Samar Hafeez, Clinical Psychologist and Counsellor, India
Caring for a loved one – whether it is an old parent, a relative or a child – is a meaningful and rewarding experience. Caregiving can be considered a spiritual experience which includes profound emotional connection, mercy, empathy, compassion, sacrifice and deeper understanding of life.
Islamic beliefs on caregiving can be seen as a way to serve God Almighty by caring for another person. As the Holy Quran encourages by instructing its believers to:
“Worship none but him, and [show] kindness to parents. If one of them attain old age with thee, never say unto them any word expressive of disgust nor reproach them, but address them with excellent speech.” (Surah Bani Isra’il, Ch.17: V.24)
The Holy Prophetsa beautifully reinforced this teaching when a man sought permission to participate in jihad. The Holy Prophetsa asked the man if his parents were alive, and upon confirmation, he advised him to strive in their service. (Sahih Muslim, Hadith 2549a). While fulfilling this duty brings immense sense of achievement, caregiving can also be physically and mentally exhausting. Islam strongly advocates self-care, as the Holy Prophetsa advised: “Your body has a right over you.” (Sahih al-Bukhari, Hadith 5199)
Hence, taking care of oneself too becomes important, as any unchecked and prolonged stress and pressure on care givers can lead to a condition called caregiver burnout – It is a state of physical, mental, emotional exhaustion that affects a person who helps people with their medical or personal needs. It happens when people take on too many mentally and physically challenging tasks that go beyond their resources.
Caregiver burnout can be an insidious process, and one may not recognise it until it has negatively impacted his/her health and general functioning.
Knowing and understanding the major risk factors and stages of caregiver burnout can help you recognise and manage its symptoms and assist you in asking for help when you need it.
Few risk factors for caregiver burnout are: Unrealistic expectations: No one can single handedly and exclusively meet physical and emotional needs of another person. If you are planning to do it all alone, then you risk burnout.
Too many conflicting demands: In addition to the caregiving role, the person might have to cater to other demands such as taking care of household responsibilities, partner, children, and job which multiplies the pressure and stress.
High workload
Excessive workload is an aggravating factor for burnout. Some caregivers might be assisting a person with complex needs and if the person is highly dependent on you, then you risk physical and emotional exhaustion.
Lack of regular self-care
Without adequate quality time for oneself, family and friends, burnout becomes inevitable.
Understanding stages of burnout is crucial to early detection, early intervention and recovery, hence let’s explore these stages along with the symptoms.
Warning stage
Initially caregivers start with lots of energy and motivation, but as the responsibilities escalate one may feel the stress and tension and over a period of time the motivation and excitement wear off. This is known as the warning stage. Some of the symptoms include: Irritability and frustration, high stress response, increased fatigue/lethargy, difficulty sleeping or changes in sleep patterns, sore muscles, gastrointestinal issues like hyperacidity, chronic bloating, constipation or diarrhoea, and poor self-care.
Control stage
In this stage the anxiety develops and increases rapidly. The caregiver might become obsessed with his/her activities and may even deny the exhaustion and overwork. Some of the symptoms exhibited in this phase are: Heightened need for control, impatience, obsessions around caregiving activities, withdrawal from family and friends, denial regarding caregiving responsibilities, guilt, feelings of helplessness, worry and fear, increased body pains and headaches/migraines, dizziness and slowed reflexes.
Survival stage
Caregiving duties begin to feel overwhelming at this point. People who enter this stage show signs of chronic exhaustion. Some of the symptoms include: Mental, emotional, physical exhaustion, isolation from family and friends circle, mood swings, eating in response to emotions, impaired selective or goal-directed attention, forgetfulness, feelings of resentment, loss of interest and motivation, impaired judgement, poor concentration, neglect of other familial responsibilities, procrastination, feeling trapped and overburdened.
Burnout stage
In this final stage the caregivers no longer are able to provide quality care. They might experience physical or mental breakdown. Some of the symptoms associated with this stage are: Chronic fatigue, difficulty learning new tasks, confusion or mind fog, nightmares, vivid dreams, loss of personal identity, decreased sense of purpose and accomplishment, extreme feelings of hopelessness and helplessness, extreme restlessness, emotional numbness, substance abuse, loneliness, signs of mood disorders and anxiety disorders begin to appear along with suicidal thoughts/ideations/attempts.
Prevention and management
A state of burnout is not only hazardous to the individual but to his/her family as well. Some helpful measures that can help prevent or manage this condition are as follows:
Be Aware of the first signs of burnout: Awareness helps in early detection and intervention, which is crucial to quick recovery. Caregivers and their family members should look out for symptoms of burnout in each other. A self-test named ‘caregiver burden scale’ or a ‘caregiver burnout index’ to check levels of stress and signs of burnout can be downloaded online. This test will give you an idea as to where your stress levels stand.
Identify your stress response: Notice if you are experiencing an over excited stress response such as becoming agitated, overly anxious and aggressive, or whether there is an under excited state like slowed reflexes, feelings of sadness and/or withdrawn.
One-minute diaphragmatic breathing exercise: The key to deep breathing exercise is to breathe deeply, as shallow breaths from the upper chest indicate presence of stress/anxiety in the body and mind. Method: Close your eyes (optional), Start by breathing in deeply through your nose (six seconds), fill lungs with air. Hold your breath for a few seconds (two to three seconds) and exhale slowly through your mouth (for six seconds), repeat the same few times. This is a quick and handy way to relax, when you have very less time.
Practice self-care: Use your time off from work wisely: Catch up on sleep, as a good night’s sleep will help you think clearly, reduces physical and mental restlessness and reenergises spirit. Also eat healthy and avoid processed/ junk food. Furthermore, eat healthy snacks during short breaks, as it prevents dizziness, headaches, and fatigue. It is also very crucial to rehydrate often. Also, do blood routine check-ups at the physician’s office and whenever you find time, engage in activities that you love.
Practice mindfulness meditation: Focus on here and now, this helps reduce the rolodex of thoughts relating to past or future. Also, during intervals, try going on ‘slow mode’, observe and consciously reduce the rate of speed of your body movements. Keep movements as slow and steady as possible, this helps to reduce physical and mental fatigue.
Try out your favourite exercise with calming music: Exercise releases endorphins (happy hormones) which are responsible for elevating mood and cognitive functioning. Exercise and music together are great stress busters.
Yoga: Stretching can reduce the immediate effects of pain or strain. Yoga asanas increase blood circulation and aid in alleviating stress levels and promote sleep quality.
Work as a team: Avoid overloading yourself, always remember ‘you don’t have to do it all alone’. Delegate responsibilities to other family members whenever possible.
Keep realistic expectations from yourself: Embrace the art of surrender. Let go of things that are not in your control and do whatever you have control over in a given situation. ‘Do Not Blame or Force Yourself’. Caregivers usually ask demanding questions like; “how could I possibly think of taking a break when my loved one needs me?” “I don’t think I am helping enough, should I be doing more?” etc., such imposing questions will only increase anxiety and tension in the present moment.
Gratitude journaling: Write down something you are grateful for at the end of each day, this acts as a buffer during difficult or challenging times.
Keep meaningful social contact and social support: Communicate your concerns with your loved ones or friends. Call someone who understands you, makes you smile, and helps you look at the bright side. Talking to someone whose suggestions you respect and value will enable you to look at your condition from an objective standpoint.
Enhance self-compassion and self-acceptance: Accepting ourselves and showing compassion to self is something we rarely do. Berating oneself is a negative way of coping that can lead to a gloomy assessment of one’s abilities and efforts, which can reduce performance and increase anxiety and conflict as a consequence. Show yourself mercy and forgive yourself for things that were out of your doing. Try to envision your best possible self and recognise failures as a shared human experience and as an opportunity to grow and learn, this helps to increase positive emotions and improve interpersonal relationships.
Prayer: Prayer brings clarity and strengthens your purpose. Small bits of prayers throughout the day, will help you to keep up your mental energy, resilience, hope, positivity and help in keeping anxious thoughts at bay.
Try using respite care services: When you think you are at the point of exhaustion, you can always choose caregiver respite care service to help you manage your responsibilities and health effectively.
Seek mental health support: If you feel overwhelmed then talk your concerns out to a therapist or a psychologist. A therapist experienced in caregiver mental well-being can help you establish healthy boundaries and tend to your emotional needs. Additionally, counselling can also help develop healthy coping mechanisms that prevent burnout in future.
Conclusion
The work of a caregiver requires sacrifice, dedication and persistence which may lead to a belief that you should not take a break or even that you do not deserve one. Some may even feel guilty about being burned out and their subsequent inability to help more. This is however untrue, as much as the work of a caregiver matters, he/she still deserves to rest, to feel content and to be healthy. Attending to your needs and well-being is necessary to be an efficient caregiver/carer.
References:
- www.medicalnewstoday.com/articles/caregiver-burnout
- healprecisely.com/blog/4-stages-of-caregiver-burnout
- www.dementiapathways.com.au/view_resource.php?resource_id=39