Dealing with Stress as a Caregiver

"I'm taking care of my partner who is being treated for breast cancer and I am feeling a lot of stress. What should I do?"

Psychiatrist David Spiegel, M.D., says that it is a good thing for partners to acknowledge that they, too, are under stress. Spiegel, Willson Professor of Psychiatry and Behavioral Sciences and Associate Chair of Psychiatry at Stanford University School of Medicine, says there tends to be the feeling that the person with the cancer is the only one who has any real stress. It is, however, important to recognize that partners of people with cancer have their own set of burdens. These are related, but different.

"There are all kinds of things going on. There are disrupted routines, anxiety about money, care giving and other issues," says Spiegel. "There are new burdens on both partners and it is important for each individual to tell the other that they appreciate what the other is doing for them."

There also may be frustration over altered social life and sex life, as well as the fact that the couple may be unable to do many of the things they did before. The fact is, frustration is normal, he says.

Couples can be anxious, too, about how much to say to any children who may be involved. Spiegel says that kids have incredible antennas for emotion.

"If something bad is going on and you are not talking with them about it, children can sense it and they feel excluded. They feel they did something wrong. Explain what is happening in age-appropriate language they can understand.

"Say, 'Mom has cancer. Doctors are treating it. We are worried about Mom, but we are doing everything we can to help her.'"

Allowing children to help gives them an active way of coping and feeling a part of the family, Spiegel adds. Explain that the family is going through a tough time now and everyone has to pitch in. Give the children things they can do to help. These kinds of things are very important.

At this time of year, too, some couples may be thinking that this could be their last holiday together. Spiegel suggests dealing with this thought head on.

"It's a tragic thought, but at the same time, if handled properly, it can draw you closer," he says. "I think it's important to find a quiet time and place to talk about it.

"If you can say to your partner - 'this could be the last holiday we have together and I want you to know how much I love you' - then that's a good thing, not a bad thing.

"I tell my patients to hope for the best but prepare for the worst. I think what that means is that you talk candidly with your loved one about your fears and hopes."

Spiegel points out one good consequence of facing ultimate mortality issues: It gets you to use the time you have as well as you can.

"Ask one another, 'How do we want to spend the time we have?' There are a lot of people who go on in this forced normality and they can actually waste opportunities by continuing to do things that aren't important. Maybe you can take a big trip together. Or spend some quiet time together. Or do things you've always wanted to do. Do them!"

In no way is that giving up or yielding to the disease, Spiegel says. "Instead, it is saying, 'Let's make the most out of whatever life we have together. If it's a long one, then great. We've lived it vividly. If it's a short one, then we have the comfort of knowing we did these really important things together, while we had the opportunity to do them.'

"Use this illness as an occasion to remember what you value about one another - whether it's a day, a week, a month, or 20 years. Cherish what you've got, while you've got it!"

Spiegel is the author of Living Beyond Limits and also heads the Center on Stress and Health at Stanford and is the Medical Director of the Stanford Center for Integrative Medicine.

This article was first printed in the winter 2006 issue of Lifeline.