I remember the days when my brother Tom, who is bipolar, seemed “normal” to me. Photographs of him taken in Korea show him as a skinny, energetic kid, popular with the neighborhood boys. After we moved to America, he had a knack for making friends despite the language barrier. Groups of boys would come to our house to listen to music and play video games. Sometimes, there were girls, and pretty ones too. Deborah was almost as tall as Tom and had long, milk-chocolate hair. One day, after school, I was surprised to find her alone with Tom in the living room. Sitting on the floor in front of the TV, she squealed as her yellow Pacman was cornered and eaten by a monster.

Decades later, Tom was living alone out of his car and experiencing what psychiatrists call an acutely manic phase. He was convinced that Deborah, by then a lawyer in L.A., whom he hadn’t seen since high school, would marry him. He called her seven times in one hour. I had to intervene and assure Deborah that Tom would not show up at her door, that the romance was all in his head.

Over the last decade or so, my brother lost all of his friends as his condition worsened. Severe mood swings and bouts of irrational behavior make it a challenge for him to maintain personal and professional relationships. According to the National Alliance on Mental Illness, 90 percent of marriages involving a person with bipolar disorder end in divorce.

Now middle-aged and living in the Midwest, my brother has no wife, girlfriend, or even an acquaintance he could meet for coffee. He is the man sitting all by himself at a restaurant on a Saturday night.

I do not know what to say to him on holidays. “Merry Christmas” seems inappropriate, because I know that most likely, he’ll spend the day alone in front of the television, or at a bar, drinking amongst strangers.

Having watched Tom live his life alone, I’m convinced that loneliness in itself is a disease. Dozens of studies have shown that people who have satisfying relationships with family, friends, and their community are happier, have fewer health problems, and live longer.

It makes me very sad that my brother and I live vastly different lives. I have great friends, I have had success in my career, and I am healthy. This is not to say that my life is perfect—like everybody, I have my own problems, and I sometimes feel confused and insecure. But whenever I feel down, I think to myself that what I’m feeling must be miniscule to the stultifying loneliness my brother has experienced. I may not have everything I desire, but I have everything in order to live a happy life.

So it is with gratitude for the abundance in my own life that I offer my brother an airline ticket and an invitation to spend the holidays with me. “We could go skiing,” I say, remembering that he loved to ski when he was a teenager. He had even gone skiing once with Deborah. “Or we could fly to Hawaii, and be on the beach for a week.” Wouldn’t he like that?

But Tom tells me that I should spend time with my husband, whom I separated from a year ago. “Work on your marriage,” he said. “That’s more important.” It warms me that despite all his problems, my brother thinks of my own well-being. That kind of empathy is the trait of someone who deserves to be surrounded by friends.

API Mental Health Findings

• According to the American Psychiatric Association, the main obstacles to mental health treatment for Asian Americans and Pacific Islanders are economic barriers, lack of awareness about mental health issues and services, and stigma associated with mental illness.

• Non-English speaking APIs have significantly lower odds of receiving needed mental health services than APIs who speak only English, according to the 2007 study “Access to Mental Health Treatment by English Language Proficiency and Race/Ethnicity.”

• Among APIs who do use mental health services, problems tend to be more severe, possibly because of delay in seeking treatment until symptoms are more severe, according to a 2006 study on Asian American Mental Health in the Monitor on Psychology.

Hannah Moon is a Korean American writer who is working on a book about how mental illness has affected her family. The names of the people mentioned in this article have been changed.

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Editor’s note (1/9/14 at 11:43 a.m.): An edit was made to clarify that “Tom” was at one time living out of his car and that acutely manic phases were regular, not a one time instance.

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