Dear Therapist: I’m Growing Exhausted Dealing With My Sister’s Anxiety

How can I balance her need for support with my own need for boundaries?

Bianca Bagnarelli
Editor’s Note: Every Monday, Lori Gottlieb answers questions from readers about their problems, big and small. Have a question? Email her at

Dear Therapist,

My older sister and I have an okay relationship. She likely had ADHD as a child, and she had aggressive outbursts that made me not want to spend time with her when we were younger. As adults, our relationship is not sisterly, because I feel like her caregiver. She has bad anxiety, and because of grad school, she developed a panic disorder that involves frequent panic attacks. She expects me to console and calm her, and I have tried, but it’s exhausting.

Now I’ve moved out of state, and she’s not handling the coronavirus outbreak well (who is?). She messages or calls me while I’m working at home to tell me how overwhelmed she is and how she’ll never finish her work to-do lists. I have tried to tell her to bring this up with her therapist; to not expect so much of herself during this time; to explain to her boss what she’s going through and ask for help; and to recognize that no one expects everything to be done perfectly or on time right now. But she has excuses for why none of that will work. She will message me the exact same complaints the next day.

Because of our tense childhood, she takes any boundaries or silence as complete rejection of her as a person, or says that I don’t take her mental illness seriously.

I myself haven’t seen a therapist since college, and at the time, I was diagnosed with depression. But I never addressed it. I’d like to now, but I am having a hard time making myself follow through.

Can I tell her to limit how much she puts on me? Or should I accept that in order to help her through her mental-illness journey, this is what is required of me? How can I balance that with my own needs?

Gaithersburg, Md.

Dear Anonymous,

These are challenging times, and you, like so many, are doing your best to cope with the coronavirus outbreak. Even so, I can imagine that feeling obligated to manage your sister’s anxiety only adds to the difficulty. The good news is that living through this moment might help you see something about your relationship with your sister that was harder to see during normal times: namely, that your sister was never the only one struggling with her condition.

What I mean is this: Mental-health conditions such as depression, anxiety, bipolar disorder, eating disorders, addiction, and schizophrenia shape the dynamics of an entire family. Sometimes the person with the condition is a parent, and this affects not only that person’s partner, but also his or her children. Other times the person with the condition is a child, and this affects the child’s parents as well as any siblings. Each family member will feel a range of emotions that might include worry, anger, helplessness, dread, or resentment, and each will respond in his or her own way. One person might try to “save” the struggling family member, another might avoid getting too close or even completely disengage, while another might stuff down her own needs and feelings in order to be “easy” and not add to the family’s collective stress.

To improve your relationship with your sister in the present, you’ll need to consider what role you took on in the family dynamic, because these roles tend to persist into adulthood in some form, and when this happens, the now-adult sibling gets stuck. Any of these roles may have been adaptive while growing up—a child finds a way to cope—but they constrain the person as an adult. That might be why you’re asking whether you have a right to set boundaries, a right to protect your psyche, a right to consider your own needs—in short, a right to live your life and not your sister’s life for her. The child who felt like she had no alternative (she didn’t choose to live in a house with this particular sibling) grows into an adult who has trouble seeing how free she has become.

To see the freedom you have now, start by exploring how growing up with your sister affected you and continues to do so. For instance, when she had “aggressive outbursts,” perhaps you felt scared, or angry, or unsafe. Maybe you felt invisible or neglected if your parents paid more attention to your sister because she took up so much air in the house, and if much of their energy was spent trying to help her while also managing their own complicated feelings toward her. Maybe whatever was going on in the house left you teetering between resenting your sister and feeling responsible for her well-being. And maybe all of this led you to question, even when you were diagnosed with depression, whether you deserve to be the focus of your own attention.

You say that you want to address your depression now but are having a hard time following through. Do you notice how you sound a bit like your sister here? When you tell her, “Here’s what might help,” she makes excuses—just like you do when you tell yourself that seeing a therapist might help. Then you both continue to complain that nothing’s changing. And it’s not, because you’re both stuck in your childhood roles: hers as a helpless person with anxiety, yours as the helpless sister of a person with anxiety.

The beauty of shedding our family identities is that it frees us up to become who we actually are. But to get there, we have to accept some basic truths, the first of which is that this freedom comes with responsibility—we are all responsible for our own lives.

This means that you can’t take away another person’s mental-health condition, no matter how much you care about them. You can only offer your love and supportive suggestions (just once, not repeatedly), and it’s up to your sister what she chooses to tell her therapist, her boss, or even herself about her perceived lack of agency. It’s up to your sister to decide whether she wants to see a psychiatrist for a medication consultation, or to be kinder to herself if she doesn’t get all of her work done during a global pandemic, or to reach out to other friends for support.

Meanwhile, it’s up to you whether you choose to say something to her like “I love you very much, and I do take your pain seriously. But I also believe that you’re very capable and strong and smart, so there’s nothing I can tell you that you don’t already know about what might help you feel better right now. I find these conversations as draining as you find your anxiety to be, and because I care about the quality of our relationship, from now on I’m going to end a call or not respond to a text when you bring this to me, because it doesn’t serve either of us.” And then it’s up to you to manage your own feelings when you disappoint her (and you will)—perhaps with the help of a therapist, or a support group for siblings of people with mental-health issues.

What strikes me most about your letter is that you describe your sister’s reaction to the coronavirus outbreak without once mentioning your own. Yes, she deserves compassion and understanding, but so do you. The more you can free yourself by becoming the adult that you are, the healthier your relationship with your sister—and yourself—will become.

Dear Therapist is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, mental-health professional, or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity.