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My Brother Has My Mother’s Disorders: Mental Illness and Heritability

It’s a sunny summer Saturday in late July and I’m attending a bridal brunch for one of my closest friends. Women are telling stories, laughing and clinking glasses, all while a charming server brings out beautiful spreads of fruits, cheeses, jams and croissants. I’m enjoying this gathering of old friends when I notice my phone buzzing. And buzzing. And buzzing. I realize it might be important, so I step away to check. Seven missed calls and four voice mails, all from my older half-brother. Today his words are more slurred than usual and he’s speaking through tears:“Well, little sister, I’m finally losing it. I feel all up and down at the same time. I can’t handle it anymore. I don’t know what’s gonna happen, but if I do anything crazy, just remember: my heart was too big for this world. I’m not a bad guy. I really love you.”I’ve got to run out on this brunch.

Helping Your Loved One During Times of Emotional Crisis

The next few hours were all about crisis intervention, a set of skills we, the loved ones of people with mood and personality disorders, often acquire out of necessity. It would be inauthentic to say that I wasn’t afraid, frustrated or exhausted by the time the wellness check had been done and my brother had settled down to sleep, promising he would not harm himself or others (with two family members on standby to check in on him in the ensuing hours). Engaging your energy to help your loved one out of legitimate crisis can be frightening and consuming, but it is sometimes necessary, and always worth it.

Mental Illness and Heritability - Bipolar Disorder and Alcoholism

My brother experiences bipolar 1 disorder and struggles with alcoholism, just like our mother (on both counts). What’s interesting is that our mother did not raise him; his paternal grandparents raised him from around the age of 4. Bipolar 1 disorder, the type our mother has, is estimated to be between 54 percent and 70 percent heritable from parent to child, and the heritability factor for alcohol abuse is also believed to be quite strong. Environment plays a strong role in “turning genes on,” of course, and unfortunately for my brother, his circumstances were not as good as they should have been.

Like a great many other people with his dual diagnosis, Dan (not his real name) experiences panic, anxiety, depression, mania, mixed states, aggressive episodes and bouts of suicidality (all of which can be said for our mother). At 41, he has a history of being fired from jobs, and experiences painful and recurrent break-ups. Given these details, it might be easy to look at him from the outside and think, “he’s a bad guy,” but I know my brother is a loving, compassionate and sincere man. The truth is simply that he struggles with mood and emotional regulation in a way most of us simply don’t have to. He admits that his drinking is largely a way to help him feel calmer and less socially awkward, and that when he drinks, he feels “less pain.” Self-medicating behaviors like my brother’s are common among people with bipolar disorder and are considered one half of a dual diagnosis—the clinical term for when someone struggles with a mental illness and substance abuse together.

Dan has now decidedly stepped through the door called “middle-aged” (I mean, really, we were just playing with his Star Wars action figures!) and he feels his life should be settling down—a stable job, a happy wife, kids. I remind him that it isn’t as though he’ll never have those things (people with bipolar 1 learn to live more healthfully with their symptoms every day, and recovery from alcoholism is more than possible); it is only that for right now, his work is to focus on himself, on getting well. I don’t believe his heart is too big for this world, but it is big. It needs care, attention, respect and tending—from all of us who love him, but mostly from himself.

He may not be living the traditional life he thinks he wants, but he isn’t a traditional guy. And that’s OK.

Posted in Mental Health

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