When the Child Becomes the Parent - Part II

Yesterday we began to explore the transition of the adult child as they become the parent to their aging parents.  Today we will continue to explore this transition as it relates to our emotions. I will conclude with some suggestions for self care.

So what about your emotions?  Depending upon the circumstances regarding your parents’ decline, feelings are subjugated to the rational thought required to orchestrate their care. Feelings associated with strength, security, wisdom and parental selflessness that remained unchallenged are forever disrupted precisely when that very support would be most welcomed. In those moments we are required to display those attributes, not in relation to our biological children (we have grown into those roles), but rather for our newly adopted children embodied as our parents!

This situation frequently engenders profound feelings of loss, heightened anxiety regarding our ability to face this impending doom, abandonment, outrage, and helplessness.  No wonder the seemingly easiest path is to deny our feelings and remain focused on the details.  Following the denial path may cause those repressed feelings to manifest as a weakened immune system, as well as a myriad of very real physical complaints. The other possibility is to play out this fear and anger on our parents with lowered frustration tolerance, withdrawal of visits and emotional distancing. 

Our emotional balance must be recalibrated.  That takes time as well as conscious intent, often when we are merely existing rather than living.  If we are aware of our feelings, it may be terrifying to feel the anxiety of anticipatory grief especially when death is not yet imminent.  It is also a struggle between gratefully assuming this new responsibility and needing them to snap out of it and once again take care of you. 

Becoming the parent to our parents is not always as dire as it may seem.  If your parent’s decline is without major crises, there is an opportunity to assume the role with at least their partial approval and perhaps even the full appreciation of your parent.  There is also time to address important emotional issues that may need to be resolved in preparation for their passing.  If your relationship has been solid, there is an opportunity to experience your parent’s fragility and helplessness with the confidence that you will now be their source of security and display your selflessness on their behalf.  They actually have the opportunity to witness the legacy they have spent their lives creating and nurturing come to fruition. 

This is one of those times in life that ongoing professional consultation and/or therapy prove to be an invaluable investment.  Our core beliefs and feelings have been shattered at a time when we must perform consistently and engage effectively.  We are confronted not only with our parents’ mortality but ours as well - in a real and undeniable way.  If you have yet to experience this phenomenon in your life, understand that recognizing your vulnerability will ultimately give you the strength to seek support early in the process so that you can go the distance and become a richer, more improved version of your prior self.  If you have already been through this phenomenon I would challenge you to replay that experience and feel proud and confident that you completed yet another unanticipated stage of life under duress and to the best of your ability!

When the Child Becomes the Parent

At some point in our lives, the majority of us experience a role reversal for which we are neither mentally nor emotionally prepared: caring for elderly parents. Adding insult to this injury, the majority of us also lack the practical knowledge that could assist us in easing into this transition, which further delays and complicates our ability to process its emotional impact. How, as a generation that has prided itself on an ability to multitask, did this life stage so significantly blindside us?

The answer is simple – management of our own lives is often so overwhelming that the reality of adding another significant responsibility can be incomprehensible! There is no perfect time for our parents to become our children, and yet it frequently parallels the added responsibilities we assume during our children’s high school or early college years. Unless our parents decline rapidly, we defer decision making about them until there is more time or when the kids leave, or when we retire. Rarely is their decline convenient, predictable or capable of being deferred.

Having lived through this experience twice myself, as well as assisting many of my clients through this journey, be comforted in knowing that eventually the logistics straighten out…. until our parents’ decline once again gains momentum. With each stage of decline we hone our assertiveness skills, our facility in navigating the red tape of multiple helping agencies and resign to solicit help while attempting to assuage our guilt. From the practical perspective, living through this experience often propels us to plan for our eventual demise, sparing yet another generation of children from that particular burden.

Logistics aside, a child becoming the parent to their parent challenges our primary mental framework and defies our sense of life’s order. Regardless of our emotional connection to our parents we believe that parents are adults: strong, capable and healthy. They are not allowed to be children. Few of us were raised with stories that challenged the security of this concept. That is why it is possible to ignore little indicators (repeating stories, memory slippage, trouble finding the words to convey their thoughts and even getting lost) because we can rationalize those events as isolated occurrences. On some meta-level we believe that parents are invincible. To witness evidence to the contrary often creates a significant dissonance between what we see and what we believe. In this instance denial becomes our partner. It isn’t until our parents’ cognitive decline becomes more blatant or is accompanied by a physical illness, a fall, or recurrent hospitalizations do the pieces come together, forcing us to confront this reality.

Even when we eventually make this cognitive adjustment, our parents may not be like-minded. Often they stubbornly refuse to relinquish their roles gracefully, causing our logic and their reasoning to lack synergy. Interactions at this stage may be laced with hostility as power struggles between the parents’ resistance to relinquish their independence versus the adult child’s assumption of the more supervisory parental role escalates. For the adult child life with mom or dad often mirrors their own daily life with their children. The adult child is truly sandwiched between two generations that may seem to demand equal doses of attention but respond with little gratitude. 


Stay tuned….. Tomorrow I will discuss the emotional impact of this transition!!

The Roller Coaster of Grief

In recent posts, I have discussed grief relative to life transitions. Today I would like to discuss bereavement; grief related to loss from death. While you may notice some similarities with burnout and other life transitions, the major difference with death is that there is no opportunity for a second chance. The finality of the experience is undeniable. This grief invades our body, mind and emotions in very real and expected ways and is neither correlated with personal strength nor weakness.

Undoubtedly grief hurts! It can literally take your breath away. Physical symptoms resembling a heart attack are not uncommon and are directly related to the intense anxiety associated with the loss. There are also real physical manifestations that often present as excessive fatigue, malaise, joint pain, gastrointestinal distress, elevated blood pressure, chronic headaches and a suppressed immune system. Have you ever noticed, quite often after the fact that you became ill near important markers such as the deceased’s birthday, one month after their passing or your wedding anniversary? That is no coincidence! Our bodies often serve as channels for our deepest emotions. Sleep (inability to fall asleep and/or remain asleep) as well as appetite impairments are also very common.

Cognitive impairments are also very expected during the grieving process. This may include impaired attention and concentration, obsessive thoughts that focus on the days, hours and minutes that preceded the death and quite the opposite, an impaired memory for details. Quite often, the grief stricken, especially when the loss was sudden, often seems to need to replay the events far too frequently when judged by the casual observer, but the grieving need this because their memories can neither embrace nor retain the reality of their loss. Our minds have a unique protective mechanism that allows only a designated amount of trauma to be absorbed at any given time before it simply shuts down. The extreme cognitive stress that is exhibited is often the result of a combination of emotional, mental and physical exhaustion. Depending on the circumstances surrounding the loss, it may take months for your memory to return to its previous level of functioning.

Emotional reactions to grief can often be characterized as extremes. In the early stages of grief, fear is amplified – fear of forgetting the deceased, fear of being alone, fear of living and a fear of dying. It is not unusual to hear your deceased’s voice, to turn around only to see them, and to experience dreams that feel so real that you dread awakening. Our emotions struggle to keep up with the reality of the recent event. At some point in the grieving process, complete despair is not an uncommon feeling neither is an overwhelming longing to be reunited with your loved one.

Feelings are often experienced in an all or nothing fashion. Along the spectrum of profound sadness, one may display seemingly non-stop crying to a complete inability to cry despite feeling as if it would bring to them a sense of relief. Feelings of apathy (staying in your p.j.’s all day and not getting out of bed) may transform to hyper motivation (cleaning, organizing and completing numerous unfinished tasks often until the wee hours of the morning). Irritability may be displayed as mild frustration (directed at seemingly benign events or individuals) to moderate irritability (rudeness and impatience) to extreme anger (road rage, physical aggression and/or property destruction). It must be noted that these extremes feel and are completely “foreign” to the individual because they did not occur prior to experiencing this loss. Many of my clients have reported feeling “crazy” due to the unpredictability of their responses to the world.

Our previously adaptable coping mechanisms (exercise, social connectedness and engaging in hobbies we once enjoyed) may require far too much energy and therefore are temporarily replaced with maladaptive coping mechanisms that could include an excessive consumption of food, alcohol, prescription drugs, illegal substances and even hyper-sexual behaviors.

The above symptoms seek to illustrate the highly individual and often solitary journey that characterizes grief. The circumstances surrounding the loss often affect and may complicate the grieving process. Complicating factors may be the ages of the deceased as well as the survivors, the suddenness of the loss (anticipated versus untimely and unexpected) and the nature of your relationship with the deceased: was your relationship in emotional order or were there things left unsaid? The specific details surrounding the loss (suicide, homicide, terminal illness or natural causes) as well as the survivor’s loss history (is it the first or fifth and in how many years) may further complicate and extend the grieving process.

So how does does the grieving person effectively tackle their grief? There are numerous theories and published bodies of work authored by thought leaders in this field. The common thread is the notion that grief follows a fairly predictable process from onset to recovery. To work through grief requires moving through these processes and with my clients, often while concurrently redefining themselves. Grief is truly a journey that lasts at the very least one year and more realistically, many years with varying degrees of intensity. Attempting to delay or avoid grieving predisposes the survivor to the possibility that their bereavement and grief develops into a clinical depression, a diagnosable anxiety disorder and/or an identifiable addiction.

When you think of grief as a multiple year journey, how do the survivors gather the initial energy to face it as well as the stamina to go the distance? In the early phases of loss there are close family and friends who rally to support the grieving. Eventually the demands of their own lives split their priorities, and often their support becomes insufficient in meeting the enormity of your need. The option for the grieving at this point is to either become angry when their friend seems to withdraw support or finally reach out for support in the form of individual therapy and/or grief support groups. Ultimately this transition provides an opportunity for your relationship to recalibrate to its previously balanced state.

During my initial session with grieving clients, a visual framework is introduced and as therapy continues, it becomes even more relevant. I equate grieving to riding a roller coaster. What is the first thing you do once you board the roller coaster? You fasten your seat belt! It helps you to stay grounded throughout the ride. Think of therapy as your seat belt on this roller coaster of grief. Just when you think you are once again feeling like your old self, something ignites an emotional spark and down you go. Yet, if you are securely fastened, it is far less scary! The beauty of grief is that with support, you may often climb to heights you never anticipated before the next inevitable dip occurs. At that point you may feel as if your progress has been thwarted, although it quickly resumes when you once again begin the ascent.

Since you can’t avoid the ride, why not step in, fasten your seat belt and hold on for dear life? Your continuing journey through life depends on it…. one step at a time!

Way Beyond Tired....What Is IT?

In a perfect world there would be ample time to accomplish all of our daily responsibilities as well as sufficient amounts of energy left to engage with our friends and family, exercise, relax, and retire at a decent hour, waking up refreshed and ready for a brand new day. We would be paid well, valued for our contribution and have the autonomy to express our creativity within our chosen professions.

If your reaction after reading this description was laced with cynicism you are not alone. The Baby Boomers as a generation have striven to accomplish this goal and have expected that the amount of effort they expended to that end would reap those well-deserved rewards. Unfortunately, elements out of their control economically, politically, and culturally thrust many into a position that severely compromised their best-laid plans.

Does this scenario more accurately reflect your life experience? You hit the ground running after hitting the “snooze” button far too many times, grab a travel mug, fill it with coffee, skip breakfast, jump into your car and face the morning commute, conference calling while driving and arriving late to your first appointment because of traffic delays. Your desk resembles your home office- piles of papers that have some relevance, but you are not certain to what, and as you rush to your next meeting, you make a vow to “clean that up” next week. You then rush off to a luncheon meeting, combining business and a meal (bonus!) then work four plus additional hours and hit the commute home.

Once you arrive home, your kids need to be chauffeured to their activities, dinner needs to be either prepared or picked up, they need help with their homework, and oh yes, then depending upon the day of the week, you run to the gym and hit the treadmill while watching CNN or catching up with your reading. If you forgot to remove your Bluetooth, you rationalize that at least you can listen to your voicemails that you had no time to check during the day.

After the kids are settled in, there is laundry, bookkeeping, the family pets, checking in with mom and dad, and next thing you know, it’s three am and you are on the couch, the television is urging you purchase the latest fitness equipment and you decide to stumble off to bed, knowing that your ill-fated alarm will sound in a few short hours….and ugh, it’s only Tuesday!

We have become masters of multi-tasking, delaying vacations, minimizing the need for self-care, and expecting to have the stamina to continue that pace indefinitely. We were not wired to perform like hamsters on a wheel, yet we often attribute success with being able to meet or exceed this expectation. Realistically what occurs is a systematic multi-system shut down characterized initially by fatigue and ultimately exhaustion – mental, physical and emotional.

Mental exhaustion can be exhibited by reduced capacity to focus, learn and retain novel information, recall important as well as insignificant facts, names, and places, increasing difficulty with mental computations, decreased problem solving skills, waning creativity, indecisiveness and procrastination. Ultimately, it can manifest into “why bother?”

Physical symptoms include initial subtle changes such as higher resting heart rate, elevated blood pressure, and perhaps reduced or increased appetite, libido, and need for sleep. As the fatigue progresses it can manifest as increased risk for a cardiovascular event, joint pain, migraines, and gastrointestinal problems that have no identifiable organic etiology. At this point, increased absence from work and more frequent doctors visits are common as is chronic tardiness.

Emotional fatigue is frequently observed by a marked difference in the capacity to feel and display empathy towards even those who matter the most, increased social isolation, lack of motivation, and diminished frustration tolerance. As the fatigue transitions into exhaustion, there may be feelings of helplessness, depression, increased anxiety, inappropriate anger outbursts, cynicism and sarcasm. There may also be an increase in suicidal ideation, or a stated desire “just not to wake up” (aka passive suicidality). Unhealthy coping mechanisms such as drinking, increased prescription consumption, gambling, promiscuity, and illegal drug use may be utilized as an “escape” or to “numb out.”


What I have just described are characteristics of burnout. It runs rampant across many professions. Compassionate burnout has been specifically identified as a phenomenon of the helping professions - physicians, nurses, mental health professionals, first responders, clergy, and anyone who provides vital human services. It needs to be expanded to all caregivers, from stay at home parents to adult children caring for their declining parents as well as those caring for spouses and children who suffer from major physical and/or mental illnesses.

In the business world, burnout is not reserved for the C-suite executive who must make significant and often highly impactful decisions that have far reaching effects. It filters down to mid-level managers, direct reports and line staff. The common denominator in burnout is a lack of perceived control over your environment. With the multi-tiered demands of life, the reality is that we are all potentially susceptible.

Burnout has been identified as mental weakness, flippantly as a symptom of menopause, and occasionally the justification for a spontaneous purchase of a convertible sports car. Equally erroneous is the thought that a two-week vacation will cure it.

What is the solution? One is that we as a society decide to recognize burnout as a normal human phenomenon. Normalization could lead to the possibility for earlier intervention because of a heightened awareness of symptoms contributing to this condition. Education directed toward at-risk professions needs to be incorporated in continuing education services as well as elevated to a topic that is addressed at corporate retreats. Human resource departments and managers need training in identifying employees whose performance declines, whose attitudes deteriorate, and who have increased absences or chronic tardiness. Developing relationships with direct reports so that there is awareness of increased demands in other areas of their lives could also serve as early intervention and help prevent the increased costs incurred from absences and disability claims.

As individuals, we need a good dose of honesty with ourselves regarding our limits. If you don’t know where or how to go about learning this, seek professional consultation. Get into therapy with a licensed professional. Utilizing denial, rationalizations, and excuses only reinforces the archaic notion of “burnout=weakness.” The ultimate goal is balance. As you take steps towards that goal, add one cluster of healthy behaviors at a time, like exercise and diet improvements. Do not attempt to change every area in a month’s time. The likelihood of sustaining sweeping changes, especially when already feeling some level of fatigue is a set-up for failure.

Solicit an accountability partner, this not only deflates the solitary burden that accompanies burnout, but provides a social and hopefully an emotional connection. Schedule regular mini-vacations rather than delaying them for a grand event; try limiting the number of activities that your children are engaged in that require your assistance as either a coach or chauffeur. If poled, children would prefer fewer activities rather than a “crabby” parent!

If you are a caregiver, seek out regularly scheduled respite care, hire a dog walker, and engage in some activity that gives you a feeling of satisfaction and renewal. These strategies begin only after burnout is conceptualized as a function of an excessive drain on a finite resource rather than a stigma attached to the weak. Get off the hamster wheel… your well-being and longevity depends on it!

How Full Is Your Cup?

Is anyone’s cup truly half empty or half full? How about the label of a pessimist versus an optimist? In the search to define who we are, such labels do more harm than good. Why? Because we believe them! Once you adopt one of these labels, you potentially begin to look at life through lenses that may not be real.

Have you ever known someone who uses an excessive amount of sarcasm and judgment yet proclaims that they are upbeat and easy going? They so desperately want to be that person, that they spin the meaning of their behaviors attempting to convince not only themselves, but also others of their “cheery” disposition.

Then there is the case of the pessimist who so desperately does not want to be viewed as negative that they soften the blow to themselves by labeling their perspective as “realistic.” This way they can minimize the joy of the optimists as well as judge the negativity of the pessimists.

My main concerns with labeling are (i) that we limit our ability to remain cognitively flexible (meaning to develop awareness and then possibly alter our course based on new information), and (ii) labels foster separateness rather than unity. Our personalities just are not that simply constructed!

Dr. Martin Seligman developed a theory that attempts to explain the cup half empty versus the cup half full cognitive style. Cognitive style refers to the templates we have in our psyches that we use to understand our world and our relationships. Dr. Seligman calls this template your “explanatory style” – simply put, how we explain our actions and beliefs.

It is comprised of three dimensions: internal vs. external, global vs. specific, and stable vs. unstable. Events in our lives are evaluated on each dimension and over time it is an extremely accurate determinant of whether we are pessimistic (half empty) or optimistic (half full).

Lets say that you just received a glowing review. How would you explain this event? One option would be to say to yourself: “I deserved it because I really give 100% effort everyday (global view) and I expect that my next review (stable over time) will be equally great because I am a responsible person (internal worth).” This would be considered an optimistic explanatory style because you believe good things happen because you make them happen, you believe in yourself, and there is no reason to think that it won’t happen again. This cognitive style evokes serenity, predictability and security. Unlike the earlier example, this evaluation is based on real information so this is not about how you want to be.

There could also be another explanation for the same stellar review. This individual says to him or herself; “ I squeezed by that time (unstable) my manager must have missed all my mistakes (external), I not smart enough to ever do this well again (internal).” This is an example of a pessimistic explanatory style. You can see that it breeds stress because it strips away a sense of stability and security. It tells you that life is so unpredictable that the other shoe will drop when you least expect it. A person who adopts this cognitive style often suffers from stress-related somatic symptoms, may be frequently depressed, and may have significant amounts of clinically diagnosable anxiety.

Is the person who has adopted a pessimistic explanatory style eternally trapped in that way of thinking? The answer is a resounding NO! There is a complimentary theory called “learned optimism” that suggests that we can retrain our thinking. We can re-enlist the cognitive flexibility I spoke about earlier and, with a consistent effort, really make significant changes! There are a myriad of self-help books on this topic.

This theory respects the complexity of the human mind, and it evaluates events after the fact, so it is much more reliable than attaching a label to ourselves and then making our behavior fit into our belief. It also identifies a spectrum of dimensions - optimism, realism and pessimism - rather than pigeonholing people in one of two extremes.

Explanatory style has very practical implications in the professional environment. Knowing the explanatory style of your employees would be extremely beneficial in the formation of teams. It would provide managers with additional data points, and, especially when coupled with measurements of Emotional Intelligence, provide more effective guidelines for motivating direct reports. From a leadership perspective, a C-suite that shared a similar explanatory style would be much more capable of timely executing a vision. That alone would breed confidence in the organization and its viability.

If you are serious about changing your explanatory style, I would highly suggest scheduling several consultation sessions with a trained professional who has a working knowledge of this theory. Likewise, if you feel your organization would benefit from integrating this theory at any level, there are numerous approaches that a professional consultant with the appropriate training could offer.