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An Early Warning Sentinel for Caregivers

Article on Caregiving. March 5, 2018

I've recently come across and have been developing a different form of support for caregivers. It is a role that I call the "early warning sentinel."

Caregiving is an emotional swamp. Wherever caregivers gather, one unvarying theme is emotional distress. One constant wish is for relief from the turmoil.

Most of us will find it. We are resilient and even though caregiving may leave scars, we will endure it and however it ends, we will survive it. But that's most of us. For a few, the pressure becomes too great, pushing them over the edge.

There are two ways we can fall: fire and ice. Fire is rage, ice, depression. Rage is uncontrollable fury, it's not anger. After all, we manage our anger. We may get angry at our boss, but not quit; at our spouse, but not leave; at our kids, but not beat them. On the other hand, rage is not within our control. Rage is the too-frequent news story of murder-suicide or violent assault or road rage. The end point of rage is prison or the morgue.

The other edge, ice, is depression. I'm not talking about sadness, being snubbed by someone you care about, losing that promotion, or watching your favorite team get beaten. That's sadness. You'll get over it. Depression is a clinical condition that requires medical intervention. People in its grip lose interest in their appearance, their friends, activities even food. The end point of depression is the psychiatric ward or suicide.

Fortunately, most of us will never succumb to either of these states but predicting who will is impossible because the turmoil of caregiving can derail stable, balanced people. One of the truths about both states is that those who are seized by them are incapable of helping themselves or of even recognizing they need help. And anyone who tries to intervene risks facing a severe, sometimes violent response.

How can we caregivers set up a line of defense against rage and depression? That is the role of the early warning sentinel. Wherever you are in your caregiving, recruit a friend or relative to be that sentinel. Choose someone who knows you well, cares about you, and whom you see often, then say to that person something like, "I want you to keep an eye on me. If you see me sliding into unusual rages or ranting against things that aren't that important, or if you see me becoming slovenly, or not eating or laughing or engaging, I ask you to call my doctor. Here's his number."

You are not asking this person to intervene. That may not be wise. You are asking him or her to take any concerns to your doctor who will have the resources to deal with them. Of course, you also need to tell your doctor what you're doing and give authorization for his or her intervention.

In most cases, your friend will never need to make that call. He or she can be just a friend. But if you do begin to slide over the edge, there will be someone there to catch you.