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Caregivers: Living With Guilt

How to keep it in check by tolerating ambivalence, maintaining balance and staying realistic

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Don't aim for guilt-free caregiving. Guilt is part of who we are.
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Whenever I'm too busy to visit my mother at her nursing home, I feel guilty for neglecting her. "Cancel other family plans," I say to myself. "Then you can go see her and alleviate your guilt." But when I announce this to my wife, I suddenly feel guilty for disappointing her. She rightly points out that it is excessive guilt that compels me to see my mother so often. I then feel guilty about feeling so guilty.

Pretty neurotic, huh? I wish it weren't so. But guilt is an ever-present emotion for many family caregivers for a variety of reasons: Because of what we haven't done for our ailing loved ones. Because of what we did, which we think was inadequate. Because we still can function physically and cognitively in ways in which they are no longer capable. A little guilt along these lines probably makes us more sensitive and attentive. But too much of it torments us and saps all possible joy.

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And guilt usually is joined by other challenging emotions. Caregivers who are harshly self-critical — those who beat themselves up — are more prone to depression. Former caregivers of now-deceased loved ones grieve longer if they second-guess their previous caregiving. And guilt often leads to what I call reactive cycles: I feel guilty. I then feel angry for having been made to feel guilty. I then feel guilty for having felt angry. I then feel angry again for feeling guilty again. And so on.

How can we come to terms with guilt and still feel proud to be hard-working, well-meaning caregivers? Here are some ideas:

Don't aim for guilt-free caregiving. The feeling that we should do more and better for one another seems to be built into our species as a group survival mechanism. Guilt is part of who we are. So that discrepancy between what you think you should do and what you're willing and able to do may always cause some guilt. Let's accept that as a given, then, and work on tempering the feeling.

Give up the fantasy of rescuing others. Caregivers sometimes try to ward off the sadness they feel witnessing a relative's suffering by believing they can provide complete relief or even a cure. But that sets an absurdly high standard. We owe our loved ones good effort, but perfect outcomes can be impossible. Hold yourself to realistic goals, not fantastic ones.

Maintain balance. Few of us have only one family role. We are children, parents, siblings, spouses and dear friends in myriad loving relationships. At some points in our lives we do have to commit far more energy to one person than another, but we still need time to maintain our other social connections. While taking those breaks from caregiving may bring up feelings of guilt, they're necessary for our own emotional health.

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Tolerate ambivalence. Some caregivers experience guilt and harsh self-criticism if they feel at all negatively — anxious, angry — about their caregiving duties. It's as if we think that dreading some aspect of caregiving means we no longer love the care recipient. But having negative feelings is part of normal family life. In the years before old age and illness, our family members were probably sometimes irritable toward one another without so much self-condemnation. Caregiving doesn't make us angels. We're still cranky humans.

Find other motivations. Guilt sometimes induces us to do things we really don't want to do. We then become resentful. It is far better for us to act on more noble impulses — wanting to provide care because it is important to us or pleases us.

That has been my wife's main point to me. I shouldn't see my mother on some rigid schedule because I would feel guilty otherwise. I should visit her because I want to see her whenever I can. The truth is I do want to see her. I will try to change my schedule to make it happen.

Barry J. Jacobs, a clinical psychologist, family therapist and healthcare consultant, is the co-author of Love and Meaning After 50: The 10 Challenges to Great Relationships — and How to Overcome Them and AARP Meditations for Caregivers (Da Capo, 2016). Follow him on Twitter and Facebook.

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