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The holidays are here, are you beginning to see FUDGE?
Today I am discussing GUILT, the G in F.U.D.G.E. As you will remember I get a lot of mileage out of this concept of F.U.D.G.E. (Fear, Uncertainty, Doubt Guilt, and Exhaustion). There’s a lot of F.U.D.G.E. in healthcare, whether you are the care recipient or the caregiver. If you missed some of my previous talks on F.U.D.G.E. they can be found on my website as blogs. Or have fun scrolling back through my Facebook page.
Today’s ingredient is GUILT.
GUILT is an interesting ingredient of F.U.D.G.E.; you’ll have no true FUDGE w/o GUILT. You do get to decide whether to go or add, nuts.
Of all the elements or ingredients if you will, of F.U.D.G.E. I believe that GUILT is likely the most difficult one to untangle.
GUILT is a state we find ourselves in or a thing we are having. GUILT comes from weird places. GUILT can be related to your matter or totally unrelated, but felt nonetheless.
Think about GUILT and how it has made you feel. Not so good (kinda like when you eat too much F.U.D.G.E).
It is not easy to shed GUILT. It can ride along with us, cause us to make poor decisions, and it can impact other aspects of our lives without us ever realizing it. It can so entrench itself in our lives that plenty of folks need to seek outside intervention to rid themselves of it or to come to terms with it.
With that kind of power, I suppose we could elevate it to the main ingredient status in F.U.D.G.E.
Let’s examine how we experience guilt in healthcare, navigation, caring for loved ones, and perhaps in planning.
The thing I find the most disconcerting about GUILT is that when I am GUILT-y it is something that I’ve arrived at, something I have done or brought on. Me, myself, and I-GUILT. Knowingly or unknowingly. With malice or with innocence.
There are not many options in GUILT. There are not a lot of ways to use it or change what we are feeling or change the outcome if we indeed are GUILT-y. It is not spurring us to the next action, rather, I feel like it is more confining us. It is hard to find anything good about GUILT at all.
GUILT in healthcare: when you think about it there seems to be a lot of opportunity for GUILT to both manifest and to stick around. Most of it seems to be a GUILT that is assigned. And along with GUILT can come stigma. We see blame assigned in healthcare and shaming. Addicts and alcoholics are blamed for a seeming lack of willpower. Obese people are guilty perceived as guilty of their own accord for lack of control as well. The GUILT that follows s a result of blame and shame can contribute to a never-ending cycle, for many.
A patient who doesn’t get better or won’t fully participate in their own healthcare may assign GUILT to a ‘faulty” provider or to their situation, circumstances, or plight. All those Social Determinants of Health which are indeed valid concepts are even a place to assign GUILT.
The emotional part of being inside GUILT, being the holder, is tremendous. Did I do this, did I cause this? Did that happen on my watch? Oh my gosh, I played a part in this unknowingly. Oh my gosh, I have caused harm.
In the planning for the aging arena, I do witness good and bad GUILT. In the bad (let’s call it less than positive) department there may be less than positive feelings that are left unresolved. For instance, when a loved one’s end of life did not go smoothly we may wonder if we did all we could do. We rack ourselves and flog ourselves, many of us for years to come.
A Story: (the GUILT-iest-GUILT story I’ve heard has stuck with me for years). Two Adult Children were cleaning out their recently deceased mother’s possessions. They were tacking the cedar chest which contained their mother’s wedding dress, old photographs, and memorabilia. That cedar chest had served as Hope Chest before the wedding, and then as storage for precious things after her marriage. In the chest, they discovered an envelope marked “Wishes”. In the letter from their mother, who’d only recently passed, she’d asked that she be buried in her wedding dress. The children’s hearts hit the floor. They hadn’t known, she’d not told them, and they’d never thought to ask. Such palpable GUILT when relayed the story to me of the conversation never held.
Let us also acknowledge a less-than-positive GUILT that many of us will recognize: Irrational GUILT is indeed irrational and many times is the result of impossible expectations! How could I have prevented this or that?, Because this or that things are terrible, surely because of me, right? This is where the Shoulda-Coulda-Wouldas come out to dance. They will set up camp and make you watch their Field Day if you let them.
The problem with GUILT is that it can hitch a ride with us for years after the fact. Front seat, back seat, but it rides with some folks years. If we had an unrealistic expectations about the parameters of that trip and something didn’t come true that we wanted, or something happened that we didn’t want the GUILT manifests and digs in for a longer haul, or as long as we will let it ride.
Now those unrealistic expectations, the real culprit, the GUILT-stigator, had a big place in my life. You’ve heard me talk about how I and my sister thought we were the two best daughters on the planet to care for our parents as they aged and changed. I, in my employment with an Employee benefits program, with eldercare resources and providers at my fingertips and lots of research skills; my sister on her job worked for the ombudsmen and was often that helpful voice on your “first call” and responding as a veritable clearinghouse of information.
I had it in my mind, deep down, that I was supposed to be a most knowledgeable daughter who could prevent every bump in the road, see it coming, alleviate and ease all of my parent’s dis-ease. That is not at all what we encountered and I beat myself up when things went wrong.
Many of y’all have heard the phrase “I should all over myself.” There’s a lot of people should-ing on themselves every day. Perhaps the time would have been better spent coming to understand the situation and obtaining proper information to make solid decisions. I know that it took a couple of “objective third parties” to help us in our journey; that is also a large reason why I do what I do now as a Patient Advocate and consultant.
But wait, there is some good GUILT to consider. And I suppose there are some constructive ways to use GUILT. I consider some of this to be in what I call the “For the greater good” category.
Some Elders can GUILT their kids into talking and planning. And so can the Adult Children – they can employ GUILT to get what they want, they’ve been doing it for decades! Think about it. We manipulate each other all the time! If we are intentional in our GUILT-ing we may tell ourselves “it’s for all the right reasons”. I see this used a little bit in family dynamics and ploys to achieve the outcome for the greater good (or Mom’s own good, or Dad’s).
Ask yourself, have you ever GUILT-ed anyone? I will pause here for your station identification.
GUILT for the Greater Good? Like bending a rule to get to a safe and better ending. Like assisting with the parent’s signing of a Power of Attorney designation, enabling a visit with an attorney “when Mom’s having a good day”. It seems warranted to help to build her team and get it in place as her cognition is rapidly changing. That as opposed to no team, “that train has left the station”, sorry, and you must now pursue guardianship, both public and pricey? Dicey GUILT.
To me, Greater Good instances are in the eyes of the beholder. Just make sure you check your malice at the door.
On our part, it’s the malice we need to avoid. And if we recognize malice then we may then become the ones assigning GUILT and blame. Caution there.
GUILT as this week’s ingredient. Don’t forget if you think nuts may be a good addition to your F.U.D.G.E. (they, or we, sure can complicate things).
I can leave you with a story that sets us up for the last ingredient in F.U.D.G.E which I will share with you soon. This story bridges From G, GUILT to E, Exhaustion. My friend Lisa was describing her massive efforts to accomplish a goal and she shared sub-stories that outlined her tribulations to get to her end game. Her stories involved a lot of parts, influences, and many people as she tried and tried to get her outcome and to take care of everyone involved. She’d take on the patient-parent’s care, the outcome, and the physical and mental health of everyone on the care-train, it seemed, and it was going off the tracks. Then she said it: “Nancy, I was last on my own list”.
Exhausted, but in the months and years to come, she would be able to let go of her Shoulds.
GUILT: good GUILT, less-than-positive GUILT, GUILT for Greater Good… Only we ourselves can decide if we want to let it ride with us and for how long.
Got F.U.D.G.E.? Need help dealing with Guilt, Uncertainty, Doubt, Guilt, and Exhaustion? I consult with patients, parents, Adult Children, and Solo Agers to plan for successful aging when navigating our complex healthcare system. Contact me to schedule, 919.628.4428 nancyruffner.com.