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The cost & courage of caring - stories that spark resilience.
Welcome to this week's episode of
the Caregiver's Podcast.
I'm your host, Dr.
Mark Ropaleski,
and you can call me Dr.
Mark.
Today, we're talking about what
happens when caregiving
pulls a family back into
everything it has never fully
resolved.
When a parent gets sick,
the crisis is never just medical.
Old roles return, old conflicts
come back into the room.
Siblings may disagree about what
happened in the family, who was
hurt, who was protected,
who was expected to help, and who
got to leave.
And often one person becomes a
caregiver while
everyone else has opinions about
how it should be done.
This conversation is about the
person who
stays, the person trying to keep
care moving inside a family that
may already be fractured by
estrangement,
resentment, politics, gender
expectations, or years of painful
history.
Our guest today is Angela
Caldwell, a licensed marriage and
family therapist who works with
high-conflict families and who
understands what happens when
care, obligation, grief, and old
family roles collide.
And before we begin, please take a
moment to subscribe or follow The
Caregiver's Podcast
wherever you're listening.
It's completely free, and it's one
of the best ways to support the
show
and help these conversations reach
more caregivers who need them.
Angela Caldwell, welcome to The
Caregiver's Podcast.
We're so happy you're here to join
us today.
Thank you so much for the
opportunity.
I'm excited.
Well, in the tradition of the
podcast, we're just going to jump
right in.
So, Angela,
you know, I think a lot of
caregivers go into a family crisis
hoping that everyone will finally
show up.
But then the old pattern returns
almost instantly.
The responsible one takes charge,
the avoidant one disappears, the
critic starts criticizing.
What does caregiving bring back
into those old roles?
Hmm.
I might prefer to look at your
question more that these crises
actually
highlight what the roles are.
So it's interesting if you think
of daily life in a family on a
regular
Tuesday, your roles don't
necessarily announce themselves
when you're fixing lunch for the
day,
or when you're getting chores done
or getting, you know, coming home
from work or something like that.
It's in these emergencies and
crises that the roles emerge.
And so we will find that, and you
know,
every family defines a crisis and
emergency differently in probably
what medical professionals
would consider real emergencies,
like a health crisis or something
like that.
The roles will emerge.
Like you said, you will find that
everyone will not be surprised who
the leader is, and everyone will
not be surprised who the Debbie
Downer is.
And so it's, we talk in terms of
these old roles.
And it's
funny because I notice in my, in
the family therapy that I do, we
use this term a lot, that I have
this
old role in my family.
It's old in that it was instilled
a long time ago, but it is quite
current.
We don't do a lot of role updating
in families.
And in fact, we, I mean, who wants
to do that?
I want to go to work and I want to
go swimming on Saturday and I want
to go to Disneyland.
You know,
I want to do all these other
things with my time.
It doesn't occur to us to say, you
know,
it's probably time to update my
role in my family.
First of all.
Secondly, you don't have much of
an
audience with a family.
If you, can you imagine going to
your family and saying, hey guys,
can we sit
down and update our family roles?
I mean, they'd look at you like
you were two headed monster from
Jupiter.
And so these old roles that we
have, they emerge because we don't
do a very good job
restructuring our family as we
transition through the different
life stages and different stages
of
family development.
So it's almost as though the
crisis brings it back on to the
much more conscious
level and almost like a big
flashing reminder sign.
Yes.
Yeah.
It's a, it's an illuminator.
Yeah.
So a medical crisis then asks of
an adult child to step into like
some serious role as a caregiver,
but inside the family, that same
person may still be treated either
as a responsible one or the
peacekeeper or the one who can't
say no.
Like what does that do to a
caregiver who has spent years
actually trying to outgrow that
role if they've been making those
efforts and then suddenly they're
pulled back into it.
What a, what a beautiful question.
I imagine so many of your
listeners
are saying, yes, what do I do when
I worked so hard either in therapy
or with my pastor or
I don't doing yoga, I don't care
what, whatever I did that it works
so hard to change the way I
operate to not be the person who
always says, says yes, or not be
the rescuer, not be the person who
always helps the family.
And now here I am and nobody else
is doing it and it's all back.
And,
and here I am.
Um, this is at the risk of getting
a little, a little psychobabbly.
I wish that more of us would look
at those opportunities, not as,
um, uh, being sucked
back into our old role because of
the things we are doing, but
rather that these are things that
need to be done in all families
everywhere and you can do them
differently now.
Now you can approach
your role differently.
If you think about a caretaker, if
you, if, if we had time, we could
probably come up with six or seven
different templates of different
kinds of caretakers,
different approaches to
caregiving.
So when we, we, we want to be
careful not to confuse
our old family role with the task
of caregiving, the, the, the, the
small day-to-day tasks like
medication management and
coordinating doctor's appointments
and, and hygiene and personal care
and things like that.
Those are things, um, if you think
about, um, in the old days,
medieval times,
big castles that had servants and
the servants were responsible for
caretaking.
They didn't all have
the same personality.
They didn't all have the same
quirks and tendencies.
You could have seven
different maids approach the
making of a bed in seven different
ways, right?
So rather than feel,
rather than give into this urge to
feel yourself, Oh no, I'd worked
so hard to get out of this role.
Yes, you did.
Rather than that, celebrate that
you have, you, you have made quite
a lot of progress
and now you approach this task,
this, this mundane task of the, of
the condition of being human.
Now you approach it differently
from this new person that you are
just because you're doing the,
the handiwork of caretaking
doesn't mean that you have, you
have regressed or gone back and
adopted
your old ways of being.
I, um, just thinking about that
scenario, I can feel the pull and
almost feel
it in the room.
So how do we avoid that?
How do we redefine our new way in
that moment?
If we're
conscientious of what we've
accomplished so far to grow and
develop from that original role
that was
established in the family perhaps
years and years ago, but when
we're feeling the pull, what's
the,
what's the strategy that we can
employ in that moment?
Is it just a reassertion or is it,
um,
a big family sit down or how do we
strategize those first steps not
to get pulled back?
Cause it's a strong gravitational
force.
It sure is.
It sure is.
That's a great question.
So you will find as you get to
know me that I'm a
big champion of family meetings.
Um, I, it's, it's one of the first
interventions I insist on
in my family therapy.
I have, uh, families have sit down
formal organized family meetings
and either they are ad hoc.
Um, like we need to have a family
meeting because we are going
through
some kind of transitional stage as
a family, or, um, we would like to
do this more regularly because we
have a problem that's going to
take a few months to work out, or
we're kind of disconnected in our
different lives and we need to sit
down and have a time that we all
connect.
But I am a big fan of
family meetings.
When a family member suffers some
kind of medical crisis and they
are in need
and, uh, and, and, and the family
structure and routine is going to
have to change.
This marks a
transition.
Most families struggle with a
transition.
In fact, when people say, what
kinds of families do
I work with in my practice?
Almost always families in
transition.
It's, it's families transitioning
to
a new chapter of life, something
different that's happening that's,
that marks a change from the norm.
So this would be a, this would be
a big one.
This would be a family in
transition.
What makes family life so
difficult is not, is not all the
quirks and personalities and
frustrations
and old wounds that you have from
family members.
What makes family life so
difficult is that we are not
very good at transitions as
humans.
And what we do is we, we establish
unconsciously, we establish a
family dance and interaction
pattern.
That's a way of being when we
first, when children are first
introduced into the picture and we
don't update that.
So I want you to think about kind
of the
different stages of family
development.
If you go from, um, being a new
parent, new parents to toddlers
and infants, we establish patterns
and routines and, and a division
of labor.
And when those
children grow up and now we are
parents of say elementary school
children, we don't adapt very
well.
We don't have a family meeting and
sit down and say, Hey, things have
changed.
We're going to
rearrange the power agreement.
We're going to rearrange
responsibilities and then the
division
of labor and chores.
We're going to rearrange how we
talk to each other.
I have new expectations
of you now.
We don't do a good job of that.
I encourage families to do a
better job of that,
to identify first a transition.
Oh, this is a transition.
And secondly, sit down and discuss
what this means for the family.
I know this is a long answer to
your question, but I would say
the step to have is to be brave
about acknowledging that things
have officially changed.
We are going to
sit down and we need to look at
all of the, and you know, families
can use their own language for
this,
but we need to look at all of the
rules and protocols and procedures
that are in place
that are outdated, that are no
longer going to work here.
Maybe when, if this had happened
to my
father 10 years ago, I might've
been in a better place to handle
this.
But now I have kids and a
full-time job and now I don't have
the capacity that I used to have.
I need my siblings, no matter how
much emotion and electrical
charges in the room to sit down
and examine the protocols that
don't work
anymore and establish new
protocols.
So I guess it's a long winded way
of saying a meeting,
a meeting that acknowledges the
transition and the things that
need to shift.
I think that really distinguishes
some of your work and philosophy
in that you bring everybody into
the
room and you bring the help you
need into the room to deal with
the family engaging in that
process,
as opposed to sending everyone
else out to their respective
therapists and doing their work
and then
trying to somehow scramble to get
their voice re-expressed in the
family.
Yes.
Yes.
If you'll give me a tiny little
soapbox, I will say this very
controversial thing.
This is
going to get me a lot of emails.
Watch, I'm about to get myself in
a lot of trouble.
Individual therapy,
having each family member in
individual therapy is the
stupidest idea I can think of.
That's the
dumbest possible way to solve
family problems.
Because unless the therapists are
having some kind
of conference call every day,
getting everybody on the same
page, if this therapist thinks
that we need
to work on this and that therapist
thinks we need to work on this,
therapists can't help but work at
cross
purposes.
That doesn't make any sense,
especially in a crisis, especially
in a conflict, in a time of
transition.
Everybody needs to come together.
Sure, have your personal
therapist, but don't skip the
family
therapy.
Don't skip the part where we're
all in the same room.
Yes, with all of our emotions and
all of
our wounds and all of our pain and
all of our flaws and all of our
deficiencies.
Yes, with all of that,
bring into the room to solve the
problem.
I disagree with this idea that you
have to solve your own
problems before you can go into
the family.
I vehemently oppose that idea.
So Angela, in a lot of families,
the caregiving conflict isn't only
between the parent and the
adult child, but it is between the
siblings.
Why does a parent's illness so
often reopen the old
sibling story of who was
protected, who was blamed, who was
expected to help, and who kind of
got to
leave and extricate themselves?
Yeah, wow.
That's a very profoundly deep
question you're asking because
it raises the question of
mortality and time.
And I don't know what other
therapists will say,
but I will tell you my opinion of
what's really going on there.
We humans may not be good at
adapting and transitioning, but
you know what we are good at?
We are good at denial.
We are very good at denial.
We are very good at kicking the
can down the road.
We're very good at delaying
solving problems.
Our parents, good or bad, healthy
or unhealthy,
our parents represent a constant
in our lives.
And if we are lucky enough to go
all the way into
adulthood and still have living
parents, we make a childlike
assumption in our unconscious that
they'll
be around forever.
And these old pains and hurt
feelings and transgressions of the
past,
we'll talk about those someday.
And then we never define someday.
And then the parent falls ill.
And when the parent falls ill,
every member of the family gets a
mortality check.
All the siblings
feel the pressure of the time.
Time is short.
Shoot, that someday that I wanted
to work this thing out with
you that happened when I was
seven.
That someday that I wanted to work
out my anger and discuss
with you why you always do this
and why I always do this.
That someday is impending now.
And I think
what you're feeling, you know, all
those siblings kind of bringing
all that stuff forward, I think
you're feeling a sense of urgency
that was never there before.
And it's there now because they
can feel
the end is near.
And so what we do when the end is
near is we panic and we blurt out
all the things
that we sort of stored up all
those years for that magical
someday that I guess is here now.
And I think those blurted, stored
away things actually are
reflective of some of the original
assigned roles that you may have
received, whether it was growing
up or in middle adulthood or
within the
family dynamic, right?
And it's almost as though the
mortality check, as you call it,
is like that
sort of spark or catalyst for that
revival of the old rules and all
of that old stored information.
You can see then in the context of
the family crisis, transitioning
to have to come up with a plan
to care for someone which may be
complex and may be under-resourced
from the system.
It's also stressful as hell.
And the other thing we don't do
well under stress is exhibit
patience for
one another.
And so the caregiver is suddenly
under-resourced and depleted and
really doesn't
have the patience for sibling
complaints.
Other sibling complaints who view
a caregiver as controlling
and not letting other people help
or have a say in what's going on.
They also are losing patience
because under pressure, under
stress, when our systems are
flooded with cortisol, we are
quick and
decisive in ways that can be
harmful to family dynamics.
I was thinking about that for a
second.
It almost makes you wonder whether
or not you're pre-selected
based on your ability to maintain
flow to the prefrontal cortex
during times of stress.
And that may
actually define your role
historically in the family because
you didn't lose it during times of
stress.
And then that you became very,
very useful member of the family
to help navigate crises, but it's
not
always quite that slick and
smooth.
When a parent's sick, you might
think that the siblings could
actually
put things aside and focus on the
care, but often the old fights
take over.
Why is it so hard for families
just to prioritize mom or dad's
immediate needs over the history
between them?
That's an age-old question, isn't
it?
I don't know if Freud ever got the
answer to that one.
You know, you guys are going to be
able to speak with a lot more
intelligence to this than I will,
but I'll try to offer some two
cents.
Our pain centers are in a dumb
part of our brain.
So,
our pain centers are not located
in the thinking portion of our
brain, right?
And so, those insular
reflexes that we have, that limbic
system, man, that's a powerful
lizard brain, isn't it?
It takes
over any, I liken it to physical
pain out in the world, right?
So, if you are, if you're trying
to
send us some emails out for your
boss and you've got a project to
work on and you stub your toe,
you could give two shits about
those emails.
All you care about is the pain in
your toe, right?
And so, we could look at that in a
similar way and say like, gosh,
couldn't you put the pain aside
to focus on what needed to be
done?
Not when the pain's big.
Not when the pain is painful.
And I think what you're seeing in
those moments, that inability that
siblings have to kind of just
put it aside, just get the emotion
out of the room, is because
they're in so much pain.
And that pain
has been either growing and
festering or forgotten and a rude
awakening into like, oh, yeah,
this thing
hurts real bad.
And so, kind of like a stubbed toe
or slamming your finger in the car
door or something,
when there's an argument between
siblings, that insular response,
that kind of limbic response
takes over the reasonable and
rational part of our brain.
Do you go over strategies and
therapy for families who are faced
with that sort of limbic
overdrive to sort of collectively
better manage painful discussions?
Yes.
Yeah, we triage.
So, again, as controversial as
this may sound, I actually think
we should deal
with the stubbed toe immediately
and get the stubbed toe or the
slammed finger out of the way
immediately.
So, if we are trying, you know, if
there's arguments over which care
facility to find
for an aging parent or something,
or there's arguments over how much
we should pay, and this one
costs $7,000, but that one costs
$2,000, but these are the benefits
of that.
And you're always so
controlling and you never listen
to what I say.
And you treat me like a child.
You've treated me
like this since we were kids.
And now you see that the pain is
rising to the top level.
In those
moments, we call a timeout and I
say, hey, we are not going to be
able to decide how much money to
spend on what care facility until
we can alleviate some of this
pain.
So, what we do is we stop the
conversation.
And I give them a time.
And I say, let's allot 20 minutes
right now.
You're not going to solve
the world's problems.
You're not going to heal your
childhood in 20 minutes.
But let's have 20
minutes, not for surgery, for a
Band-Aid.
What do you need right now to be
able to talk about what's
best for your mother?
Well, I need an apology.
Well, I need her to acknowledge
all the times she...
And
then I stopped.
Okay, got it.
We go to her.
Let's say it's a sister.
We go to the sister and we say,
in order for you to make a
decision about how much money to
spend on a care facility,
your sibling needs an apology.
This is your moment.
This is your moment to put a
Band-Aid on this pain.
We'll come back to it.
We will deal with this later.
But if we're going to make a
decision,
we have to address the pain right
now.
Now, what that sounds like
probably is the equivalent of a
first aid kit.
So, yeah, I do some first aid
right there and some kind of, you
know, medic on the
battlefield, heal this pain for a
second, with a promise to the hurt
party that this will be addressed.
We will attend to this once we can
make these two decisions that have
to be made by Friday.
It sounds like potentially a very
effective strategy.
It depends on how good I am.
Well, it also depends on what
people are willing to bring to the
table as well.
And they can put some of their
vulnerability aside.
So, thinking of that scenario,
Angela, with the phone rings,
your parent had a stroke, received
a horrible diagnosis, suddenly
needs care.
In a family where people were
already hurt, strained, and maybe
barely speaking even,
what happens emotionally
to that family before anyone can
even chance figure out the care
plan?
The most common thing that we see
is deflection.
And so, that there is tremendous
fear.
There's fear of what this means
for us in the immediate days,
and what this means for us in the
coming years.
There's tremendous fear.
There's fear about my parents'
well-being.
How long do I have my parent?
Will my parents change?
Will they be able to speak
anymore?
Will we still have the same
relationship?
If it's an adult child,
there is an acknowledgement that
none of this fear is appropriate
to discuss with a parent.
And so, all of that emotion, in
psychology, it's called, we
deflect.
And we deflect it onto a safer
place,
which is a, probably, relatively
speaking, healthier member of the
family,
which is my sibling who I've been
pissed at for 20 years.
And that, and I can, in a way,
sort of vent some of this emotion,
even though that isn't really the
source of what I'm feeling at this
time.
And, by the way, that's why you'll
see that those arguments are so
unproductive,
because that isn't really what's
going on for me in those moments.
What's really going on is I'm
terrified.
And I'm terrified about this
situation and this news I just
received.
And it is, should I say, easier?
I don't know about easier.
It's safer, for sure,
to make myself believe that all
this emotion that is so scary and
out of my control
is about this other thing that is
within my control and someone
else's fault.
Right.
It's pretty much human nature,
right, to react in those
situations.
We've all done it.
We all can probably recollect
moments where we did that.
So what happens then when
caregiving pulls someone back into
the whole family circle
that they had spent years trying
to stay away from?
Siblings, spouses, partners, old
alliances, old conflicts,
and now a parent who needs care in
the middle of all of that
historical gamish of stress.
We need to do some expectation
management here.
And we also need to do some
utilizing of the support system.
So caregivers who have, like the
caregiver that you're describing,
in my imagination,
I'm seeing someone who's worked
very hard on themselves, maybe
gone to some therapy,
maybe created and nurtured really
meaningful relationships in their
adult life that are more
satisfying than their family
relationships.
That adult then has done a very
good job, whether they realize it
or not, creating a support system,
a healthy and reliable support
system.
That adult now in a crisis needs
to manage expectations, needs to,
you don't really get to be
surprised anymore
when you go back into your family
of origin and everyone's acting
the way they've always acted.
You don't get to be surprised
anymore.
You can, you'll probably get your
feelings hurt and you'll probably
become angry and resentful
and all of those are normal,
non-emergency human conditions.
But the two things that we need,
that probably that caregiver needs
to hold in mind is,
if you have a, you know, lame
sibling who never contributes
anything and doesn't help
and lets everybody else do the
work, then go into this crisis
expecting that same behavior.
Now, of course, you're still going
to get upset about that.
You're still going to, it's still
going to frustrate you.
But any kind of expressing that
frustration to that sibling or
trying to work it out inside
of the family is not going to
magically work now.
It didn't work in the past.
It's not going to magically work
now.
That's a phone call for your
support system.
Now you go to your spouse, your
best friend, your pastor, whatever
sort of support system
you have worked so hard to create.
That's where we take those
emotional expressions.
In the family, it is now business.
It's now business and you just
have a bad business partner.
That's all.
And we all, we all hopefully have
developed skills to work with a
bad business partner.
I think that's brilliant.
What I'm also hearing is after all
the work that you've done and all
you've built for yourself,
when you're back in the room, it
doesn't mean you have to change
and revert back.
And I think that's, correct me if
I'm wrong, but that's the concept
of differentiation that
you've alluded to in the past
where you differentiate yourself
from the environment and say to
yourself,
I can't exist here.
The new me, if you will, can exist
here.
And I don't need to become the old
me in this dynamic.
Yeah.
Yeah.
No, that's right.
Yeah.
That's a part of differentiation.
The piece that I would add, you
might, you might even, because
this might appeal to you
too.
The pieces, maybe the central
drive of that concept of
differentiation is that when we
grow
up together and when we are living
under one roof, it's hard to
differentiate.
It's hard to distinguish which
feelings belong to me and which
problems belong to me.
The ability to differentiate is
the ability to walk into a family
situation like that and
be able to say to yourself, that
is not, that does not belong to
me.
This emotion, this does not belong
to me.
That's my brother's problem.
This is, I'm not, I'm okay.
My brother's clearly not okay, but
I'm okay.
This, this problem that's being
brought to me, it doesn't really,
it shouldn't really be
brought to me.
This is not, this is not mine to
deal with.
Here are my, I can differentiate
between what belongs to me in
terms of emotions and problems
and conflict and what doesn't
belong to me.
There's a, in a way, it's sort of
detached.
There's an emotional detachment
that's very healthy, that you can,
you can look at things
from a more cerebral, I guess,
more logical perspective in terms
of compartmentalizing what
you're going to take on and what
you're not going to take on.
And in my world, we consider that
a pretty healthy, adapted human.
I really agree with you on that.
And I think it potentially, with
practice, it can be a very
powerful tool and maybe even
a powerful tool for caregivers in
different dynamic scenarios.
Maybe not just working within the
family, but working within the
healthcare system, trying
to navigate that for their loved
one.
And again, not giving over their
strengths within the broken system
and assuming all of
those weights and perils and
everything else, but trying to
keep partly reserved, as you
say compartmentalizing.
Compartmentalized a little bit
away from it without being
compartmentalized in the
pathologic
sense.
Right.
A lot of caregivers don't start by
asking, what's the right care
plan?
They're actually asking, am I a
bad person for dreading what this
is going to cost me?
What is underneath that guilt when
they can already see the family
battles and emotional strain
ahead, just as they're about to
scrape the surface of what do we
need to do here?
Hmm.
I don't know if this will surprise
you or not, but you just described
a moment that all caregivers
can relate to.
Like, oh my God, I can't believe
what I'm thinking and what I'm
feeling about this.
Why am I not more loving and more
considerate?
Why am I not more, why am I not a
better family member?
And what is underneath that is
wisdom and maturity.
What is underneath that is usually
an adult who is not naive, who is
aware of what this is
going to entail, who is aware of
this burden that they didn't ask
for because they've been
on the planet for a while and
they've seen this movie and they
know how this one ends.
They know how this goes, right?
So what's under that dread is a
mature adult who's going, oh, this
is it.
This is what this is going to
probably look like.
I've seen this with my friends and
other loved ones and now it's
happening to me.
Not wanting a burden is a
psychological concept as old as
time.
Freud called it the
pleasure-seeking principle.
Avoid pain, seek pleasure.
Not wanting a burden is the most
natural human tendency.
I think it must be buried down
into our bone marrow.
That is the most natural tendency
that we have as humans.
I don't want this burden no matter
what the burden is.
Not wanting the burden of
caretaking your family member, I
don't know how to say this loudly
enough.
Not only are you not a bad person,
you are completely normal and
probably more realistic than the
average person.
Understanding what has just fallen
onto your lap.
Now, acting out in anger and
resentment and harming family
relationships, that's another
story.
You know, talk to a therapist and
your support team about that.
But the not wanting the burden, we
talk about that all the time in
family therapy.
There's a comforting thought I can
offer you here.
I hope, maybe.
It's comforting to me.
I don't know if it's comforting to
everyone else.
I love talking about this concept.
I love talking about this concept
of burden.
Because when we think about
burden, we think about, oh, I
never want to burden anyone.
I would hate to be a burden on
someone.
We don't like the idea of
burdening one another because we
don't like the idea of causing
discomfort and distress to one
another.
But actually, let's take it to
like a marital level.
When we are exchanging our vows,
in my opinion, if we're doing it
the right way, yes, there's the
love.
And yes, there's the romance and
the pretty flowers and the nice
dress.
Yes, there's all of that.
That's all lovely and that's all
fun.
And yes, there's going to be
beautiful times together and we're
going to go through this life and
some of it is going to be rosy.
But when we are exchanging our
vows, I hope that what we're
really doing is saying, from a
quite unromantic point of view,
Okay, husband, I see all of you.
I see that when I say yes to all
the good parts, I'm also saying
yes to your mother.
I'm also saying yes to your
baggage.
I'm also saying yes to your flaws
and your weaknesses.
And there will be times in our
marriage where you are going to
burden me.
I don't want it, but I accept it.
In exchange for you accepting me
as your burden too, right?
That there is a, I know I just
sucked all the romance out of a
wedding, but an exchanging of
vows,
but there is a transactional
loveliness to that.
This kind of like, actually, you
are kind of a pain in the ass and
I'm kind of a pain in the ass.
And so when you need to lean on
me, I will say yes, but then that
means I also get to lean on you.
We get to burden one another.
In my world, we call that
interdependence.
It's not dependence and it's not
independence.
We don't like either of those
concepts.
We like interdependence.
For your listeners who are
parents, when you have children,
those are burdens.
Holy cow.
Those are the biggest burdens in
the world.
And they are burdens that I want
and that I accept.
And it's a pain in the ass to stay
up with you because you won't go
to bed.
And that's not the fun part of the
relationship.
But I accept the burden because I
want all the rosy parts of the
relationship.
And because I hope that you'll
take on my burden when I'm old and
aging.
I hope that there is a unromantic
but beautiful transactional aspect
to our relationship.
I'll burden you and you burden me
and maybe it'll even out in the
wash over time.
But if we learn to accept these
burdens in the hopes that we will
also be able then we'll be free to
burden someone else with us, with
ourselves, in our lives.
If we can kind of, I don't know,
it's a comforting thought to me.
If we can kind of like zoom the
lens out and take the 30,000 foot
view in those moments.
Yes, you are being burdened right
now.
But you know what?
You're going to burden somebody
else.
And maybe in sort of a weird
cosmic spiritual way, we all end
up sharing an equal portion of the
burden if we're all taking care of
one another at different points in
our lives.
I know, it's kind of cheesy.
It depends on family dynamics and
how individualized each member of
the family is.
Because I think a lot would say in
this age of toxic individualism,
that sort of continuum of shared
burden may not necessarily float
as well.
But one thing I did hear, and I
think it's really important to
emphasize about the wedding vows
and the taking on of each other's
burdens.
That's probably the most holistic
way you can stay loyal to the
relationship and the commitment to
the true relationship.
And what relationship means is by
that assumption wholeheartedly of
each other's burdens in the name
of the relationship.
Yeah, yeah, yeah.
I have a lot to say about toxic
individuality.
I like your term.
I wish we'd be doing a little bit
more, just as a society in
general.
I do wish we'd be doing a little
bit more, a little less what's in
it for me, and a little bit more,
hey, somebody needs some help.
Yeah.
Yeah, I think we've touched on
that in several episodes, and it's
certainly something that pops up
on the grid now pretty regularly.
How do siblings then take the next
step to making care decisions when
they don't agree on the family
history or even on who each of
them has been in the family and
their roles?
Is it possible to coordinate care
when the conflict isn't just about
the parent who needs help but
about everything each person
believed happened before the big
medical crisis?
Yeah.
You're calling to mind for me two
families that I have in my
practice right now that are, you
know, one of them is demanding a
lawsuit against the hospital and
all the buildup to everything that
happened.
And the other one is saying, oh,
there you go again.
You're always so aggressive and
just don't we have enough to deal
with and you're adding this to our
problem and wrongful death and,
you know, all this kind of stuff.
And the first, well, I guess it's
a piece of advice.
The first piece of advice is for
siblings to coordinate care.
There needs to be an acceptance of
at least some level of messiness
that this isn't going to run like
a well-functioning board of
directors.
It's going to be messy.
And that's okay.
That's okay.
Families are messy.
I've never met a clean family in
my life.
I don't want to.
Families are messy.
I am in favor when we talk about
coordinating care.
So I used the word triage a minute
ago.
And in my therapy, I have to
triage problems.
You can imagine when you have, you
know, five people sitting in your
office and there's 800 different
dynamics.
I have to choose which two are
going to get my attention today
and the rest I'm not going to be
able to attend to today.
That's similar.
Yeah, it's similar with the family
crises.
You have to triage problems.
And so for coordinating care for a
medical crisis, that's on top of
the list.
And so what we need to do, as
messy as it sounds, and yes, it
probably will cause a little bit
more damage, but I argue
repairable damage down the line,
you probably need to name a team
captain.
The team captain is responsible
for ultimately making the
decisions, hopefully in somewhat
of a democratic process, right?
Hearing from the other siblings,
but that they are the decision
maker.
And yes, in difficult families,
that will cause more damage.
But that damage that it causes,
and this is where we go back to
the triage idea, is less emergent
than the medical crisis that needs
to be dealt with.
And so whatever, and I hate to be
dismissive about it, but whatever
damage is caused because one of
the siblings is being bossy and
isn't handling it the way that the
other one wanted to, and whatever
old sibling dynamics are being
drawn up, and they're so
controlling, and they're arrogant,
and they think they know
everything, and all that old
sibling stuff that can be brought
up.
I heard myself say, you're causing
more damage.
I'm not even sure about that.
You might just be sort of, you
know, salt and peppering some old
damage that's always existed that
you have time for.
We have time to deal with those
problems.
I think it's important to have
some kind of decision-making
hierarchy, someone who will
ultimately make decisions, yes,
messy, and yes, hurting feelings
along the way.
But I think that decision maker
then has a responsibility to make
a promise to the other siblings
that this stuff that is being
drawn, you know, drawn up will be
dealt with timely, you know, next
month, within the next six months,
next week, whatever it is,
whatever the crisis, whatever
timeline exists for that family.
It's to be an acknowledgement of
the power position that, yes, I
see that I have the power, so in
exchange for this, I promise you,
we will finally talk about that
thing that happened at our
cousin's wedding.
You know, we will finally talk
about the family secret we've all
been holding.
I promise you, I promise you, in
exchange for this decision-making
power, we will get to that, and
not someday.
We will get to it in December.
We will get to it at Thanksgiving,
you know, whatever that is.
So what I'm hearing from you then
is with the election of this sort
of captain, at least temporarily,
to get the family through the
medical crisis of a loved one,
you're also setting some terms of
reference on the table for this ad
hoc structure to actually function
with some trade-offs to be able to
maybe achieve some healing in the
process, or at least not worsening
the wounds.
Yeah, that'd be ideal, and yes, as
I keep saying, it's messy, but we
don't really have a lot of options
here.
I mean, is part of what makes
sibling conflict so painful in
caregiving is that the parent who
now needs the care may actually be
the person who helped create those
roles in the first place?
One thousand percent.
One thousand percent, yes.
Yeah, there's, well, it turns out
parents are human beings, and they
are quite flawed.
And in, you know, there's, we can
come up with a million scenarios
here, but in one family, you might
have favoritism.
In another family, you might have
actual harm, harm done between a
parent and a child.
In another family, you might have
a chauvinism or a sexism, a
gendered trauma of some kind.
And in each of those families, the
parent themselves that either
caused or contributed to the
sibling, you know, the parent,
they never let the siblings be
siblings.
They stood in the way of a brother
and a brother or a sister and a
brother, you know, stood in the
way of those siblings being able
to develop that oh-so-important
sibling relationship.
There's quite a lot of resentment
there.
I will tell you, though, that
ailing parent, whoever, the
criminal parent who caused that
problem in the first place, the
fact of the medical crisis or the
fact of the aging often is healing
for the siblings, depending on the
family.
But if the siblings, the siblings
now, just practically speaking,
will probably have to talk a lot
now, right?
They'll have to talk, they'll have
to be in communication a lot
about, you know, day-to-day
decisions and if, you know,
everybody's local, who's going to
run to the store to get this thing
that our dad needs or whatever it
is and who's going to go to the
doctor's appointment.
So there's a lot more kind of
boring sort of superficial
logistics communication that's
happening.
The more that happens, the more
the superficial communication
happens, the more it lays the
foundation for siblings to talk
for real, to start really talking.
Also, because the aging or sick or
ill parent, because they are in a
weakened position, their abuse or
harm or whatever it was is likely
to be easily visible.
This time, visible probably to the
sibling that wasn't harmed or the
sibling that was favored or
whatever.
What I have seen, and it's hopeful
to me, what I have seen is that in
adults, when they are, when they
actually get a front row seat, oh,
this is what, wow, mom really is
awful to you.
Or, wow, the difference in the way
our parents treat us or whatever
the original crime was.
The siblings come together.
There's a, you finally, after all
these years, if you're the
aggrieved sibling, you finally,
after all these years, get what
you wanted.
You wanted your older sister, your
older brother, your younger
brother to see.
And they go, oh, wow, I see.
And this is something that
actually has happened in my own
family.
You know, like, wow.
I had this thing.
I thought you were just
complaining this whole time, all
these years.
I see it now.
I mean, that's a huge
acknowledgement.
And do you think that weighs even
stronger than just the adult
children sometimes still waiting
for that ill parent to finally let
them out of the role they've been
carrying for years?
Like, the sibling acknowledgement
may actually be more powerful?
It's called validation, and it is
more valuable to us than striking
gold in California.
Having especially a sibling,
somebody who was in the trenches
with you, somebody, you can get
validation from a therapist, and
that's nice and everything, but
the therapist doesn't really know.
And you can get validation from a
friend, and that's nice, but to
get it from somebody who was in
that bedroom, who was in that
kitchen, who sat at that table,
that is more valuable to us than
unobtainium, what was that called
in the movie Avatar, right?
That is more, it is a precious
metal to us, and that's why it is
sometimes, it's sometimes the
salve, the ointment.
That's all we, we don't even,
maybe don't even need to resolve
the conflict or the trauma
anymore.
We got what we needed.
We got validation from somebody
who was right there with us,
standing next to us.
Sounds powerful to me.
Folks, we're going to take a
break, and in the tradition of the
podcast, get a chance to field
some questions from our
illustrious production team.
This is a surprise tradition,
Angela, we get our producers
involved, and they're in the
background processing, they're
part of the team, and they're part
of the think tank, so we have this
nice tradition of getting them
involved.
Well, actually, it's where I get
free therapy from all of our
guests.
That's the joke.
That's why you wanted me to do the
podcast, Fred.
I knew there was a motive.
All right, Frederick, tell me all
about your mother.
Funny you should ask.
We've dealt with a lot of those
issues so far, so I'm going to
open this up a bit more broadly,
but there's something that you
said earlier in the show.
You were talking about managing
expectations.
And as someone who's going to
therapy and tried to do a lot of
work to sort of escape from some
of the dysfunctions that I grew up
with in terms of my extended
family, I had this thing that I
kept doing, and I just sort of
more recently recognized the
pattern, is that I would go back
into these relationships when I
would visit, and I would always
show up with this blank slate.
And I would give everyone the
benefit of what felt like the work
I had done, and I would just
expect them to sort of mirror that
in some way.
So I'd go back, and I wouldn't
expect that they would act the
same, and I wouldn't expect that
they would necessarily repeat some
of the more toxic behaviors, which
caused all of the problems to
begin with.
And that seems to me like it's
almost the definition of emotional
insanity is going back and, you
know, expecting the same, you
know, getting the same results,
getting the same interactions, but
somehow expecting it to be
different and repeating that over
and over and over again.
So I'm wondering, I can't believe
that I'm the only person that may
not be managing the expectations
properly, but when you unlock
that, it really frees you in a way
to go in and expect, okay, this
person's always behaved this way.
They've done things that have hurt
me over and over and over again in
very similar ways, and I'm no
longer going to go back and expect
it to be different.
Maybe you could just expand on
that a little bit for our
listeners.
I'd love to.
You're breaking my heart a little
bit because you are reminding me
right now of myself, my clients,
my friends of mine that have gone
through therapy, and we go through
our own growth.
So let's talk about therapy right
now.
That's one form of growth.
There's lots of ways to
self-improve, but that's one way.
So we go through therapy, and I'll
speak for myself and maybe speak
for you.
I don't know.
Maybe speak for other people.
But what I was conscious of during
therapy is I was working on
myself, and I was examining my old
ways of being.
I was examining why I had my old
ways of being.
I was examining what it was that I
was wanting from my dad, what it
was I was wanting from my sister,
and kind of letting go of those
wants and letting those needs be
met by myself or my spouse or my
friend, you know, other parts of
my life.
And I did all this work, and I was
conscious of that.
What I was unconscious of, and you
can tell me if you had this too.
I didn't know it until I kept
banging my head against the wall.
I kept going back.
What I was unconscious of was I
had this tiny little hope that I
wasn't giving any voice to because
I didn't know it was there for a
while.
And that tiny little hope sounded
like this.
I'm healed.
I'm better.
Now they'll change.
That's exactly right.
Yes, yeah.
And that little, whatever that is,
that little flicker of hope or
that little baby delusion that we
have, like, okay, I've done all of
this work on myself.
We have to admit to a hope or an
expectation that all this work
we've done on ourselves will be
the thing that makes our family
finally change, that makes them
see us, that makes us love us,
that makes them love each other,
that makes them behave better,
makes them see the error of their
ways.
And that, that, that's what I'll
say about kind of managing our
expectations is, is coming to sort
of a grim reality and acceptance
that, oh, this is work I've done
on myself.
They didn't do any work on
themselves.
So I can be better, but if I'm
going to go put my arms around a
crocodile and give it a hug, it's
still not going to feel good.
It's still not going to feel good.
And in these situations that we're
talking about today, right, where,
where, where you realize, oh,
crap, I'm going to have to hug a
crocodile for the next six months.
Okay.
Well, the crocodile didn't go to
therapy and become a swan, right?
I did.
I became a swan, but they're still
a crocodile.
So when I hug the crocodile, it's
going to hurt, right?
And so that, and so that, that's,
that's maybe a way of
understanding what I mean by that
very deep managing of expectations
is just because we did all the
work and we did good work.
And we actually are different and
we are changed.
We can't, that's not a silver
bullet.
It's not a, it's not a panacea.
It's, it's, it's not, it doesn't
mean that now they will see the
light.
On the contrary, it means that we
know they won't see the light, but
we can handle ourselves
differently.
We can take on pain differently.
We can manage pain and stress
differently.
I don't know exactly when I
realized that, that, you know, the
work I had done on myself wasn't
going to transfer or fix anything
external to myself, but it took a
lot of kicks in the teeth.
And I think, is it, do you think
it's just a matter of just
repeating that pain until you get
it?
Or what, what's the, how do you,
how do you, how do people come to
the realization?
Gosh, great question.
I guess everybody comes to it
differently.
If you have a good therapist, the
therapist can, can prep you,
right?
The therapist can coach you and
say, Hey, listen, let's, you're
going back for Thanksgiving.
We know what to expect.
Right.
Um, I think, I think a few kicks
in the teeth.
That's one way that people can
come to that realization.
Um, but, uh,
Or when the therapist just becomes
so bothered by the fact that you
keep repeating the same patterns,
they kind of want to pull their
own hair out.
And they sort of, there's like a
little bit of a breach of protocol
where they're like, listen, you
can't stop doing this.
I had that kind of moment.
Yeah, you're talking about when
the, when the therapist kicks you
in the teeth that we do that for
our clients.
We can, we, we kick them in the
teeth.
Sometimes sometimes we go, uh, we
go, what's the matter with you?
Um, but yeah, yeah.
There's those moments of weakness
that turn out to be gifts.
Um, that too.
I, I, this isn't really what
you're asking, but I'll tell you
kind of where my head goes.
And, um, I think for some of my
clients who are religious, not,
not all of my clients are
religious, but I, I, I'm learned
from watching them.
Um, if I take a page out of their
playbook, um, they, uh, they, they
really, they really work on
forgiveness in, and not in like a
Hallmark card way, but like in a
really deep human way.
Um, and inside of the forgiveness
is this, is this mandate of
acceptance, right?
Is this, I understand that my
father is the way that he is
because of the way that he grew up
and he's not going to change it.
And that hurts and it's harmful.
And I accept and there, and, and
it's, there's a, there's a
forgiveness flavor to that.
Right.
Um, and I noticed that my clients
that can get there do better
managing their expectations.
I think that's it.
Like I was sort of looking back at
like how these people grew up and
the examples that they had and
they didn't have access to
therapy.
They didn't have access to any of
this, these tools and then sort of
just coming to a radical
acceptance of, could they really
have done any better given their
history?
Probably not.
Um, so that, I think that really
struck, that really struck a nerve
with me when you said that.
I think that's absolutely true.
It's just getting to that point
where you can accept and forgive.
Yeah.
I wonder, Fred, where, whether
forgiveness is actually the
radical relinquishing of blame.
Mm, exactly.
Makes a lot of sense.
Oh, I want to write that one down.
Thanks very much for, uh, for
spending some time with that on
me, or spending time on that for,
for my benefit.
Thank you.
And hopefully everyone listening
gets something out of that too.
Absolutely.
Thanks for the question.
We're back with Angela Caldwell
having an amazing discussion today
about family dynamics.
Angela, many caregivers tell us
that they are carrying the burden
while the sibling is effectively
disappearing or has disappeared.
And sometimes that sibling is
absent from the work, but still
has plenty to say about decisions.
What does it do to the caregiver
when someone opts out of the work,
but not the opinions?
The peanut gallery.
Boy, do we hate the peanut
gallery.
Uh, so bad news.
There's not a lot we can do there.
Whatever, I will give you the, the
sort of superficial answer that
whatever powers of ignoring you
have developed over your lifespan.
Let's, let's, let's use those now,
right?
Go, go gadget, ignoring.
Um, so, uh, so that sibling, uh,
we all have that sibling, uh, that
sibling that has a lot to say and
nothing to give.
Um, you're going to become
resentful and frustrated.
You're going to lose your temper.
You're probably going to say
something you regret a few times
to that sibling.
It's okay.
It's okay.
Apologize later.
Here's the thing, guys.
Here's the bad news.
You can't control other people.
That sibling is going to do that
and they're not going to stop,
probably.
And the best thing you can do,
I'm laughing because we all have
that sibling.
Don't use your powers of ignoring
as much as possible.
Don't stonewall.
Don't block.
Say, like, thanks for the
suggestion and I'll take it under
consideration.
And all the things that we say, go
ahead and say the right thing.
And then put your head down and go
ahead with what you're doing.
Let them, cast them in the lot of
the, of the, of the audience, you
know, the peanut gallery.
Take what they say with a grain of
salt.
You know what you're doing.
You know what, you know the burden
you're carrying.
You know all the moving parts.
They do not.
Put your head down and keep moving
forward.
Sorry, kind of a bad news answer.
Well, but also, you know, it means
you keep, you keep your power and
the power you've built
up if you've been through therapy
and other things.
You keep it within your control
and within your domain as opposed
to relinquishing it by re-engaging
and then, you know, it means you
keep moving forward.
Now, estrangement can be chosen as
a real form of protection too, but
in caregiving, you know, can it
also become a way for some family
members just to avoid
responsibility while someone else
just carries the whole of the
care?
Well, I suppose, I suppose, I
suppose there are families where
you could look at it like that.
Estrangement is, that is a very
scary swamp.
There are, estrangement, Joshua
Coleman writes so much and speaks
so much on this stuff.
He actually had him on the show
last week.
Oh, really?
I really admire him.
He's a person really too.
So only listen to my answer for a
minute.
Really go listen to his answers.
But estrangement is a terrible,
terrible darkness.
And in the rare cases, no family
therapist is ever rooting for
estrangement.
We are, I mean, think about it.
We're doing the opposite.
We're trying to repair family
relationships.
There are rare instances where
estrangement is the answer, but we
want those to stay rare.
We want those to be exceptions.
And in situations where there is
an estranged sibling or a family
member who is not going to
participate in the care, there
needs to be some compassion on
their part, where, I hate to use
this word, where it's real, where
it's legit, where the estrangement
was the correct moral and mental
and emotional psychological answer
to a very, very severe problem.
Unfortunately, and I know, I know
Coleman speaks about this a lot.
I speak about it sometimes.
Unfortunately, what we're seeing
is an uptick in estrangement that
is incorrect, that is mentally,
morally, spiritually, emotionally
incorrect, where it actually
speaks to more of an avoidance of
conflict resolution and dealing
with confrontation.
We're using this word toxic with
far too much freedom.
We're using a lot of psychological
words have made their way into the
zeitgeist, and they're misused all
the time.
Narcissist is misused all the
time.
Gaslighting is misused all the
time.
But worse than misusing the
terminology is then using the
terminology as some kind of
justification to avoid an
uncomfortable relationship or a
relationship with someone who has
divergent viewpoints or doesn't
live the way that you live or that
you don't approve of or doesn't
approve of you.
So it's a complicated question
you're asking, because in
situations where there is, again,
he probably has such better words
than I do, but I'll use the word
legit, where there's a legitimate
estrangement.
That should be rare.
And, yeah, probably considering
the circumstances of what led to
that estrangement, that probably
is a person who's exempt from
caretaking, probably.
In the more common situations,
though, I hear your question, and
I'm not talking to dad right now
when it's not really legitimate.
Yeah, it's sometimes used as a
really cheap, dirty shield to not
have to participate in the
caretaking.
Now, what do you do about it?
Well, depending on your
relationship with your sibling,
you can call them out.
You can have a fight about it.
I always encourage people not to
be afraid of fighting about issues
because it's okay.
We might say things that we regret
in fights, and we might raise our
voice, but that's all damage.
Those are all cuts and scabs.
We can repair those damages.
You can confront a sibling.
You can choose not to.
You can accept it as it is that
the sibling is being kind of
cowardly, actually, and I bet if
that's the situation, then that
wouldn't be the first time you've
had that thought about that
sibling, or it would be sort of a
repeat of a family pattern where
you have a sibling who's kind of
hiding from responsibility and
accountability.
You can be demanding.
A team captain, you can delegate
responsibility and be demanding
and sort of bully your sibling
into helping.
There's some families where that
actually does work, and then you
can send your sibling three or
four referrals for a therapist who
can hopefully talk some sense into
them.
Angela, when a parent needs care,
are women still expected to step
in as the organizer, the emotional
manager, and the person who holds
the family together, even if that
is the same role they've spent
years trying to escape from?
Yeah.
Yeah, we are still seeing a
massive differential in the number
of female caretakers as opposed to
the number of male caretakers.
It has everything to do with how
we are socialized in Western
society, even now.
So I have two daughters.
They're nine and ten.
And my two daughters, we are a
possibly obnoxious feminist
family.
And we're raising strong feminists
in the world.
And, you know, we don't like the
Disney princesses who are being
saved by the Disney prince.
And as much as I am trying to
raise them to be strong women in
the world and to defy traditional
gender standards, well, you know
what?
When we go, when we need a new
winter jacket and we go shopping
at Target, can I tell you that the
girls' section is all pink and
purple and unicorns and the boys'
section is all blue and red and
trucks and Legos, right?
So there is still a genderized
socialization that happens.
Women are—I'm sure you guys are
familiar with all of the sociology
studies that came out of the East
Coast about how teachers respond
to girl problems and how they
respond to boy problems on the
playground and in the classroom.
There's a little undertone in how
we raise women of you should know
better when it comes to meeting
someone else's needs.
There is almost a reflexive,
automatic—think of a dinner table
where you've got brothers and
sisters sitting around.
There's sort of a reflexive,
apparent—even me, even me, a
staunch feminist will look to my
daughters to clear the table and
not my husband, right?
And so we are still
unconsciously—we are still
socializing women to be the
caretakers and the administrators
and the organizers.
I would like to, if I can, I would
like to direct your listeners to
Cheryl Strayed's podcast.
It is the Dear Sugars podcast, and
there's an episode there.
You'll have to Google it.
I don't know how to find it, but
you'll have to—you'll Google the
episode that is The Invisible
Labor of Women.
And she does an elegant job of
discussing how women are raised
and all of this labor, emotional
labor that women do,
invisible labor that women do
that, yes, to your question, we
are still expected to do.
And we can't help ourselves
because a lot of us, because we're
socialized that way, we get really
good at it and maybe even a little
controlling.
And frankly, I don't want that
guy, my brother, I don't want him
in the room making the decisions
because I've been making all the
administrative decisions and
organizing everything for as long
as the family has been around.
And so I'm going to continue it
because I know better.
And that's what I was told as a
child, that I know better.
Yeah, yeah, that I can do it
better than you.
Now, in some families, caregiving
is happening across some major
deep political divides.
What do those differences become,
or why do they become so
emotionally charged when a family
is already trying to make
decisions about care,
responsibility, and trust, now
throw in the politics?
Yeah, we are in a time where the
political has become personal.
I don't know about you, but I hear
people older than me talking about
times when that was separated.
I can't imagine that.
I don't know about you.
I can't imagine times where you
could separate your political
beliefs from your personal
identity.
Our political beliefs are founded
in a very personal and intimate
space.
It's interesting because maybe
what is different now from times,
I don't know, you might know
better than I would.
What might be different than it
used to be is the politics around
health care.
And our discussion today is about
health care.
And it's about access to health
care and the cost of health care
and the burden of health care and
all of that.
And so you can see how political
arguments can arise around, I'm
thinking of a family member
screaming at another family member
because they can't access some
kind of health care for their
aging loved one.
Well, you voted for this, right?
And that coming to the surface,
that's the impact of the political
divides in family is, well, it's
something new that I see in my
practice.
Let me take a quick little detour
here.
Because of the division that we
see in the United States right now
politically, there are, I have
gotten more than I ever have, and
I've been doing this for 21 years,
more than I ever have, I have
gotten politically divided
families.
Those beliefs run deep.
They are woven with religious
beliefs.
They're woven with personal
beliefs.
They're woven with relational and
familial beliefs.
So they come up all the time.
But they are more resolvable than
other differences I have come
across.
I actually, those are my favorite
families to work with.
Because those differences in
viewpoints are, we are able,
because they are so personal,
if I'm able to get a family to
discuss not the belief, and if I'm
able to get the family to drop the
agenda, to prove your rightness
and prove their wrongness,
if I'm able instead to get the
families to discuss why they
believe what they believe, for
real, why they came to this.
It's almost always some kind of
personal experience, some kind of
way that I grew up, some fear that
I have, some idea that I'm scared
of losing, that I cherish, that is
so important to me for these
reasons.
Almost always, I have been able to
build a bridge.
I'm not sure that that bridge
building can happen in medical
crisis, when there is a suffering
adult, a parent or a family member
that needs caretaking.
I think that there needs to be,
imagine your brain kind of
cluttered with thoughts of
medication and doctors and the
oncologist appointment and
radiology and like cluttered with
thoughts.
In order to become curious and
interested about your siblings'
political beliefs, you have to
take a broom to it.
It has to be kind of, you need
some space.
You need some clean space in your
brain.
You need a lot of space, yeah.
Yeah, yeah.
And so I don't, I think I'm a
little pessimistic that there can
be much resolving of those
differences in an acute caretaking
crisis.
We got to be graceful in those.
I coach my families to exercise
grace and then actually I make
people do journal entries and
really like decide for themselves,
what does that word mean?
What does that word mean, this
word grace and graciousness to
other people?
Can it be a pause button on that
conversation?
And kind of what I said before
with a promise to return to it,
but not when I'm cluttered with
medication and doctors and
radiology appointments and care
facilities and nurses and not when
I'm cluttered.
And fear.
And so, yes, yeah.
And so almost like a pressing
pause on those political
differences.
But yeah, it's a long answer to
your question.
What is the impact?
It's enormous, enormous.
Well, you speak to the fabric of
it all and people carry that
identity with them day to day.
I mean, I think back as a kid, I,
we'd spend summers up at the
cottage and was
multi-generational, lots of family
members and extended family
members.
And I still remember one night,
you know, old Auntie Mary was
really crapping on the prime
minister at the time.
Had nothing good to say about the
current government, but everybody
woke up the next morning and said
good morning to each other.
It was just, it was a forum for an
opinion and there was some back
and forth and disagreement, but it
wasn't woven into how the next day
was going to turn out in the days
afterwards.
Yeah, I don't think that social
media is doing us any favors there
because now everyone feels,
everyone, you know, we're getting
opinions at us like a fire hose,
you know, and we are expected to
develop our own opinion and
participate in the conversation.
And we want to, and we're
influenced by the way this
person's thinking and by the way
that person's thinking.
We go out into our families and we
announce, we announce our feelings
because that's what we're supposed
to do on TikTok and on Instagram.
And so, yeah, it's, I don't, I
don't think that the socials are
really helping us there.
I think it was a lot easier when
Aunt Mary did it one night and
then we have stuff to do the next
day and I'm not scrolling on Aunt
Mary and all the Aunt Marys that
there are in the world.
I think that's, those were, oh
God, I hate being this person.
Oh, the good old days.
Those were better times.
So can a fractured family still
coordinate care if they're not
going to agree or forgive each
other or repair relationships
first?
Like what's the basic that needs
to be in place for the family to
be able to make it work to
caregiving that moment?
Yeah, they're, they're not going
to be able to do it without
difficulty.
So this might, this might not be
what you were expecting.
What needs to be in place is a
third party, not related to the
family.
Depending on the size of, and the,
and the age of the fracture.
That needs to be a rabbi, a
therapist, a social worker.
That family needs to come to the
most basic of agreements.
And the most basic of agreements
is that we are unable to function
in a healthy way.
We are unable to function in a way
that helps our ailing person.
The person who needs our help, we
cannot help them because there is
too much bad blood here.
And I think the, the siblings or
the children, you know, whoever it
is, the other family members need
to relinquish control, not of
decision making, but need to
relinquish some level of emotional
control or relational control to a
third party.
And that that third party is,
rather than, let's say that I have
a lot of angst between my brother
and me, we are not allowed to
discuss what to do about mom, but
I can talk to the third party and
he can talk to the third party.
And the third party can mediate
some common area and help us make
a decision about what to do about
mom.
I'd like to switch gears a little
bit and focus in on the
caregivers.
Caregivers who are grieving
several losses at once, the person
whose health is declining in front
of them, the relationship they
once had, or maybe the
relationship they never got to
have, and the family they hoped
would show up in the moment.
What, what, what kind of grief is
that?
Mm-hmm.
We call it complicated
bereavement.
It is the cruelest aspect of the
human condition.
Um, having to grieve so many
obscure things.
Sometimes you've got one sort of
obvious thing that you're grieving
and everything else is abstract
and hard to define and hard for
other people to relate to.
It's complicated bereavement.
I will say that my field and the
medical field have done a, a, a, a
fantastic job writing about this.
That caregiver needs books and
groups are, are both of those
fields.
The medical field and the
psychology field have put together
organizations and causes and
resources so that you don't feel
alone.
Um, you will find, um, that so
many people can relate to these
undefinables, these unnameables.
Um, more importantly, I hope
caregivers would find that
validation.
You are, yes, this is complicated.
This is not so simple.
Um, you're, you're not crazy.
You're, there's nothing wrong with
you.
This is a heavy load.
And working with a therapist or
whoever, um, can help you, this is
a strange way to think about it,
compartmentalize your grief, even
though it's all kind of layered,
um, and help you grieve things one
at a time.
And I, what I, what I don't mean
by that is grieve this until it's
grieved and you're done and now
move to the next thing.
But they allow space for today,
I'm grieving the relationship.
And then maybe next week, you
know, today I'm grieving what I've
lost in my life, you know, and,
and grieve that.
And the next week when they, when
they come, you know, today I'm
grieving my dad.
My, I'm watching him, you know,
and, and to let, let the grief be
compartmentalized that way.
And as much as possible allow, you
know, there's permission for you
to, to, to pay attention to one
piece of the grief at a time.
But it is, um, that's a
heartbreaking time in our lives.
That is a, that is a sad time in
our lives.
And, um, yeah, we need, we need a
lot of support and resources
during those times.
One thing we've noticed, and I
certainly read all the comments
coming in on social media, but
it's all about giving a name and a
language to what's happening to
you.
And I think, as you aptly point
out, the presence of community and
connection through resources, and
whether it's online communities or
in-person communities, uh,
wherever you live, that all helps
give that sense of language to
what's happening and the shared
collectiveness of a language that
everybody speaks.
In an age of, in an age of, in an
age of, in an age of, where
everybody feels alone, that walk,
putting one foot in front of the
other towards community, once
again, I think is massive, as you
so well point out.
Yeah, for sure.
Can someone be a good caregiver,
Angela, when love is no longer the
main reason that they're showing
up?
Yes.
Yes.
Think of all of the doctors and
surgeons and nurses and lawyers
and who would not say that they
love their patients, but are
exceptional caregivers.
If you do not feel love for the
person you are caregiving, well,
first call me, because I
questioned the premise.
I bet somewhere deep inside
there's some love.
But if you do not, if you do not
experience, uh, the more daily
kind of pleasantries that you
would hope for, if you are, um,
not happy with the person that you
are caregiving, the task of
caregiving is still the task of
caregiving.
You still have to do things with
your hands and your phone and your
computer, and those things can be
done unemotionally and quite
effectively.
But then when someone's caregiving
from obligation instead of love,
what has to be protected so care
doesn't become resentment,
self-erasure, and punishment?
Yeah, that's, that's a great
question because you start to, uh,
worry about, um, adult or
dependent abuse, right, um, that
can happen.
Sometimes we, um, sometimes we, we
make that sound really nefarious
and we think of, um, you know,
sons and daughters that are, that
are twirling their mustache and
taking financial advantage of an
ailing parent.
Um, and that is elder or adult
abuse.
Um, but really what happens in a
more realistic way in lots of
families is that the abuse was
never planned or intended.
It just sort of came
circumstantially out of, out of
anger and resentment.
Um, and yeah, yes, that you are,
if you, if there is quite a lot of
resentment built up between you
and the person you are giving care
to, um, that, that's a problem.
Um, and so you, you, you need to
be very mindful about your, um,
the decisions that you're making,
that you're making.
You need to be mindful about, uh,
excuse me, you need to be mindful
about the decisions that you're
making and you need, you need
fresh eyes on it.
It's almost like, it's almost, I,
I think of it as, um, as a
responsible action.
If I am very unhappy and not
feeling any kind of pleasant
feeling toward my mother, but it's
my job to take care of my mother,
it would be responsible of me to
have a third party check my work,
right?
To have someone that I trust, a
friend, a, a, a, someone that I
trust on the outside checking and
saying,
eh, you probably were pretty harsh
to her right there.
That was uncalled for.
I think you're making that
decision out of anger, not out of
what's best for her mom.
Well, I don't know if that's the
right course of action.
I, I say rely on, um, outside, un,
unconnected, uh, parties for that.
Let's see if you can, uh, yes,
check your resentment because that
resentment can, in these
circumstances,
not always, but in these
circumstances, that resentment can
become dangerous.
Resentment becomes more dangerous
also when you feel like it's truly
you who's doing it alone
and it's going to be for a long
time to come.
And again, building that team
around you or that community
around you can take away that
sense of aloneness
and maybe just detune that sense
of resentment.
So when does the goal need to
shift from repairing the family
relationships
to truly creating a caregiving
arrangement that's safe, clear,
and workable?
Pretty immediately.
I think, I think that shift needs
to happen.
That's, in fact, I was just
thinking, is that the first order
of business?
That might be the first order of
business is to shift, shift the
relationships, or excuse me, shift
the focus.
Um, and, uh, maybe that's that
family meeting that, that I really
want all the families to have.
Maybe that's the, uh, whoever the
leader of the family is.
Let them be the leader.
Let them call the meeting.
Say, okay, we have a problem.
Everybody sit down.
And whether it's in a living room
or on Zoom, let's have everybody
sit down and let's shift focus.
So here are the problems in our
family that we're going to set
aside for the moment.
Don't forget that promise for one
day being able to resolve those.
But, um, shifting.
Here's the problems in our family
that will not be addressed right
now.
Here are the problems that will be
addressed right now.
Um, I, I, this is so nerdy, but
I'm a big diagrammer and list
maker.
And, you know, and I, I, in my
vision, families are sitting down
with a whiteboard and kind of
writing down, like, which problems
we're going to address with whom
and how and at what point in the
timeline.
So how do you do that when other
family members seem more invested
in fighting old conflicts than
solving the immediate care
problem?
Well, can you be disinvited from a
family meeting?
Yes, yes, yes, yes.
You do it artfully, and if even
that isn't working, and even if
you're using all of your people
skills and all the stuff that Fred
learned in therapy, right, even if
you're, you're using all of that
stuff, um, if someone is being
disruptive to the process or
causing some kind of, um, uh,
obstruction in decision making,
they're not invited, they, you
treated them as an adult, they did
not act like an adult, so they are
dismissed from the adult meeting.
Give, give a few chances, though.
Here comes grace.
Don't, don't be so swift with the
sledgehammer, right?
So, so someone who's being
defensive and unproductive, give
them three or four chances because
also they're also scared.
Their, their parent is terrifying
them, too.
And we do not behave very well
when we are scared and under
stress.
Give them a few warnings, give
them a few chances, and then
gently ask them to leave.
I think that's a really meaningful
clarification.
I'm really glad you said that.
So, Angela, if someone listening
today is the one who stayed, the
one who's carrying most of the
burden, and is the one trying to
keep care moving inside this
fractured family, what do you want
them most to understand and stop
blaming themselves for?
Hmm.
I really felt a sense of peace and
warmth a few minutes ago when we
were talking about this idea of
burden or resenting the burden or
feeling like you're a bad person
for wanting this to go away or not
wanting to help or not, or, or all
of those.
I think I think I'm going back to
that.
I, I hope that caregivers in
fractured families who are having
all of what they think are the
wrong emotions or the wrong
thoughts to know that there is no
such thing as a wrong emotion or a
wrong thought.
And we can't, or, or, or, or, or,
or, or, or that make you selfish
or that make you any number of
wrong or bad things, they don't.
Those are, those are, those are,
those are profoundly natural human
emotions that everyone has, and
there's nothing wrong with you for
having them.
I really wanted to thank you for
joining us today.
This has been an amazing
conversation, and you've taught me
so much.
To everybody listening, grace,
compassion, acceptance,
self-directed compassion, and also
compassion to everybody around the
table.
Because as a family, you are going
through a difficult time.
Don't try and go through it alone.
Folks, that wraps up this week's
episode of the Caregivers Podcast.
I'm your host, Dr.
Mark Ropolesky, and we'll see you
next week.
Caregiving inside a fractured
family is complicated, and for
many people, it can feel almost
impossible to explain from the
outside.
If this conversation helped you
feel less alone or gave you
language for something your family
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The conversations you hear on this
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We're not a substitute for
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Listening to this podcast does not
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If you're facing a medical
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