It’s time to take care of the Caretaker!

As a physician for about forty years I have encountered so much stress in people taking care of their loved ones. The sad part of this is that so often they do not get any positive recognition, or worse just criticisms. It seems everybody knows how and what the caretaker should be doing, but so often that is the extent of their participation in caring for the person in need. I do not think it wrong for the caretaker to be assertive when outsiders (even friends) criticize the caretaker for what and how they are doing this task. It is alright for the caretakers to state they are the ones that are doing this job and “I will consider what you say, but remember that you are not me and not in my shoes or circumstances.” This may even be the time to hint strongly that positive active help would be appreciated.

This is a typical case! Sylvia is an 88-year-old woman that is having her fourth bout of cancer. Her husband has progressive Alzheimer’s Disease (AD). Sylvia was never a patient person and may even be described as a hyper -obsessive personality. She was also a very demanding and angry person with her husband who she believed did not make enough money although they lived quite comfortably. But she was a caring mother and wife and always worked to help support the family. She was also very active in many social activities about everyday of her life before having to be watchful every minute due to her husband’s dementia that could potentially cause a dangerous situation if left alone. When her husband Martin was diagnosed with AD he was at first quiet, but as the AD progressed it was not a case of just not understanding, he also became quite abusive to Sylvia and often got mixed up who his wife was with other women and was abusive to them. Martin in his salesman’s life was a very gentle person with a good sense of humor, even to the point of injecting his humor when the conversation was serious and therefore he could be annoying even in his cognitive days. He became not only abusive verbally but also started to get physically abusive. Fortunately he was feebly weak; but to an 88-year-old woman this was scary.

When friends and relatives came to visit they were always concerned about how Martin was doing and of course had many suggestions of what Sylvia should and could do for him. Most stopped coming after awhile since Martin could not communicate and Sylvia was always too tired to really entertain. Visitors showed little concern about her cancers, her treatment status, taking care of Martin and her emotional and mental status of caring for him. In a short time Sylvia was depressed and tired and often in tears. She decided it was time to put Martin in a nursing care center, which she did. She visited him many times a week, which was not easy for her at 88 years old especially one with cancer.

This case is so typical and the story can go on and on. But we are interested in the psychology of the caretaker and options they can take to alleviate a sad situation. We have an elderly person (but the person could be much younger) taking care of a person that they have been with for many years. She still loves the person but also a lot of this love has turned to obligation and guilt. She also has anger.

The anger may or may not be on a conscience level or admitted to oneself. So the following are hypothetical but could be real with some caaretakers. She could be angry because her life has been completely changed from being an active person with lots of friends and acquaintances to one of being a stay-at-home caretaker. Angry because she herself has health problems that she has to put in the background to be a caretaker. Angry because most of her recognition by others for being a caretaker is negative contributions of what she should be doing and/or could be doing foor her spouse. In line with the latter is also that she is not getting recognition for having cancer since all the sympathy is going towards her husband. Angry because she has guilt about not wanting to be in this situation with someone that she may not even love anymore except in her past memories. Anxious maybe because we all know that we may be the one that needs to be taken care of someday and who will be there? If it is a loved one will they feel angry about being put in this situation? There is the visual knowledge when caring for someone that they may be in the same situation having to give up their independence such as a car for example. This may not be an overt thought but just underlining the conscience mind that we are getting older and our society has no great provisions for these “golden years”.

Another negative emotional feeling that may creep into a caretaker’s mind is guilt for the way they believe they treated this disabled person in the past. They can of course talk to this person and discuss calmly why they did not always understand the other person’s side and instead became aggravated by this person that they really did love. This is even more apparent and difficult when the loved one dies and then it is very difficult to communicate regret of how they acted toward this person. But the caretaker can still forgive himself or herself. This can be done in a verbal way with different techniques using visualization. There are counselors and psychologists trained in the latter. It works!

This case study only illustrates one common situation whether it is a man or a woman that is the caretaker caring for a long time companion. As stated some of this case can be applied to young people that fall into a caretaker situation with a spouse or girl/boy friend. Or a young person that is involved in a similar situation with a parent and that their life now revolves around care-taking that person. They may love that person but it is a change of life that may interfere even with other evolving opportunities in their life. There may be an ambivalence of love and anger of the situation. This guilt diminishing the love because care taking can be a full time job. This is especially true if money is inadequate to get help and the government only helps sparsely, and this after very time consuming paperwork and interviews.

So often the caretaker starts off feeling love and responsibility for the person but after a time they may not see this person as the same one that once bonded them together. In fact, the caretaker may view the person as a complete stranger occupying the body of the loved one. Because of this they may feel stuck in a situation of a time consuming and often an unclean job of taking care of the person.

For both the caretakers young or old, there is often the unromantic role of the caring of someone that was once strong and often the caretaker of the caretaker. So often the new role of caretaker is worsened because they were always the one cared for by this new person and they themselves do not know how to manage all the everyday business things that are required by our society.

One trap that the caretaker may fall into or create themselves is that of being an enabler. This is a person that does or overdoes so much for the person that the person becomes less and less capable of doing things for themselves or even gives up trying to do anything for him/herself. The incapacitated person still may be able to do a lot of things themselves and probably wants to do so. An example of an enabler is the following: take a person that is an alcoholic and ends up in jail a lot. If the same person rescues them from jail all the time they are allowing the alcoholic to remain status qua since the alcoholic knows he will be rescued. The person doing the rescuing is not really helping the alcoholic make decisions to change but rather enabling the person not to have to make this decision. This simple example can be transferred to an incapacitated person when the caretaker does not allow or more so encourage the person to do things for themselves.

When compassion becomes pity and nurturing becomes rescuing there is a problem. Compassion and nurturing are empowering to the caretaker and the patient. Pity and rescuing are not only a burden to the rescuer but also devalue the targets of those sentiments. Because the underlying message is that the disabled are incapable of growing or learning to take care of themselves.

Enabling people may have different paths that lead them to be enablers. They may have been taught to be so since childhood watching one of the parents enact this. It could be that it makes them feel righteous or powerful. With the later I find that this type of person is often an enabler to many people not just for the one that they are in charge of caring; but it may just be the one person. They may even have ambivalent feelings for the person and get enjoyment at having them at their mercy. Then there is the martyr personality type person that wants all to see including the invalid how they are sacrificing their life away by care taking.

There are probably other reasons for people becoming enablers. Of course, there are the caretakers that have really earnest, loving motives. But in their method of showing love, if they are not cognitive of overdoing things for the person, they may not be realizing that they could be furthering a crippling situation or facilitating an eventual progression. For example, there is the parent that keeps feeding their child to show love and the child is getting fatter and fatter causing social problems and eventually maybe even diabetes. So often this is done with good and loving intentions. This latter example of the type of loving person can be forwarded to the caretaker that believes they have to do everything right away for the invalid and more because this is what love is to them – no guilt or anger-just love.

So what are some of the things a caretaker can do to protect and take care of him/herself? If the caretaker does not take care of his/her health physically and mentally they may not survive the ordeal of helping another. They may even be shortening the time that they will be the patient.

1-I believe first the caretaker should analyze the situation as to how much money and how much time caring for another will be.

2-Consider what available helpthere is for giving the caretaker time off for themselves. This couold be close friends, relatives, and I have had good luck when I worked as an ER physician with Social Services. Also, as an holistic physician I have called Social Services and almost always received help or optioans for my client.

3-Either at the same time or just after this assessment they should try and reason out why they are undertaking this task. What are their real feelings about becoming a caretaker? This is so that they can come to terms with the situation and themselves.

For this latter they may need outside help that helps them discover the whys. They can do this with a person that is non-judgmental and gives unconditional love. It is difficult to find a friend that can do this being the latter two qualities are rare in a friend who can step outside the situation knowing the two people involved. A trained social worker or counselor I think would be the best source for this task.

Another option, is to venture into hypnosis or integrated guided imagery; I know from many experience of my own and clients that this helps. Again with a trained person that gives unconditional love and is non-judgmental.

Namaste, and maybe being a caretaker is the road for some of us to realize and come to terms with evolving; it did for me.