How The Caregiver Should Take Care Of Themselves

Those who care for people with chronic mental illnesses – such as schizophrenia, paranoia, bipolarity, melancholy or autism – come to medical consultations when the situation has pushed them to the limit : they suffer from symptoms of depression, phobias, persistent psoriasis, anxiety attacks … How do you get to this point?

The particular relationship with the caregiver in case of mental illness

We must start from the basis that those who are in charge of people with serious chronic mental illnesses are usually, for the most part, women (although they can also be men) who maintain some type of family or emotional bond with the patient. They are usually daughters who take care of one of their parents; parents who have to live with a child with psychological problems, sisters or brothers; or even a couple.

Be that as it may, although some of these patients can live independently, the truth is that most of the lives of these caregivers are subject to the vicissitudes of the people in their care. The accompaniment to the different professionals (psychiatrists, social workers, psychologists, aid centers …) and even to hospital admissions, subordinate the daily agenda of the caregivers, marked by the institutions that surround them. But that is not the biggest problem they face, since these circumstances can occur when they are in charge of people with other pathologies that are physical.

The biggest problem when caring for a person with a mental illness is that the caregiver wants to understand and make the patient understand what is happening to him, with the idea that this will help him and a more fluid coexistence will occur. A commendable undertaking if it were not because, in these cases, the rational coordinates with which the caregiver and the caregiver move are absolutely different.

Competing visions

The caregiver gets down on himself trying to explain, for example, why he has to take his medication, take a shower or stop calling him compulsively when he is distressed. The patient sees it in a very different way.

These people do not accept the absence of their companion. It does not matter if this exposes them the reasons or obligations that you have to leave. For them, their presence has to be permanent. There are many cases in which they openly declare it themselves: “A mother has to be, above all, for her children.” Or the other way around: “Children have the obligation to always take care of their parents.”

They are absolutists. And if any specialist tries to qualify or contradict them, they get angry or do not want to see them again.

It is clear that they are the first victims of your mental system, even if they are medicated. But, internally, these patients do not feel that they have a problem, but that others do not understand them, although they cannot say what is the reason for their behavior.

If they are asked why they did this or that thing, they answer with the first thing that comes to mind, even if it has nothing to do with the subject; they say what they think they should say or they simply lie.

This way of acting that occurs, to a greater or lesser degree, on a daily basis, means that caregivers do not know how to distinguish when they are telling the truth, when they are fables or when they are lying. Therefore, communication becomes impossible.

Endless demands

Added to all this is an exasperating negativism. Any proposal that is made to them to improve their life, be it physical, social, cognitive or entertainment, has a negative for an answer. They only accept, with exceptions, if from prepared institutions – such as day centers, therapeutic groups … – they are obliged.

All this causes that, with respect to family members, their degree of dependence is increasing, generating in their caregivers a feeling that oscillates between impotence and guilt.

• Impotence because they no longer know what else to do to make them take responsibility for their lives and needs.
• Guilt because, to the extent that their demand is insatiable, since they always want more, they can become exasperating, and even make the caregiver feel that they are doing very badly.

Those with severe mental disorders (schizophrenia, chronic deep depression, paranoia or bipolarity) regress that leads them to behave like young children, sometimes spoiled.

They cannot bear waiting, frustration, or absences, so they create a thousand and one strategies to get others to compensate them. Saying that they have lost the keys, the DNI, that they are sick or that something serious has happened in the house, even though it is all false … can be used so that the caregiver has to leave their things and take care of them.

Their model is that of the state of the sleeper, they do not want any disturbance and, if there is one, to have it removed, and do only what they feel like doing. If we give in to these continuous claims, we are only enhancing that infantile involution, with the consequent effect that, with the flight of a fly, they can feel anguished and begin the cycle of requests.

Combining the understanding of mental disorder with not falling into its nets becomes a very difficult task.

Help guidelines for the caregiver

• Delegate as much as possible

A lot of functions are concentrated in a caregiver of people with mental disorders , ranging from having to resolve institutional issues, aid, income, medical visits, to the most daily tasks of subsistence, hygiene and treatment.

The caregiver is not a specialist in any of these tasks. You should not blame yourself if you do not get everything, but rather try to delegate some care to others.

• Adjust affective expectations

The patient perceives the caregiver as the representative of all those professionals who, according to his way of reasoning, do not leave him alone and force him to do things that he does not like. The account starts negative. In addition, there is an affective bond between the caregiver (or caregivers) and the patient.

But these patients with mental illnesses may not understand affection, affection and love like the rest of the people. What others do to make them feel good can be interpreted by them as the opposite. Let us not forget that, in this case, the patient is like a child who does not want to go to the dentist.

The caregiver must be prepared and not get frustrated if they do not find recognition or anger develops.

On the contrary, when they are distressed they do refer to their emotional ties and demand the unconditional presence of the caregiver, pretending an immediate and absolute symbiosis. When the crisis is more or less resolved, they still prefer that he leave. Let’s not expect them to be interested in the difficulties or how the caregiver’s mood turned out.

• Assume different perspectives

Let’s not pretend that they understand our logic. We can explain it to you, but it will be like a bream dialogue. One is speaking in one language and the other, such that a shredder, is assimilating it to his, which is totally different.

Apparently they are understanding us, and will even say yes; but, after a very short time, they will repeat the same behaviors.

• Negotiate as much as possible

The most effective option for coexistence is to reach agreements. Being able to mark an exchange : if they perform certain tasks or obligations, such as taking medication, showering or not calling compulsively, they will receive in return some of the things they like, such as watching television or accompanying them to a distraction that attracts them.

• Empower the person cared for

Sometimes the reverse also works. When they have fabled that they have lost something, but they do not want to look for it, or that they have a problem, for which they say that we must leave everything to solve it, the best thing will be to reassure them but force them to describe it and try to solve it them, that get involved and don’t infect us with your anguish.

Let us remember that, until the onset of the crises, these people have been able to lead normalized lives, but once the disorder has been triggered and with the blocking medications that are used today, they may have changed a lot.

The main idea would be that the caregiver can recover their own life and take out the guilt for not being able, nor wanting, to be one hundred percent for them.

• Don’t forget about the person you care for

It is convenient that they do individual psychotherapy to rescue something of their initial personality. In the case of dementias or Alzheimer’s, although the person is also becoming a stranger, here we cannot pretend that they will improve. Be that as it may, caregivers would have to seek some psychological support, either individually or from groups of relatives with similar patients.