The Reluctant Caregiver

A reluctant caregiver grapples with guilt.

By Hara Estroff Marano, published January 2, 2019 - last reviewed on March 4, 2019

My husband has a toxic personality; the definition of gaslighting fits his behavior perfectly. He is bossy, controlling, and a bully. I have tried to leave many times, but was always pulled back. Recently, I moved to another city and was ready to file for divorce when he was diagnosed with cancer. He insisted that, as his wife, my job was to help him through chemotherapy. During the first in-hospital treatment regimen, he was so mean to the doctors and staff that a patient advocate was dispatched to talk to us about his hateful behavior. Of course, he said it was my fault; it was humiliating. I cried. He argues about every treatment, every medicine, every meal. More treatment cycles lie ahead. His family doesn't talk to him. I am the only buffer between him and the hospital staff. I am helping them, but it is killing me. If he dies, how much guilt is mine?

HARA ESTROFF MARANO askhara@psychologytoday.com

It's one thing—and a big thing at that—to take on the burden of caring for someone. What you are being asked to do is much more: At a moment when it has life-and-death consequences, you are also being asked to take on the burden of your husband's failed relationships and his inability to get his own needs met because of his unpleasant personality. It's unclear how he has managed to get this far while failing the most basic task of adulthood—taking responsibility for himself.

If you choose to continue being your husband's buffer, then, at an absolute minimum, you must pace your visits to him; they are too demanding and demeaning. Taking care of themselves is a great challenge all caregivers face. To save yourself, and to be of any value to anyone else, you should not be going to the hospital more than every other day during the treatment periods. Your husband is in a place designed to provide all the medical care he needs. You can be assured that pacing your visits will not jeopardize his life.

Will you feel guilt? The calculus here is one of values, not of love. Your husband is blinded to the needs of others by his own narcissism. But you do not appear to be. Take a deep breath, step away from the situation emotionally for a second, and ask yourself this question: Do you feel the obligation to take care of your husband because he expects you to be the adult he never became and dumps on you the entire burden of his miserableness? You do not have to accept that responsibility—even in the face of serious illness. Or are you feeling duty-bound because your own deepest values compel you to be caring? Your answer won't diminish the abuse, but if you know that you are acting out of fidelity to your own moral values, they become something of a psychological shield. They are a source of self-worth beyond the reach of the most malignant narcissist.

Whatever the root of his misery, it is not you. You are not responsible for his meanness, his unhappiness, no matter how he spins it. Other people know that. One of the cruelest tricks of narcissists like your husband is to destroy the confidence and self-esteem of others; they exploit the insecurities of those around them. You don't say why you were repeatedly pulled back in, but whatever the hook, your husband's M.O. is to trample your humanity to get his own needs met.

You can let your husband—and the hospital staff—know that you will take on the challenge of running interference for him, but because the job is so bruising, you can do it no more than every other day. On the alternate days, your husband will have to do what every adult on the planet does all the time—be responsible for himself.