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I recently attended a presentation at the IMH about the ways in which adult children face the challenges of looking after a parent who has dementia. This was informative but a chance discussion afterwards with a colleague got me thinking about one of the elephants in the room: sibling rivalries.

Many of us, especially those of a certain age have a broad range of responsibilities and these can seem difficult for older people to consider. For example, my numerous siblings live across the UK, in self-employment and some in paid employment. Most have children, some still of school age and none above the late 20’s. I’m the third child out of 4 and the second daughter. My sister, as eldest sibling lives nearest to my elderly parent and has willingly taken it upon herself to declare herself as the main carer. You may detect a certain strained note in this as my youngest brother actually does daily “monitoring” of our parent, although my parent and sister deny this emphatically.

This is where it all gets a bit confusing and complex. In many ways I am deemed “lucky not to live too close to care” according to my sister, who has a tendency to moan and enjoys being the virtuous “absolute angel” as described by the local community nurse. As the distant siblings, we are excluded from all major family occasions and then blamed for not taking any initiative or interest. Nothing is further from the truth. We all care, we all moan, we all want the best for each other. Somehow these noble aims inhabit an esoteric void.

My parent has very limited insight into her own confusions with her everyday life and indeed is able to cocoon herself in a world to the absolute exclusion of all others. This isn’t especially new but the siblings find it at best bemusing and at worse an insult. There are and have been constant games played out to the exclusion of the rest of the family. This is nothing new either. There is a latent sense of obligation but also a tendency to throw in the towel and simply focus on the avenues in life which make more sense. Frankly I’m left thinking maybe we really do reap what we sow? If so then I’m better sowing elsewhere and tendering that crop with all my energies than trying to resurrect a failed crop.

All these factors and more have led to a distancing and limited contact with those who care; my sister now manages all the affairs to the exclusion of any consultation with others and this includes a distinctive wariness to obtain any help from health or social care. My brothers are unable to discuss with the GP our concerns about the regular behaviours of our parent which may need some investigations such as the sun downing, sending off for gadgets which are never opened, being verbally abusive, sacking the home help, sacking the gardener and generally sitting in the silent darkness of the home because of the wish to save energy.

This issue is one of the current  key tensions within my sibling network and one you may recognise. In a couple of months it will have shifted to another matter. It is emotionally tiring. It seems to be common and leads to frustrations and a sense of helplessness in the knowledge that an accurate early diagnosis may help in so many ways.

The sibling rivalry reasons are complex and at least 50 years old. This raises the issues about families and how professionals need to tread a delicate path between historic family tensions and newer ones which are related to the changing dynamic as a parent grows more dependent on others for safety and care. Frequently time constraints lead to a less than comprehensive family history taking by others in contact with the main carer. As a professional, I used to sometimes find it difficult to understand the apparent “state” into which some older people were able to get into despite family members being around…I now understand that the complexities of family dynamics crowd in so easily and like a tornado sweep through the veils of time, which over the years have managed to soften the underlying tensions. As siblings we now fall into old habits of childish retorts and stubbornness, looking towards the parent to sort out. But the parent is no longer parenting and so these tensions are submerged into a myriad of Chinese whispered comments. It isn’t wonderful and is incredibly dysfunctional but so common in so many large families and dare I say middle class ones where the unspoken speaks far louder than the spoken. The dysfunctional silence is deafening.