Caring for the carers - how to deal with the challenges carers face
Caring for The Carers
Much has been written about the benefits of mindfulness for people suffering a whole array of medical and psychiatric conditions. But what about the carers? Those people who devote their lives to caring for the dying, sick and disabled.
Many people make heroic efforts looking after their loved ones who suffer various debilitating or life-threatening illnesses. These illnesses include psychiatric conditions such as schizophrenia, depression, bipolar disorder, severe anxiety disorders and substance abuse disorders. They also include a whole variety of medical conditions including terminal cancer, dementia, chronic pain disorders and so on.
The toll taken by looking after loved ones is sometimes referred to as burden of care. This burden of care can affect health care professionals even though they have the respite of going home in the evenings and on the weekends. In 2012, JAMA Internal Medicine published the first comprehensive study of doctor burnout—and found that 46 percent reported at least one symptom of burnout, especially those who work on the front line of care. There may be a relationship between the symptoms of compassion fatigue and the risk of committing medical errors and patient dissatisfaction with care.
Constant exposure to pain and suffering is a risk for anyone in these types of roles, whether they are be a professional or a family member who has chosen to support their loved one. It is difficult being present to the pain and suffering of others, especially those that we love. Through a process known as emotional contagion, we feel their pain and suffering, as if it is our own. If we become overwhelmed by that, we are no longer in a position to help the other person and we are in danger of getting quite sick ourselves.
How do we deal with this?
Sometimes people harden themselves and create a kind of emotional cut-off as a way of managing this. This emotional cut off then pervades that person’s entire life including all their other relationships. This is a tragic outcome for too many health professionals and is obviously not a good solution.
Sometimes carers take on impossible rescue missions in an attempt to manage their own distress about the deterioration of the ill person. A professional may work ridiculously long hours. A loving carer may allow caring for a loved one take over their whole life. The modern philosopher Ken Wilbur, in his book Grace and Grit, described how he had a meltdown doing this while looking after his wife who had terminal cancer. He realised he had been totally ignoring his own needs.
Mindfulness is a great way a carer can look after themselves. With the practice of mindfulness we can remain empathic, letting ourselves feel the patient’s pain and suffering without absorbing it as if it were our own. We don’t have to make ourselves hard and callous in order to cope. We can develop an inner steadiness whereby we find it easier to resist going on impossible rescue missions.
The serenity pray used in Alcoholics Anonymous can be a very helpful reflection in these circumstances:
Give me the courage to change the things I can
The serenity to accept the things I can’t
And the wisdom to know the difference
When we practice mindfulness, we inevitably step back and gain perspective. This perspective allows us to notice when we are getting exhausted and depleted. Then instead of pushing ourselves even harder on automatic pilot, we have the choice to be skilful. We have the choice to step back and think about what we can do to look after ourselves. We don’t have to wait until we have a meltdown like Ken Wilbur did.
Here is a simple practice that can help the helper get perspective:
Step 1: Spend a few minutes focusing on your breathing. When the mind wanders onto whatever subject (such as the ever increasing to do list), simply bringing the mind back to the breath without judgement.
Step 2: Imagining a friend or a patient in exactly the same situation that you are now.
Step 3: Imagining what advice you might give this person about their self-care.
Step 4: Imagine receiving that advice for yourself and breathing it in. As you breathe it in, notice the sensations in your body. Noticing how it feels in your body to receive your own advice.
Most helpers find that in this visualisation, they are much kinder to the hypothetical helper than they are to themselves. With this visualisation the helper can discover how to treat themselves with as much respect and love as they are treating the patient. When the self respect and love is in balance with the respect and love for the other, we are able to achieve the best possible outcomes.
Daily practice of mindfulness guarantees we regularly take time to nurture ourselves. Moreover, as we practice mindfulness regularly, we noticed that our emotions become cleaner. They come and go without leaving so much residue. If we become cranky out of tiredness and feeling unappreciated, that feeling is likely to come and go, without leaving us with a lingering resentment. If we become distressed to the point of crying, again that feeling is likely to come and go, without depleting us even further. This is one of the ways that mindfulness makes a stronger. Mindfulness also helps us to become more flexible. This means we are more likely to recognise opportunities for relaxation and enjoyment that might otherwise pass us by. These benefits accrue with regular daily practice.