En español | I hadn't yelled this loud and long since my kids were little and disobeyed me. I had never yelled like this at my mother. But one night recently when I was very tired and had discovered she had frittered away money she couldn't afford, I lost my temper and let loose with a top-of-the-lungs rant. She closed her eyes and didn't respond. This made me madder, and I yelled some more. It took me minutes, not seconds, to calm myself down.
I felt terrible afterward, guilty and angry at myself for having exploded at a loved one impaired by mild dementia. I also was frightened by my sudden loss of self-control. When I apologized to my mother the next morning and she forgave me, I felt slightly relieved but still shaken. Like the many caregiving clients who've confessed to me during psychotherapy sessions about shouting at their own loved ones, I worried I was turning into some monstrous abuser.
Why do family caregivers occasionally yell — even when they know it only inflames a bad situation? Because, as caregiver advocate Carol Levine has pointed out, we are "always on call" for our care recipients' needs, and this constant strain erodes our patience. Because our loved ones' behaviors, truth be told, can be very annoying, and our frustrations build up to the boiling point. Because we feel angry about being overwhelmed by caregiving demands and then wrongly lash out at the people for whom we are committed to providing care.
We then feel great regret for much of the rest of our loved ones' lives and afterward. In a 2011 article in the Philadelphia Inquirer, reporter and spousal caregiver Stacey Burling wrote about how commonly caregivers have meltdowns and how these experiences complicate their bereavements once the care recipients die. "We end up feeling bad about behaving like normal, flawed, frightened, exhausted human beings," she said.
How do we avoid such blowups? And, if we are prone to them, how do we prevent their recurrence? Here are some ideas.
Distinguish abuse from simply bad behavior
Elder abuse is a serious national problem. Unfortunately, sometimes frustrated family caregivers are the culprits. If ever a caregiver hits, pushes or in any other way strikes a care recipient physically, then the situation has become so dangerous that the caregiving arrangement must cease immediately — even if it means that the care recipient has to be placed in a facility. Yelling is more difficult to define as abuse. Most of us fume angrily at our family members at some point in time, but that doesn't make us abusers. However, if yelling becomes a frequent occurrence or the intensity of the outbursts is steadily increasing, then the current caregiving plan clearly isn't healthy for the caregiver or the care recipient and should be quickly changed.
Heed the warning
Yelling should be considered our psyche's signal that we are overstressed and need to shift our emotional stance, get more rest or seek help. We ignore that signal at our own peril, making ourselves more likely to burn out and lose control. Instead, we should decrease our caregiving burden by changing the caregiving plan to include others' support.
For example, in the aftermath of my yelling incident, I called my brother and cousins to report that I was struggling and needed greater assistance from them. They made arrangements to visit my mother in the near term, thereby providing me with some respite, and began calling me more often afterward to inquire about my well-being.
Forgive yelling and other imperfections
Ultimately, beating ourselves up for expressions of pique is probably more harmful to the caregiving than the harsh, loud words we've uttered. Excessive guilt usually renders us more demoralized — not kinder or more conscientious — and therefore less able to sustain ourselves in our crucial caring roles. That can only be detrimental in the long run to the loved ones who depend on us.
What's more important for us to accept, though, is that we are fallible humans who are doing our best to muddle through difficult circumstances. Like the care recipients whose foibles we attempt to tolerate more graciously, we make mistakes, including losing our tempers.
If we can forgive our own imperfections, then we are more likely to forgive those of the addled and sometimes exasperating people for whom we try so hard to care.
Barry J. Jacobs, a clinical psychologist and family therapist, is a member of the AARP Caregiving Advisory Panel.