Sunday, February 14, 2016

Constructed Guilt

An Alzheimer's diagnosis can elicit a mess of grief-fueled attempts to shift responsibility to others, and a particularly sad aspect of the disease happens when the patient blames his or her primary caregiver for...everything. This can happen even to good and Godly patients, but it is perhaps more likely if the individual has experienced discord with a spouse or other loved one over years of time. Here is a word of warning for all of us who suspect the future could hold a diagnosis of dementia; work hard to forgive. People who go into Alzheimer's disease with unforgiveness or unresolved anger intact can become a menace to those they love. 

Dementia patients lose the ability to draw accurate conclusions from environmental cues, and when a  patient's perceptions are also canted by an assumption that the caregiver is guilty of wrongdoing, disease-riddled logic may conclude that sarcastic and vindictive responses are justified. Patients who hold bitter resentment toward their caregivers can cause emotional damage.

Sometimes caregivers assume blame where none exists in order to excuse a dementia patient's hurtful words and attitudes. There is probably a more correct psychological term, but I call this "constructed guilt." It happens when our loved ones' bitter anger toward us as caregivers is so painful that we construct guilt for ourselves to explain their attitudes. We do this because it is easier emotionally to believe that we brought some of the harsh treatment upon ourselves than to feel we are hated without reason. In Alzheimer's, grudges from the past become mangled and garbled. Patients are no longer certain why they are angry or with whom, and it is the primary caregiver who is likely to receive the cumulative detritus of resentment, anger, and blame.

Releasing guilt can leave a caregiver feeling more vulnerable; it seems safer to say "I don't handle caregiving situations very well and that's why my loved one is having a bad day," than, "My loved one feels hateful toward me just because I'm me!"  But it is better to give and receive forgiveness on a daily basis and then deal with the suffering caused by being the recipient of anger as the Bible directs: "Therefore let those who suffer according to God's will entrust their souls to a faithful Creator while doing good" (1 Peter 4:19 ESV). 

Here are some ideas that may help when dealing with an angry dementia patient:  
--Keep yourself clean of resentment, bitterness, and anger. Bring your sorrows to the Lord on a daily basis. Ask forgiveness and forgive.

--Don't stop praying for your patient.

--It can be nearly impossible to redirect a dementia patient who is angry, but it's worth a try--a tasty snack, an entertaining movie, or physical comforts such as a warmed blanket or sweater may distract. The primary caregiver is often the target of the patient's irrational anger, and so calling a friend or co-caregiver to take over for awhile can help defuse out-of-control emotions. Gauge the level of anger and use your knowledge of your patient to help you decide what course of action to take--and pray.

--Understand that even if venomous words and actions are truly directed at you (as opposed to being misdirected due to confusion about your identity, or simply a symptom of the disease) it doesn't have to devastate you.  If your patient is a loved one, this takes time and effort.  Practice not being devastated, and remember that the Lord's love for you will not waver.

--If don a mantle of excessive care and kindness, you will risk being mocked; if you engage in a shouting match you will affirm your patient's suspicion that he/she is the wronged party. A relatively neutral and matter-of-fact demeanor is best.  Don't allow the patient to elicit strong negative emotion from you.

--Watch your body language. Do not communicate anger. School yourself to keep your caregiving interactions gentle and friendly, even if you are being berated as you comb hair, help the patient into a sweater, etc.

--If the patient is safe, don't hesitate to leave the environment until you feel calmer. Call a friend or co-caregiver to take over for awhile when you need time to recuperate. 
 Of course there are no perfect caregivers, and in any human interaction there is most often wrong on both sides. That is why we must seek the Lord daily and pray "...forgive us our trespasses, as we forgive those who trespass against us."   

8 comments:

  1. Good post. I've experienced this a little but not to a big extent but I can see the time coming. Have a blessed day.

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    1. Thank you Melanie. Not all patients experience the kind of vindictive anger I describe here. If you've seen it just a little thus far I pray that your patient's ill tempers have sprung more from physical factors such as exhaustion or discomfort of a UTI, for example, rather than from the repressed anger and resentment that some people can't contain. Perhaps it won't happen for you. God bless and keep you.

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  2. Thank you so much Linda for your guidiance/ideas. Its so hard to deal with all the bitter terrible words that the one I love can say to me. My husband at the tender age of 64 has dementia. I pray to god to always forgive me when I get upset with him. The things he says about me and to me, like I gave him this terrible disease and that I am happy he is like this, I took his driving license away talked to the Drs to remove it so I can keep him home all the time. Its hard Linda but yes I ask God to forgive us. Thank you I needed to hear this today. I always read your blog but first time I have actually made a comment Thank you again Rina

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    1. Oh Rina. I feel such compassion for you, and the strength of this emotion lets me know it is the Holy Spirit expressing the Lord's love and compassion for you...I'm so sorry for what you are enduring, but I have faith that the Lord will see you through. Hugs and prayers your way.

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  3. Linda, You are amazing. I see God working through you. I am a Christian, but I don't have the strength to deal with 24/7 caregiving; nor do I have a house that is accessible for my mother. I am glad I was able to find good quality care for her and that I can still enjoy my life. Not all are capable of being good live in caregivers but I respect those who are living it day in, day out. It's got to be the most difficult job in the world! :(
    Thanks for your blog. You are an inspiration to me.

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    1. Beth, thank you. The emotional burdens of caregiving aren't restricted to those who provide in-home care. Prayers for you as you walk this path with your mom.

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  4. Thank you Linda for these words of wisdom and encouragement. My mother cares for her sister in their home. One of the things that works for my aunt when she becomes angry or agitated is for someone other than my mother (the caregiver) to visit or call (at my mother's prompting). It seems to break the mood. I've even been able to bring my aunt to laughter, which of course brings a thumbs up from my mother. win/win - since I live 1/2 mile away, it's easy to pop in when needed. A simple distraction, like you mentioned is enough to make the patient forget they were upset. Have a blessed day. ~ Abby

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    1. Thank you, dear Abby! Yes, this strategy of soliciting hep from another does need to be added to the list; poor Farmer John is often sent to my mother's room when my efforts to placate her fail. He can nearly always elicit a smile from her. I will edit this post to add this suggestion.

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