I'm Mary Mohouse, psychotherapist at Insight Counseling Duth, where I specialize in anxiety and in providing support to individuals affected by cancer and their loved ones.

I'm your host for our episode tonight on mental health and caregiving.

The success of this program is very dependent on you, the viewer.

So, please call in your questions or send them to our email address at askpbsnorth.org.

Our panelists this evening include Gina Dixon, licensed psychologist, grief support services program manager for Essentia Health in Duth, Dr.

Missy Don from Duth Psychiatric Clinic, and Rachel Linder from Northern Waters Clinic in Duth.

Phone volunteers are standing by to answer your calls.

And now on to tonight's program on mental health and caregiving.

Thank you all so much for uh showing up tonight on this very chilly night.

Um um so I we're going to just kind of get going um here and start talking about this caregiving and mental health.

Gina, if I could talk to you about so you work a lot obviously in the grief support center at Essentia, which is a wonderful place.

Um, and so can you tell me a little bit about grief and and um and uh caregiving and and mental health?

Well, people sometimes don't realize that uh we grieve from the moment that we learn of a serious illness or a serious diagnosis.

We we talk about anticipatory grief and um as that illness evolves um we lose things in pieces as caregivers.

You know, there's there's changes in our lives.

And so having the opportunity to just be able to identify what those impacts are for many people, anxiety about the future and irritability is so common and uh also just low mood, isolation and uh just connecting with other people that uh can normalize.

These are common reactions to stressful life events can really make such a difference.

Yeah.

And I think that's such an important point.

I work with a lot of cancer patients and their families and it's that anticipatory grief of the unknowns and the whatifs and it's the caregivers and the patients that have are looking at it from two very different angles.

But it's that anticipatory grief is for the caregivers is very real and it it affects affects them greatly and their ability to care.

Absolutely.

Their ability to to care for uh the the person who's seriously ill and their ability to care for themselves and maybe they're sandwiched also between caring for children at home and caring in their work.

And so there can be this imbalance between the demands of caregiving and the resources that are in place.

Absolutely.

Absolutely.

Thank you so much.

And Dr.

Missy, would you mind telling us, we talked a little bit before the show, tell us a little bit about, you know, some of the caregiving that you are personally um experiencing and and I feel like that could help because obviously you, you know, you're a retired professor from UMD and so you've been doing this work and as a psychologist for a long time and you're in this in this caregiving space.

So, if you could share, I think that would be very helpful.

Um I have my husband and I have been on quite a journey and um since about 2015 I have been in somewhat of a caregiving role for my husband.

As time goes has gone on my husband has become more disabled.

Um he's capable of taking care of most of his basic needs.

Um, but things like driving, I used to complain because my husband used to drive all the time and it drove me nuts.

And you should be very careful for what you want because sometimes you get it.

So now I have to drive all the time.

Um, you know, things like your lack of freedom because you have responsibilities at home.

Uh the wonderful thing about COVID is that it has now allowed me to continue my work as a psychologist from home because I can do it by Zoom.

Um, but the the thing about being a caregiver is that it's it's demanding and there are times when you um don't intend to be snippy or irritable, but you do get snippy and irritable and I find myself apologizing a great deal.

Um, sometimes I've had to literally get in the car and run away for not very long, half an hour.

just to get out of the house.

I'm very fortunate in that my brother lives with us, so I have I have help.

Um it was sort of difficult in the last couple last six weeks because he had to have surgery.

So I had two people that needed some help.

Um, the other thing though that really has helped me is putting myself into therapy to to manage that stress to have somebody to talk to.

And my husband, wisely enough, put himself into therapy.

Um, because it's really hard to be the person that needs help.

It's really hard uh to feel dependent when you've been independent all your life and need to ask for things that any other person would think would be just so simple and it's not simple.

Yeah.

And I think that that is that shows just the you know the difficulty of the caregiver as difficult as it is for us as the caregiver to also understand that the person who is receiving the care is also going through such difficult times.

So trying to balance so a continual balance with that.

Yeah.

Yeah.

Absolutely.

Absolutely.

Um Rachel, um what if you could speak to a little bit of what are the early signs that a caregiver is being overwhelmed or burnt out?

Yeah, I think that it's easy to to see the signs when they're taking over your life, right?

Some of the things that you you that were already mentioned.

Um but there are some early signs.

Um some of them were already mentioned as well.

So increased irritability.

Yeah.

Um lower frustration tolerance.

So if something changes in your life or if um or if even small changes in your in your structure of your day cause you to feel more irritable than you usually would, less adaptability, right?

And really it's about capacity.

So, when you're noticing, I don't have as much to give, I'm not as um I'm not as available, I'm not as flexible, and I'm more on edge.

I think those are really good early signs, right?

Sleep difficulties are a very, very good early sign to look out for.

Um when I work with my clients, it no matter what they're presenting issue, I always ask, they always roll my their eyes at me, but I always ask about sleep and appetite, right?

because when those things are affected, they can be very early signs that something's shifting in mental health.

So, um I think it's really important to be very aware.

I mean, we know that more than 60% of caregivers develop uh caregiver burnout or compassion fatigue.

And so if you're in that role, it's very important to just be vigilant about any kind of changes in your mood, your behavior, or your energy level.

And it might be good to for the caregiver to reach out to their support system and say, let because as the caregiver, sometimes it's really hard to notice it for yourself.

years ago.

Um, this we I was in a caregiving role with a bunch of with a bunch of friends and um, a good friend of mine told me I had done an overnight shift and a good friend told me the next day that I needed to go home.

And I and I looked at her and I said, "You're right.

I need to go home."

And so um not very many people could have told me that at that time but I knew so I had to have because I thought that I was being you know superwoman and helping all but I was really I was being I was not being good.

I was told to go home.

And so I think really to kind of get that those core people that are around you too to kind of like you know what I'm going through.

You I sometimes I may need some extra help to kind of let me know when when I may need some help because sometimes you know like your husband who got the the help with a therapist maybe that might have been your suggestion or did he come with up with that on his own?

Um I think he came up with that on his own.

you know, he's been married to me for a long time.

Um, but but I didn't uh I didn't ride him about that.

He came up with it on his own.

Um, he had to struggle to find somebody.

He he wanted somebody that was very directive.

So, you know, he ended up initially with somebody that was just nodding her his or her head and saying, "Oh, how does that make you feel?"

And that was not working for him.

Um so and you know he he also needed med management right and that's an important piece because when somebody including myself you develop depression or anxiety and you can use all the coping mechanisms in the world but your nervous system is under assault.

Absolutely.

And so many many people need to have medication in order to manage that or your sleep is going to go out the window and your appetite's going to get screwy and that is your nervous system not functioning properly.

And I think that's a great reminder Mity that you know if you know in your pre life that you didn't have to deal with this.

this is an extraordinary caregiving situation and so to ask for those extra help and those extra things that you hadn't normally needed because you you weren't in this situation before.

Y back to you um Gina, how can caregivers advocate for themselves in medical settings and I saw that there's a caregiver bill of rights.

There is there in Minnesota and other states.

So yeah.

So tell me about again since you know and I know you have a big history you know in in the hospital system but caregiving in the medical in the medical system.

Yeah.

Our grief support services uh department's actually celebrating our 40th anniversary as the first hospital-based uh grief center in the country.

uh so we have uh collaborated with health care providers for a very long time and with with families and uh what I would say is that don't hesitate to ask health care providers uh to talk about resources and it might be part of the spiritual care team it might be a social worker it might be uh a a nurse or a physician but um have conversations ations.

Um, ask questions when um, something isn't clear for you.

And it can be helpful to bring someone in who maybe has had a better night's sleep.

That can help.

Yes.

Or take notes or keep a keep a notebook because concentration and tracking when we haven't been sleeping well is are one of the challenges, right?

Ask for things in writing.

That can be a very useful strategy as well.

Yeah, absolutely.

and the and the caregiver bill of rights has respect, support, and access to resources.

So those are things that are absolutely embedded within all the hospital systems that that is you have complete access to those things, right?

Respect, support, and access to resources.

And I think that's very important for caregivers to know their rights because I think a lot of times they don't quite understand what their rights are.

Yeah.

It's and it's important.

Absolutely.

Important to important to know that.

Um, how can So, back to you, Mitsy.

How can care caregiving and boundaries?

Say more about that.

I'm not sure, Mary, what you want.

So, how can they set boundaries without feeling like they're abandoning their loved one?

How can they how can you set boundaries with with your the person you're caring for, with other family members?

Because there are some family members, I'm sure, who are like your your brother or your your brother who, you know, who is who is is right there and then other friends or family members who aren't.

So, you know, speak to like boundaries and and and caregiving.

So, maybe people who want to kind of get up into your business a little too much or we're for I'm fortunate that has not been an issue.

Okay.

uh for me, but I could imagine that there are people who are really opinionated about what you're doing in the family and decide that hey, I would do it this way or whatever.

I think the primary caregiver knows best because that's their loved one and they need to hold their ground.

Okay.

Um that doesn't mean you don't listen to other people.

Um but I think it's really important that you that's your territory.

that's your that's your loved one and you know that person better than anybody else.

Um so I'm fortunate in that way.

I haven't had anybody my brother or my kids or anybody uh step in and and and try to take over or you know maybe they make suggestions but they're just suggestions.

Yeah.

I can think of some examples of families that have shared with me that perhaps um visitors had should on them.

Um you should be uh going to church more, you should be looking at another hospital center, you should do this, you should do that.

And so uh I really encourage uh caregivers to be uh respectfully direct of that is not helpful for me at this time.

There you go.

That is not helpful to me at this time.

That is a brilliant statement.

Yeah.

I want that written on every caregivers's piece of paper that they're taking notes at the hospital.

That's great.

Yeah.

Very Yeah.

Very very important that again so great that you haven't experienced it but other people and get lots of different opinions and a lot of a lot of different opinions can happen.

Um, a couple of questions about seasonal effective disorder, you know, specifically affecting, you know, the caregivers.

This is a tough time of year.

It's cold outside right now.

Um, the seasons, you know, we just had a holiday.

We're coming up with to um some more holidays here.

Holiday season is a is a tough time of year for caregivers and their loved ones, for families.

Things don't look the same.

They can't be the same.

Seasonal effective disorder can happen.

So, if you wouldn't mind talking a little bit about all those things, holidays and seasonal Yeah, holidays are something that's obviously the forefront of most of my therapy sessions right now for pretty much everybody, right?

Exactly.

Um there's there's all kinds of things that come into holidays and those things are true if you're in a caregiving position as well.

you have your own things that you're bringing to the table, which means past experiences, um, childhood traumas, and also you're coming into a time of year that has increased expectations for all of us, right?

With lower capacity.

Yes.

Right.

So, that's a big thing.

And I think that there is sometimes a tendency to want to make up for the things that have been lost, which is extra pressure that sometimes caregivers place upon themselves um or to to continue to make things special um with the barriers that that are now that are now present.

Um, when it comes to seasonal effective disorder, I think that we can talk about that in the same way we can talk about anything that impacts a caregiver, their own mental health.

And, you know, seasonal effective disorder affects so many people, particularly in in where we live, right?

Yes.

Um, it gets very dark very early in the year and people start to feel it.

And so not only can this lead to increased depression symptoms which include fatigue, um anhidonia, which is the inability to experience joy, right, or to enjoy things that that you used to enjoy.

Um as well as the decreased frustration tolerance.

all of those things that we already know are signs of caregiver burnout um can be increased with seasonal effective disorder or with um depression symptoms.

So once again, your capacity is lower.

So um that's why it's really really important to make sure that you're maintaining your mental and your physical health, but mental health particular um because you're not going to be able to pour from an empty bucket.

Yeah.

Right.

Yeah.

Um one Yeah.

Yeah.

And so so many times people think that that is being selfish, taking taking care of themselves because I have this big thing that I'm doing.

I'm taking care of this big person.

I'm going to put my needs second.

And you know, nobody nothing good happens when, you know, you're you're you're trying to pour from an empty cup.

I mean, you're doing the best thing you can do for yourself is to be the most selfless thing you can do as a caregiver is to take care of yourself so you can be a better caregiver.

Yeah.

I think we've I think we've all heard the metaphor of, you know, if you're in an airplane, what do they tell you to do if the cabin pressure lowers and the masks come down?

You put your mask on first.

Yeah.

And I um That's because you can't help other people if you're passed out.

So, I mean, I think that we have to care for ourselves first because then we don't have anything left to give.

Yeah.

and our quality of caregiving um to others in our lives dramatically increases when we're better, when we're healthier.

Yeah.

Yeah.

Absolutely.

One of a very dear friend of mine who um was very very ill.

I went into the bathroom and on the on the mirror he had written no more used to.

And I was like what is what is this?

What is this Jim?

And he and he said, "I had to learn to stop thinking about what I used to do and start thinking about what I can do."

And I think that's a real way to get through the holidays.

Stop thinking about what you used to do and focus on what you can do, what you can what you can do to make the holiday okay, good for you instead of what it used to be when you know, you had all this energy and strength.

And it at my age at 73, I don't have the energy I had when I was 35.

You know, I mean, I'm sorry, I don't.

Well, if you did, then that would be the medical sign of I would want I would want to interview you next week.

The other thing about seasonal affective disorder, many of my clients really benefit from bright light therapy, you know, and they do make these amazing visors.

Have you seen those?

They work.

Yeah.

These visors that they clip on.

You clip them on to a ball cap and you can walk around with that instead of having you sit in front of the light, which a lot of people have a problem of just taking the 20 minutes to sit in front of the light.

Yeah.

I haven't I haven't heard the the ball cap thing.

I'll have to I'll have to take a look at that.

So, I mean, so bright light therapy works in in Scandinavia.

Every school, every school has bright lights rooms for the kids to go into while they eat breakfast.

While they eat breakfast.

I love it.

Gina, you have a couple books here.

I I want you to to talk about those.

Yeah, thank you.

And and it really connects with what you were just sharing, Mitsy.

Um uh I just started reading this wonderful book, Positive Caregiving, Caring for Older Loved ones using the power of positive emotion.

And it really draws on uh research on positive psychology.

And this idea when we can both acknowledge the stressors of caregiving but also look for the ways and opportunities for connection with the person we're caregiving for increased meaning and purpose uh for memory making that that there are some really um simple ways.

One of the examples in the book talks about moments of connection.

Saying something as simple as um something I love about you is the way you make me laugh.

You know, we say I love you all the time, but just that little addition to the sentence.

The reason why do you why I love you.

The reason why I love you so much.

We can all do that.

We can all do that, right?

You don't have to be a caregiver or or a patient.

Yeah.

Exactly.

Exactly.

Um, and just to point out that there are many books for youth as well.

My parent has cancer and it really sucks is one of my personal favorites.

Uh, so that caring resource center, our public libraries, that can be a start as well for people to um access other resources um that can just help them think about their experience in new ways.

Yeah, I really encourage that.

Yeah.

Wonderful.

Um, if a caregiver has only five minutes for themselves, what should they do with that time?

We'll just we know we'll start anywhere.

I My first, you know, as as someone who specializes in trauma and the nervous system, um my first go-to is do something to regulate your nervous system, right?

That can be as little as five to 10 deep breaths.

We know that that affects um that lowers your blood pressure.

Um it affects um all kinds of things in your body.

You know, decreasing anything you can do to decrease cortisol or just do something that brings you a little bit of joy.

Yeah.

Because I think that often times when you're caring for someone else, you forget to seek out and experience your own joy.

And that's a need.

We need joy.

We need leisure.

We need things we love.

Um things that give us meaning, things that make us happy.

Yeah.

Even if they're little.

Yeah.

Right.

And most, you know, and life is made up of usually just lots of little moments, right?

It's not the big things.

It's the it's it's those.

So, identify maybe some of those little things.

I mean, I think touch is really important.

If you have a pet, go pet your dog.

Pet your cat.

Pet yourself.

Massage your feet.

Get some really nice lotion.

Massage your feet.

Massage your arms.

Massage your scalp.

Yeah.

Yeah.

Um, it's amazing what five minutes of self-touch or touching a pet can really do for you.

You know, you're oftenimes you're touching the person that you're caring for, right?

But you're not getting that touch yourself.

Yeah.

You know, we're lucky we have five dogs.

We get a lot of too much stuff.

That's a lot of time.

I don't even want to go into why we have five dogs, but um we'll talk after.

Yeah.

Um but and and that's another thing I think that pets re they may cause more strain but they really help absolutely everybody.

Well, you're not helping my program here and not wanting to get another dog here.

Okay, real quick.

Five minutes.

A couple things that people can do.

Oh, um prioritize social connection.

And by that I don't mean uh social media.

I mean connecting with someone either of of setting a date to meet or saying yes to an opportunity.

Um and uh another grounding strategy maybe it's as you're laying in bed getting ready to go to sleep at night uh calm safe place.

So just close your eyes and visualize a place that you feel peaceful and calm.

Uh it could be laying on a warm beach, the colors, the smells, the sounds, just lose yourself for a few moments in something that sparks your joy because there's all kinds of research that visualizing something like that has the same effect of actually going to a place, going on vacation and uh that's good for all of us.

Wonderful.

Thank you so much.

I want to thank our panelists Mitsy Don, Rachel Linder, and Gina Dixon.

Please join Doctors on Call next week where Dr.

Ray Christensen for a panel discussion about eye problems including cataracts, glaucoma, macular degeneration, and other vision concerns with an emphasis on prevention and early detection with a panel of experts from around the region.

And if you're looking for more tips, tricks, and conversation around health and wellness in the Northland, make sure to check out Northern Balance on the PBS North YouTube channel.

Thank you for watching and for joining us for season 44 of Doctors on Call.

Good night.