Over a period of more than a decade my younger sister struggled with impulsivity, avoidance and addiction. She had a great job, a lovely daughter and many opportunities in life.

As a family we noticed that she had difficulties dealing with her own expectations and developed elaborate strategies to avoid decision-making and ownership of any issues that she faced. She was always pleasant and seemed happy on the surface and would do anything to help others but this masked her struggles with mood swings, anxiety and self-doubt.

It became more evident that she had serious troubles when she started stealing medication for pain from my father and then eventually from the patients at the facility where she worked. She voluntarily admitted herself to rehab facilities for treatment several times but eventually lost her job and her connections to most of her friends and family. She did keep in touch with me and I was able to liaise with her therapist and support her emotionally and financially through the early parts of her recovery. Unfortunately she even withdrew from these supports, perhaps due to some sense of shame that she couldn't seem to get herself on track and stay there.

Finally, she became physically ill and had to be admitted to hospital for serious health issues. Despite getting wonderful and prompt care she was unable to recover from the damage she had done to her body from more than a decade of alcohol and prescription drug abuse and succumbed to liver failure and cancer. She was in her early 40s and after her death it was painful to discover that she had struggled silently from her early teens onward with anxiety and depression and had never let on to anyone. This experience has made me more and more willing to engage anyone in listening to how they are really feeling and not to avoid hearing things that may be painful or uncomfortable.

Shane (Toronto)