Triangles & Caregivers

It’s always a dance, this caregiving thing.

This week three words jump-started some crucial role shifting for me: Karpman Drama Triangle. I learned about that psychosocial theory, developed by Stephen Karpman, years ago in my first Psychology 101 class. Then it popped up again in a Family Systems Theory class, and then, much later, in a class called “Literature and the Novel”. 

It’s a valuable tool for assessing most relationships: families, family stories (hence, novels) and even workplaces.

It is absolutely a safe (though maybe uncomfortable) way of looking at your self in a caregiving situation.

Karpman describes his cycle-- or triangle –as a way to understand where individuals find

their comfort in a group and how we move from rescuer or persecutor to victim—and shows how easy it is to cycle to victim, victim, victim.

Take a look at the triangle diagram here and see if the words help you find your favorite spot. (You may need to think about ways that people (family) have described you. Are you the bossy one, always in control (you wish) or sure you are right? 

Are you the one who claims to have no ego, just trying to help, make life easier, “Oh let me do it”, but secretly you enjoy some pride and moral superiority?

Or maybe no one understands you, always blames you, “Its not my fault.” It just doesn’t make sense, does it,  that you are always the victim?

But Karpman’s theory is that these three “characters” (siblings/coworkers/friends) need each other to keep the dysfunction in stasis. And the only way to grow as an individual or change your life is to step out of your corner—regardless of what the others do.

That can feel really scary and chaotic—but that way growth lies.

Karpman’s characters: Victim, Rescuer and Persecutor show up in hospitals, waiting rooms, nursing homes and family care meetings. It takes a lot of staying conscious and listening to your own inner refrain, to “out” yourself. And note: the only way out is to say, (to yourself) “I’m playing Victim again” or “I need to stop being a Rescuer.” You get no points, no personal growth and no benefit from pointing out that someone else is a Persecutor or a Victim. 

I know, I know...that does seem to take away some of the self-righteous fun. But you want to grow. I know you want to grow

Cancer care is loaded with victims, rescuers and persecutors all vying for top billing: Who can be the biggest victim. We even say “cancer victim”. (Stop saying that.) It’s so easy to say, “Take care of yourself first”--but in real life, and real caregiving, theory is honored in the breach. 

Maybe the Karpman Triangle should be taught to caregiving teams. Maybe we can give out little triangle pins as a reminder. 

Maybe I need to get a little triangle tattooed on my right hand. 

Hidden Caregivers--Children Caring for Adults

It's so much more than, "Mommy's Little Helper." In the United States there are tens of thousands of children who are the primary caregiver for a parent or grandparent. These very young caregivers--ages 6 to 16--do more than bring a glass of water--these are children doing primary physical care for an adult. That means bathing, mobility support, feeding and medication delivery and management.

And they need help. But here's the rub: children is positions of medical/physical care can be at risk of a CPS (Child Protective Services) call which would disrupt the family. So what is a teacher, neighbor or clergy member to do?

Find safe ways to get additional help for the family---and look at this fabulous model in Florida's Palm Beach County.

Here's a link to a great article this week by Jane Brody in the New York Times.

Please do share this one with educators, social workers, faith communities. All of us who know the realities of caregiving--and being cared for--can help out.

Here is the link:
http://nyti.ms/25bgUwl

Move a Muscle Change a Thought

What happens to our bodies and our brains when we are caregivers?

We know a lot about the brain and addiction and stress. We know that caregivers are at high risk of misusing drugs and alcohol abuse and eating problems. The attitudes of people around us are not always the helpful. “Well, she deserves a glass of wine” or “Sure he smokes some dope but really—all that stress—he has to relax.” Or, “Yes she’s gained a lot of weight but taking care of her partner is really hard.” 

But what are we missing? How can we manage that stress and even the trauma of

caregiving?

A few weeks ago I attended a workshop with Bessel van der Kolk—who is the Director of The Trauma Center in Boston and considered by many to be the world’s top expert on trauma. He talked a lot about what happens to soldiers and veterans, of course, and what happens to people that experience terrible sexual traumas or who are in horrific accidents. Those are the folks who come to him for help.

But he also talked about the relationship between trauma and stress and addiction. He talked about what happens to doctors and nurses and caregivers. We’ve known about that intuitively, of course. Most professionals recommend support groups where we are encouraged to process our stress with lots of talking and sharing. But van der Kolk explained that talking can only help to a degree; we need to change the body first or words won’t work. “Calm the body to calm the brain,” he says.

That helped me to understand why I can’t always talk myself out of my feelings, and why it’s frustrating when someone says, “You don’t need to feel that way” when we are mad or sad or scared. We can’t get at our thoughts with other thoughts—we need to go through the body.

What trauma experts like Bessel van der Kolk recommend are breathing exercises, yoga, walking, stretching, dancing (not any formal kind of dance but rather moving around to some music)—movement. Now it’s been documented: Changing the body can change the brain.

The Easter Brother

I consider the following to be quite telling about my own personality: I never believed in Santa Claus. I never, even as a little kid, imagined or believed that a man would go house to house in a red suit and bring toys and stockings to boys and girls.

I did, however, believe, until I was ten or maybe even older, in the Easter Bunny. 

In my own defense I have to explain that we lived near the woods and I saw all kinds of rabbits, little baby bunnies and distance-covering jack rabbits, all the time. But I also had two older brothers who, as only big brothers can, facilitated, my belief. Sig and Larry would talk just slightly out of my earshot about The Bunny. “Don’t let her see him”, and “Did you see the basket he left next door?” They also, to make it more convincing, put bite marks on the handles of our Easter baskets.

My brothers died when they were 42 and 48. Now I’m the oldest. At Easter I miss them. I miss having an Easter basket from Lar who –even as an adult—made me one that included the bunny’s teeth marks to remind me just how naïve I had been. And I miss our sibling tradition of finding the family “King Egg”.  As Easter approached we would each decorate our own hard-boiled egg, fortifying them with dye and crayon and competed (Sig and Lar were both went on to become engineers) by ramming our colored eggs together to see whose broke first. 

I also miss dressing up for Easter services, complete with new dress and corsage. The three of us continued to go to church on Easter even when we had walked away from organized religion. We kept this holiday because we all liked the uplifting Easter hymns like “Up From the Grave He Arose”. 

I kept going to church on Easter even as, and after, Sig and Larry were dying because those Easter hymns gave me a weird hope.  It was not a hope of miraculous recovery for  either brother,  or necessarily for a reunion in the “Great Beyond”, but  hope for  my  own  “arose” from the heartache of losing my  brothers,  my playmates,  co-conspirators and occasional torturers.

One of my final conversations with Sig was about my car. I was 40 years old but still easily defeated by my car worries.  Larry, who was then sick, was caring for Sig who was dying, and I called their house in tears to report the impending death of my car. Larry, who was on the phone with me, relayed the mechanic’s opinion to Sig who was lying in what would soon be his deathbed. 

Lar said to me, “Sig wants to talk to you”. I was surprised because Sig’s speech had become painful and very difficult for him. I waited until Larry positioned the phone for Sig to talk. 

“Here’s what you tell them….”, he began, and he proceeded to dictate a set of car repair instructions to convince any mechanic that I knew a nut from a bolt, and that this girl had a brother who would not see his sister taken for a ride.

At Easter I have the best memories of a girl with brothers—of a basket-carrying rabbit who was “just here a second ago” and of making faces to spoil the, “Come on; Say cheese”

Brownie snapshots that Dad took of our Easter outfits.

Apart from any theology, Easter lets me believe in the resurrection of my family, of my all too gullible girlhood self, and in a life that rises, falls, rises and dies over and over as we each cycle through our layers of loss and gain.

Are You a Caregiver?

If you read this blog you probably are a caregiver and you probably recognize a caregiver when you see one. But there are many people who do serious caregiving who do not identify with that term. They may think, "Well I'm taking care of my Mom or my wife and that's just what people do."

And while that is true, and sweetly humble, there are serious losses when caregivers don't know they are caregivers.

Caregivers, often men who are caregiving or younger caregivers who don't identify with the term are missing a ton of services and supports that are available to them. They are not getting respite, navigation, or intervention services and they may be by-passing the articles and workshops that would save them time--and their sanity. That has big consequences for them--and for the loved one they are caring for.

Because this has been identified a s a big problem in healthcare AARP has created an advertising campaign to help caregivers to recognize that they are caregivers. I know, I know…you would think…but it's crucial that people know they count.

So here (below) is the link to the first "Are you a Caregiver?" ad that will run in November. It stars Jeff Foxworthy the comedian who is known for his "Are you a redneck?" comedy.

So click below and watch this great fun Youtube ad. And please share it widely so the conversation about caregiving will expand.

https://www.youtube.com/watch?v=WJUyfrsJDCY

Dying Nurse Is a Nursing Teacher

Here is a great story from today's New York Times. Martha Keochareon was a nurse with a passion for teaching. This passion--or dharma--carried through all the way to her deathbed where she offered herself as a study subject for nurses in training.

Read this article (link below) to see how passion and usefulness persevere no matter what but also to see how death from cancer is described and managed. It is quite moving too to read how the nursing students came to understand the role and experiences of family caregivers in cancer care.

http://www.nytimes.com/2013/01/11/us/fatally-ill-and-making-herself-the-lesson.html?smid=pl-share