The Third Third

Patterns of Care

  My mother-in-law was absolutely certain her husband intended to lash out at her when his dementia took hold.  “He’s not sick,” she would say. “He’s just doing this to get at me.” Let’s ignore for the moment her need for Denial as the personality and strengths of the man she had married 50-plus years ago slipped away; was he “doing it” to her? For that matter, was my 89 year-old father intending for me to regress to my obedient, terrified 12 year-old self when he berated me for the meals I cooked, how much food I put on his plate, or for buying the wrong sized socks after he specifically told me what size to get?  Was his hyperbolic anger really directed at me, or, for that matter, at whichever daughter was attending him? I now think not.  At the time it was excruciatingly difficult not to take personally what amounted to verbal abuse when you were trying your darnedest to be helpful and caring. My mother-in-law, in fact, died trying, and never knew the relief I have recently discovered. In the manuals we might read about caring for aging parents and/or debilitated spouses, I now believe there should be a chapter on the psyche of the one being cared for. Because, as I listen to friends caring for their elderly parents in crisis and/or in one case, a failing spouse, I can hear patterns in the care-giving relationships that, had I recognized them when I was the caretaker, would have spared me considerable angst and grief.  He wasn’t angry with me.  He wasn’t cursing me. He wasn’t blaming me.  He probably didn’t mean to sound so demanding, so imperious, so dismissive of anything else I might have had to, or even just wanted to do. Instead (though let it be said my father had a whole lot of anger and made a whole lot of demands throughout his life) what we were more likely witnessing was his fear and frustration, his anger not with us but at his circumstances, his anxious realization that end-stage disease meant end-stage and the concomitant -- and absolutely abhorrent --loss of control and abilities and independence.  As if dying weren’t insult enough. Thus, in a friend’s case, her mother after a bad fall insists upon eating only food she prepares, a certain color of elastic-waisted pants to wear to rehab, the putting up and taking down and packing away of Christmas decorations exactly as she would have done it, and not having any more help in the house; and she insists without regard to the reality within which her daughter is operating and not at all politely.  She insists, in fact, in anger, waking people up with a two year-old’s temper tantrum about all the things she wants to control even as she realizes, very, very unhappily, that she cannot. I can listen objectively as my friend vents about an episode, and I can hear the pattern now of sick, old, scared people as they grasp for something, *anything* to control.  They are unconsciously, I think, acting like bullies out of insecurity and fear.  And as it turns out in most cases (though not, let’s be clear, in ongoing cases of abuse), when a caretaker kindly, gently, but firmly establishes her own boundaries, “No, Mother, I can’t do that now; we’ll take care of it tomorrow,”   or “Well, Dad, I can fix this sock situation pretty easily; if you’ll stop yelling about it, I’ll go back to the store tomorrow,” the crisis can be diffused.  I don’t write this to excuse bad behavior.  It can be really mean and nasty.  On occasion I felt compelled to apologize for my father’s cursing at nurses and aides. Sometimes I called him on it, and other times my sister would try to cajole him, “Just say ‘That’s Nice,’ Dad, no matter what you think.  Let’s practice.  ‘That’s nice.  That’s nice.’  No, not ‘Bull\----’” And they would laugh.  The other helpful modifier, I found, especially with my father-in-law, was medication -- in his case, an anti-depressant that kept him sweeter and gentler, but not doped up. But the insight here is not about the patient’s behavior; it’s about the caretaker’s understanding and mental health.  The job is hard.  We need not make it harder by taking personally every slight or affront.  It’s all part of a pattern, perhaps the most basic human (and/or animal) instinct.  When frightened, we go to the “Fight or Flight” response. .   .until we can’t escape.  Then all that’s left is “fight,” which, with my dad in the end, I realized was a good thing.  On his worst days, he was fighting, after all, for his  very life.  It was when he tol;d me he was "just too tired" to fight any longer that he died.
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