I have counseled many twins whose siblings were born with medical challenges. Even after these issues are resolved, the “healthier” twin often carries an enormous emotional burden, struggling with guilt, obligation, or resentment.

Recently, I spoke with a female identical twin in her 50s, whom I will call Lily. She had been feeling unusually depressed, unmotivated, and sad—emotions that are uncharacteristic for her. She expressed confusion and self-loathing about her lack of motivation for self-care and a diminished interest in aspects of her life that once brought her joy.

As we talked, it became clear that her twinship conflicts were at the heart of her distress. Lily described an intensely enmeshed relationship with her twin sister, Lana, who lives near her. Their children are close in age, and during COVID, they homeschooled their four children together. However, in recent years, Lana has struggled with a variety of mental health issues that have profoundly affected their relationship.

Lily’s life has been shaped—if not controlled—by Lana’s physical and emotional needs. Lana was born with a cleft palate, which was surgically repaired when she was five. Lily explained that the time she spent away from Lana during college and graduate school felt liberating and gave her a sense of personal growth. Yet living down the street from each other seemed like a natural choice later. Over the past five years, however, the situation has worsened.

As Lily spoke, she began to realize how much she has been emotionally and physically impacted by Lana’s controlling and self-absorbed behaviors. Lana reacts with hostility when Lily does not comply with her expectations and often resorts to emotional blackmail, threatening to prohibit Lily from seeing her niece.

Lily needed an outside perspective to help her see how deeply she had been swallowed up by this dynamic. She struggled with intense ambivalence—deeply loving her sister and wanting to care for her yet feeling controlled, manipulated, and trapped. Our conversation helped her clarify why she feels so weighed down by these conflicting emotions.

So many twins feel that their connection is starkly black and white—either complete loyalty or total disconnection. Many struggle to create a “gray zone,” a space where they can love their twin while maintaining personal boundaries. But finding that middle ground is essential. Loving your twin should not mean surrendering yourself out of fear of losing the connection.

Image by Bernhard Stärck, Pixabay