Have you ever met a real life "grumpy cat"? Perhaps you know a person that can't see the beauty in a rainbow, one who never utters a kind word or a positive comment. It's like they are stuck in a bad mood and can't escape from the negativity and sometimes hateful thoughts and feelings they carry with them. Now imagine what your life would be like if you were required to care for that person on a daily basis. “Caring for the Hateful” patient can be a common situation for caregivers of older adults.
As caregivers, whether you are a healthcare professional or caring for a family member, friend or neighbor, this difficult situation will often evoke very negative feelings in the caregiver. Although we may not necessarily hate the “hateful” person, we can often “hate” their behavior. Yes, hate is a strong word, and just hearing the word can evoke negative intense feelings which are often linked to fear and anger. The caregiver may even justify those negative feelings because they are just not easy people to be around! But, because it is challenging to care for someone who responds so negatively; there is a tendency to avoid spending too much time around them. As a result, that unpleasant person may be denied good access to healthcare.
The responsibilities of a caregiver are difficult enough without adding the burden of caring for someone who makes a complex job even harder. One thing to keep in mind is if the difficult behavior is relatively new, then perhaps it’s due to a new medication, a change in diet, an emotional experience or any number of issues. Some patience and gentle probing may be the way to finding the root to this change. On the other hand, there is the person who generally exhibits hateful behavior that may be due to feelings of anger, helplessness and depression and it’s usually the caregiver, the one closest to the patient, the person trying to help the most, who gets the brunt of those feelings.
Harvard psychiatrist James Groves, MD, wrote a memorable essay in the New England Journal of Medicine in 1978 (298:883-887) entitled "Taking Care of the Hateful Patient. Dr. Groves describes four patient types that "kindle aversion, fear, despair, or even downright malice in their doctors." He labels these patients:
- Dependent clingers
- Entitled demanders
- Manipulative help-rejecters
- Self-destructive deniers
Dr. Diana B. Denholm, a psychotherapist in West Palm Beach, Florida, and who also served as a caregiver for her husband for over eleven years, wrote “The Caregiving Wife’s Handbook.” While the book focuses on wives as caregivers to their husbands, some of the following suggestions apply to all caregivers. She wrote, “Co-dependence is the single biggest cause of our deepest discomfort, causing irritability, anger, excess work, stress, feelings of guilt and fights with sick husbands and relatives.” Dr. Denholm also suggests to “Speak up for yourself and take a hard line on safety issues” and “Don’t assume roles and jobs just because somebody thinks you should.”
While caring for a hateful patient may focus on the needs of that person, how the caregiver responds says much about the caregiver as well.
Dr. Thomas Weiss, a frequent and popular presenter on mmLearn.org, once again provides viewers with an exceptional background and multi-faceted analysis of caring for the “hateful” patient. This webcast "Caring for the Hateful Patient," offers various approaches to help guide the caregivers in managing these stressful situations. This video is one of many in our "Ask the Geriatrician" series.If you're looking for a comprehensive resource for family caregivers, check out our online Family Caregiver Guide.