Anger and the Grieving Caregiver
Anger is one very difficult subject for the caregiver to face – to discover and discuss. It is a socially unacceptable emotion in general. However, dying disrupts the routines of daily living. It disrupts not only the desired and comfortable routines of behavior. It disrupts emotional routines as well. Suddenly, new routines are required in caring for the loved one who is dying. New feelings also spring up. There they are, unwanted, unwelcome, confusing, but present anyway. Something must be done with these feelings. How? What? Anger is a frequent answer. It is spontaneous and impulsive and perhaps frightening to the caregiver. Nevertheless, it is entirely human.
Anger must find a target. The first such target is the dying loved one. After all, he is the one who has forced the caregiver to make unpleasant and unwanted changes in otherwise preferred life routines. The feeling of anger against the loved one is usually intolerable for the caregiver. It is perceived to be shameful and embarrassing – certainly nothing to be proud of. If so, then, the anger may also be displaced onto others instead of – or in addition to – the loved one.
One such secondary target is often the attending physician or another medical professional. A perfect textbook example of anger displaced onto the doctor is offered by Dr. Monica Williams-Murphy, herself. It is clear, crisp, uncensored. She receives the ultimate insult that a nurse can hurl at a doctor. It is word murder.
“I had originally asked if there was anyone else in the family whom I needed to talk to [about the elderly dying lady] and the initial answer was, ‘No.’ But shortly after, an out-of-state daughter called identifying herself as the power of attorney and said, “I want you to take the DNR order off, because this means you won’t do anything to help her.”
I politely attempted to explain otherwise: “No, I actually had filled out a limited resuscitation order which directs doctors to do everything but place her on machines. And above all, we will help her to be as comfortable as she can be no matter what kind of treatment she is receiving.”
Her response: “Well, I’m a nurse and I don’t believe you.” [emphasis added] (click here to read original article)
In this regard, also, there is a reason why the very first order of the Ten Commandments states: “Thou shalt not kill.” That is a moral imperative. Anger is ubiquitous and potentially dangerous. If thoughts and words could kill (as every young child believes), probably all of us would be dead.
Anger is often viewed not only as shameful but also immoral, especially when directed against someone who is already dying. The caregiver frequently finds additional ways to deal with this awkward and inconvenient emotion.
Anger can be turned inward against the self, also. This happens outside of conscious control. It says, “You are a bad, bad person to feel angry.” Major depression can result from this turn against the self. It is not a healthy solution to anger.
Anger, however disguised, is moreover a common cause of guilt. Guilt in itself can cause extreme fear, panic – as though there weren’t already enough reasons to be scared!
Better to talk about it. Don’t wait till anger becomes a sickness. Don’t practice self-deception. Talk soon. Open up. Don’t be too afraid to do it. Talk about it with those who are patient and compassionate and able to listen without blaming. Choose to talk with people who see that anger is complex and painful and has emotionally logical reasons. And yes indeed, love and anger can coexist. Anger does not mean love is dead. Talk to someone who is resilient, who knows dying and surviving.
–Rea Ginsberg is a retired director of social work services, hospice coordinator, and adjunct professor of clinical social work.
Publication History: Originally published on the OKtoDie blog, June 18, 2013:
(image credit: www.michellehan.wordpress.com - "pieces of a broken heart" )
Strength and Growth of the Bereaved Caregiver*
I know an elderly gentleman. He is 85 years old. He is a physician, and he is my friend. One day, he joked about his mother. She died 60 years ago. He said with a slightly wry smile, “I think I’m over it!” He isn’t. He knows it. I know it. And he knows that I know. He likes that. It is our special secret.
Mark is also one of my friends. He was 20 when his grandfather died. The two were very close. Mark wrote a letter of thanks and sorrow to Grandpa. He folded it into the box with the ashes. That letter was buried with the ashes. Then we hugged each other and he cried. Of course we know Grandpa didn’t read the letter…unless he did. I know Mark still hurts. He knows I know. It is something we share. It is good. Mark will not “get over it.” He will grow with it. He will grow into it.
Every loss changes us. We incorporate the experience. It revises our concept of who we are. Self concept. Self identity. Every loss is finally a growth experience. In that sense, every loss also makes us more fully alive and unique. That deserves recognition.
Too often, we think of strength as a stoic disregard for feelings. It is the no-tears approach. “Move on,” we say. “Get over it.” Not so fast! That attitude makes it nearly impossible for the bereaved caregiver to feel accepted – accepted by himself and by others. It is an unrealistic expectation. Grief is for keeps, not for weeks. And that’s OK. It needs respect. It is normal. Even in the best circumstances – the well-planned “good death” – the caregiver is left to cope with a weight of conflicting emotions. Each of us has our own time line for grieving. That time line needs permission and appreciation, both from the grieving person himself and from those who surround him. If given a chance, then, emotional strength will show up. Strength comes from working with those feelings in an atmosphere of dignity and compassion.
What is strength? How does it show? In broad practical terms, it looks like this:
1. Having strong feelings that are not necessarily pleasant;
2. Having the courage to become aware of those emotions and look at them squarely;
3. Not being afraid to express them openly – belief in self-resilience.
These are almost inseparable qualities.
The “good stuff” is easy to take and to express. It is the happier feelings. The “good stuff” is the sense of having done it “right,” of having conducted the passage to a “good death.” Pride of accomplishment feels fine. All the details of dying receive attention: advance directives, place of dying, pain control, gentle care, promises made and kept, forgiveness requested and received and offered, permission to die granted, goodbyes said, important people present, after-death care given as expected. More. All of that is a distinct source of self-congratulation, self-esteem, and growth for the bereaved caregiver. It is an achievement. It feels grand and extraordinary. It feels just. It feels moral!
Dealing with the “bad stuff” is not as easy. What’s the bad stuff? At least some or all these:
Guilt (for any suffering that might have been prevented – the what-if’s; survivor guilt);
Anger (at the loved one, because he left);
Sadness (of course);
Fear of abandonment (by the whole human world);
Fear of losing one’s mind (becoming insane; uncontrollable repetitive thoughts);
Fear of inability to recover successfully from the loss (sense of enduring emptiness);
Preoccupation with health (exaggerated concerns about physical illness and dying);
Flashbacks, nightmares, and restless nights…
At first, it is hard for the bereaved caregiver to differentiate these feelings. They are overwhelming. They are usually irrational. They are always excruciating. They are also natural.
Even under the best circumstances, recovery for the caregiver is tough. The “bad stuff” needs attention and expression. The feelings are mixed up, and they are powerful. They feel more than a little crazy. The caregiver needs to be able to face these feelings. Strength is not stoic silence. It is not the buck-up stiff-upper-lip way. It is not denial of pain. And it is not “forgetting” about death and dying.
Strength is having the energy to reach out, to show pain, to ask for a sympathetic ear or two or three. It is unashamed tears. It is the guts to talk about the unspeakable and to know, at the same time, that those words and that talk are survivable. It is the belief in the adaptability of the self. It is the maturity of insight. It is trust in intuition. It is confidence that life will return to some sort of balance, an equilibrium. It will be a new and different balance but a balance nonetheless. It is knowing that the relationship to the loved one endures, but in a different form. Strength is the caregiver’s ability to gradually rearrange the relationship in his mind, internally. It is knowing and accepting that he will never exactly “get over it.” The process takes patience and perseverance. All of this is strength. All of it contributes to recovery – to a brand new and higher level of being well. It is a level that has included healthy grieving. Inner resources have been enriched. Life will feel OK again, and renewed. Refreshed. Death shows us how.
Yes, it’s OK to die. And yes, it’s OK and clearly wonderful to live on.
* Dying is a pre-existing condition: we all do it someday. A fundamental fact of life is that it ends (to paraphrase Dr. Monica Williams-Murphy). Dying is not a mental disorder, although it is an unprecedented event in the life of every human being. Grief is not major depression. This is so obvious that it hardly deserves a footnote. Grief is a normal occurrence in our lives. By definition, it hurts. It has no automatic timetable for ending. This essay is not an effort to address or rewrite any part of the controversial Diagnostic and Statistical Manual of Mental Disorders (DSM), nor does it reflect on the International Classification of Diseases (ICD). Rather, it is an attempt to broadly view the sense of grief as it is perceived by the close caregiver(s) after the death of a loved one. In addition, it is intended to help the bereaved caregiver to cope with, and understand, various intense emotions – some of which reoccur every year, on or near the anniversary date of the death.
Here is a Dr. Murphy “mantra” from her excellent book, It’s OK to Die. Read it, keep it, and then reread. Memorize. It will make mourning easier to bear.
Life is fleeting and fragile. Live and love as though every day is your last, or your mother’s last, or your child’s last. Leave no words unsaid, leave no plans unmade. (pp. 19 & 21)
Publication history: first published June 25, 2013 on OKtoDie blog:
An appreciation to Monica Williams-Murphy, MD, for her invitation to write this piece and for her unfailing support and encouragement. Life in the land of monsters and mourning requires the kindest company.
(image credit: www.hospiceofsiouxland.com)