Conflicts Within Individual Caregivers

August 22, 2007

A partial catalog of caregiver and other family reactions consequent to dementia might include the following -

1. Anger with the patient for seeming to be stubborn, perversely and inconsistently “stupid,” argumentative, unreasonable, and verbally and physically abusive.
2. Feelings of being overburdened with care of the patient, yet experiencing guilt over having those feelings.
3. Indecision about caring for the patient in the home as opposed to sending him or her to a long-term care facility such as a nursing home.
4. Frustration with the patient for behavior that he or she seemingly should be able to perform more competently, more quickly, or with ­ out constant reminders.
5. Embarrassment at the odd and often negative behaviors that the patient displays in front of others who do not understand, who stare, or who ask thoughtless questions.
6. The tendency of the caregiver to become isolated from social contacts and thus to feel lonely and alienated from normal society.
7. Ambivalent feelings of love for the individual who was, and desire to get away from the person who is, at least for a short respite (as well as guilt about the latter feeling).
8. Grief over the loss of the loved one (unfinished and confusing grief because the loved one is still present, if only in body).
9. Depression over the lost relationship and all the rewards that it entailed, be they warmth, security, sex, nurturing, companionship, intellectual stimulation, or any of the multitude of complicated interactions between intimate human beings.
10. Guilt about negative feelings and behaviors toward the patient in past years, and futile desire to atone to the patient, or irrational belief that the caregiver is responsible for the patient’s condition.
11. Denial of the need for assistance in caring for the patient in an attempt to be everything for the patient.
12. Denial of feelings of hopelessness out of a fear that giving in will lead to a complete breakdown.
13. Total immersion in care giving in order to avoid anger, guilt, and grief.
14. Guilt and anxiety about neglecting other family members, such as the nuclear family of the grown child, or the work responsibilities of the spouse or grown child.
15. No time to self.
16. Role engulfment and loss of self.

Compared to younger caregivers, older caregivers (usually spouses of the Alzheimer patients) are more likely to suffer adverse physical and psychological consequences from the stress of caregiving.

Perhaps more disturbing yet is the finding of a vicious cycle in which the stress reported by caregivers was reflected in their critical attitudes toward the patients, which in turn was associated with more destructive patient behaviors (threatening, physical abusiveness, wandering). These problematic behaviors, in their turn, led to more stress on the caregivers.

Posted in Alzhemier Disease