April 6, 2011

The late Dr. John Burnum, a Harvard graduate who practiced for many years in Tuscaloosa, AL, wrote an article for the New England Journal of Medicine called “The Daughter from Dallas.” In this article he described a situation familiar to most physicians outside major metropolitan areas: An out-of- town family member from a major metropolitan area comes home for the holidays, panics at her parent’s deteriorating mental and physical condition and blames poor medical care in her parent’s relatively small town. In this day and age, the daughter would come with several hundred pages of “medical literature” pulled from the internet, so she could tell the doctor what to do.

The “daughter from Dallas” type family members enact similar scenes in the home. Picture this: A loving wife cares for her husband with Alzheimer’s disease, day in, day out. She partners with her physician, feels comfortable with her, and together, they have developed an excellent plan to deal with her husband’s condition. Her son comes for visits only to criticize the care his mother gives, his father’s condition and the poor medical care that contributes to it, the food fed to his father, the fact that the house should be cleaner, his mother’s worry that she may have to place his father in a facility, etc. You name it, family members have probably criticized it.

The first thing you should do is to realize that most criticism arises from shock, grief and feelings of helplessness. The caregiver sees her loved one every day. From her point of view, his decline is very gradual, almost imperceptible. To the son, it seems as if his father has fallen off an Alzheimer’s cliff. Talking on the phone to someone is not the same as seeing him try to accomplish tasks. Also, caregivers often do not paint a realistic picture of the situation in the home. “How are things, Mom?” “Fine, dear.”

That being said, you need family support, not criticism. The best way for your family members to gain understanding is to experience what you experience. My grandmother and mother used to leave me to care for my grandfather with Alzheimer’s disease when our family would come for visits. In this way, I understood to a small extent what my grandmother’s life as a caregiver was like. In our scenario, the mother should leave the son to care for his father while she gets some much-needed respite.

Another way to deal with criticism is to take it as an offer of help. Your daughter criticizes how dirty the house is? Respond with, “It really does need cleaning! Would you rather clean the house or watch your father while I clean?”

Unfortunately, sometimes you have to confront criticism head-on. Strive for a firm and loving tone. Talk honestly about the issues you face, especially the really serious ones — living arrangements, finances, your need for respite, etc. Often, this will resolve the situation. If it does not and the family member still is critical, respond with this, “Please do not criticize me unless you are willing to take over your father’s care.” Try not to escalate the discussion into an argument if possible. The journey through Alzheimer’s disease is difficult for everyone and each person deals with it in his own way. Some lash out, others withdraw, some grieve publicly, some privately. Stand firm, but do so gracefully.

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