During my years in family practice, I often noticed that the death or illness of a person, especially among the elderly, was rapidly followed by the illness or even death of the spouse. Such “coincidences,” noted by many physicians, have now been documented by a large-scale medical study.
The report, published in the New England Journal of Medicine, found that elderly people whose spouses are admitted to hospital are themselves at increased risk of death in the near future. “People are interconnected, and so their health is interconnected,” said Nicholas Christakis, the lead author and a professor at Harvard Medical School. His article acknowledged the existence of, so-named, “interpersonal health effects.”
This study illustrated, again, the mind/body unity too often ignored in medical practice — the indissoluble interconnections between people’s emotional lives and their physiology. Speculating on the reasons why a spouse’s admission to hospital should pose a higher death risk, the authors surmised that “stress and lack of social support may . . . adversely affect immunologic measures.”
Caregiver stress, one of the factors influencing the outcome of the NEJM study, has long been recognized as a source of illness. The caregivers of people with Alzheimer’s dementia, for example, have been shown to have reduced immune response to the flu vaccine, and a greater risk of falling ill. They also have reduced wound healing. In a study two years ago, the mothers of chronically sick children were found to have deterioration of their chromosomes of up to 10 years in advance of their chronological age.
The psychological burdens of caregiving trigger the body’s physiological stress mechanisms, with multiple and often silent effects on the nervous system, the hormonal apparatus and the immune system — silent, that is, until they present themselves in the form of illness. Such psychological burdens can also directly affect the heart, the intestines and other organs.
But what to do? In our fragmented society, the communal supports that have traditionally sustained human beings — tribe, clan, village, community, extended family — have been eroded. Many people find themselves isolated, having to act as the primary caregiver to a family member, be it a child, an elderly parent, or a spouse. How can they protect themselves from the negative health consequences of chronic caregiver stress?
The first step is to recognize that you are being stressed. The most damaging stress is the hidden kind — hidden because we no longer pay attention to our bodies, to how we feel, and to our own needs. Recognition requires taking some time regularly to check in with ourselves. How was my day? Did I have even five minutes to call my own? Is my body sending me any messages in the form of symptoms, such as fatigue, headaches, stomach aches, neck pain, muscle tension or depression or signs of anxiety such as poor sleep or a dry mouth? Such symptoms may be, and most often are, the body’s way of telling us that we have taken on too much. Our body is trying to say no when we haven’t been able to.
Recognizing your ignored needs, you have to honour them. No matter how great the demand for our services, we must find regular respite from our caregiving duties. I have often noticed that in many families certain individuals automatically take on the role of the caregiver, and that everyone around them automatically expects them to do so as well. Many people, especially if all their lives they’ve been the hyper-conscientious sort, always feeling responsible for everyone else, take on the burdens of caregiving without a murmur.
For example, among several adult siblings, one will assume responsibility for the care of the parent with Alzheimer’s. It may take courage on the part of the consensus caregiver to assert her needs for respite and support, but not to do so is to invite ill health.
The form of respite — listening to music, a walk in nature, a hot bath — will vary from person to person. The absolute necessity is to create space for it in our lives.
It is also important to express your emotions concerning the stresses of care giving. Some people experience guilt if they tire, physically or mentally, of the endless responsibility and are ashamed of owning anything but positive feelings. Yet, such fatigue is natural. Sharing our emotions is an essential ways for human beings to alleviate the physiological consequences of stress.
Finally, we have to drop whatever unconscious beliefs keep us stuck in the role of the automatic caregiver. One common way of thinking is: “I must be strong. I mustn’t have needs or demand anything from others.” Such beliefs keep us from accepting our own universal, vulnerable humanity and, far from helping us maintain our strength, will in the long run surely undermine it.
Comedian Gilda Radner discovered such truths only too late in her life. Until shortly before her death from ovarian cancer, she poured her energies into looking after the needs of others, even of strangers, completely ignoring her own. “I couldn’t cry all those tears for others,” she finally wrote. “I had to take care of myself. . . . It is important to realize that you have to take care of yourself because you can’t take care of anybody else until you do.”
written by Gabor Mate -originally printed in The Globe and Mail, February 25, 2006