Guilt is one of the most unpleasant feelings a person can experience. It weighs on people, as if they are carrying an inward scale freighted heavily with regret. Most persons cannot wait to escape this extremely uncomfortable feeling.
What engenders guilt? Where does it come from?
Guilt arises when a person has a sense of somehow not measuring up. The late ethicist James Q. Wilson, a former professor at UCLA and Harvard, said guilt is a sense of disappointment with oneself when one fails to live up to inner standards or falls short of honoring obligations. Guilt is to be distinguished from shame, he said, because shame occurs when a person's moral shortfall is exposed to others. Guilt comes from more internal measurements.
Caregivers may be prone to guilt. Chaplain William Selig, a hospital chaplain at MedStar Washington Hospital Center, says, "Caregivers, particularly those taking care of a family member, are especially vulnerable to regret, self-accusation, and a sense of powerlessness. There can't be anything more gut-wrenching than to see your parent in pain and know that there's nothing you can do to relieve the suffering."
Ultimately, an aging loved one doesn't get better under a caregiver's care, except temporarily. No caregiver can defeat the inexorable forces of aging, illness, and death, yet some feel guilty for being unable to do so.
Caregiver's guilt, Chaplain Selig says, "is a real emotion." He says that caregivers "might blame themselves" over a loved one's health situation. "They feel it's their fault or that they made the wrong decision. Feelings of sadness and anxiety can lower a person's self-esteem and worth. They may feel like 'I'm a failure... I'm a bad son (or daughter).'"
A study published in The Gerontologist showed that guilt is pervasive in caregiving situations. Sons who were not as involved in caregiving as daughters or daughters-in-law felt guilty in relation to their parents' care. What was more, daughters-in-law felt as guilty as daughters when it came to their own perceived inadequacies in caregiving.
If guilt is a common caregiver emotion in every day circumstances, medical crises and/or end of life issues can compound it. Chaplain Selig and his wife Donna, who is a hospice volunteer at Montgomery Hospice in
Chaplain Selig said, "Certainly the best situation for a patient dealing with serious medical issues is to sit down ahead of time with their loved ones and discuss their wishes about their medical care. It's also important to put in writing one's wishes about medical treatment."
Yet the unfortunate reality, he noted, is that only about 10% of patients have an advance directive or have had "the conversation" with their families.
"In the midst of a medical crisis," Chaplain Selig says, "I have seen many times that families can fall apart, and suddenly each child has their own opinion of what's best. Instead of unity in the middle of crisis, there may be chaos, anger, and outbursts of emotion. In those circumstances, it's inevitable that there might be guilt or second-guessing over decisions being made."
Chaplain Selig and his wife Donna recommend consultations with the patient's care team (doctors, nurses, case manager, social worker and chaplain). "Counseling can help family members sort through their feelings and deal with the spiritual and emotional pain," he says.
In caregiving situations that are not in crisis, emotions can still run high. For example, a caregiver may feel guilty about feeling anger at times: "I'm angry that I have to drive my dad everywhere. I'm running around like a chicken without a head trying to keep my life together and serve his needs at the same time. I feel guilty about that anger."
These are normal reactions and one need not feel guilty over them. Caregiving stretches individuals and families sometimes to the breaking point. It is important to recognize these feelings and arrange for enough respite and help to keep the situation from becoming overwhelming.
The guilty-feeling caregiver is probably someone who has high standards she measures herself by. The conscientious caregiver should probably spend more time patting herself on the back for all that she/he manages to do. All caregivers should refrain from beating up on themselves for any real or imagined shortcomings.
Peters-Davis, N. D., Moss, M.S., Pruchno, R. A. (1999). Children-in-Law in Caregiving Families. The Gerontologist, 39(1):66-75. The Gerontological Society of
Wilson, James Q. (1993). The Moral Sense. Simon & Schuster, Free Press Paperbacks,