The mental illness of a daughter or son affects the well-being of the entire family, including healthy siblings.
Examples of this are illustrated in Jonathan's Return, the latest documentary by the Oscar-nominated Eran Preis, the Israeli-American film director and associate professor of film and media arts at Temple University.
Jonathan, 33, the youngest of Preis' three sons, had behavior problems since the second grade. But it wasn't until his early 20s, when he returned to his native Israel and suffered a mental breakdown while in the army, that he was diagnosed with paranoid schizophrenia.
The film began as a project for Preis to get closer to Jonathan, then 12 years old and diagnosed as hyperactive. It ended up documenting how Jonathan and his family coped with his illness.
One in every five families is affected by a serious mental illness, according to the National Alliance on Mental Illness. A focus of the film is how different siblings respond differently to the situation and how some siblings are conflicted about requests to help with caregiving.
A tense scene in the filming occurred when Preis, and his middle son, Abner, confronted Sam, the eldest son. It had been almost two years since Jonathan's diagnosis and his return to Philadelphia. Initially, Sam did not believe the diagnosis of schizophrenia, and had been emotionally unavailable to his family for most of those two years.
During the scene, Sam was incredulous. He couldn't believe his family didn't understand his reasons for disbelieving the diagnosis. He said he had always been a good brother.
His father said that Sam had been a good brother. But during the worst crisis his family had to face, when they took Jonathan from hospital to hospital until his behavior became manageable, Sam wasn't there. Ouch!
So what were Sam's reasons?
During a recent phone interview, Sam, currently 39 and a bank manager in Chicago, said that Jonathan had been described as manipulative and a drug abuser for years. So it was hard for him to suddenly switch gears.
The diagnosis seemed like just another excuse, in a long line of excuses, for bad behavior.
Ten years ago, Sam was getting married, and Jonathan always acted up during major life-cycle events. He thought it was because Jonathan couldn't stand sharing the spotlight. Plus, Sam was starting his own business.
Abner, on the other hand, currently 37 and an artist living in Rotterdam, flew from Europe to Philadelphia for two-week stays every two months, till Jonathan's behavior got a bit better.
During one stay, Abner said he leafed through a book about schizophrenia by his father's bedside. He read about "the top 10 things schizophrenics have in common." That's when he realized Jonathan had been schizophrenic his entire life.
Abner said he felt obliged to be there for his parents, his brother and himself. He wanted to help out. He added that he enjoyed being pampered when at home.
Diane Marsh, 70, professor emerita of psychology at the University of Pittsburgh, conducted groundbreaking studies on the effects of mental illness on healthy siblings and adult children, published in the 1990s.
Marsh said that prior to diagnosis, siblings often think that their parents overindulge the sick child. Drug abuse is generally viewed as just bad behavior.
What siblings don't realize is that symptoms of mental illness intensify during stressful life-cycle events. And that drug abuse is a form of self-medication.
Marsh said that Sam's reaction made sense. But then again, Abner's reaction made sense, too.
Abner understood that his brother was sick and that his help was needed. Marsh said this may be due to factors like his personality, values, role in the family and proximity to Jonathan.
Marsh said that siblings may resent the different familial responses. For example, the absent sibling may resent the caregiving sibling because he gained parental approval by just reinforcing the sick sibling's behavior. And the caregiving sibling may resent the other sibling's absence.
What's most important for both parents and siblings, Marsh said, is that families accept their different responses and hold on to family bonds.
Preis said one of the things he has learned since creating the film is that "everybody has their own pace." The film is slated to be shown at Temple's School of Medicine later this month.