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Caring For Someone
Who is Always Angry
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One of the more common laments we hear from
those caring for someone with a disease that can
change brain function is "He's/She's always so
angry!"
"I'm always walking on eggshells."
"I never know when he's going to go off on a
rampage. Sometimes it can go on for hours."
For many people with Alzheimer's disease,
Parkinson's disease, multiple sclerosis, and a
host of other illnesses, mood swings and angry
outbursts seem to be part and parcel of their
day. For caregivers this can be disheartening,
frustrating, and sometimes frightening. Being
the regular target of someone's rage is
certainly unfair, no fun, and can lead to our
own escalating anger. Everyone's blood pressure
is at risk when trying to care for an angry,
needy person.
If your loved one has always been quick-tempered
and hard to get along with, angry episodes will
probably not be anything new. When someone who
was always sociable, agreeable and downright
easy to be around turns angry, impossible to
please and nasty, it can come as a very painful
surprise.
Having an intellectual understanding that many
mental changes, including anger and paranoia,
can arise from an illness is one thing. Living
with these behaviors is another. Although we all
hope that we're rational beings, sometimes our
instinctive reaction is to lash out in return.
Which, of course, makes us all very human but
doesn't help much.
Many of these angry, ugly behaviors arise
because the illness is encroaching on the part
of the brain that regulates judgment and impulse
control. The frontal part of the brain handles
these functions. When it is affected by a
brain-altering disease, angry outbursts,
impulsive actions and socially inappropriate
behavior can result. Some of this behavior can
be immensely hurtful.
The pain of being the target of this awful
behavior can build to epic proportions. If
you've reached the point where you can't "just
get over it" and swallow your feelings any more,
you're not alone. As a matter of fact, we worry
far more about caregivers who deny ever having
"bad" feelings about their nasty family member.
These are the caregivers who are more likely to
snap one day and do their family member or
themselves harm.
It helps immensely to get together with other
caregivers who can be honest about their "bad"
feelings and give each other support. Find an
honest group that focuses on realistic goals and
discourages saccharine affirmations. Those only
serve to make everyone feel worse about their
imperfections.
In addition to finding a support group and
dreaming about running away to Tahiti, there are
a few more things you can do to preserve your
sanity and your ability to keep going:
First, your own safety is paramount. If
you have any concerns that aggression might turn
physical, have a safe place you can retreat to
immediately. Leave the room at the first hint of
possible physical aggression. If possible, stay
within hearing distance. A locked bedroom is a
good retreat. Be sure to have a permanent
working phone in your safety area as you could
forget to take a portable phone with you.
If your family member does not calm down within
a reasonable period of time you may have to call
for assistance. Never hesitate to call 911 if
you or your care recipient could be in danger.
The consequences of not doing so could be
devastating.
Remove or lock up all weapons and potential
weapons. Guns and ammunition obviously need to
be either removed from the home (first choice)
or well secured. Power tools, kitchen knives,
even scissors can be used as weapons. Put a
sturdy lock on a cabinet or drawer and secure
these things.
If your agitated family member is verbally
lashing out but does not present a physical
danger, leave the room and occupy yourself with
other things. You may have to go into the yard,
or for a short walk or drive if your angry loved
one is a "follower." The lack of an audience
often works wonders. Headphones and soothing
music can also be quite useful.
Try to identify common patterns. Just because
someone has a brain-altering illness doesn't
mean they lose their ability to push your unique
buttons. Back off if you find yourself falling
into a pattern that has had bad results in the
past. If you fall into the trap, stop. Very few
things need to be accomplished right now.
Offer a distraction. One family member had an
agreement with her
"can-do-no-wrong-in-Dad's-eyes" brother. When
things began to escalate she would retreat and
call her brother from another room. He would
call back and distract his parent with a short,
low-key but cheerful conversation for a few
minutes. By the end of the conversation his
sister could walk back in and the anger would be
at least diverted for a while, if not forgotten.
If the anger seems to be getting worse, or if
you can no longer manage to cope with it well,
talk to the doctor about getting medication help
for your family member. While we don't believe
in medicating emotions away, sometimes the
choice lies between medication management and
placement in a locked dementia facility or a
nursing home, where they will quite certainly
use medication anyway. It can sometimes take a
while to find the right medication and the right
dose, so bring it up with the doctor before you
find yourself completely at the end of your
rope.While the doctor is assessing your angry
loved one for possible medication management,
s/he will also be looking for anything physical
that may be making things worse. Urinary tract
infections are notorious for causing horrible
behavioral changes. So are many other things
that are quite treatable. While treating pain or
an infection may not make your nasty family
member sweet and loveable, it may reduce
agitation and bad behavior back to the
"bearable" level.
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