Next of Kin: Caring for My Adult Sister

by Bethanne Patrick
Originally Published: 
A blurred photo of a high Ferris wheel while rotating

Mom and I don’t joke about Sunnydale Rest any more, but that’s not because she’s closer to moving there. It’s because neither one of us expects that she’ll ever relax enough to enjoy a community life with her peers. She’s too busy taking care of my sister.


My parents were big John Denver fans, with his Greatest Hits in heavy rotation. Each time the schlocky “Grandma’s Feather Bed” came on, my younger sister Jenny would spin into a herky-jerky barefoot suburban version of a clog dance. Grownups loved it: “So cute!” they would warble when my mother put on the record and Jenny began to hop and wave.

Now in her 40s and known as Jen, she still hops and waves, at a karaoke joint near the house she shares with her husband and young son. She’s there most nights until the wee hours, smoking, drinking, sexting, and dancing, dancing, dancing. The dancing—really, any kind of movement—becomes more and more important each year around this time, as the manic phase of her bipolar illness worsens.


I am 12. A very young, sheltered 12; my mother keeps me busy with violin lessons and church youth group. I don’t have much of a social life and don’t really know much about how other people’s families behave. Even though my mother belongs to the second generation of her family born in the United States, I’ll later recognize this kind of weird cocoon as an echo of immigrant culture: “We understand each other, let’s stick together.”

So when I come upon my sister one afternoon banging her head against her bedpost and sobbing, I don’t immediately register what’s going on. “The animals!” she wails. “They’re killing all the animals!” What animals? Who’s doing the killing? My brain, foggy with afterschool fatigue, tries to make sense of the banging, the sobbing, the wailing, my sister’s contorted face. She keeps crying and yelling. I turn to go downstairs and get our mother.

But I don’t know what to tell her.


Mental illnesses rarely follow a recognizable path. The reason we still say “mental illness” rather than simply “illness” is that illnesses of the brain—depression, schizophrenia, bipolar syndrome—so often go hand in hand with personality disorders—narcissism, borderline, sociopathy—that are not physical in nature and require a completely different course of treatment. Personality disorders don’t respond to pharmaceuticals. They can be greatly aided by therapy, but the person with the disorder must be willing to engage in that therapy in order to be helped.

In the decades since my sister’s childish dancing, I’ve learned a lot about mental illness and personality disorder. So has our mother. Mom attends National Association for the Mentally Ill (NAMI) meetings and workshops. She does Internet research and reads books about walking on eggshells and manic depression and how to help children with bipolar parents.

That’s because even though she knows she’ll always love my sister, always help my sister, always be my sister’s mother, she also knows that my sister, once her baby, always her child, is an adult. My sister’s son, her grandson, my nephew—he is not.


There are at least two other adults in this picture. One is my brother-in-law, a decent man and loving father, whose own issues cloud his ability to deal meaningfully with my sister’s chaos. Last year, they filed for divorce, but chose not to finalize it so that my sister could receive expensive health insurance through his employment. They will probably divorce, for good, sometime in the next few years.

Which leaves me—the person who will most likely still be around in the event of my mother’s incapacitating illness, injury, or death. It does no one any good to ignore these possibilities. It does no one any good to pretend that I can ignore them or my sister’s current spiral. I may not be legally Next of Kin, but our family is small. I am Next in Line.


Jenny has become Jen. The whirling dervish of a little girl is now a middle-aged, troubled, and very sick woman. Sometimes—usually late in the year, during autumn’s gray, sad days—she turns from manic to depressive, writes awkward apologies, and spends her days and nights at home. The holidays pass, and she feels lonely. My mother spends nearly all of her time with Jen and her family; this is my mother’s community, now.

Each year, when the crocuses push through, so does my sister’s next manic phase. I wish my mother were tending a bulb garden at Sunnydale Rest, but instead she kneels before my sister’s house and digs her spade in to find what she hopes will be healthy soil.

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