Tag Archives: stress reduction

What about the caretaker?

Take care of the caregiverIt’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.

Stress and your Well-being I

stress reductionAvoiding stress is difficult for most of us since our modern world has made stress an inherent part of life. Stress begins in early childhood and never lets up throughout our linear lifeline. So, it is accepted on an unconscious level but not on a mental and physical health level. I refer to people that cause us stress as emotional vampires. They seem to feed off our emotions for their own survival and profit while sapping us of our energies and health. But emotional vampires are only a part of our stress and therefore our dis-eases. We are affected not only by overt stress, but also the stress of which we are unconscious, that we may accept as just the way life is and not taking time for rest, exercise, and a good diet instead of fast food, business luncheons and cocktails; excessive air travel, may be a necessary part of business life, but it is a source of stress; the young mother who multitask from getting up to going to bed; and so on.

I do not believe that the role stress plays in the causality of pathologies is well appreciated, by either laymen or physicians. In 2004 the National Institute for Occupational Safety and Health came out with some interesting statistics: two hundred billion dollars a year was the cost to business due to stress, in stress-related absenteeism, tardiness, the loss of talented workers, divorces and executives quitting; and stress was a factor in 70-90% of employee hospital visits (quoted in Adrenal Fatigue, by James Wilson DC, ND, Ph.D.). Other stress factors are: the motivated business-person who pushes him/herself constantly; our environment with the obvious ones being heavy metals such as lead, mercury, aluminum, arsenic and cadmium. Then there are plastics (known medically as phthalates) that act as estrogen mimics and play havoc with the estrogen receptors: and even a lot of our pharmaceuticals. Pharmaceuticals as mentioned, for example the statin drugs for lowering cholesterol. These have so many side effects that I devoted a whole section in my book Emotional Vampires and your Hormones: an holistic physician’s view of how stress affects your well-being.

But even antibiotics, An article in Emergency Medicine (November 2004) indicated an association between antibiotic quantity, the cumulative number of days used and breast cancer. These antibiotics are also known to cause gastrointestinal diseases such as dysbiosis (killing of the helpful intestinal bacteria and letting a lot of the harmful bacteria and yeast take over. Synthetic hormones in our meat and now genetically modified foods (GM) in so many of our vegetables and fruits. Just note also all the insecticides, pesticides, fungicides and preservatives that we eat. Anyway, I could go on and on with the list of stressful factors that our body has to fight each day besides just the emotional vampires but this blog is what stress can do to our well-being and that is our health. the brain reacts to mental stress the same way that it reacts to physical stress using the same adrenal hormones, cortisol and adrenaline. It does not differentiate between the two types of stress, even though you might expect your brain to know that fight or flight is not a helpful response to an overbearing boss or a recalcitrant teenager or not enough money to pay the mortgage. Under any kind of stress, physical, emotional or mental, the brain stimulates the stress response and releases the stress hormones. This is why  the best athletes use imaging of the exact performance of their sport. The same hormones are released during these images and the physical body responds at rest as if it were active, thereby building up the muscles needed for the active act.

Humans (and other animals) have developed a “flight or fight” response. For humans this response is the adrenal glands giving off adrenaline and cortisol. This response, for example, lasts only enough time (about 10-15 seconds) to get away from the tiger. Of course if one does not get away in this time they never have stress again. But our modern society has created constant continuous stress.

Cortisol is the hormone that powers the stress response. When the body perceives a stressor, the brain signals the adrenal gland to increase the production of adrenaline and cortisol. Cortisol signals all the body’s systems involved in the stress response to go into high gear. If he/she remains in stress the adrenal gland needs to persistently excrete cortisol and therefore we get into a potentially pathological state. The cortisol stays high all the time stimulating the liver to put out sugar (from its glycogen stores) for fuel so the person can “fight or flight.” The high sugar levels stimulate the pancreas to put out insulin constantly to push the sugar into the cells via the cells receptors. Now there are a few sequels to this scenario. First the cells cannot use all the sugar that the cortisol-liver-insulin axis delivers continuously, so it pushes it into storage as fat [triglycerides]. This gets deposited in women in the thighs and buttocks and then the abdomen. In men it is first deposited in the abdomen. (This is why it is near impossible to lose weight or keep it off when a person is constantly stressed). Another thing that can happen to some people is the surge in insulin drops the blood sugar too much so they get what is called a reactive hypoglycemia. This makes the person lethargic, angry-aggressive and sleepy. This hypoglycemia is an added stress to the already ongoing stress. More stress!

If this stress continues to stimulate the former reactions eventually cortisol levels remain high until the adrenal gland fatigues out and produces low levels or none of cortisol. Also the receptors on the cells for insulin get tired of being hit with insulin so much and consistently that the insulin cell receptors develop a resistance to the insulin. So the pancreas puts out more insulin to push the perceived needed sugar into the cells. This vicious cycle continues causing more cell receptor resistant that we call Insulin Resistance. This is the first step to diabetes mellitus (Diabetes II) and the Metabolic Syndrome [once called Syndrome X]. The Metabolic Syndrome in synopsis consists of a male with a waist over 40 inches and a female with a waist more then 35 inches; high insulin levels and high blood sugar pre-diabetes] or diabetes type II; high LDLs [bad cholesterol], low HDLs [good cholesterol], triglycerides are often high and high blood pressure. These diseases are becoming a major part of the health problem in the Western world to adults and children. Be patient all this is expanded in the book Emotional Vampires and Your Hormones.

This constant outpouring of cortisol can lead to other problems that are not being addressed in the conventional medical world even though they know it. One is the problem of osteoporosis. It is known that high night cortisol levels lead to bone absorption. For example, the same warning is posted on the box for people that have high cortisol levels because they are kept on corticosteroids medications [ex. Prednisone]. We could go on about all the side effects (ulcers, lowered immune system, poor absorption of amino acids) of cortisol under chronic stress but that is one of the reasons I wrote a more comprehensive book for the laymen, because there is just too much for one blog.

When I introduced the concept of stress into my practice I was surprised at how many people thought that if they admitted to having anxiety or stress in their lives they would be judged as being psychologically “sick,” as if mental illness and stress were the same thing. Patients would often tell me there was no stress in their lives. However, on further questioning I would hear that the patient was dealing with sometimes horrendous things that they were just putting off as ordinary human conditions (even sexual and physical abuse for which they were blaming themselves). When I would talk about exercise [or self-time] to alleviate such problems as depression (which has been scientifically proven to be as effective as antidepressants for mild to moderate depression), but without any negative side effects, to lose weight, and for general good health, I would often get a response of: “I do not have time.” This response in itself indicates busyness and not having time for oneself or their health. It is more important to take care of others such as the children, spouse, boss, etc.. and not devote thirty minutes a day for oneself. People only think of large stresses but even small stresses accumulate and eventually add up to ill health especially when the large stresses occur in addition to the small ones. To me there always seems to be an hierarchy of problems in a person’s life, and we are lucky when we have a reprieve of a few weeks to months without something dramatic to arrive on the top of the list.

While I had come to believe in the important, perhaps paramount, role of stress in creating dis-ease in my patients’ lives, it took a powerful shock to my system to realize that I had to practice what I preached in my own life. While I had followed a healthy diet and exercised regularly most of my life, and had begun to meditate and practice yoga several years before, I was not as diligent as I could have been in addressing emotional stress. Three years ago I suffered a cranial bleed, and blood clots that infarcted several organs, including my lungs. It took six weeks in and out of the hospital and intensive care, two near death experiences, and a team of eight specialists, to figure out that I had a congenital blood disorder.

I had lived with the disorder my whole life, and could have lived to a ripe old age without ever knowing about it, had not something intervened to trigger it. It is my firm belief that it was triggered by stress. Certain personal decisions and events in my professional life had created a protracted period of extreme stress, chronic anger, insomnia and their many attendant dis-eases, and my body finally said: enough. At that point I had no choice but to withdraw from everything in order to give myself an opportunity to heal.

I believe stress is a main, and perhaps the most important, component of dis-ease. My 40 years of experience have led me to believe that stress is more important then the genetic factor, since it is the fire that lights the kindling wood (A major breakthrough of environment versus genes influence on our lives is in a wonderful book “The biology of belief” by Bruce Lipton PhD). The kindling wood is composed of all the microbes, carcinogens (cancer causing), emotional vampires to which we are constantly exposed, as well as our genetics. But if we maintain a healthy life style (to an enjoyable degree not having to be a stoic angel) we are able to defer major dis-eases. But with the factor of stress thrown into the everyday cauldron of potential dis-eases the boiling point is exceeded and we develop major health issues. Once we understand the role of stress and how it affects the body we are able not only to live a healthier life but a life that is emotionally relaxed and with the freedom to grow. Learning a positive response to stress is not only a way to rid our bodies of dis-ease but a pathway for preventive medicine and anti-aging practice. It is also a joy to see oneself evolve. Even if one already has a chronic dis-ease which in itself is a stressors, learning to alleviate or deal with the stress of chronic illness can be curative or at least give quality of life.

In my own experience and in treating patients I have found that the best ways of learning to deal with stress are through hypnosis and Interactive guided imagery. This being done with a therapist that can do one or a combination of them. A therapist that is non-judgmental and can also give unconditional love is the fastest route and least expensive in my opinion and experience. Also, from a well trained person in these fields the client can learn to do these techniques on themselves so they can deal with other stressors. As I mentioned there is usually an hierarchy of stress factors but so often not all of them have to be dealt with just like a multitude of illnesses. If one pictures these as a pyramid, so often just getting rid of one or two at the bottom collapses the pyramid and the ones on top become insignificant or disappear.

The mind plays a very important role in making people sick or well. Our intentions affect not only ourselves but others around us. If a person is positive the people around them will behave in a more peaceful manner. (Have you ever noticed how just saying “Good-morning” with a smile to a stranger brightens up their face?) The opposite is also true, and those sharing space with a negative person will very likely feel the effects. There is much evidence-based research on the mind transmitting energy and healing others through prayer and meditation. These studies, conducted in medical schools such as Duke and Harvard and many others, have not only recognized the mind-body factor in our health but also in transmitting wellness or sickness to others.