Problems of the Caregiver
Unless they take extraordinary care of themselves, many caregivers face high levels of stress, burnout, and financial problems. They get frustrated by insurance companies, health care centers, and paperwork. They live on edge around someone who is subject to psychotic relapses. They often feel a pervading sense that they are responsible for it all. That is not true, of course. But parents, for instance, feel responsible for their children; if a child has schizophrenia, it is not unusual for feelings of regret and guilt to linger in the background.
Do You Have to Be a Caregiver?
Your answer is probably yes, but it doesn't have to be. At a minimum you must care for a minor if you are her legal guardian. If the person in need of help is older, you have a legal and moral obligation to prevent her from harming herself or others. But these responsibilities can be less taxing than those faced by people caring for minor children.
The mental capacity of the person you care for will influence the degree of your involvement. For example, if her level of functioning is high but she is overly dependent on you, it might be better for both parties if you arrange to cut back on your help and shift the burden of care more onto her, her case manager, her psychiatrist, or her therapist.
If, by contrast, the patient's level of functioning is low, you may need to step in to protect the person from himself and ensure that his basic needs are being met. You may be able to do this with the person's consent or you may need to obtain the legal power from a court of law (see Chapter 11). In this situation, you should seek the assistance of mental health care professionals and therapists. Let them know when you can no longer handle the burden and ask them to suggest possible solutions. Also, be sure to alert them to any suspicions of illegal drug use so the patient can be treated for substance abuse.
Not Everyone Can Handle It
Remember that different people have different capacities for handling stress and responsibilities. You are within your rights to cut back on your contact with a person whose symptoms flare up and become especially difficult to deal with. Again, make sure she is not a threat to herself and others before you step away and allow others to help. You are not obligated by law or moral ethics to allow someone else — even someone you love — to create chaos in your life.
Your friend or relative may have schizophrenia, but you still are entitled to a life of your own. It is okay to seek help if you feel you can no longer provide the level of care you feel your loved one needs. Do not let schizophrenia destroy both of you.
There won't always be a professional ready or able to step in when you are overwhelmed, but you should use your community's programs to your best advantage. Your best option is to learn everything you can about the system and what resources it can offer you and the patient. See Chapter 11 for legal options that might help you.
Stress increases for the caregiver as the severity of the patient's symptoms increases. Negative symptoms and disorganized behavior common in schizophrenia have been shown to significantly increase the caregiver's burden. Make sure you take care of yourself. Watch for the following signs of stress and work to remedy them.
Signs of Stress in Caregivers
Anger and frustration
Fatigue and exhaustion
Difficulty with concentration and attention
Anxiety and stress
Adapted from Sharon L. Johnson's Therapist's Guide to Clinical Intervention.
Caregivers feel tension, distress, and a sense of being overwhelmed. It is important, therefore, that you find the best psychoedu-cational programs, social support, and therapy for yourself to help you deal with the challenge you face.
Try to Escape Somehow
There are multiple ways to counter stress and burnout. Unfortunately, many of them require money or resources. It may be convenient to turn to someone else while you take a break, but it can also be costly. If you, like many others, don't have enough money to buy free time, you can still strive to find some activities you can do alone. Plan something for yourself when the person you care for is attending therapy sessions or doctor's appointments.
If all you can do is go for a walk by yourself, it still is something you can use to escape, both physically and mentally. This can benefit you tremendously. Make dates with acquaintances or friends for thirty or sixty minutes at a time if you can manage it. Seek out positive, supportive people at self-help group meetings or in other gatherings. Don't allow yourself to be consumed by your role as a caregiver.