Shame and Dependence

I am tiptoeing in, having found this place only last night.

For about 7 years now, I have been fascinated by the study of shame. This is the first time I have ever come upon a group of like minded people!

I am a Social Worker, coordinating social work services in a 13,000 bed nursing home company, where I have been since 1978. I have dealt with thousands of families as they move through one of the most traumatic experiences a family can endure, recognition of the need of a family member for professional medical care on a 24 hour basis.

Most family systems manage to cope with what really is a very severe stress, with amazingly similar reactions. This reaction is, to my way of thinking, a classic grief reaction. There is the kind of numbness, the shock....then the feelings begin to surface and need for the support of other humans for healthy resolution, and then gradual reestablishment.

(An aside..Patients also experience this grief reaction but recover much more rapidly than families do...they are surrounded 24 hours a day with people who focus on their situation and are there to give comfort. The family gets little or no support from a "natural" support system, in fact, their grief/guilt mechanisms may be heightened by the negative response, or the lack of response, of friends, chuch, co workers, etc.)

In these years, I learned to consciously use, and teach, grief support strategies that are immensely helpful to "almost all" families.

There are, however, a few families -- or individual members of families who react VERY differently to these comfort strategies. These people react SO differently that the staff of the centers, accustomed to the gratitude of the many who are eased through the struggle, are at a complete loss when confronted by the "unexpected" fear driven attack behavior of these folks.

I have many examples to offer, but may I tell of a phone conversation I had just yesterday (August 6, 1997) with the administrator of one of our centers.

The patient (who is always sweet, and "never" the "problem") was brought by her daughter to the state of her residence from several states away, telling later that the reason was that her several brothers and sisters in the other state "did not care for mother well."

The daughter has no family in the area where she now lives, and so far as can be determined, few friends. Mother has advanced Altzheimers Disease.

As typically happens with these "special" people; she had called the State Liscensure agency 3 times within the first 2 weeks of residency to report abuse. She never spoke to anyone in the center about her concerns, none of which were found valid when investigated.

This behavior has not abated, there is no "reasoning" with her, according to the staff....she is unreasonable. "Nothing we can do pleases her," the staff says. I usually get the story when the administration is seeking any and all ways of solving the problem by relocation of the patient!! (And, when I hear the story, the first thing I get is this very long list of courageous and unusually labor intensive efforts made to satisfy....to be met with verbal abuse. Assuring the staff how utterly stupid and non caring they are.)

The notion of "shame spiraling describes this phenomina to a tee.

Needless to say, this scenerio is truly "toxic" in this environment. Before we (I) had a clue, we floundered about, usually worsening the situation by our attempts to "turn the family member around - to convince them that their lack of trust is mistaken."

When I happened into Bradshaw's book I began to "get the picture," starting me on this quest for more knowledge.

It appears to me that we have here persons who are seriously deficient in ability to trust caregivers as a result of early and severe shame, and who have preverbally come to a world view involving having to fight to be safe and cared for. Many are relatively successful in other areas of their lives, but are rendered literally "without ablitiy to reason" when forced to depend on caregivers not "familiar."

I have read Dr. Nathanson's Shame and Pride, but am really in need of discussion in order to incorporate these splendid theories and turn them to this purpose. I am at a loss as to how to even share this knowledge with other professionals without specific mental health background tho I do keep trying and we are successfully managing a good many of these people here and there in the system.

My most urgent need is for guidance on suggestions of managing these "shame bound" people in the least destructive, most effective way. Like others here, I shouted "Shame bound" to the roof tops when I thought I saw the clues, only to be met by...you guessed it....polite but clear resistence....and then I recognized that nursing homes are themselves shamed systems.

I dont think any other health care environment inflames these folks quite like the long term caregiving required by severe chronic illness.

Thank all of you for being here, and for any suggestions or clarification you might offer.

• Difficult Families and Caregiving: Attack-Other? by Sue Deppe, MD, Burlington, VT, 8/7/97
  • Thanks by Dorothy Chance, 8/7/97
  • Additional Factors by Dorothy Chance, 8/10/97
    • Syndrome in difficult family members in institutional settings? by Sue Deppe, MD, Burlington, VT, 8/11/97
      • More Later by Dorothy Chance, 8/11/97
    • Shame in Institutional Settings by Don Nathanson, 8/11/97
      • Taking Issue by Dorothy Chance, 8/11/97
        • Better name needed by Don Nathanson, 8/12/97
          • A Rose by any other name by Dorothy Chance, 8/12/97
      • And we wonder why they come back for more by Mell Williams, Jr., 8/18/97
        • Understanding the relevance of shame for rehabilitation by Don Nathanson, 8/20/97
          • Shame in corrections by Mell Williams, Jr., 8/20/97
            • See if this works by Jim Duffy, 8/20/97
              • positive regard by Mell Williams, Jr., 8/23/97