I have just come across your name on the OBAD site. I was searching for an answer to a specific issue. I am hoping that you will be able to help me, in helping my two sons.

My older son Ben, 18 today, has bipolar disorder, and is being treated with Lithium and Lamictal. The medications seem to be helping, and we are working closely with a psychiatrist for monitoring and dosage. We also see a family therapist on occasion.

My younger son is 14, and he is feeling angry and removed emotionally from his brother. I understand what he is feeling, because Ben (older) has been unpredictable, and physically overpowering. We cannot possibly be around always to monitor Ben's reaction to frustration. He will act out by striking Brian (younger). Brian says he ‘hates' Ben and does not want to be around him at all.

I believe Brian truly feels this, yet I also believe he is sad about Ben's illness and the brother he wishes he has. My question to you is, other than acknowledging Brian's feelings about his brother, is there any hope in them having a loving relationship? This is sad to me as their mother, to think of my son's becoming more estranged.

Thank you - Sharol

Dear Sharol,

It's hard to watch a relationship become estranged. And even harder when you don't know what the future holds. I don't want to give you false hope, because I cannot predict the future– but I have seen horribly wounded relationships return to loving caring ones. The relationship is changed in many ways, but loving nonetheless.

I was extremely estranged from my parents when I was going through the worst of my illness. My parents had no idea if they would ever have a good relationship with me. For years I barely communicated with them despite their attempts. It was only as I grew healthier, more mature, took personal responsibility, learned positive communication and coping skills, understood and accepted my illness more that my relationship with not only them, but with others, improved.

Being a teenager, as Brian is, and having a brother who has a chronic mental illness and mistreats him isn't easy. Being a teenager period isn't easy. My relationship with my mom and dad, slowly, slowly did get better. Very much better. And much healthier too. It took effort on both sides. Give it time, lots of patience and a healthy dose of faith.

Acknowledging Brian's feelings will most definitely help, and perhaps encouraging him to do several of the following will as well:

Encourage him to:

• Identify and express his feelings appropriately and effectively (whether to you, his brother, a therapist or most importantly, to himself)
• Act assertively vs. passively, passively aggressively or aggressively; his anger and sense of separation will only escalate if he chooses otherwise; granted he is young, but this doesn't diminish his capacity to learn these skills
• Acknowledge his own worth and ‘work on' (for lack of a better phrase) his self-esteem. I ran into many difficulties, as I have seen many others, as a result of my very poor self-image and lack of self-acceptance and healthy self-love
• Recognize he has the power to choose, obviously not over how his brother behaves, but over how he deals with those behaviors, how he feels about himself; and how accepts his own feelings of anger

It may be, for a time, things get worse before they get better. As I have said before, I am a big fan of therapy. When I finally accepted I had a mental illness, I continued the counseling I had started before my hospitalizations. I focused on cognitive-behavioral therapy (CBT) and interpersonal therapy.

Family sessions are an excellent choice, and individual therapy is equally important. When it comes to a mood disorder, I see psychotherapy in combination with medication (when medicine is deemed essential, as it was in my case) is the best of both worlds. It might be of benefit for your son Ben to look into counseling to deal with other aspects of the illness, not addressed by the medication. While your younger son, Ben, might like talking to someone about his own stress and issues. If it seems right and Brian is open to it, one on one therapy could be helpful.

Some psychiatrists practice therapy along with pharmacology or you can seek out a psychologist who works specifically with the issues of your concern (often covered by extended medical benefits, if you have that). Ask the psychiatrist, if he/she does offer psychotherapy, what kind or approach he/she takes. It's important to make sure their skills match your needs.

I wish you all the best. And I send wishes for a smooth, or at least somewhat smooth, road to recovery for your entire family.

Best, Victoria