Care giving for a person with psychiatric illness is quite different from care giving for a person with physical illness. Psychiatric illness has a multidimensional presentation extending much beyond the emotional and mental schemas. It is not just the longevity but the lack of insight and acceptance on the part of patient and family, the stigma and fear attached along with taking care of much more complex emotional needs, other direct and indirect physical needs, relatively anxiety producing social needs amongst many other said and unsaid needs of the patient that gradually lead to caregiver burden amounting not just to stress or burnout but syndromal depression and anxiety in the caregiver itself.
The major concern though is not just the presence of such, but the total ignorance, non acceptance and unimportance of this significant entity. Multiple studies, both national and international have repeatedly found a higher prevalence of depression and anxiety in caregivers of persons with mental illness vis a vis caregivers of patients with physical illness. Howsoever, it has never received due importance in the management plan of patients illness itself. It is quite easy to fathom the relationship of caregiver depression and anxiety with the patients prognosis. Whether it is an overtly anxious mother spilling her anxiety onto a young psychotic daughter, or a middle aged wife coping with her husband’s depression after a loss in business by taking care of children, family, finances whilst ignoring her own fears, anxieties and insomnia or the parents of an aggressive, violent, drug abuser son….it is all too evident to see and feel the need for addressing these complaints of the caregivers.
Most of the times, these needs are not addressed as the caregivers themselves ignore their complaints and sweep them “under the carpet” for the need to focus on the patient without realizing that this would directly affect their caretaking abilities by making them feel irritable, anxious, weak, tired, lethargic and finally worsening the already challenging situation. At other times, the family and loved ones too ignore this by deciding to work more upon the patient than the caretaker. Sometimes, even when the caregiver does reach a psychiatrist, it is mostly about medication but the equally important task of learning adaptive coping skills, stress management and regular counseling is not attended to. The caregivers need a significant amount of social support and understanding to tide over their difficulties.
Hence it becomes the onus of each and everyone involved, the patient, the family, the caregiver and the treating doctor to identify and address this important entity called the caregiver burden.