“Nearly 1 in 3 children have been physically abused, while 1 in 5 have been sexually abused, and 1 in 10 suffer criminal neglect (CDC). Nearly 1 in 10 witness family violence (Safe Horizon). Half of the men who abuse their spouse also abuse their children. In cases when only one parent is abusive, the other parent will often permit the abuse or refuse to believe it. Half of homeless youth are running from abusive situations, many because of sexual abuse. […] Some parents continue to abuse their children into adulthood, while others only abuse them when they are young or for a certain period of time. Other parents leave their children in the care of relatives and re-emerge years later. Or raise their children in loving homes, only to disown them for coming out as gay, trans, or marrying outside of their religion.
That leaves millions of adult children to grapple with the decision of whether or not they should provide support to their abusive or estranged parents when they become ill or elderly.
One study of 1,000 caregivers found that 19% had been abused as children and 9% had been neglected. Caregivers of abusive parents were more likely to experience signs of clinical depression.
Some people make peace with their abusive parents, but that doesn’t mean there will ever be a healthy relationship between them.” — Michelle Daly for The Caregiver Space, Aug 11, 2015
21st century Western culture has some very, VERY conflicted ideas about elder care, especially in palliative stages of mental or physical decline.
“Can she really turn her back on an elderly, ailing parent?
That would violate a deep-seated social and cultural understanding (even, in many states, a legal obligation). Your parents did the best they could for you; when they’re old and need help, you do the best you can for them. But physically or emotionally abusive parents have already violated that convention. Is there still an ethical duty to assist them? Even “filial responsibility laws” requiring adult children to care for parents make an exception for those whose parents abandoned them or otherwise did some injury.” — Paula Span, for The New York Times, October 20, 2011
“We know relatively little about how many adults become caregivers for abusive or neglectful parents, or about why they choose to — or not to. But thanks to a recent study, we can see that those who report having endured childhood maltreatment are more vulnerable than other caregivers to depression when tending to their abusive parents.
The researchers divided their sample into three categories: those with no history of childhood abuse or neglect; those who had been abused and were caring for their non-abusive parent; and those who had been abused and were, to borrow the study’s memorable title, “caring for my abuser.” They also compared caregivers neglected as children with those who were not neglected.
Those who had been abused or neglected were more likely to have symptoms of depression — like lack of appetite, insomnia, trouble concentrating, sadness and lethargy — than those who had not been. No surprise there, perhaps.
But the link was strongest for the third category. “The key was caring for the abusive parent,” said the lead author, Jooyoung Kong, a doctoral candidate in social work. Years later, “they are still affected. They’re more depressed.” — Paula Span, for The New York Times, January 20, 2014
I have previously written about families as “sick systems”; the more work I do within family systems, the more convinced I become that what we are taught to believe MUST be our strongest instinctive bond is often the deliberate OR unwitting author of some of our society’s deepest and most damaging trauma. The sense of unhealthy fusion into the abuser’s care seems to have little concern for gender or birth order of the caretaking adult child(ren).
The sense of obligation and loyalty to dysfunctional family structures is a difficult thing to address when it feels like it’s rooted bone-deep in our values. As a therapist, I always start a line of questioning there: are these actually YOUR values, or are these something you were told SHOULD be your values (and if that’s the case, we have to wonder: WHO told you these had to be your values? My odds are always on the abusive elements themselves, or at least those who implicitly condone or support those systemic elements). Standing by our abusers is similar in reasoning to why women in particular tough it out with domestic violence; it’s why adult children succumb to implicit or explicit pressure to involve themselves with aging or palliative parents in the elders’ decline. We feel we SHOULD. It’s that simple. And it’s that complicated.
In looking at the advice and support available online to caregivers of abusive elders, there are some frustrating limitations placed on those who can’t afford to hire in professionals to provide the service the adult child(ren) don’t feel safe providing themselves. Suggestions of placing the ailing elders in some kind of long-term care, or hiring a care manager or non-familial legal guardian, often require the adult caregiver have the financial means to pay for these services. Even with the privilege of that kind of financial security, there may be more resentment for assuming that financial burden than alleviation of guilt for not doing the work themselves. It’s a Catch-22 that strains a lot of adult-elder relationships even in the best of circumstances.
Beyond the potential for financial burden, when these adults do take on the responsibility for some or all of that abusive eldercare, what’s the invisible price tag? Fear of decline and death may exacerbate the elder’s abusive behaviours that caregivers remember from childhood, triggering a whole new round of the abusive cycles. At best these might be simply awkward and uncomfortable, or at worst escalating (for example) as adult children now in role reversals begin to exercise their new powers in retaliatory fashion. Attempts to repair and reconcile are emotionally perilous if the elder abuser is still in denial about owning their actions or the impacts–both intended or otherwise–of their actions. Especially if the caregiver is an only child and feeling trapped on the hook of providing care or support even from a distance for an unrepentantly abusive elder, there will be precious little safety for them in this situation.
If the members of the sickened family system can step outside those old habitual patterns and fears, there might be a chance to reconcile old issues. That is an exceptionally large “IF”, however. Holding onto the hope of reconciliation can be costly; the risk of reoffence is high, therefore so is the impact of newly-redamaged or repeating disappointment or reopened wounds. Therapy can help keep a balancing, observational eye on the caretaking relationship as the situation develops. We implement a series of self-assessments and situational assessments for the caregiver, and we give explicit permission to consider alternatives. We also use therapy as a safe(r) place to vent frustrations the caregiver will preferably choose not to vent on the ailing parent. The venting space also allows the caregiver to give voice to feelings and experiences an otherwise-supportive spouse may have trouble hearing or managing for themselves, especially if the eldercare situation extends over long periods of time without respite from the care… or the abuse.
There are no clear-cut paths to “right” or “wrong” in caring for abusive elders, especially if the adult child is facing any amount of obligation-driven guilt. The sentiment “blood is thicker than water” fills a family system with a sense that the entitlement of some members to mandatory loyalty is more important than the individual mental and emotional health of other members. Often this sense of entitlement involves considerable upheaval to the caregiver’s life: relocating temporarily or long-term to be closer to ailing elders, or moving parents closer to the caregivers; full or partial financial support; intervention and/or advocacy with the parent’s medical, therapeutic, or palliative care providers; estate planning and management; acute or ongoing family mediation. All of these tasks bring their own levels of turmoil to a relationship already pockmarked or undermined by unresolved abusive behaviours, past or present.
As with any survivor of abuse, emotional support is key. Permission to consider options outside the struggle to fulfill a sense of obligation is also important. Recognizing the signs and symptoms of caregiver burnout is a big part of supporting adult caregivers under any condition (and this also applies to those supporting the caregiver, who may burnout in their own support processes). Unpacking a sense of helpless entrapment and layers of familial guilt are work best done in therapy, even if it’s not going to be a quick process. Families will always be our most complex systems, and the ties of embedded obligation among the most difficult to unravel.