October 6, 2023 • 18 mins
Caregiver burnout is a real thing and can result in depression as well as physical health issues. Dr. Saltz tells how to get past the guilt, resentment and fatigue, and make the situation better for you and the loved one you’re caring for.
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Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I Help? I'm doctor
Gail Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, the psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. You know the saying,
if the plane is losing oxygen, put your mask on first,
and then that of your child. This saying applies to
caretaking as well, with three quarters of caretakers not going
(00:48):
to their own doctors as often as they should, and
sixty three percent reporting poor eating habits fifty eight percent
poor exercise habits, that most caregivers have completely abandoned their
own oxygen masks. It isn't just lack of time and
(01:09):
stress that keeps a caregiver from self care and propels
them toward burnout. In fact, it's really the emotional toll
that makes the biggest impact of all. This is because
of the very complex set of emotional reactions set off
by caring for someone you love that is sick or dying.
(01:32):
The feelings are often a kind of grief and mourning
for the fully functional person you had, for the life
you had been leading, for the loss of a happier
time when you were not surrounded by sickness and loss.
This grief cannot be fully dealt with because your loved
one is not gone. Therefore you are in essence in
(01:56):
a mourning limbo. Add to this that caretaking is difficult
and therefore naturally you wish you didn't have to, and
you have an emotional recipe for burnout. So today I'm
addressing a listener's question that is about caregiver burnout. One
(02:18):
emotional piece you may be less aware of is the
unconscious drive to be relieved from the burden of caretaking
and instead get to be the one getting taken care of.
That drives behaviors of self neglect and risk taking. These
(02:39):
feelings cause caregivers to ignore their own care. For example,
twenty three percent of those who have been providing caregiving
for five or more years report that their health is
fair to pour themselves worse. Yet, and this same group
(03:01):
over half skip their own doctor's appointment, have bad eating habits,
and decrease their exercise without being aware of it. Your
mind is screaming if I get sick, then I can
stop this madness and someone will help me. In reality,
(03:22):
that rarely happens. Instead, health and mood both suffer, and
misery is simply compounded. Perhaps the biggest impact of the
constant stress of caring for someone else is the development
of depression, with as many as one half of all
caregivers actually having diagnosable clinical depression. All told, the stress
(03:49):
of being the primary caregiver of a loved one can
take as much as ten years off your life. Yet
most people, especially women, tend not to see the impact
on themselves. This denial is based on feelings of guilt.
For many a caregiver, it just doesn't seem right to
(04:12):
resent taking care of someone you love, and guilt about
that normal and natural resentment leads to self punishment in
the form of ignoring one's own needs and self preservation. Additionally,
the constant reminder of both loss and impending mortality lead
(04:35):
to existential questions of how their situation fits into the
meaning of life and love. Taking care of someone means
not only assisting them with basic needs, it means identifying
emotionally with their situation. This is a scary proposition. Many
(04:57):
a daughter has struggled with standing in her parents shoes
as they lay, losing their ability to think, to move freely,
to be comfortable, and to have a future with quality
of life. Imagining being them is extremely emotionally taxing, leading
to both depression and anxiety. Women already suffer depression and
(05:22):
anxiety disorders twice as often as met. Being a caretaker
just ups the ante. What are red flags that caretaking
is exacting a toll on you, a toll requiring some
specific action. New health problems are sometimes the first harbinger
(05:43):
of lack of care for yourself and chronic stress. An
increase in blood pressure, headaches, back pain, constant fatigue, weight
loss or substantial weight gain, sleeplessness, and repetitive viruses or
colds can be physical signs of stress. Signs of depression
(06:07):
that require professional attention are a change in sleep and appetite,
lack of concentration, feelings of hopelessness and helplessness or worthlessness,
pervasive feelings of guilt, loss of pleasure in any activities,
loss of sexual desire, and thoughts of suicide. Similarly, signs
(06:30):
of anxiety that should be evaluated are frequent, thoughts of
worries that move from one topic to another throughout the day,
or feelings of nervousness with nausea, sweating, or shortness of breath.
So with that, let's get to my listener's question and
(06:51):
ask how can I help, dear doctor Salts. My mother,
who is eighty two, has become increasing unable to manage
on her own in her home. So I got together
with my siblings and decided to move her in with
my family so that I could help her. I really
(07:11):
did want to do this, and my siblings supported this decision.
It's been six months and I am really struggling. I
no longer recognize my own life. I don't do anything
with friends anymore. There just isn't any time, and I'm
constantly exhausted. I do feel good about helping my mother,
(07:36):
but at the same time, I feel sad watching her decline,
and I feel frustrated that I literally have zero time
for myself. I have not been able to make it
to my dentist, which I need to do, nor for
my own annual checkup. But when I look at my mom,
I guess, comparatively speaking, I'm really in good health. I
(08:00):
am just feeling bone tired, and there isn't anyone else
who can or will help my mother. I only see
her needs growing, which is making me very nervous. What
can I do to deal with this situation. I'll be
back in a moment with an answer for my listener.
(08:33):
Back with an answer for my listener's question. Like most
people who become the sole caregiver for a parent, you
sound like you are struggling with caregiver burnout. The treatment
for burnout, which it is necessary to do else do
you end up totally unable to care for yourself or
(08:55):
your mother, is to make sure that you bring in
some reinforcements. You mentioned siblings, They too can and should
pitch in to help with mom and give you breaks.
They can come to your house and rotate in to
take care of your mom so you get time off.
(09:15):
Everyone needs time off, time to go have fun with
a friend, catch up on sleep, exercise, see the dentist
and the doctor. You need to let your siblings know
that you really anyone can't do this alone. You do
need help. Sometimes help would be in the form of
(09:39):
their doing it, or if it's truly not possible financially
or they're far away, then contributing financially to you. For
a home health worker that can come in periodically to
do some of the care and have you get a
break is necessary. Top of the list of solutions to
(10:00):
burnout of any sort is delegating and limiting how much
is on you. There really is no replacement for this.
You also need an ongoing system that allows for seven
to nine hours of sleep per night, regular exercise, and
(10:21):
social supports of your own that are people that you
can call, that you can meet up with for coffee,
to see a movie with the things that you may
have told yourself you don't have time for, but actually
are the very things that can prevent you from developing burnout.
With burnout, you are no good for yourself or your mother.
(10:46):
It's a lose lose, so much so that it really
is better for both of you to enlist respite from
the care for portions of each day one way or another.
Sometimes guilty feelings that we shouldn't make it appear to
us that we can't, but we framed as this is
(11:06):
part of the necessity of preserving yourself really for anyone
and everyone, so that you can be a caregiver can
help you ask others to pitch in and frankly to
tell others that you need the support as a form
of respite. Money for a professional to come in for
(11:27):
a few hours, a sibling to come stay in your
home for a week and give you that week off,
your partner stepping in to sometimes hold down the fort,
even a good friend spotting you for a couple of hours.
Make that time that you do something that brings rest
(11:49):
for your body and mind, something fun interesting, connecting with
others for support and activity. Do not make it the
time that you vacuum the house or drive out just
for caregiving supplies. Another helpful idea is to seek out
and join a support group for people struggling with caregiving.
(12:13):
There are even ones that are online to make it easier,
but talking to other people in a similar circumstance can
actually really help you feel much less alone and feel
supported and get other ideas for managing this situation with support.
I hope that was helpful. Being the caregiver takes an
(12:38):
emotional toll, and that is clear working through these emotions,
making the thoughts you are having conscious and then understanding
them is exactly what will help them to lose their
power over you. There are three key emotional roadblocks to
making them conscious for being able to manage them. First,
(13:04):
there is the idea of grappling with mortality. When someone
is sick, it makes you think about what would happen
if they don't get better. Following this line of thought
usually leads to some contemplation of death. Not only the
death and loss of your loved one, but it's also
(13:25):
normal and common to imagine being in your loved one's
shoes and facing your own being ill or dying. As
normal as these thoughts are, they can be upsetting. Therefore,
it is also quite typical to avoid the awareness of
them and not even know that you're thinking about it.
(13:48):
When fears are out of awareness, they have the power
to make us feel things and do things we normally
would not, like feeling sick and anxious, or running away
from really talking to the person that we're caring for
because of the fear they are thinking of dying. Try
(14:09):
journaling about your fears, keeping a book that you write
in daily or every few days about your thoughts and
fears about the concept of death. This can be really
cathartic and make you realize at the same time that
you don't need to be afraid of dying now. Also
(14:31):
doing things that make you feel very full of life
and very present in the moment really helps. For example,
intentionally tuning in while sipping your morning coffee, how does
it taste, how does it smell? How do you feel
while drinking it? Having an active sex life helps too.
(14:55):
Few things make you feel as alive as having sex.
Next is the issue of resentment. It is entirely normal
to feel resentful of all the time and energy you
are putting into all this caretaking, no matter how much
you love the person and truly want to take care
(15:17):
of them, Frustration with how much you have to give
up and how difficult the task is is inevitable. Sometimes,
when you feel a lot of resentment, it becomes difficult
to hold onto any positive feelings about the person you
are caring for and about your own life. Accepting that
some resentment is normal, and also having personal outlets for
(15:40):
me time like friends to talk with or exercise and
do activities with to engage with, will help keep resentments
at an acceptable level. Try to hold out thirty minutes
each day to do something for yourself. It could be exercise,
a funny TV show, listening to music or chatting with
(16:04):
your friend. Also, hold on to one thing from your
life before you were doing caretaking that you enjoyed and
keep it continuously in your life now. And Last, but
not least, is guilt. If you can realize and accept
that resentment is both normal and that it in no
(16:27):
way means you are not a good person doing a
good thing for someone you really care for, then you
will not go on to struggle with guilt, which can
be a real problem. It is guilt that tends to
make people depressed, anxious, and even unconsciously do things that
are self destructive. Is a means of self punishment. Sometimes
(16:51):
guilt is really irrational, the feeling that you should be
able to save or fix your loved one. Make a
list on paper of the things you feel guilty about.
What exactly do you feel guilty about? Is it something
reasonably fixable or are you expecting magical powers from yourself.
(17:13):
When you actually make a list of guilts and reread it,
you will be surprised to find your guilt diminishing. Getting
someone to spell you, having others to talk with, taking
care of yourself are all important parts of avoiding caregiver burnout. However,
it is sorting through some of the emotional baggage that
(17:36):
comes with being a caregiver that will help you the most.
To whether a difficult and loving task. Do you have
a problem I can help with? If so, email me
at how can I Help at senecawomen dot com. All
centers remain anonymous and listen every Friday to how can
(17:57):
I help with me? Gale Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I Help? I'm doctor
Gail Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, the psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. You know the saying,
if the plane is losing oxygen, put your mask on first,
and then that of your child. This saying applies to
caretaking as well, with three quarters of caretakers not going
(00:48):
to their own doctors as often as they should, and
sixty three percent reporting poor eating habits fifty eight percent
poor exercise habits, that most caregivers have completely abandoned their
own oxygen masks. It isn't just lack of time and
(01:09):
stress that keeps a caregiver from self care and propels
them toward burnout. In fact, it's really the emotional toll
that makes the biggest impact of all. This is because
of the very complex set of emotional reactions set off
by caring for someone you love that is sick or dying.
(01:32):
The feelings are often a kind of grief and mourning
for the fully functional person you had, for the life
you had been leading, for the loss of a happier
time when you were not surrounded by sickness and loss.
This grief cannot be fully dealt with because your loved
one is not gone. Therefore you are in essence in
(01:56):
a mourning limbo. Add to this that caretaking is difficult
and therefore naturally you wish you didn't have to, and
you have an emotional recipe for burnout. So today I'm
addressing a listener's question that is about caregiver burnout. One
(02:18):
emotional piece you may be less aware of is the
unconscious drive to be relieved from the burden of caretaking
and instead get to be the one getting taken care of.
That drives behaviors of self neglect and risk taking. These
(02:39):
feelings cause caregivers to ignore their own care. For example,
twenty three percent of those who have been providing caregiving
for five or more years report that their health is
fair to pour themselves worse. Yet, and this same group
(03:01):
over half skip their own doctor's appointment, have bad eating habits,
and decrease their exercise without being aware of it. Your
mind is screaming if I get sick, then I can
stop this madness and someone will help me. In reality,
(03:22):
that rarely happens. Instead, health and mood both suffer, and
misery is simply compounded. Perhaps the biggest impact of the
constant stress of caring for someone else is the development
of depression, with as many as one half of all
caregivers actually having diagnosable clinical depression. All told, the stress
(03:49):
of being the primary caregiver of a loved one can
take as much as ten years off your life. Yet
most people, especially women, tend not to see the impact
on themselves. This denial is based on feelings of guilt.
For many a caregiver, it just doesn't seem right to
(04:12):
resent taking care of someone you love, and guilt about
that normal and natural resentment leads to self punishment in
the form of ignoring one's own needs and self preservation. Additionally,
the constant reminder of both loss and impending mortality lead
(04:35):
to existential questions of how their situation fits into the
meaning of life and love. Taking care of someone means
not only assisting them with basic needs, it means identifying
emotionally with their situation. This is a scary proposition. Many
(04:57):
a daughter has struggled with standing in her parents shoes
as they lay, losing their ability to think, to move freely,
to be comfortable, and to have a future with quality
of life. Imagining being them is extremely emotionally taxing, leading
to both depression and anxiety. Women already suffer depression and
(05:22):
anxiety disorders twice as often as met. Being a caretaker
just ups the ante. What are red flags that caretaking
is exacting a toll on you, a toll requiring some
specific action. New health problems are sometimes the first harbinger
(05:43):
of lack of care for yourself and chronic stress. An
increase in blood pressure, headaches, back pain, constant fatigue, weight
loss or substantial weight gain, sleeplessness, and repetitive viruses or
colds can be physical signs of stress. Signs of depression
(06:07):
that require professional attention are a change in sleep and appetite,
lack of concentration, feelings of hopelessness and helplessness or worthlessness,
pervasive feelings of guilt, loss of pleasure in any activities,
loss of sexual desire, and thoughts of suicide. Similarly, signs
(06:30):
of anxiety that should be evaluated are frequent, thoughts of
worries that move from one topic to another throughout the day,
or feelings of nervousness with nausea, sweating, or shortness of breath.
So with that, let's get to my listener's question and
(06:51):
ask how can I help, dear doctor Salts. My mother,
who is eighty two, has become increasing unable to manage
on her own in her home. So I got together
with my siblings and decided to move her in with
my family so that I could help her. I really
(07:11):
did want to do this, and my siblings supported this decision.
It's been six months and I am really struggling. I
no longer recognize my own life. I don't do anything
with friends anymore. There just isn't any time, and I'm
constantly exhausted. I do feel good about helping my mother,
(07:36):
but at the same time, I feel sad watching her decline,
and I feel frustrated that I literally have zero time
for myself. I have not been able to make it
to my dentist, which I need to do, nor for
my own annual checkup. But when I look at my mom,
I guess, comparatively speaking, I'm really in good health. I
(08:00):
am just feeling bone tired, and there isn't anyone else
who can or will help my mother. I only see
her needs growing, which is making me very nervous. What
can I do to deal with this situation. I'll be
back in a moment with an answer for my listener.
(08:33):
Back with an answer for my listener's question. Like most
people who become the sole caregiver for a parent, you
sound like you are struggling with caregiver burnout. The treatment
for burnout, which it is necessary to do else do
you end up totally unable to care for yourself or
(08:55):
your mother, is to make sure that you bring in
some reinforcements. You mentioned siblings, They too can and should
pitch in to help with mom and give you breaks.
They can come to your house and rotate in to
take care of your mom so you get time off.
(09:15):
Everyone needs time off, time to go have fun with
a friend, catch up on sleep, exercise, see the dentist
and the doctor. You need to let your siblings know
that you really anyone can't do this alone. You do
need help. Sometimes help would be in the form of
(09:39):
their doing it, or if it's truly not possible financially
or they're far away, then contributing financially to you. For
a home health worker that can come in periodically to
do some of the care and have you get a
break is necessary. Top of the list of solutions to
(10:00):
burnout of any sort is delegating and limiting how much
is on you. There really is no replacement for this.
You also need an ongoing system that allows for seven
to nine hours of sleep per night, regular exercise, and
(10:21):
social supports of your own that are people that you
can call, that you can meet up with for coffee,
to see a movie with the things that you may
have told yourself you don't have time for, but actually
are the very things that can prevent you from developing burnout.
With burnout, you are no good for yourself or your mother.
(10:46):
It's a lose lose, so much so that it really
is better for both of you to enlist respite from
the care for portions of each day one way or another.
Sometimes guilty feelings that we shouldn't make it appear to
us that we can't, but we framed as this is
(11:06):
part of the necessity of preserving yourself really for anyone
and everyone, so that you can be a caregiver can
help you ask others to pitch in and frankly to
tell others that you need the support as a form
of respite. Money for a professional to come in for
(11:27):
a few hours, a sibling to come stay in your
home for a week and give you that week off,
your partner stepping in to sometimes hold down the fort,
even a good friend spotting you for a couple of hours.
Make that time that you do something that brings rest
(11:49):
for your body and mind, something fun interesting, connecting with
others for support and activity. Do not make it the
time that you vacuum the house or drive out just
for caregiving supplies. Another helpful idea is to seek out
and join a support group for people struggling with caregiving.
(12:13):
There are even ones that are online to make it easier,
but talking to other people in a similar circumstance can
actually really help you feel much less alone and feel
supported and get other ideas for managing this situation with support.
I hope that was helpful. Being the caregiver takes an
(12:38):
emotional toll, and that is clear working through these emotions,
making the thoughts you are having conscious and then understanding
them is exactly what will help them to lose their
power over you. There are three key emotional roadblocks to
making them conscious for being able to manage them. First,
(13:04):
there is the idea of grappling with mortality. When someone
is sick, it makes you think about what would happen
if they don't get better. Following this line of thought
usually leads to some contemplation of death. Not only the
death and loss of your loved one, but it's also
(13:25):
normal and common to imagine being in your loved one's
shoes and facing your own being ill or dying. As
normal as these thoughts are, they can be upsetting. Therefore,
it is also quite typical to avoid the awareness of
them and not even know that you're thinking about it.
(13:48):
When fears are out of awareness, they have the power
to make us feel things and do things we normally
would not, like feeling sick and anxious, or running away
from really talking to the person that we're caring for
because of the fear they are thinking of dying. Try
(14:09):
journaling about your fears, keeping a book that you write
in daily or every few days about your thoughts and
fears about the concept of death. This can be really
cathartic and make you realize at the same time that
you don't need to be afraid of dying now. Also
(14:31):
doing things that make you feel very full of life
and very present in the moment really helps. For example,
intentionally tuning in while sipping your morning coffee, how does
it taste, how does it smell? How do you feel
while drinking it? Having an active sex life helps too.
(14:55):
Few things make you feel as alive as having sex.
Next is the issue of resentment. It is entirely normal
to feel resentful of all the time and energy you
are putting into all this caretaking, no matter how much
you love the person and truly want to take care
(15:17):
of them, Frustration with how much you have to give
up and how difficult the task is is inevitable. Sometimes,
when you feel a lot of resentment, it becomes difficult
to hold onto any positive feelings about the person you
are caring for and about your own life. Accepting that
some resentment is normal, and also having personal outlets for
(15:40):
me time like friends to talk with or exercise and
do activities with to engage with, will help keep resentments
at an acceptable level. Try to hold out thirty minutes
each day to do something for yourself. It could be exercise,
a funny TV show, listening to music or chatting with
(16:04):
your friend. Also, hold on to one thing from your
life before you were doing caretaking that you enjoyed and
keep it continuously in your life now. And Last, but
not least, is guilt. If you can realize and accept
that resentment is both normal and that it in no
(16:27):
way means you are not a good person doing a
good thing for someone you really care for, then you
will not go on to struggle with guilt, which can
be a real problem. It is guilt that tends to
make people depressed, anxious, and even unconsciously do things that
are self destructive. Is a means of self punishment. Sometimes
(16:51):
guilt is really irrational, the feeling that you should be
able to save or fix your loved one. Make a
list on paper of the things you feel guilty about.
What exactly do you feel guilty about? Is it something
reasonably fixable or are you expecting magical powers from yourself.
(17:13):
When you actually make a list of guilts and reread it,
you will be surprised to find your guilt diminishing. Getting
someone to spell you, having others to talk with, taking
care of yourself are all important parts of avoiding caregiver burnout. However,
it is sorting through some of the emotional baggage that
(17:36):
comes with being a caregiver that will help you the most.
To whether a difficult and loving task. Do you have
a problem I can help with? If so, email me
at how can I Help at senecawomen dot com. All
centers remain anonymous and listen every Friday to how can
(17:57):
I help with me? Gale Salts
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