Helen put up with many indignities during her years of providing care to her stroke-addled husband, including spoon-feeding him and changing his diapers. But when he became frustrated one day and started yelling and throwing food at her, she became both terrified and incensed. How could she possibly justify to herself making sacrifices on his behalf if he was going to mistreat her? How could she protect herself from getting hurt?
It’s a difficult topic that’s rarely discussed. But sometimes caregivers are the targets of abusive behaviors by the very people for whom they’re providing care. That abuse can take several forms: Care-receivers may lash out verbally. They can throw tantrums and destroy property. Or, in the worst case scenario, they can grab, kick, hit or spit at their dedicated and innocent family caregiver.
Why does this occur? The reasons are various. Patients who have had neurological damage--from a progressive disease like Alzheimers dementia or a suddenly acquired injury such as traumatic brain injury—may now lack the capacity to regulate their impulses and may consequently say and do things they never would have before. Other patients may be depressed and are expressing their sadness, helplessness and hopelessness as anger—often toward the loving person who’s closest at hand. Still other abusive situations may stem from long-standing relationship conflicts between the caregiver and care-receiver that predate the illness. Being cooped up together in the house doesn’t usually improve their relationship but instead fans old hostilities.
For whatever the reason it occurs, abuse by care-receivers puts caregivers in an impossible moral dilemma. Do they protect themselves by gaining distance from the people they’ve vowed to help? Or do they continue to allow themselves to be literal and figurative punching-bags? Helen couldn’t decide. She wanted to see her husband’s outburst as an anomaly, but now flinched whenever he raised his voice. Yet she wasn’t able to bring herself to leave him either. She felt stuck in a state of fear.
