Showing posts with label Mental Illness. Show all posts
Showing posts with label Mental Illness. Show all posts

Friday, August 01, 2008

Dismaying Story #127: Dealing With Mental Illness

Dear Andrew,

My friend is remarried and has three boys, 14, 11, and 9. Her first husband has a lot of mental problems, which is why she left him. She's out of the toxic relationship, but her boys aren't. Their dad is still in contact, and that contact is troubling. Dad was diagnosed with mental illness years ago.

Dad has often promised to send holiday presents to the boys, yet they never come. My friend is not inclined to cover for him and buy the gifts for the boys as she believes that's deceitful. I don't see how she could, anyway. Dad will contact them after the holiday with photos of the gift cards he's bought, saying if Mom lets them visit, he'll give them their presents. He's accused her (to the boys) of stealing the gifts he sent, money he says he sent, etc. He can't see them as there is a court order barring him from private contact. He's hurt the boys physically in the past. He won't give them anything in front of her or the court-appointed representative because he thinks they are both working against him to take his money.

My question is this - with the courts guarding his right to talk to his children, how can Mom address the topic of Dad and his illness? These boys, especially the youngest, are hurt by his behavior. I think she's done a great job, but she's even said there are times she doesn't know what to say to the boys when Dad hurts them again. She chooses silence, but as she said, the oldest boy is beginning to want more of an explanation and maybe just a sounding board.

Any suggestions would be welcome.

Signed, Dealing With Mental Illness


Dear Dealing,

That is a tough situation. Often it is much harder to see our loved ones hurt than it is to be hurt ourselves. I suspect your friend would do anything to protect her children, and she clearly feels hand-cuffed by the circumstances.

Your friend seems to believe that being honest with the boys would be hard on them. Maybe she worries they are too young to understand the concept of mental illness, or that they would be inclined to shun their “crazy” father if they apply that label in their minds. Or maybe she worries the boys would find the truth more unsettling than his seemingly inexplicable behavior.

Admittedly I am not as close to this situation as your friend, but neither of those worries seems as potentially damaging to me as the situation you describe. The boys are hurt over and over again by their father’s actions.

What can they conclude from this?

Children often see the world from a self-centric point of view. They will interpret his actions with themselves at the center of the issue. In their minds, they are directly related to the cause of his actions.

“He doesn’t give me a present because he doesn’t like me, because he doesn’t think I’m good enough, because I’m really not good enough” ... and so on.

This is obviously hard for the boys. They have zero responsibility for the situation and for their father’s behavior. Allowing them to believe otherwise can lead to problems with low self-esteem and all that brings with it.

My suggestion is that the best way to protect the boys is to explain to them in an age-appropriate manner that their father has a sickness. Reassure them that the specific things he does are due to the sickness, not because of any bad opinions of the boys or because of any failings on their part.

Children often surprise adults with their ability to absorb and cope with life issues. I suspect your friend can help her children by leveling with them, giving them a truthful explanation of what is happening, and helping them deal with all their reactions, questions, and doubts, both immediately and over time as they think about the issues. I bet they handle the revelation better than their mother might predict, and chances are good that their overall stress level will be reduced.

Please wish her good luck for me.

All the best,
Andrew

Tomorrow (Saturday) is a first for me. I will be interviewed on a nationally-syndicated radio program. People in 120 different markets will listen to me talk with Darla Shine of the Happy Housewives Club. The interview arose because of Dismaying Story #14: The Affair-Proof Marriage, which is slated to be the topic of the interview. If you happen to live in a city that carries Darla Shine, perhaps you’ll get a chance to listen in.
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Sunday, March 04, 2007

Not Really Trying

Dear Andrew,

I recently read the story you called "Missing the Game of Life." I agree with your response to the woman who was writing but have a related question to your answer.

How do you insist that your husband change? I mean, I would love to just go to my husband and say – you need to do more around the house, I am not happy with our current situation, etc. and believe me I have tried that in the past but I only come away feeling guilty for even bringing up the subject to begin with.

A little history . . . my husband is 12 years older that I. We have been married 18 years. He has a definite problem with clinical depression – in fact has been diagnosed as bi-polar with depression being predominate. To add to the mix he is a licensed counselor although he does not do that currently. He has a definite tendency towards being a hypochondriac and often acts like a chronic victim.

In our marriage it has meant that often I pick up the slack and do “everything” other than have a job outside the home. We have 3 children one of which is special needs and I have been a SAHM for a long time now.

In the past 7 years he has lost 3 jobs – one of which was a dream job – due to his depression, being “victimized” by his bosses, etc. It has been a horrible roller coaster ride with health and financial losses.

We attended counseling about 6 months ago and it was somewhat helpful at the time. He also sees a psychiatrist for the bi-polar/depression and takes medication for it.

When he is having a “hard” time at work, etc. he comes home and doesn’t do much of anything but talk with the children (he is a good dad) and watch TV. I do everything else – clean, cook, laundry, grocery shop, do household repairs, take care of the cars, plan for the kids and their needs, home-school my special needs son, take my girls back and forth to their extra activities, handle the finances, pay bills, etc.

He will help if I ask him to do something and is supposed to have the regular job of taking out the trash but if he is depressed that will get ignored unless I point it out.

My problem is that when I approach him about either helping me – like please put your glasses and dishes on a certain side of the sink so the other side can be used to fill glasses, etc. – he makes me out to be some weirdo for even asking.

If we sit down and I try to bring up issues he gets extremely defensive and says things like ‘I am doing my best’, ‘I am depressed’, etc. and has this way of turning the issues around so that I am the bad guy and I am picking on him. I tell him sometimes that he puts on his “counselor” voice and says “I am doing the best I can.”

We learned in counseling that I have a tendency to be too harsh (according to him) when I bring things up but when I try to soften it, rephrase, etc. the result is always the same . . . He says he will TRY to do his best and sometimes things improve for a few days but it does not last.

I know that I enable him to “be depressed” and just not do anything because I will do it (I learned that from my counselor) but how do you get a depressive person to want to change and how will the household continue to run, if I don’t do it?

I wish it was just as easy as saying – gee, honey I need more help and need you to be more involved and take responsibility and keep a job – but it does not work that way for me.

I am at the point of thinking of leaving him simply because I am tired of having my life (housing, income, health insurance, etc.) being decided by someone who is just going to TRY to do his best. I would rather succeed or fail on my own merits than be dependent on him.

There really is a long, long history here that I can not really get into but I feel sort of desperate. He has once again “lost” a job in that he has been demoted and has to take a pay cut. He knows how this is like the last straw to me and when I tearfully asked him if he would promise me to not lose the current job his response was “I will TRY to do my best.” I want to scream: "Obviously your best is not enough, don’t just try to do it, do it.”

We tried to talk last night about the situation and I tried to bring up how I feel and how I don’t trust him to keep the current job and think of his family first. I know that it was not fun for him hearing that from me. But he turned it around again and said how I was getting off topic and how much humiliation he has taken from his superiors in the past and his current boss and how he has stayed with the jobs “because of the family.” But he then loses the jobs or just quits (he once just quit a job because his boss “yelled” at him too much).

How do I approach this? How do you insist that someone change? How do I express what I need and get his cooperation in fulfilling my needs?

Signed, More Than Just Trying


Dear More Than Just Trying,

Simply insisting your partner should change is effective only when the problems are relatively minor. For example, if a husband is merely unaware of how much his wife needs his help, then her insistence may bring this to his attention. That might be enough in that instance to prompt him to respond to her needs. That can only happen, though, when a relationship is generally robust, with many other positive characteristics. The scenario I described only works if both people are generally predisposed to be supportive of each other and the husband merely needs a nudge to bring this to the fore. If, on the other hand, trust, closeness and supportiveness tend to be in short supply in a relationship, demands for change rarely have any long-term effect.

Telling the chronically unsupportive spouse to step up is similar to informing the long-term smoker they should quit, or the chronically overweight person they should lose weight. People in these types of circumstances are already aware of the issues. They already know their partner is unhappy with the status quo. Informing them yet again about this fact does little to change the situation.

Generally the answer lies in developing your relationship to the point where both of you feel good about doing nice things for each other. It's about developing an attitude of mutual supportiveness in all aspects of life. This is made more difficult in your case by your husband’s personal life challenges. He is incapable of meeting even his own needs for fulfillment and achievement, which makes it even more difficult for him to provide for others.

It is good and necessary that he is seeing a psychiatrist for his bi-polar symptoms, but the results prove that is not enough to address all of his needs. He also needs a life skills coach. Many people might assume that would be part of the service when seeing a psychiatrist, but often this is not the case. The psychiatrist’s focus is on responding to the acute depressive symptoms; the response usually comes in the form of medication. Assuming the prescription is effective, the result is typically a person with a somewhat improved ability to respond emotionally to life’s challenges. As you can attest, though, your husband still has bi-polar symptoms, though hopefully less severe than they might be otherwise.

So your spouse still has emotional challenges and must try to deal with a plethora of ineffective life skills and habits. For instance, he seems to have a habit of turning your requests for change into discussions about how you request change. This means you spend all your time talking about how you fight, rather than the issue you wanted to address. This is a classic mistake. A more effective strategy is to ban this as a discussion topic when attempting to resolve conflict, and to consciously keep the discussion on the underlying issue.

Your husband would benefit greatly from working with a life skills coach. He could use help with developing strategies for meeting challenges rather than running away, resolving conflict, and no doubt a number of other strategies and skills. At some point it also makes sense to involve you so ineffective patterns of communication and interaction between the two of you can be replaced. At the beginning, though, the primary focus should be on helping him learn to cope. Such skills can be taught, and they most certainly don’t come out of a medication bottle.

If interested, he could talk to his psychiatrist or other health care professional about where to find such a coach in your area. I suspect this could make a significant difference in your lives. Good luck!

All the best,
Andrew
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Wednesday, December 20, 2006

Dismaying Story #95: Forgiveness Is A Gift You Give Yourself


Dear Andrew,

About six months ago, my boyfriend of two and a half years and I broke up. We still love each other, but since we were finishing university and were embarking on significant lifestyle changes, we decided that it was best to call it off, rather than fighting to keep together a relationship that was already falling apart. (The one thing we shared was that we loved each other. We wanted very different things out of life; had very different interests; different values; different approaches to life. My family didn't like him, he didn't like them. Once we finished university we could no longer sustain the relationship we had enjoyed as students.

About three months ago, I met a guy that was the polar opposite of my Ex. We hit it off right away, and began to hang out on a daily basis, on a platonic level, after work, and it seemed like everything we talked about just brought us even closer, and brought to light more similarities between us. About a week later, he expressed a romantic interest in me. I was flattered, and admitted that I was attracted to him as well, but expressed hesitation to get involved in anything with him because a) we are coworkers; and b) I was just coming out of a very serious relationship, and didn't want to start something on the rebound. He agreed to take it slowly and just see where things went. However, he didn't stop pursuing me fairly aggressively. And I didn't object to being pursued in this way. It was nice to feel desirable and wanted, especially since my Ex had cut himself off from me entirely.

What transpired was a fairly intense relationship that remained unlabeled and underhanded. Because we are coworkers, and didn't want to become fodder for office gossip, we conducted a lot of our romantic activities on the sly. About three weeks in, my Ex showed up at my front door, crying, and begging me to take him back. Although I had spent three months wishing for this situation, I finally felt as though I was moving on, and told him that I was seeing someone else. A few days later, the new guy took me to his home before a party we were going to attend together, and we slept together for the first time. The entire experience felt dirty and wrong. Two days later, he said that we needed to talk and told me that he felt that our relationship had come together in a very dysfunctional way, and it made him uncomfortable, and he didn't want to end up hurting me in the same way he had hurt girls in the past, so he thought we should stop seeing each other.

I agreed that we had rushed things and jumped into a sexual relationship that I, at least, was not ready to have. We agreed to rewind a bit, and revert to the "dating" stage, and take things one step at a time. The next day, at work, as we went to get our morning coffee, he said that he had thought about it some more, and wanted us to be entirely platonic. That evening, as we chatted online, he explained that after we had slept together, he had started thinking about a serious relationship that had ended about two years ago, in which he and his girlfriend had been on the verge of engagement, before he panicked, and she gave up on him. He said that in retrospect, he thinks he should have married her, and every relationship he has been in since has ended up being a train-wreck, because of his inability to connect, and he claimed that he didn't want me to become part of his "relationship chaos and carnage roadshow."

This made (and continues to make) me very angry. I was entirely upfront with him from the very beginning about my reservations about getting into a relationship, and my personal and emotional difficulties. He knew that I'd been struggling with depression for a few years; he knew that I used to cut; he went in with all the cards on the table. He also knew what his own background was. But he chose to not share any of this information with me; he chose to lead me to believe that he really wanted to be with me. He chose to convince me that he was looking for a serious relationship. I feel used, and dirty. If he felt that he wasn't ready for a relationship, he shouldn't have started one. In effect, he told me what I wanted to hear, and toyed with my emotions until I began to believe that I might actually be able to be happy with him; and the moment I slept with him, he lost interest and backed out. I've tried to give him the benefit of the doubt, because I DO still have to work with him, and see him five days a week, but the more I think about it, the more used I feel. I feel as though he took advantage of my vulnerability and naivete, and turned me into a notch on his bedpost.

Am I being unreasonable? Because of him, I destroyed any possibility of getting back together with my Ex, as well, and that makes the anger even more intense. I want to stop hating him and I want to stop loathing myself, but I have no idea how to do this. The worst part is that deep down, I really want to believe that he's a good guy, and that once he sorts himself out, we will end up together.

Signed, Hurting and Hating


Dear Hurting and Hating,

Both of the guys in this story told you, "I don't want to be with you." This is a difficult message to hear because it bashes your feelings of self worth and clashes with your strong desire to make a relationship work. More than that, they delivered this message in an ambivalent, on-again, off-again fashion, which makes it even more difficult for you to decide what you want and predict what will happen. You spent three months wishing for your ex to show up and you still hope to end up with the co-worker.

For your own sanity, the first thing I recommend you do is realize neither of these guys is the one for you. Regardless of the reasons, "I don't want to be with you" is a pretty clear indication that they don't want to be with you. Why should a dynamic bundle of personable hotness like you put up with that? You deserve (and need) a better deal than that. You gave it a try with each of them and it didn't work out. You learned some lessons and got your feelings bruised. If you step back and look at the big picture, though, you will realize that you are still a whole person and you are now free to get on with life, which hopefully includes meeting Mr. Right and having many wonderful bowls of ice cream together. Don't hold on to the flimsy hope of getting back into one of these damaged partnerships. Doing so will only prevent you from finding a fulfilling relationship. Put them behind you and move on, and do it today.

Regarding your co-worker, you did not destroy your chances with your ex "because of him." If you and your ex were meant for each other, if things were great between you, then (a) you wouldn't have broken up (this happened because of real problems), and (b) no fresh-off-the-vine new boyfriend would have been enough to make you turn away the crying ex. You would have swept him into your arms and held on tight. It didn't work out between you and your ex because of the problems between the two of you, not because of your co-worker.

When your ex showed up and you "felt like you were moving on," that was because you were moving on. You were not at your final destination, though, just the next stop along your life journey. You may feel like you wasted your time with your co-worker. I would argue, though, that dating your co-worker helped you understand there was life after your ex, which is something you needed to find out. While hurtful in the end, this brief relationship also fulfilled some of your needs for a while. Rather than focusing entirely on the painful aspects of this experience, it might help you to realize that some good came from it as well.

Then there is your anger over feeling used and poorly treated by your co-worker, about all the things he should have done differently. Naturally you are interpreting the relationship from your point of view. If you are honest, I suspect you'll have to admit to yourself that you entered the relationship because of what it might mean for your life; it made you feel desirable and wanted, like you were moving on, etc. You did not say to yourself, "I should start dating this guy because it will help him feel good about himself." No, we enter relationships because of our own hopes and needs. That doesn't mean you don't care about the other person, just that your own viewpoint dominates your thinking at the beginning.

This is evident in your letter, which interprets what happened only from your point of view. This is natural and understandable, but I believe you can gain a greater understanding of what happened if you now step back and also consider events from his viewpoint.

You now know that he has been carrying a big load of emotional baggage for at least two years. He entered your relationship in a state of weakness, and was hopeful this would be the one to break him out of it. He desperately wanted this to succeed so he could get past his problems. Of course he wouldn't dump his baggage on you at that point. Suppose he said, "Just so you know, I'm a total emotional mess inside and I can't get over my old flame and I have sabotaged every one of my recent relationships with my dysfunction." That would have you (and most women) making excuses and heading for the door in short order, which is exactly the opposite of what he was desperate to achieve. And in the eternal optimism of the dopamine-driven early stages of dating, he truly hoped and believed he would never have to tell you this, because THIS one was finally going to work out for him, dammit.

But it didn't, in fact couldn't. He needs to get over his internal anguish and forgive himself for his past decisions, and no new relationship can help him do that. He needs to heal inside before he will be able to fulfill his end of a functional relationship.

But he didn't know that when he started dating you, and in all probability he still doesn't realize it. You say he should have told you, and he should have realized, and he should have known better than to start something with you. That is the same as saying he should be aware of the nature of his dysfunction and should be able to get past it. Clearly he hasn't been able to do that; he is still mired in his past and can't see a way out. "Except maybe," he thinks, "if I find someone else, that will make the memories go away," which is what he tried with you.

You feel like he got the sex he wanted and then lost interest. I don't see it that way. I believe he failed in achieving what he wanted (to feel a strong attachment for you, thereby erasing his painful past). He ended it with you because his pain persisted in spite of how your relationship had progressed. He wasn't happy to notch his bedpost; he was miserable that his hopes didn't pan out and he was right back where he started ... and he had hurt you in the process. Considered from this point of view, his statement that he didn't want to hurt you any further was probably sincere.

Yes, one could argue that he might have spared you the pain if he had been more honest about himself up front. And you could beat yourself up wondering if you should have seen the signs and avoided getting involved with him. None of this helps you, though. All it does is make the pain persist longer than necessary.

Do you really need to assign blame? How does this help you? You need to forgive him for hurting you. And don't do it for his sake; forgiveness is a gift you give yourself. It is the way you free yourself from the pain and allow yourself to gain closure, to move past the recriminations and brooding. I truly believe your co-worker did what he did based on hopefulness. Perhaps this realization will help you feel compassion for his pain, as well as forgiveness for sharing it with you.

Similarly, you need to forgive yourself for being human. We all want to feel desirable and wanted, and you shouldn't beat yourself up for trying to find happiness. I've yet to see a crystal ball that really works, so at the beginning there was no way you could have been expected to know how things would work out.

A better approach would be to open your heart in case Mr. Right walks by later today. And in case he happens to be on his way to an ice cream parlor.

All the best,
Andrew

Is the holiday season hard on your relationships? Or does this time bring you closer to your friends and family members? Weigh in with your opinion by checking out the current Question of the Week.
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Wednesday, September 27, 2006

Dismaying Story #60: As If the Loss Is Not Enough

Dear Andrew,

My mother-in-law and I don't get along well at all, especially now. I married my husband just over one year ago. We moved away and had a beautiful baby girl seven weeks ago. Our life seemed to be going well. Of course there are ups and downs but who doesn't have those.

Here is part of the problem. My mother in law didn't really seem to approve of her only child marrying me. My husband has had mental issues in the past and has become a fairly heavy drinker since high school. We would fight about it almost all the time, as I didn't want my child to have an alcoholic father. His mother thought I was just being a nag.

Now, when our child was only 3 weeks old, my husband and I had a fight. He took off drinking and driving (something he never ever did) and ended up totaling our vehicle, and hurting himself quite badly. He just woke up from a vegetative state in the last week. His mother blames me. She thinks I was on his case again for drinking. And, in this situation, is it any wonder why I always tried to get him to cut down? She still won't speak to me, and now as I am going for trusteeship and guardianship of my husband (so i can take care of our bills and our child) I worry that she will contest it in court and make it more difficult for me to take care of her only grandchild. I don't think she has even considered the fact that I loved my husband and now am raising his child on my own.

How do I deal with her? Why does she blame me for this when I even called the cops on him that night to try and stop him from getting hurt?

Signed, Hurting Over My Husband


Dear Hurting,

I'm very sorry to hear about your husband, and also about your troubles with his mother. It is challenging enough to be a new parent without all these other issues on top of it.

You and your mother-in-law are both grieving what happened to your husband / her son. The senselessness and bad luck involved are incredibly difficult to deal with, as are the consequences -- the impacts on you, your mother-in-law and your child.

Even strong relationships can break down under such stress. For instance, marriages sometimes do not survive when parents must try to cope with the death of a young child. Your relationship with your mother-in-law was not strong to begin with, so it is not surprising the two of you would struggle when under this additional pressure.

Grief often goes through several stages and one of them is anger. Your mother-in-law's ability to deal with everything, including you, is probably at an all time low, and she may be likely to think things and say things that she wouldn't if circumstances were different. With all you are going through, your ability to cope is undoubtedly diminished as well.

She doesn't want to blame her son. She must realize at some level that it was his decision to drink and drive. That is difficult emotional terrain for her right now, though. She is grieving what happened to her son and doesn't want to criticize him. It is easier for her if her son is blameless, so her mind casts around for someone else to take the blame. The next obvious choice would be you. It's not fair to you, but it might be one coping strategy that helps to mitigate her grief.

This has to be incredibly hard on you, to deal with this broken relationship on top of everything else. Unfortunately I know of no way for you to hurry your mother-in-law through her grief process. I suggest you wait it out; her grief will eventually evolve. She will move through other stages beyond anger, hopefully to coping and eventually acceptance. This will not necessarily change things between the two of you, but at least then you may have a fighting chance of mending fences. Yours would not be the first relationship to benefit from the passage of time.

That leaves you with the issue of how to deal with her in the meantime. You mentioned she is not speaking to you. In the short-term, a little distance between the two of you might not be a bad thing, knowing you will likely have an easier time bridging the gap in the future. (And this is something you should try to do so your daughter can enjoy her grandmother.) If she contests you in court, then you'll need a lawyer's advice.

I wish you the best of luck as you try to deal with every aspect of your difficult situation.

All the best,
Andrew
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Monday, September 18, 2006

Dismaying Story #55: My Sister's Boyfriend

Dear Andrew,

My adult sister has a history of being with sponge men - they take all she has in money and emotions and give nothing in return. Her daughter is five years old and hasn't seen her father in four years, and in that time, he hasn't contributed anything. He only worked some of the time, was a pothead and cheated on her. Her most recent man is exactly the same. They have been together off and on for over two years. He keeps going back and forth with the same woman. He and this other woman have an eight year old and a one year old, obviously conceived while he was with my sister. He also gave my sister an STD. She found naked pictures of this other woman on his camera phone and broke up with him but two weeks later they were back together.

Whenever he does something wrong she calls and cries and rants to me. Finally I got fed up with it. I told her I didn't want to see this man and I'd leave if he showed up at her house if I was there. She respected that and didn't put me in that situation, although both he and I attended my niece's preschool graduation and mutually ignored each other. My mother feels the same way about this man and has made it quite clear to my sister for over a year.

My sister came into about $24,000 a few months ago. She gave half to my mother for a credit card debt she ran up, and we have no idea what happened to the rest of it except she bought a second car she doesn't need. My niece says it was for this man. Six weeks after she got this money, my sister in the same week got evicted, had some furniture repossessed, had her phone turned off and lost her job.

My sister's birthday was two weeks ago and she had the audacity to bring this man to my mother's house and a huge fight ensued. There was some talk about my sister not letting my mother see my niece. I have sent her several long emails letting her know how furious I am with her.

She and my mother are no longer speaking. I have avoided her phone calls. I am tired of being her emotional support in this when she goes right back into the same area. I'd rather lose my sister than deal with all this. I am, however, extremely concerned about my niece, who isn't even in school all the time.

I have also had behavioral issues in the past, which were helped tremendously when I was diagnosed with bipolar disorder and received medication. I see some classic bipolar symptoms in my sister and have urged her to get an evaluation.

Signed, Exasperated Sister


Dear Exasperated,

Your sister's boyfriend is not the problem. He is a symptom of her deeper underlying issues, whatever they may be. You suspect bipolar disorder but there is no way to know until she is properly evaluated.

You and your mother are understandably frustrated by her behavior. She is clearly challenged by life and makes choices for herself and her daughter that are far from ideal. Part of your collective response is to fight with her, put restrictions on how she can be with you (no boyfriend) and avoid speaking with her. From her point of view, these actions make life more difficult and put distance between you.

It is easy to convince yourself that these actions are for her own good. If you do nothing, if you simply act as her sounding board and act as if everything she is doing is okay, then you feel like you are enabling the destructive behavior. Not only that, it is emotionally exhausting to care so much for her and to see her continue to make what in your view are bad decisions. Your reactions are completely understandable.

They are not, however, necessarily in your sister's best interest. For example, let's take the issue of the boyfriend. You are afraid that if you have a normal relationship with him, you will be telling your sister you approve of him. You want her to dump him for good so you refuse to have anything to do with him.

Okay, what would happen if she did dump him for good? Her history provides the answer; she would find another guy you would probably dislike just as much. Like it or not, she is an adult who will make her own decisions. You can't save her from herself because she will be with herself for the rest of her life. While it makes you feel somewhat better to not see the boyfriend, you have also introduced a major strain between you and your sister, and a major headache for her. Now she has to deal with a boyfriend whose feelings are hurt because her family doesn't like him. She is under pressure not to be nice to you because that would send a clear message to him that she approves of how you are treating him. I doubt these are the outcomes you are shooting for.

All this not speaking and refusing to see her boyfriend is designed to reduce the strain on you and your mother, not to help your sister. While this is an understandable defense mechanism on your part, I believe you would really rather help her.

You are on the right track when you say she should be evaluated by a health professional, probably a physician or psychiatrist. The strategy you and your mother should adopt is one that has the best chance of convincing her to seek this evaluation. In other words, you want to be able to influence her. Unfortunately, the strategies you mentioned -- fighting, placing restrictions, not speaking -- all put distance between you and diminish your ability to influence her.

While you want to be firm and not admit that you approve of her choices, you also want to show her that you support her and have her best interests at heart. Reach out and be welcoming rather than pushing her away.

She has resisted taking your advice, so maybe you can enlist the aid of a third party. As counter-intuitive as it might seem, have you considered asking the boyfriend for help? He is obviously giving her something (e.g. companionship, validation) or she wouldn't stay with him. Maybe he would be delighted if she got help for her behavior. Remember, he is directly in the firing line. Perhaps he could convince her to see a doctor.

When deciding how to deal with your sister, try to make choices that increase (rather than damage) your closeness and ability to influence. If you are able to do that, you should have a better chance of moving her situation in a good direction.

All the best,
Andrew
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