Looking After Yourself While Looking After Them
Looking After Yourself While Looking After Them
There are usually two people in my consulting room, and I am only paid to look after one of them.
The other one has driven here. She has the reports in a plastic folder, arranged in order. She knows the dose better than the patient does, and the date of every appointment for three years, and she has not slept properly since some point she can no longer identify.
Nobody asks her how she is. Not the family, not the neighbours, and often not me, because there are eleven people waiting outside.
So this page asks.
The short answer
Carer exhaustion is not a weakness of character. It is a predictable consequence of doing a demanding job continuously, usually alone, usually without training, usually without anyone noticing.
Three things protect people, and they are unglamorous. Spreading the load so you are not the only one. Keeping one thing in your week that belongs to you. And having somewhere you can say the things you cannot say at home.
None of that is selfishness. A carer who collapses does not leave behind a well-cared-for patient.
What this actually costs you
It is worth seeing the bill written out, because carers tend to describe their situation as though nothing much is happening.
— Sleep, first and worst. Broken sleep, or lying awake listening for movement in the house.
— Work. Leave used up on appointments. Promotions quietly not pursued. Sometimes a job given up entirely, usually by a woman, usually without discussion.
— Money, and not only the treatment costs. The travel, the lost days, the thing that got broken.
— Friendships. Invitations declined until they stop coming. Explaining is exhausting, so people stop explaining, and then they are alone.
— Your own health. Carers skip their own check-ups at a remarkable rate. I have met people managing somebody else’s medication with great precision who have not taken their own blood pressure tablet in a month.
If several of those are true for you, you are not coping badly. You are carrying something heavy, and it weighs what it weighs.
The things carers feel and never say
This is the part I most want you to read, because in fifteen years almost nobody has said any of it to me first. It comes out later, usually at the end of an appointment, usually with an apology attached.
— Anger at the person who is ill. Real anger, not concern in disguise.
— Resentment at the relatives who ring for updates and do nothing else.
— Relief when they are admitted, followed immediately by shame at the relief.
— Wishing, in some tired moment, that the whole thing were simply over.
— Embarrassment in front of neighbours, and then guilt about the embarrassment.
— Grief for the person they used to be, which is a real bereavement and gets no funeral and no sympathy.
These are not signs that you have stopped loving somebody. They are what happens to ordinary people under sustained strain, and they are so nearly universal among carers that their absence would surprise me more than their presence.
A thought is not an act. Feeling it does not make you cruel. Saying it out loud once, to somebody safe, takes most of the weight out of it.
The two kinds of guilt
The first is backward-looking. I should have seen it earlier. I dismissed it. I told him to snap out of it.
You were not trained to see it, the early signs of most mental illness look exactly like ordinary unhappiness or ordinary teenage behaviour, and doctors miss them too. Hindsight makes the pattern obvious in a way it simply was not at the time.
The second is present-tense. I lost my temper. I shouted. I have started avoiding coming home.
That one is a signal rather than a crime. Losing your temper repeatedly with someone you love is usually the sound of a person past their limit, not a person who has become unkind. It means the load needs redistributing. It does not mean you should try harder, which is the thing every carer decides to do next and the thing that reliably makes it worse.
Do not become the only one
The single riskiest arrangement I see is not severe illness. It is one person doing all of it.
It happens by drift. One family member is more available, or more competent, or simply more willing, and within a year the whole thing has silently transferred to them. Everyone else is grateful and absent.
So share the work, and share it in named tasks rather than in feelings. Do not ask a brother in Pune to be more supportive — that produces nothing except a phone call. Ask him to take the Thursday appointment, or to handle the insurance paperwork, or to ring at eight on Sundays so you have twenty minutes. Specific, allocated, repeating.
A helper who does the job imperfectly is enormously better than no helper. This is worth remembering when you are tempted to redo their work, which you will be.
What actually helps
— One named person handles medical communication. Confusion multiplies when four relatives each ask the doctor a different question and carry home a different answer.
— Write things down. A page in a notebook — what changed, on what date, what you want to ask next time. It relieves you of remembering, and it makes appointments far more useful.
— Protect your sleep as if it were medical treatment, because functionally it is. Everything is worse on four hours, and nothing is fixed at 3 a.m.
— Keep one hour a week that is entirely yours and is not about the illness. A walk, a temple, a friend, a class. It will feel indulgent. It is the load-bearing wall.
— Keep your own doctor. Your own check-ups, your own prescriptions. Put them in the same calendar as theirs.
— Find one person you can be completely honest with. Not the whole family. One.
— Learn about the specific illness from something reliable, once, properly — and then stop reading at night. Understanding helps. Two a.m. searching does not.
What does not help
Some of these are things carers are actively advised to do, which is why I am listing them.
— Arguing with a delusion. You will not win, and it costs you both something. Neither agree with it nor debate it — respond to the fear underneath it. “That sounds frightening” is true, and it is not a lie about the content.
— Becoming the medication police. Supporting somebody to take treatment is one thing; surveillance and daily interrogation is another, and it reliably turns the medicine into the battleground of the relationship. If treatment is being missed, that is information for the doctor, not a war to fight at home.
— Sacrificing everything and expecting it to be recognised. Illness does not produce gratitude on schedule. Carers who bank on being thanked end up bitter, and the bitterness is nobody’s fault.
— Keeping it entirely secret. Sometimes there are good reasons for privacy. But total secrecy costs a family every source of help it might have had.
You are allowed limits
Caring for someone does not require you to accept being screamed at, hit, or having money taken. Loving somebody and declining to absorb that are not in conflict, whatever a relative tells you.
You are allowed to say: I am going to sit in the other room until this passes, and I will come back. That is not abandonment. It is the difference between a carer who lasts ten years and one who breaks in two.
If there is violence in the house, or you are frightened, that is not something to manage privately out of loyalty. Tell the treating doctor plainly. Safety comes before appearances, including the family’s.
Your own mental health
Carers get ill too, and it is usually missed because everyone, including the carer, has agreed that their job is to be fine.
Worth noticing in yourself: nothing feels enjoyable any more, even in the good hours. Waking very early and not getting back to sleep. Drinking more than you used to, or drinking to get to sleep. Crying at things that are not the thing. Snapping at your children. A steady flat conviction that this will never change.
None of that means you are failing. It means the strain has moved from your schedule into your health, and that is treatable — for you, on exactly the terms it would be for anyone.
Going to see someone about your own state is not disloyalty, and it is not competing with the patient for attention. It is maintenance on the only person keeping the arrangement standing.
And if you find yourself thinking about harming yourself, do not wait for a convenient moment. Call Tele-MANAS on 14416, or tell your own doctor today. That is the one item on this page with no room for postponement.
The children in the house
Children notice everything and are told nothing, so they fill the gap themselves — usually with the conclusion that it is their fault.
Tell them something true and simple, matched to their age. Mamma is unwell, it is an illness like any other, doctors are helping, it is not because of anything you did, and she will not always be like this. Answer what they ask and do not deliver more than they asked for.
And keep an eye on the eldest daughter in particular, because in Indian households she is the one who quietly becomes a second carer at fourteen and nobody registers that it has happened.
When it is going to be long
For some illnesses this is a season. For others it is the shape of the coming years, and carers usually work that out privately somewhere around the second or third episode.
If that is your situation, the task changes. It stops being an emergency to be endured and becomes a life to be designed — one where your work, your health, your friendships and your own future continue alongside the caring instead of being suspended indefinitely waiting for an ending.
People find that thought disloyal. I would put it the other way. The version of you that still has a life is the version that can keep doing this.
One family
A woman in her thirties had been looking after her mother for four years. She brought her to every appointment, managed the medicines, handled the bad nights alone. Her two brothers rang on Sundays and asked whether everything was all right.
She came in one day for her mother’s review and mentioned, in the doorway on the way out, that she had not been out of the house socially since 2022.
Nothing about the illness changed after that conversation. What changed was that one brother took the Thursday appointment, permanently, and she got a Thursday morning back. That was all. She described it later as the first time in four years anyone had treated her as a person with a week of her own.
Small, allocated, repeating. That is usually what rescue looks like — not a dramatic intervention, just one fixed thing that somebody else now owns.
This account is fictional and composite. It is built from patterns seen in practice and does not describe any individual patient or family.
What to do this week
Name one task and give it to one other person, with a day attached. Not “help more”. Thursday, the appointment, yours now.
Book one hour that belongs to you and put it in the calendar where the appointments live.
Start the notebook. One page. What changed, when, what to ask.
Tell one person the honest version — including the ugly parts. Once is enough to make them lighter.
Make your own overdue appointment. The dentist, the blood test, the thing you have been postponing since last year.
If you recognised yourself in the section on your own mental health, treat that as the item to act on first.
Sources
Mental Healthcare Act, 2017 (India) — the role and rights of the nominated representative and of family caregivers.
Indian Psychiatric Society — Clinical Practice Guidelines, on family interventions and caregiver support.
World Health Organization — mhGAP Intervention Guide, on carer support and psychoeducation.
Before you go
This page is educational. It is not a substitute for consultation with a qualified doctor, and it cannot account for your family’s particular situation.
If you or someone near you is in crisis right now, call Tele-MANAS on 14416 or 1800-891-4416. Free, any hour, available in Marathi. That number is for you as much as for the person you are caring for.
About the author
Dr. Muktesh Daund is a Consultant Psychiatrist and De-addiction Specialist practising in Nashik since 2016. MBBS, Dr. Vaishampayan Memorial Government Medical College, Solapur. DNB Psychiatry, LGBRIMH Tezpur, an autonomous institute under the Ministry of Health and Family Welfare, Government of India. Maharashtra Medical Council registration 2009/02/0243. Life Fellow, Indian Psychiatric Society. Life Member, IMA Nashik.