"On Healing" August 2007

Posted on Mon, August 20, 2007
Anxiety, like ducks, will never be orderly
By Dan Gottlieb

My friend Anne called recently to tell me she was thinking of leaving her job to work independently. A successful professional, she loves what she does, but realized that the pressure of working at a book publisher was affecting the quality of her life. She didn't want to overburden her coworkers or be judged harshly by her superiors, however, so she would stay on for a little while - "just until I get my ducks lined up."

I said her plan made sense, except for one thing: They're ducks! Once you get them in line, they start wandering around again!

Anne is not alone, of course. Most adults have some variation of misaligned ducks inside our heads: "Once I get my work done, e-mails answered, get dinner, and help the kids with their homework, then I can rest." Teenagers tell themselves that once they get an A on the next exam or are accepted by their preferred college, then everything will be OK.

The content changes, but the formula stays the same: Once these things happen, then I won't have to worry.

And that's what ducks really are, metaphors for our anxiety. It will go away, we tell ourselves, as soon as everything is in order. But hard as we try to line up our ducks, the anxiety never seems to go away. It seems we are always working harder and so are our children. Even with maximum performance, the anxiety doesn't go away. Sometimes it gets worse. So we work harder.

But consider this: Perhaps what causes our distress is not job performance or children's test scores or any of the other things we are trying so hard to manage. Perhaps the issue is the anxiety itself. And the harder we work to try to manage it, the more we fail. Obsessive compulsive disorder is the extreme version of devoting one's life to managing anxiety unsuccessfully.

So how do we manage our anxiety successfully? We start by giving up the illusion that we can do something to make it go away.

I recently saw an 8-year-old boy who developed anxiety about airplanes flying into his window after seeing a documentary about 9/11. When he went to bed, he was afraid that he and his family would be killed. I told him that many children think about death at this age and, while it's frightening for everyone, it's simply worse for some kids.

I told him it was real bad for me when I was a boy. My fears were not about airplanes; I was afraid of the bogeyman beneath my bed. I told myself that if I lay perfectly still, he wouldn't know I was there and wouldn't kill me. My young friend understood that I understood - but then he wanted to know if that bogeyman was still under my bed.

"To be honest," I told him, "he is still under my bed but, after all these years, he is old like I am and he no longer has the ability or the desire to kill me. The worst he can do now is keep me up at night worrying about stupid things I have no control over. In a strange way, we are like old friends and I would miss him if he left!"

Of course, people with debilitating anxiety disorders should seek treatment. But the rest of us would do well to remember that these fears and insecurities will visit whenever they wish, no matter what we do. So instead of fighting unwinnable fights, I recommend going to the park and hanging out with the ducks.

Posted on Mon, August 6, 2007
Guilt can wear down caregivers
By Dan Gottlieb

According to the National Family Caregivers Association, more than 50 million people care for an aged family member or friend during any given year.

A lot of them write to me about feeling exhausted, helpless, worried and guilty - particularly guilty (about feeling exhausted and helpless). Few stories capture these emotions better than one told by a woman I'll call "Lori."

Her story began, she told me via e-mail, in 1993. Her parents were living in their longtime home in the Philadelphia suburbs, but were no longer able to take care of it. Then her father, who was legally blind, called to say he could no longer handle his personal finances. As an only child, Lori knew she had to do something. She also was overwhelmed and alone.

After much research, her parents agreed to move to a continuing-care community, where they spoke daily and she visited frequently. Her father died several years later. Her mother's physical and emotional health deteriorated, so Lori moved her to a nursing home 20 miles away from where she lives. She visited three times a week and arranged for her own children and grandchildren to visit frequently.

When Lori sent me that e-mail last year, her mother was 94 and still living in the nursing home.

"I think I have done as well as I could for my parents," she wrote, "helping them move, managing their finances and being an advocate for their care. I'm 62, recently retired, and I have plans to make a lifetime dream come true - spending a month in Tuscany. I am terrified that my mom will take a turn, or worse, while I'm away and wonder if I should go at all.

"But I'm not proud of some of the feelings I'm having lately. I'm just tired of doing all this 'tending' of my parents. I feel 'anchored' to visiting her, like someone with one foot nailed to the ground who can only travel in a small circle.

"And then my feelings get even more shameful. Both of my parents took care of me for about 21 years, until I got married immediately out of college. I have been taking care of one or both of my parents in various ways since 1983, and after all these years, I'm tired. I know I am not going it alone, because the staff of the nursing home is wonderful. But her care and her needs are always on my mind and have been for a very long time.

"I would like to be free of traveling every week to visit her, but she looks forward to my visits. My mom doesn't talk as much as she used to, but she always asks how I am and how the kids are. I certainly don't want her to die, but I don't want to keep doing this all the time. I love my mom, and I'm grateful that she had me, but I want to stop being the mommy to my mommy, and I know I can't, and I feel guilty for wanting to."

- Lori

Regular readers undoubtedly can fill in the blanks of my guidance to Lori - mainly, I told her, all caregivers need rest and an active support system. The best advice I can offer any caregiver involves compassion for oneself. As I suggested to Lori about going on vacation to Tuscany:

"Imagine there is one person in this world who adores you and cares about nothing other than your well-being. What would they say?"

Several months ago, I received the following e-mail:

Dear Dr. Gottlieb,

"I did find compassion for myself and went to Italy last fall. While I was there, my daughter called me every week from my mom's room and we spoke together. After I returned, my mom seemed weaker and less communicative, and early in December she died.

"She died with such grace, but it was very hard for me. I am still processing it all, alternately grieving and lost without her, and guilty/relieved because I no longer have to care for her."

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