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Caregiving and the Blame Game

How to avoid finger-pointing and guilt while caring for a family member

While looking after others, caregivers should also look after themselves and avoid accepting unnecessary blame or guilt for situations beyond their control.

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While looking after others, caregivers should also look after themselves and avoid accepting unnecessary blame for situations not under their control.

To err is human, goes the common saying. To blame seems to be human, too.

When one of my patients, a 70-year-old I'll call Victor, suffered a cerebral hemorrhage after falling off a ladder while cleaning rain gutters, his whole family joined in the blame game. Victor blamed his second wife, Alice, for not coming out to hold the ladder steady. His adult children from his first marriage blamed her for allowing a man of his age to attempt that dangerous chore. She blamed herself for not preventing him from drinking three beers that afternoon.

Roundly faulted, Alice felt guilty and depressed at first. She threw herself frenetically into caring for Victor to repair the damage she'd supposedly caused. But over the many months of his slow recovery, she eventually became infuriated. No matter how much she did and how many of her own health problems arose, he and his children demanded more of her. It was as if she could never dig out from under the mountain of blame heaped on her.

Human beings resort to such finger-pointing for myriad reasons: It helps us vent fears and frustrations as well as ward off unbearable guilt. It allows us to avoid feelings of grief over loss. It is also an attempt to gain control and avert repeat disaster in what may feel like a chaotic free fall.

Caregiving families are no different. Care receivers blame caregivers for inadequate care. Caregivers blame care receivers for inadequate effort. Caregivers blame other family members for failing to show up. Other family members blame caregivers for failing to share information and opportunity. Both care receivers and caregivers blame "uncaring" health care professionals — who blame them right back for being "noncompliant" to their expert instructions.

If blaming were an effective strategy for rallying people together, then caregivers would greatly benefit. But it causes most of us to feel hurt and alienated.

How should caregivers handle being blamed and avoid blaming others? Here are some ideas.

When blamed, respond with understanding. It is a natural reaction to defend ourselves when unfairly blamed. But putting up a vigorous defense or pointing the finger elsewhere often makes us look guilty of the charges. Instead, try to extend empathy to the blamers. If we can sense the fear and sadness — not measured logic — behind family members' reactions, then we won't feel stung by their accusations.

It galled Alice that her stepchildren initially blamed her for their father's fall. But eventually she understood how difficult it was for them to see their once powerful father sapped of strength and clarity by his brain injury. By empathizing with them, she was able to work with them through and after this challenging period.

Don't accept undue responsibility. No caregiver should accept blame for matters outside his or her control, simply to mollify others. In the long term, the caregiver would wind up feeling demeaned and demoralized. Instead, caregivers should calmly agree to disagree about who's at fault and then focus on the caregiving problems at hand.

Over time, Alice decided she'd no longer beat herself up or argue with her husband about the beers. It was his choice as an adult to climb that ladder. By continuing to understand and love him, she ultimately helped him stop ruminating about the past accident and turn his attention to his present efforts toward recovery. Condemning one another is just an indulgence if we really intend to heal each other as much as we possibly can.

Barry J. Jacobs, a clinical psychologist and family therapist, is a member of the AARP Caregiving Advisory Panel.

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