Caregivers: Depression or Grief

“A broken heart is also an open heart. Your vulnerability is also your strength. Do not run from your openness.”

David Kessler

Caring for and loving our parents, partners, children, friends, and clients can be a huge opportunity for growth, openness, and fulfillment. Caregiving also brings up the age-old question of how to balance one’s own needs with those who we care for. In caregiving relationships, much like other relationships, keeping one’s heart open may at times feel like an enormous challenge. It’s important to experience, be open to, and be kind to, the full range of our feelings — both positive and negative. An open heart is necessary so that we don’t burn out, become resentful, or shut down. Being open to one’s vulnerability may actually prevent one’s difficult feelings from turning into depression.

As a psychotherapist I work with both grief and depression, and I find that often people confuse the two. Grief can be understood as a very natural experience, usually characterized by intense emotional pain following a significant loss. There is an initial deep sadness, sometimes overwhelming, which is then followed by waves of emotions that get triggered by thoughts, memories, particular dates, or familiar activities.

There are a number of reasons why a caregiver might be especially likely to experience grief, including loss of mental and physical capacities of a loved one; death of a loved one; isolation if doing the caregiving alone; long distance caregiving; loss of one’s own lifestyle; and less time for play, romance, exercise, contemplation or sleep.

Depression is characterized by severe symptoms that impact how one may feel, think, and experience daily activities such as sleeping, eating and working. Caregivers with depression may experience persistent sadness or anxiety as well as feelings of hopelessness, guilt, worthlessness, or helplessness. There may be a decrease in energy, feelings of restlessness, or difficulty concentrating. There may be other physical symptoms such as unexplainable pains. One may notice intrusive thoughts about death or suicide. Some combination of these experiences is common when one is depressed. https:// depression-test

Recently I had a vivid experience of the relationshipbetween grief and depression. My partner of over 40 years was diagnosed in 2012 with a rare form of a basal cell cancer, which is not currently curable. Since that diagnosis, life has felt precious. The ups and downs from diagnosis, to treatment, to remission, to the most recent reoccurrence, have impacted us both.

In November 2017, I began to experience intense angina at the same time my partner decided to take a break from the medication that was keeping his cancer in remission; it was beginning to cause him great discomfort. I had several weeks of intense episodic chest pain that I kept to myself. As I have a history of heart disease, I wondered if I was having a heart attack. This was ruled out with lab work. My cardiologist diagnosed my distress as “broken heart syndrome”.

This syndrome was an expression of my not being fully open to my grief, of holding my pain inside me. This suppression of grief, if continued, could have turned into depression. Instead, my pain became a reminder to open to my fear, sadness and powerlessness.

Even as a psychotherapist, I hadn’t considered my own mind-body connection in what I was experiencing. My grief was potentially on the way to turning into depression, but thankfully the angina got my attention and I was able to address my grief directly. Being a better caregiver for myself helped me be a better caregiver for my partner.

As a caregiver, a first step for better self-care is an honest assessment of how you are doing. If you are feeling emotionally overwhelmed, irritable, consistently tired or anxious, then this is the time to start talking with others. You can begin by risking some vulnerability with your friends and colleagues. If it seems appropriate, make an appointment with your favorite medical professional, and/or psychotherapist. If you don’t ask for help, it’s unlikely that you will get any. This might be challenging for those of us who are used to taking care of everything ourselves. Do it anyway! As they say, put your own oxygen mask on first, before trying to help others.

In Boulder County we are fortunate to have many resources for caregivers. We have psychotherapists who specialize in issues of loss and grief, as well as depression. We have bereavement support groups, and Death Cafes. Our senior centers and the Boulder County Area Agency on Aging have resource specialists that can help us find the resources we need to make caregiving more manageable. Whether it’s mental health resources, in-home supports, adult day care, or respite, they can help you find what you need.

Caregivers provide an incredible service and must deal with incredible challenges. At the emotional level, our work is to return, over and over again, to the intense vulnerability that we step into every day. Open heartedness, however difficult, is also our best protection.

Reva Tift MA is a psychotherapist in private practice for 40 years. She specializes in working with mid-life and older adults.

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