How to Support a Sister Struggling with Depression and Self-Destructive Behavior

How to interact with a sister who has depression?

My sister is 23 years old, graduated from vocational high school, and due to her low educational background, obesity (unable to control her sweet cravings), and various physical ailments, along with a smoking addiction, she has been unable to find a job and has lost her confidence.
She once became infatuated with online bulletin boards and engaged in online dating.
After finally getting a boyfriend, she broke up with him due to his infidelity (he has a child from a previous relationship).
She has attempted suicide by carbon monoxide poisoning once (and has previously attempted wrist cutting twice).
Just before losing consciousness, she called me to come back and save her.
When I returned, I found out that she had fainted after falling onto charcoal while trying to open the door to escape, resulting in multiple burn injuries.
Later, she was diagnosed with depression by a doctor and is currently on medication.
After taking her medication, she stays online until the early morning and sleeps until the afternoon, ignoring my mother’s repeated knocking on her door (I actually think she is deliberately ignoring my mother).
She is also unwilling to look for a job and expects my mother to help her pay off over 100,000 NT dollars in credit card debt.
When my mother scolds her, she gets angry.
Currently, she is still in contact with her ex-boyfriend, trying to win him back, and has started using her credit card again.
I have looked up her previous posts online and often feel that she is wallowing in self-pity, making a big deal out of small issues.
In our family, I am the only one who can communicate with her calmly; our father has given up on her, and although our mother cares for her, she is overly nagging, often leading to arguments.
The other siblings either ignore her or argue with her (because she tends to meddle in her younger brother's affairs).
The responsibility of communicating with her has fallen on me.
Although I am already married, I frequently receive complaint calls from family members.
I have had serious talks with my sister several times, but after a few days, she reverts to her old ways, which exhausts me.
Doctor, in a situation like my sister's, should I let her be, or how should I guide her?

Mandehling, 20~29 year old female. Ask Date: 2004/03/31

Dr. Chen Wenke reply Psychiatry

Hi Manting,
From your letter, it seems that your sister's situation is quite challenging and influenced by many factors.
She appears to be exhibiting significant emotional issues, along with some impulsive behaviors such as overeating and reckless spending.
These long-standing problems have likely become unbearable for the family, and she may be feeling increasingly hopeless.
Additionally, I wonder if she might also have some cognitive impairments, which could contribute to her difficulties in understanding situations.

Based on your description, it is possible that she may be experiencing an affective disorder, such as bipolar disorder.
If this is the case, without comprehensive psychiatric treatment, her symptoms and behavioral control are unlikely to improve.
Therefore, I strongly recommend that you take her to a psychiatric hospital for assistance.

Wishing you well.

Reply Date: 2004/03/31

More Info

Supporting a sister struggling with depression and self-destructive behavior can be incredibly challenging, especially when the situation is compounded by various factors such as low self-esteem, financial issues, and strained family dynamics. Here are some strategies that may help you effectively communicate with and manage your sister's condition.

Understanding Depression
Firstly, it's essential to understand that depression is a complex mental health disorder that can manifest in various ways, including feelings of hopelessness, lack of motivation, and self-destructive behaviors. Your sister's history of self-harm and suicidal ideation indicates that she is in a vulnerable state, and her actions may stem from deep emotional pain rather than a desire to hurt herself. Recognizing this can help you approach her with empathy rather than frustration.

Open Communication
Establishing open lines of communication is crucial. Since you are the only family member she feels comfortable talking to, try to create a safe space for her to express her feelings without judgment. Use active listening techniques—validate her feelings, acknowledge her struggles, and avoid minimizing her experiences. Phrases like "I can see you're going through a lot" or "It's okay to feel this way" can help her feel understood.

Encourage Professional Help
Encourage your sister to continue her treatment and consider seeking additional help if necessary. If she is currently on medication, remind her of the importance of adhering to her prescribed regimen. Additionally, suggest that she might benefit from therapy, where she can explore her feelings and develop coping strategies in a supportive environment. You could offer to help her find a therapist or even accompany her to appointments if she feels comfortable.

Set Boundaries
While it's important to support your sister, it's equally vital to set boundaries to protect your own mental health. You cannot be her sole source of support, and it's okay to take breaks when you feel overwhelmed. Encourage her to seek help from other family members or friends, and remind her that she is not alone in this journey.

Promote Healthy Habits
Encourage your sister to engage in healthy activities that can improve her mood and overall well-being. This could include physical exercise, which has been shown to have a positive impact on mental health, or engaging in hobbies that she enjoys. Even small steps, like going for a walk together or cooking a healthy meal, can foster a sense of accomplishment and connection.

Address Financial Concerns
Financial stress can exacerbate feelings of depression. If your sister is struggling with debt, help her create a budget or explore options for financial assistance. Encourage her to seek employment, but be sensitive to her current mental state. It may be beneficial to focus on part-time or volunteer opportunities that can help her regain confidence without overwhelming her.

Be Patient
Recovery from depression is not linear, and setbacks are common. Be patient with your sister as she navigates her feelings and behaviors. Celebrate small victories, and remind her that progress takes time. Your consistent support can make a significant difference in her recovery journey.

Seek Support for Yourself
Lastly, don’t forget to take care of your own mental health. Supporting someone with depression can be emotionally draining, so consider seeking support for yourself as well. This could be through therapy, support groups, or talking to friends who understand your situation.

In conclusion, supporting your sister through her struggles with depression requires a balance of empathy, encouragement, and self-care. By fostering open communication, encouraging professional help, and promoting healthy habits, you can help her navigate this challenging time while also protecting your own well-being. Remember, you are not alone in this, and seeking help for both of you is a sign of strength.

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