By Vicki Rackner, M.D.

My friend Mary, who is a caregiver, said to me, “I feel guilty all the time. When I’m with my father, who just went into a nursing home, I feel guilty I’m not with the kids. When I’m with the kids, I feel guilty about neglecting my husband. And when I take that occasional trip to the gym, I feel guilty about letting everyone down.”

Guilt is clearly a common feeling in the landscape of caregiving. Dark feelings, like guilt, sadness, and depression are real and normal for caregivers. These painful feelings serve the same function as any other pain you experience. It’s your body’s way of saying, “Pay attention.” Just as the pain of a burned finger pulls your hand from the stove, guilt and other painful feelings can help keep you safe, guide your actions, and optimize your health.

You have a picture of who you are…what values you hold, how you relate to others, and how you conduct yourself. Let’s call this person the “Ideal You.” Guilt often arises when there’s a mismatch between your day-to-day choices and the choices you think your Ideal You would make. 

Your actions may not be in line with the actions your “Ideal You” would take. If you are not living to your own values your actions may cause feelings of guilt. Your Ideal You may be the kind of caregiver who attends all of your Dad’s doctor appointments. When you miss an appointment, you’re falling short.  But remember, you may have needs that are not in line with the “Ideal You”. Your “Ideal You” may not want to “waste” time doing such mundane things as eating, sleeping, or exercising. You may feel guilty when you even recognize those needs (such as feeling tired), and the thought of acting upon them may seem unthinkable (who has time for a nap when there is so much to do?).

You may have feelings that are not in line with the Ideal You. You might feel angry about the injustice of your loved one’s illness. You might even feel angry at your loved one for getting sick! Then you might feel guilty for feeling angry. You may even feel guilty about feeling guilty!

You may long for answers to the question, “Why did my loved one get sick?” You may think that if the “Ideal You” acted more often than the “Real You”, your loved one would be healthy. What if you had served healthier meals? What if you had called 911 instead of believing your husband when he said his chest pain was just “a little heartburn?” What would be different? Anything?

The truth is that you do your best and you did your best at the time. And you can’t change the past.

I would love to offer a magic tip for eliminating guilt from your life, but the truth is that nobody can offer this. If you’re the kind of person prone to guilt, your most effective strategy is learning how to manage guilt so guilt serves you rather than imprisons you.

Here are some tips for managing guilt:

Recognize Guilt 

Unrecognized guilt has a way of eating at your soul. Name it. It’s like looking at the monster under the bed. Drag it out into the open. Sally said, “Sometimes I feel better just saying to myself, ‘I feel guilty that I didn’t bake brownies for the school bake sale.’”

Look for the Cause of the Guilt

What is the mismatch between the Ideal You and the Real You? Is there something that you really want, for yourself, but you don’t want to admit? (Like a day off?)  Do you have a feeling like sadness or anger that you would rather not feel?

Take Action

Get your needs met. If you need alone time, find someone to be with your loved one so you get it! Identify your feelings. Dan said, “I hate to admit this to myself, but I’m resentful that Dad’s illness changed all of our lives. Once I put into words how tough this has been, I was able to remind myself how fortunate I am that we have what it takes to take care of Dad.” Change your actions so they’re in line with your values. Clara felt guilty because her friend was in the hospital and she didn’t send a card because it was hard to get to the store to buy one. Her guilt propelled her to buy some beautiful blank cards so it would be easier to drop a note to a friend the next time.

Ask for Help

You can call a friend and say, “I’m going through a hard time. Do you have a few minutes just to listen?” You may want to renegotiate the contributions your family members make. Have a family meeting and say, “Our lives have been a lot different since Grandma got sick. I’m spending quite a bit of time with her and it seems that sometimes I am stretching myself too thin. Let’s look at the job chart and figure out how we can get everything done together.”

Revisit and Reinvent Who you Want to Be

Who is this person that you want to be? What values do you hold dear?  Understand that in order to be the person you want to be, you need to love yourself and give yourself a break. You are a wonderful person and the “Ideal You” is closer to the real you than you realize. Take a deep breath, thank yourself for all you do, and take pride in all the good you do each day.