The distress of the business of caring

THAT'S MEN: Both carers and those being cared for can find it a very wearing and exhausting experience

THAT'S MEN:Both carers and those being cared for can find it a very wearing and exhausting experience

THE OTHER day I heard a man called Jon Nicholson talk on the radio about caring for his wife when she was dying of cancer. What struck me most was his account of how the relationship between himself and his wife suffered during this experience. She found it impossible to accept that the children were turning to him, and not to her, for help with everyday things. Her emotional responses to issues of this kind and to her own impending death brought much anger into the relationship and he came to quite dislike her.

This isn't to say he stopped loving her, but his love was now of a different kind, changed by conflict, upset and sickness.

In bringing these experiences into the open, Nicholson has given voice to a rarely-acknowledged truth about caring.

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This is that the caring relationship can be wickedly hard on everyone involved. The generous, self-sacrificing carer and the grateful carer are probably figments of the imagination.

The carer is likely to be distressed at what is happening to the person he or she is caring for, at his or her own ambitions being put on hold, and at the endless struggle to get help from the health and other social services.

The person being cared for has to cope with being in a dependent position, with regrets and, perhaps, with fear of what is to come.

The result can be anger and resentment as both sides struggle with their different losses.

According to existential psychotherapists such as Dr Irvin Yalom, we all have four major concerns. These are our awareness of our own ultimate death, the need to find meaning in our lives, our isolation (only you can experience your own birth or death) and our need to be free to shape our own lives.

You don't have to study philosophy to agree that some or all of these concerns are very much part of our approach to life.

But apply these four principles to the caring situation and what do you get?

You have a person coping with the knowledge that death may be uncomfortably close. Some people faced with this knowledge "rage against the dying of the light" in the words of the Dylan Thomas poem. The brunt of that rage may very well be borne by the carer. Others may be distressed in other ways - think of that radio interview with Nuala O'Faolain.

What of both parties' need to find meaning in their lives? What if both are interrupted from doing the things which gave their lives meaning? Many carers find meaning in carrying out the caring role. Others don't. And how do you find meaning in being cared for? Some do, but for others it must be impossible.

Issues of isolation are crucial for both parties. Carers can be cut off from their social lives. Family members may stay out of the way, in case they get drawn into the work of caring. The person who is being cared for may have only a few people who keep in touch, or may have nobody except the carer.

And then there is the question of the freedom to shape your life.

This freedom is constrained in any case, since we live in a world in which there are many forces outside our control. Still, we do what we can. However, in a situation of caring, each person involved may feel that they have lost that freedom.

It's important that carers give themselves permission to think about these issues. It's also important that people being cared for think about these issues. Doing so could help each to avoid taking their anger or distress out on the other.

And families need to realise that what's going on in the caring situation is more complicated than it looks from the outside. They need to appreciate carers rather than criticise them. And if they are tempted to criticise the carer, they need to ask whether this is just their way of coping with their own distress and perhaps with their own guilt at not doing more.

Jon Nicholson has written about his experience in a new book called I want my mummy back. Dr Yalom's books are widely available, fascinating and readable.

• Padraig O'Morain is a counsellor. That's Men, the best of the That's Mencolumns from The Irish Timesis published by Veritas