Recently, researchers Bott, Schekter and Milstein wrote in JAMA Neurology that the best long-term care insurance for an elderly parent was a conscientious daughter.  Bott et al., calculated that even caretaking for a parent without dementia takes about 66 hours a month, and for those with dementia, 171 hours.  The findings that such caretaking demands fall upon women who may still be in the work-force, and possibly still parenting their own children, makes them jugglers of time and energy.

How does this all work out for the daughters?  Our anecdotal observation of ourselves, our female friends, and our colleagues is this: it’s not so good.   

In his 1960 paper, published in the International Journal of Psychoanalysis, British pediatrician Donald Winnicott coined the term “the good enough mother” to delineate the psychological processes of empathy and mothering.  As the infant’s dependence on the mother moves from absolute, to relative, toward independence, the mother’s caregiving moves from complete (perfect) sacrifice of self to the infant to becoming good enough (imperfect, incomplete).  Permission to be a “good enough mother” comes from the awareness that the infant’s growth comes from the movement toward independence.  Yet, even in this theory there was ample room for chunks of guilt to be placed on the mother for misjudging and missing the infant’s needs. 

Guilt is what brings us to the “good enough daughter” (our derivative from Winnicott).  How much sacrifice of self is enough when caring for a parent?  Is it okay to be a “good enough daughter” by sacrificing keen awareness and ceaseless response to the elder parent’s needs?  How imperfect, and perhaps even inconsistent, can the caregiving be? 

Complicating all of this are not just societal expectations, but if women are to be frank about this, our own expectations.  It doesn’t matter that our roles have broadened from mothering as the primary occupation, to occupying almost half of the U.S. workforce (wherein we hold positions of authority across a variety of fields). 

“Good enough” may not be good enough.

Receiving A’s at work does not cut it.  Being a “good enough daughter" (if we are to be honest) may result in giving ourselves F’s as nurturers.  We risk failing as mothers to our mothers and fathers.  Bott et al., found that daughters are 28 percent more likely to care for a parent than sons.  Yet, there is a toll on daughters assuming a disproportionate amount of the care of their parents (and in-laws, as it turns out).  The psychological effects are that of depression (some studies suggesting between 40 percent to a high of 70 percent of caregivers have symptoms approaching clinical depression), physical fatigue, sleep problems, and health problems.  

Much of what daughters do for their mothers and fathers does come from love and empathy.  But unlike the developmental process with infants, where the movement is toward independence, with our elderly parents the movement is toward dependence—physical, psychological, or many times, both. 

The existential reality is rough.  This type of caregiving is fraught with tensions, expectations, fears of parents’ death, fears of our own death, and anxiety about not spending “quality time” with the elderly parent when it is still possible.  In addition, there are feelings of resentment:

  • Spending all our quality time in non-quality ways.
  • Conflicts regarding the parent doing things that are maddening (e.g., not using a walker and falling).
  • Parent not trying to make our caretaking efforts or their own lives easier (e.g., forgetting to turn on the cell phone or refusing to learn how to use one).

It has long been known that the desire to be perfect takes a physical and psychological toll.  Moreover, perfection is an abstract construct, subject to interpretation.  In assuming a caretaking role for a family member, we must remember and ACCEPT that everyone has limitations (us as well as the recipient of our care).  By keeping this thought foremost in our mind, the challenges of caretaking become less distressing.  Doing the best you can, in concert with accepting the reality of the situational circumstances, is more than “good enough.”

References

Winnicott, D.W. (1960). The theory of the parent-infant relationship. International Journal of Psychoanalysis, 41, 585-595.

Bott, N. T., Sceckter, C. C., & Milstein, A. S. (2017). Dementia care, women’s health, and gender equity: The value of well-time caregiver support. JAMA Neurology, Published online May 8, 2017. doi:10.1001/jamaneurol.2017.0403

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