therapies have been developed over the past decade or so that deal with specific disorders. They help all family members learn illness-management skills, including how to identify triggers of bad behavior. Families can learn specific strategies for preventing aggressive and intrusive behavior. I urge you to do some Internet and, ultimately, phone sleuthing to track down such a therapy and a local practitioner. Perhaps you can treat your sister to an initial consultation and even offer to accompany her. Such therapies don't take the place of medication; they are adjuncts to it and recognize the large psychological component to any mental disorder. Probably the prototype of such treatments is Family-Focused Therapy, specifically intended to help those coping with bipolar disorder, developed by psychologist David J. Miklowitz. You can also help yourself, to say nothing of your sister and nephew, by seeking to cultivate in yourself a certain amount of compassion for her and her situation.