Archives for August, 2011
Ideas of vicarious trauma have long been applied to healthcare and disaster relief workers as well as mental health professionals who work with severely traumatized populations. Other labels capturing facets of vicarious trauma have included secondary post-traumatic stress disorder (PTSD) and compassion fatigue. These concepts however, are rarely applied to loved ones (friends and family) impacted by illness. The foremost author on compassion fatigue, Charles Figley, has used the term “family burnout” to describe the impact of caregiving for family members with medical illness. Compassion fatigue can be applied to caregivers, especially those who become engulfed by their caretaking role. Becoming compulsive about caretaking is likely a way caretakers try to avoid overwhelming feelings of grief, sadness and loss. Through this lens, some caregivers may suffer from the avoidance symptom observed in PTSD; they cut off their feelings and become focused on survival of the person they are worried about. They may also try to manage their own survival by eliminating difficult feelings.
A recent report by AARP, as described in the North Carolina publication The Progressive Pulse, finds that in North Carolina alone, 1.2 million residents cared for a family member, partner or friend with a chronic illness. That’s a lot for one state. Regarding the entire country, the AARP Report notes that “in 2009, about 42.1 million family caregivers in the United States provided care to an adult with limitations in daily activities at any given point in time, and about 61.6 million provided care at some time during the year.” Almost two-thirds of caretakers are women.
There is a lot we have to do to take care of ourselves these days. Current recommendations regarding optimal health include eating multiple fruits and vegetables, getting a lot of uninterrupted sleep (in a dark room, no less), plenty of moderate exercise and not smoking or drinking alcohol (though alcohol guidelines vary from moderate use to not at all depending on the study). We also need to manage depression, anxiety and stress, as these contribute toward health risks. Now, added to this list, we need to be concerned about our mouths. Brushing our teeth, flossing, and managing periodontal (gum) disease is now thought to increasingly protect us and lengthen our lifespans. As if we need something else to worry about. The reality is, taking care of our teeth and gums is essential to overall health. Here’s why:
A survey in 2000 revealed that 42% of Americans are in physical pain every day and 89% report experiencing pain monthly. Chronic pain is a serious problem and likely to increase given our increased longevity. When pain becomes chronic, there are a number of psychological and physical effects, including depression, slowing of metabolism, sleep disturbance, physical deconditioning and changes in appetite and sexual behavior. Although pain can start out as a symptom, it can become its own disease. Over time, chronic pain can take over and people can have trouble participating in normal activities. Chronic pain, when it interferes with daily activities such as going to work, relating to others, and enjoying oneself is often referred to as Chronic Pain Syndrome. This title captures the overwhelming nature of chronic pain and the ways it can intrude on and impact the lives of patients and loved ones. The field of medicine has a long and complicated history regarding the sensitive treatment of patients who are in pain. As many people with chronic pain know, some medical clinicians have tended to blame or pathologize people in pain. Though this happens less often, many patients still complain that physicians resist prescribing certain medications for people with chronic pain and are not as sympathetic as they should be.
Physical pain is one of the least understood perceptions in all of emotional life. Pain is deeply personal and hard to define. A lack of knowing how someone feels, however, does not mean that you cannot be supportive. Loved ones play a tremendous role in the experience of pain. Good relationships can be a buffer against the limitations caused by chronic pain. Patients with chronic pain are charged with a number of options regarding managing their condition. Medications are one option, but it is a common misconception that medications cure chronic pain. Medications dull uncomfortable sensations, but in many cases, pain does not go away. There are also a number of behavioral things patients can do to help minimize suffering. This can be a blow to some patients who themselves hope that medicine can provide a cure to their disease.
Last week I had the pleasure of being at the American Psychological Association (APA) Meeting in Washington, D.C. In addition to being surrounded by nearly 14,000 psychologists and having access to cutting edge presentations by some of the best clinicians and researchers in the field, something else amazing was going on. It was Shark Week. No, this is not some clever and not so subtle metaphor about the APA. I am referring to the Discovery Channel’s annual week of programming about the lives of sharks and the humans who try to get to know them. After long days of meetings, I found myself captivated in the evenings watching sharks in all of their beautiful and terrifying glory. I saw real and simulated shark attacks (fake blood in the water looks really fake), learned how it is that sharks can do the damage that they do (serrated teeth and thrashing—it’s not just the bite), and gleaned insight regarding what to do to avoid a shark attack (stay out of the water). Shark Week boasts 30 million viewers. Apparently, I am not the only one who got caught by shark mania. Why?