On Healing 7/15/2002: Caregivers shouldn’t fear seeking help for themselves

Dear Dr. Dan: I have been married for more than 30 years, and have three grown children. Although two are doing quite well, one is living alone with her teenage children after being divorced for the second time. She struggles both financially and emotionally.

My husband has had chronic anxiety and depression for most of our married life. Fortunately, he is able to maintain his job. Although he is getting help, he has been with the same psychiatrist for 15 years. Despite medication, there have been many difficult times. He says he is content simply watching television and doesn’t want to do anything else. As his depression worsens, his hygiene is poor and his alcohol consumption increases.

I have a sister with a developmental disability who is living with a companion. Although this arrangement works well, I am responsible for supervision, and have her at least one weekend a month and vacations and holidays. My mother is 95, in good health, in assisted living. I take care of her needs, too.

I see the pattern of my years: going from my sister’s difficulties, to helping my daughter, to my husband’s problems, to taking care of my mother. My children are growing estranged from one another, and family gatherings are very stressful. I have done everything in my power to diminish the stress and make everyone happy, but it is not working. One of my children has become so distant that she rarely returns calls. I know she worries that she is going to be like her father.

I need help to get myself some objective insight and to bring the family together. Now I am even isolating myself.

Dear reader: This well-known serenity prayer opens every 12-step meeting:

God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

After the prayer, the “steps” are read. The first several steps address the issue of powerlessness – realizing that you are not able to control that which you want to control.

So my first piece of advice is to find an Al-Anon meeting in your neighborhood. You can find a convenient one in the telephone directory. Next you must figure out what you can be helpful with and what you cannot.

Let’s start with what you probably cannot change. Your daughter, although she is obviously having a difficult time, is an adult. I doubt you can change her circumstances. The same is true with your sister and mother. So you cannot change your loved ones’ circumstances, or their suffering. But there is something you can do for them: When most of us suffer we want compassion and companionship, not intervention.

I am confident that all three of these women will appreciate your care and kindness. As far as your husband is concerned, I’m sure you know that you cannot change his depression. But perhaps you could offer him the following information and let him decide what to do:

Although research suggests that long-term therapy is more effective than short-term, some studies have found that the benefits are greater during the first 18 months of treatment. After 15 years, his relationship with his psychiatrist may be very valuable for him, but it is probably not having an impact on his depression. The department of psychiatry at the University of Pennsylvania offers a program for people who have had a long-term depression that’s been difficult to treat. Your husband might benefit from a consultation that will look at both his medication and psychotherapy.

I’m not necessarily recommending he make a change – just get a consultation. However, like your daughter, sister and mother, he is an adult and can choose to live his life essentially as he wishes. Now, believe it or not, you can also live your life differently if you choose.

Out of everyone in your family, I am most concerned about you. Many of the estimated 54 million American adults who are caregivers are at risk for diminished health, stress-related disorders and depression.

Your withdrawal could be an early sign of depression or a symptom of emotional exhaustion. And there is another possibility: Your withdrawal could be your body/mind’s subconscious way of quitting your job as a caregiver. In either case, the symptom must be acknowledged. Caregivers also are at risk for self-neglect. Many place other people’s symptoms and illnesses above their own welfare.

I know you don’t need another person lecturing you to take care of yourself. You described in your letter how this is a long pattern of behavior and may be there for a reason. If you are right (and I suspect you are), you can only begin to explore this after you have given up this apparently compulsive pattern of caregiving.

I would guess that your desires are on the other side of your helplessness. You spend many hours with others. You can begin to change your life by spending more time with you. I would also guess that you long for the same kindness and compassion you offer your loved ones. Caregivers often get neglected – not just by those they care for, but by themselves.

If I were your caregiver, I would sit with you as we talked about your exhaustion, helplessness and fear. We might hear about your emptiness and anger at the people you care for. We would talk about dreams that have died and desires that have never found a voice. And through this process you may discover that simply listening to the voice of your heart will not necessarily change anything in your environment, but it might make you less afraid to stop working so hard.

By the way, I have not forgotten your concern about your children feeling alienated and distant. I frequently tell parents that if you sell your soul, your children will be stuck with the monthly payments. The kids often see their future in their parent’s behavior. On the other hand, if you have the courage to face your demons to pursue wholeness, your children will reap the benefits.

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