When Caring for an Ailing Parent Raises Internal Conflict

caretaker with ill motherA newspaper article recently described how a woman with a seriously ill mother quit her job, drained her savings, and devoted herself to her mother’s care. With no apparent conflict, she said she was giving back what her mother gave her.

Like this woman, some people I work with in therapy find satisfaction and pleasure in providing for their parents. This is not to say they don’t feel overwhelmed or occasionally resentful. Nevertheless, this woman’s experience struck me as very different from that of many people who have a great deal of conflict as they try to manage their lives and figure out their roles as adult children of in-need elderly and/or ailing parents.

Conflict and Avoiding Unwanted and Intolerable Feelings

The conflicts about providing for parents’ needs that I will describe are not between parent and the adult child. Rather, they are internal conflicts. Each person in this situation has many divergent and clashing feelings. Sometimes, a parent will make specific requests or demands for help; sometimes, it is the adult child who has the experience that a parent needs help and they are supposed to provide it.

The thoughts often include:

  • What is wrong with me that I’m so willing to give my mother whatever she wants?
  • My father has no idea what it would be like for me to do or not to do what he wants.
  • Is there a moral responsibility I have to become a caretaker for my parent?
  • If I take care of my father and resent it, am I a bad person?
  • If I take care of my mother by getting someone else to help when she wants me, is that OK (morally, socially, spiritually)?
  • Why should I take care of my parent when she didn’t take care of me growing up?
  • What will other people think of me if I don’t take care of my parent?
  • Why do I feel so guilty?
  • Is it good enough to give even if it’s out of obligation rather than wanting to?

By creating distance in the relationship emotionally and/or geographically, some people have been able to protect themselves from their parents’ assumptions that they are supposed to provide for their needs. These adult children often continue their pattern of saying no to their parents literally and figuratively: they move away and rarely visit; they may show up for obligatory holidays but are careful not to share their emotional lives.

Greta is a person with a separate and individuated sense of self who has developed both emotional and geographic distance from her mother, who has narcissistic tendencies. Now, to her dismay, she is obsessed and in conflict about how to respond to her ailing mother: “My mother was never there for me. She never played with me, never read to me, never seemed interested in my life. When I was a teenager, she gave me money to do things. It felt like she wanted to get rid of me. We’re very distant. I didn’t return home after college. I make a superficial call about once a month. Now she’s 79 and has cancer. Can you believe that she told me she wants to come and live with me? I would rather be dead! She doesn’t deserve my care. More than that, I would be too angry. It would deny the reality of what kind of parent she was. … She and my sister aren’t close either, but she doesn’t want to live with her. The problem is, she is my mother. She’s sick. Is it right to turn her away? If I take her in, I will resent and hate her. But I couldn’t live with the guilt of saying no. But I don’t know if I could live with myself for saying yes.”

When the parent is the one who gets his or her needs met, it can feel like the adult child is being dismissed, disrespected, and made invisible. These intolerable and painful feelings are what adult children try to keep away in their obsessive attempts to figure out what to do. But it is difficult to give up the ruminating: the noise of the struggle in their heads interferes with feeling the unwanted and intolerable. This can create a situation of perpetual conflict with no resolution.

Thoughts such as Greta’s weigh on the people with whom I work in therapy. They become obsessive and overwhelmed with feelings of anxiety and depression. For many of these adult children, the struggle feels very black-and-white: Whose needs will take precedence? Whose voice will be heard? Whose sense of self will be acknowledged and respected?

In contrast to detached adult children, people who have remained closely attached continue to engage in familiar behaviors of making sure the parent is not angry, unhappy, or experiencing unwanted feelings. They ignore their own feelings, make no demands, and express no needs. If this dynamic has not been resolved (e.g., through distancing, forgiveness, or healthy separation) there is often a strong, familiar pull toward compliance with the parent’s wishes.

Garrett, the oldest and only son of three siblings, was always very closely tied to his mother, an unpredictable, angry, and anxious woman. Garrett explained: “I never knew which mother she would be at any given moment. I learned that my job was to keep her happy and untroubled. My life is still devoted to keeping her smiling. My sisters moved away and have little to do with her. I live a mile away. Now that she’s sick, I visit almost every day. My wife is getting more fed up than usual. I hardly see my 7-year-old daughter. I hate that I’m such a wimp. But I can’t say no to Mom. I resent her and how totally she needs me. But what else can I do?”

Meeting parental needs does not insulate the adult child from feelings of resentment toward the parent or from self-attacks for being unable to protect the self from parental demands. At the same time, self-attacks for feeling intensely guilty for not wanting to provide what the parent needs can be intolerable. For Garrett, to not comply with his mother’s wishes would mean feeling self-hate and excruciating guilt and fear of his mother’s attacks for being a bad son. Although Garrett always feels that he is invisible and unseen by his mother, his guilt and fear make it seem as if there is only the usual choice to abdicate his needs and wishes and resume the devotional position of the child he was growing up.

Compared to Greta, Garrett has less conflict and has not sufficiently separated and individuated from his mother. While Garrett feels resentment, he feels he has no choice. Greta, who is more individuated, has greater conflict. She feels strongly pulled between serving her own needs and providing for her ailing mother. She is more connected to her old feelings of being unloved, invisible, hurt, and angry.

Greta expressed bewilderment: “I’m really surprised at how hard this is for me. I would have thought it would be easy to say no to my mother. But it isn’t so simple. I wish I could forgive her. She seems so lost, so sad, so little. She seems frail, not the big, bad mother I have always known. I wish she could have been a loving mother.”

When the parent’s power appears to be diminished or gone as they become more fragile and elderly, it can be more difficult for some adult children to continue their detached stance. This can increase conflict. On the one hand, the child recalls the bad feelings of having their needs be less important than those of the parents. On the other, guilt increases as they see the now-fragile, powerless parent before them. If they see the parent as powerless, they may feel guilty for thinking that the parent was ever a powerful and hurtful person in their lives. This can feel confusing and could lead to a softening of the child’s detached stance. Seeing the now-powerless parent can make it safer to feel the childhood longing for a loving and nurturing parent (who was not available growing up). This can result in the adult child taking on a nurturing role toward their now-frail parent. For some, it may lead to forgiveness.

Addressing the Conflict

As I reflect on the feelings and behaviors of adult children as they confront these issues, I am aware that they represent many different worries, solutions, and parent-child relationships. Even with these differences, every conflicted person seems to share a search for doing it the “right” way. One of my tasks has been to help each person come to what the best way is for them and to give up the idea that there is a “right” way to respond.

At some point, the obsessing has to end and the adult child has to make a choice about how to respond to their parent’s needs. Whether the choice is fully responding, partially responding, or a total refusal of what the parent wants, there are usually guilty feelings. Whatever the course of action, the adult child has to be able to acknowledge that they are making a choice. They also have to recognize that their choice means they are in charge of their actions—that they have a sense of agency. This means that they are responsible for their actions. Even if the choice is total compliance with a parent’s wishes or demands, the power of yes or no, or yes to this and no to that, resides in owning the experience of choosing. Experiencing this sense of agency helps one to feel that he or she has made himself/herself heard and visible. This should decrease self-attacks and promote feelings of self-worth.

The more a sense of agency can be developed, the greater the ability to tolerate the choices that have been made. While the choices may not feel good, recognizing one’s agency can make it feel better.

Note: To protect privacy, names in the preceding article have been changed and the dialogues described are a composite.

© Copyright 2014 GoodTherapy.org. All rights reserved. Permission to publish granted by Beverly Amsel, PhD, therapist in New York City, New York

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Joy

    Joy

    July 17th, 2014 at 12:32 PM

    My own internal conflict has had to do with the resentment that I feel toward my siblings. I have two other siblings who could step up and do more to help me out but they don’t do it willingly and when I do have to ask them to help they always act as if it is this huge imposition that I am placing on them.
    Have they ever stopped to think for one second how much of an imposition this has been on me? I have put my life on hold for months now taking care of our mother, and I know that I live a little closer but either of them could step up and give me a break every now and then but they don’t. I am so mad at them and I think that they know that but rather than confront them I try to hide the anger because I don’t want my mom to feel like she is the cause of all of this. She isn’t but they are.

  • kelly

    kelly

    July 18th, 2014 at 8:26 PM

    Your awareness is great. Your siblings understand that you are more capable which is why you take on the responsibility of caring for your mother. Your mother also realizes the goodness in her work as your mom when she looks at you. Your siblings will help with what they are able to accept acknowledge this time is special for you and your parent. It is also temporary. Good for you for being that kind of adult child that gives back.

  • Judith

    Judith

    July 18th, 2014 at 7:14 AM

    I struggle with whether I owe them this type of care or not. That sounds terrible doesn’t it? But you have to know that I had a terrible childhood filled with a great deal of emotional abuse and so to think that I feel obligated to give back to them even when they gve me pretty much nothing but grief leads me to believe that really, I owe them nothing.

  • kelly

    kelly

    July 18th, 2014 at 8:19 PM

    You’ve accomplished more than many.

  • Benji

    Benji

    July 20th, 2014 at 5:47 AM

    I want to be able to give this thoughfully and willingly but I think that in the back of my mind- this will sound horrible- if I had to give up my life for taking care of someone 24/7 I would be so regretful for the things that I was having to give up to make this a possibility. Even though I know that it would be the right thing to do and that in all likelihood my parents would do it for me, I know that there would be a measure of sacrifie there that would be very difficult to overcome.I hope that I am not ever in this situation but if I am I know that it will take a whole lot opf soul searching to come up with the most beneficial solution for all of us.

  • Gwen

    Gwen

    July 21st, 2014 at 4:14 AM

    This is not always going to be a situation where you give joyfully, you give because you have to and many times this is absolutely enough.

  • tyler

    tyler

    July 22nd, 2014 at 4:33 PM

    Is it that hard to get other people to help you?
    I am going to speak up and be honest that if any of my friends neede this help I would be there to step in and help because this is not a job that anyone should be expected to do alone.
    Where are all of the family members and friends when the going gets tough?
    That is when we need to be there to give that helping hand that we so often profess and yet never seem to when it is actually needed.
    I point no fingers of blame becaus eI am as guilty as the next guy but if I see someone that I love really struggling with something like this then I am gonna be there.

  • Starla

    Starla

    July 25th, 2014 at 4:29 AM

    Yes Tyler, I think that for many families it IS that hard to find others who are willing to help. You sound great, and if I ever have to face a challenge such as caring for my mom and dad then I would definitely want someone like you that I could turn to. You have to see though that many people have no one like you in their lives and that they are basically on their own confronting this challenge. They have no one else that they can depend on and even those around them who do have the time and resources somehow mysteriously disappear when they think that you may ask for their help. Ideally this would never be a situation for anyone but too often it is and it can be quite emotionally draining for someone to experience alone.

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