Caring for someone with any chronic disease or mental illness can take an emotional and even physical toll on caretakers. And many times, that investment can lead caregivers to lose sight of their own needs in the service of another’s care.
As a clinician and former caregiver, Dr. Frank Chen discusses how family members can be intrinsic and critical parts of a loved one’s diagnosis and treatment journey. Also, support and coping strategies are needed if everyone is to effectively emerge throughout the process. In this podcast, we discuss the definition of compassion fatigue, how it affects caregivers – professional and family members – and what caregivers can do to take good care of themselves.
Key Takeaways
01:27 – Dr. Frank Chen joins the show to share what drew him to the field of psychiatry and his difficult experience seeking help for a member of his family
12:57 – Compassion fatigue explained
18:39 – Shay opens up about her own experience acting as a caregiver in her family
20:41 – Advice on caring for yourself as a caregiver
27:14 – The value of speaking to a therapist and other practical self-care acts you can do
34:13 – Shay thanks Dr. Frank for sharing his story
Resources Mentioned
JFlowers Health Institute – https://jflowershealth.com/
JFlowers Health Institute Contact – (713) 783-6655
Subscribe on your favorite player: https://understanding-the-human-condition.captivate.fm/listen
**The views and opinions expressed by our guests are those of the individual and do not necessarily reflect those of J. Flowers Health Institute. Any content provided by our co-host(s) or guests is their opinion and is not intended to reflect the philosophy and policies of J. Flowers Health Institute itself. Nor is it intended to malign any recovery method, religion, ethnic group, club, organization, company, individual, or anyone or anything.
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Listen to the podcast here
Dr. Frank Chen – Taking Care Of YOU: Care For The Caregiver [Episode 67]
Caring For The Caregiver
I have the privilege and the pleasure of being joined by our friend and colleague, Dr. Frank Chen. Dr. Chen is one of our psychiatrists here at J Flowers Health. He’s board-certified by the American Board of Psychiatry and the American Board of Neurology. He’s the Chief Medical Officer at Houston Adult Psychiatry in Houston Behavioral Hospital, and I’d like to say welcome. Good to have you.
Thanks, Shay. We bump into each other quite a bit in the hallways, and it’s great that we are sitting down and having a conversation.
Normally, we have a little witty banter that goes on, and we have a lot of fun together, so we can do some of that, but we have to keep our professional hats on too. I’m excited to have you here. You bring so much to the table as one of our providers, and we tend to throw you cases that are fairly complex, so I appreciate your ability to jump in and be creative in your approach.
I like the challenges. They are the fun ones, and really, they make me think a little more. That’s part of the exercise that I get out of this because this is a very unique population. Sometimes you do have to think about what’s happening behind the scenes with the developmental background of someone that may contribute to coming here, so I do appreciate it if you guys want to call it the harder cases but they allow me to be challenged.
The thing that I like to do also, when we have guests that come on, I like to talk to people about things that are personal to them. What we are talking about is caring for the caregiver. I know that you have your own experience, not only as a professional but also as a son. Would you like to tell a little bit about your story?
I immigrated to the United States back in the 1980s, and a lot of things that came in the United States in the 1980s, I have this big stamp that says “Made in Taiwan.” From an early age, I spent time in Los Angeles and very much got into the culture over there, but there’s something in the background that was always influencing me, this pervasive cultural issue of being in the United States, being Asian American, and having to be stuck in two different cultures. I tried to flee from some of that as much as possible. In my early years, I went far away from my parents, and I went to the Wharton School at the University of Pennsylvania. The ironic thing is that the business school education was a platform to launch me into medicine, and it sounds illogical, but that’s how, sometimes, cultural influences work.
Tell me what you mean. The business school launched you into medicine. How did that happen?
I talked about this familial influence, this cultural influence, that they wanted their number one son to be a doctor. No pressure and so you are stuck. You are stuck between doing what you want to do or what you think you want to do at the time and fulfilling some obligation. It’s quite powerful, the influences that your parents have on you, even into your twenties.
It was a struggle for me, to think about going to med school, and I did. I got into med school, but there was always this conflict that I struggled with. Am I at the right place? As a psychiatrist practicing for the last several years, I look back on that, and that’s not something that a normal twenty-year-old would struggle with. There are so many twenty-year-olds, in their quest to find their identity. They think about what they want to do. They think they want to do something, and they end up doing something else instead. That’s all normal, but there was a very regimented path forward when you got into med school, and it always seemed like it was very difficult to break away from that.
I think that part of this unconscious conflict that I experienced was probably what ended up attracting me to the field of psychiatry to conquer this conflict if you will. In order to conquer this conflict, you get a good therapist. It’s not something that you can do on your own, but I do think that the sense of being lost at that age and the sense of wanting to do something else are the struggles that twenty-year-olds have. I wish I could tell every twenty-year-old to get started in therapy early so that you can be a more secure self.
“It always seemed very difficult to break away from the very regimented path forward when you get into Med School. Part of this unconscious conflict probably attracted me to psychiatry – to conquer this conflict. I know now that to conquer this conflict, get a good therapist.” (
It helps process your life and the things that are going on in those big challenges and big life decisions that we make when our brain is not even fully developed.
It’s so often that we feel like we have to fulfill a path. We feel like a failure if we deviate from that path. Sometimes, when you are twenty years old, you can figure out your path. You can make mistakes, you can pivot, you can turn in every direction and find something that you love to do, but so many people feel stuck. They feel like they must fulfill some type of path, otherwise, they feel like losers. This is why I encourage anyone who has these intrapsychic conflicts to start seeing a therapist because having someone out there to help you navigate through those struggles and know what’s normal and what’s not normal may build a much more secure self.
“I encourage anyone who has intrapsychic conflicts to start seeing a therapist to help navigate those struggles. Knowing what’s norm and what’s not may build a much more secure self.”
While I was going through this match process in medical school, where you ultimately determine what field you are going to go into. I got this call from a girlfriend of my brother saying, “He’s acting bizarre. Would you please come over here and see what’s going on?” Being from a minority family and maybe a lot of families there’s not a problem until there’s a problem. We turn a blind eye to some of the warning signals. He told me how much pot he was smoking at the University of California in Berkeley, telling me about some of the recreational stuff that he was doing, and I figured if he was going through school if this was a cultural thing that was permissive in Northern California, who am I to judge?
The devastating phone call was that he was feeling like people were after him. That someone was using him as a project. When I got to his place, it was a mess. He saved maybe 50 boxes of empty Domino’s Pizza containers, saying that if I throw this stuff away, someone’s going to use it. I remember, at the time, I didn’t know much about psychiatry. I remember going out for a drive with him, and it was about talking in codes and making sure that no one was listening to our conversation from the nearby cars. What do you do with that?
You’ve been in the industry for a long time but talking to someone with a delusion, a fixed false belief, is like talking to a brick wall. You can’t introduce logic. That was the first entrée into this helpless feeling as a family member because I couldn’t tell him that you could do X plus Y and then you could get Z, let’s get some help. It was a very helpless feeling. It felt like I had to go along with whatever delusions, otherwise, he would not listen to me. We played this game of having him dictate what to do, and eventually, I got him to move out of there and move in with me in St. Louis for about a three-month period of time. That was probably three of the most depressing months that I experienced.
Is this pre-diagnosis for him? This is pre-medication, pre-any of that.
Pre-anything. That was the first warning that there was something going on. Getting him to acknowledge that he may be at a safer place halfway around the country was helpful, but getting him to acknowledge that he needed help was difficult. We can’t go to a psychiatrist because this is not something that a psychiatrist could solve, and I didn’t, at the time, as a graduating medical student, know great ways of differentiating major depressive disorder with psychotic features versus schizophrenia.
As a naive family member, I thought this was something that he was going through that would resolve, and we got to get him some help and it’ll be fine. It didn’t turn out that way, but I got to witness the course of a person’s struggle with mental illness in a very different way from a lot of people because I juxtaposed the experience as a family member with the clinical knowledge as I was going through psychiatric residency and seeing that live and raw.
Even in that place where you had some knowledge and you were a professional or in the works of becoming a physician, you were still dealing with the same thing that our families deal with every day. Providing care, whether it’s chronic mental illness or some type of physical illness. It’s a difficult journey.
How do you get someone reluctant to get care to get the care that they need? It’s such a helpless feeling. It was a struggle even to try to connect him to services. What’s the appropriate venue? How do we go about this? It was overwhelming, and having to care for him for a three-month period of time was something I never did before. I never cared for anyone to that extent as a then 26-year-old.
How do you motivate someone who looks depressed? How do you make sure that they are bathing? How do you make sure that they are eating? How do you make sure that they open the drapes so that some sunlight can come in? It was so difficult living in a situation like that. That’s part of why sometimes I almost understand some of the struggles that families may have leading up to a client getting help. It’s not just something that happened yesterday. They have been dealing with this for months if not years.
Compassion Fatigue In Caregiving
You do such a nice job with our families who have been dealing with things for a long time. We have this conversation about compassion fatigue. If I’m understanding correctly, that’s something that a provider can have a person who’s a therapist that’s maybe working with somebody with severe trauma or, sure, something, or a family member that they are caring for. Can you explain what the definition of compassion fatigue is? Could you sum it up?
You’re so vested in a family member getting well that you end up devoting everything, all your energy, to that project. Subsequently, you stop taking care of yourself, and you let that project be your existence. Sometimes, you feel like you are the only hope for that person. When you stop taking care of yourself, you may not be doing your family members any justice in terms of trying to help them because you are going to stop. You are going to get depressed. You are going to end up getting anxious. You are going to end up not being able to help. You are going to end up having someone else try to help you.
“When you stop taking care of yourself, you may not be helping your family member because you’re gonna get depressed and end up getting anxious and not being able to help.”
There are so many family members who I have talked to who experience those same struggles that I experienced as a caretaker. A different episode in my life was back in 2018 when my father was diagnosed with pancreatic cancer. Even as a seasoned physician, pancreatic cancer was a very different space from psychiatry. I was trying to digest the treatment, the prognosis, the treatment, what can we do? Truthfully, I will tell you that I knew I was out of my league. It’s not as easy, even as a physician.
When you have a lot of knowledge about a field in general, people say, “You are a doctor. That should make it easier,” but it doesn’t. You get the same burnout and the same exhaustion.
I’m not that doctor.
You don’t know everything.
I’m good at forecasting things in psychiatry, but that’s because I have been seeing patients every day for the last several years and know their stories. You can almost forecast the progression of the illness very quickly after talking to a patient, but there was no vision for me when it came to pancreatic cancer. I’m sure other families have gone through this in taking care of their loved ones, but I remember going through the Blue Cross Blue Shield provider directory for the Los Angeles area and printing up a thousand oncologists.
It’s like throwing confetti in the air and seeing where it’s going to land. How do you know?
I knew logically that was a futile exercise, but there was such a need to grasp some control that I had to do something. I knew logically, as a seasoned psychiatrist, that I was not going to be able to envision his treatment. I can’t do enough research to figure out what is the best path forward because I have never seen it before. He’s a sample set of one. In my field, I have tons of sample sets. This stuff is easy for me, but it was incredibly difficult, struggling with that helplessness, that need for some answers, that need for some control.
My father did well for about three years, and he very precipitously took a turn for the worse, and that was difficult for me as well. Being a physician, knowing about death, dealing with death, knowing about terms like palliative care and hospice. When I hear those terms as a family member, there’s a very different emotion associated with it.
It was a tough situation where I want to thank my wife and kids for being so patient with me during that period of time, but it was something that I almost had to completely devote myself to, to the extent of having cameras around. This is the insanity of being a doctor. I had cameras around, not to spy on him, but to make sure he was okay. I had 24-hour care for him, and, I understood that I had to work as a team with these caretakers, and it was not having a camera to micromanage and criticize. That became exhausting. Being a caretaker takes a toll.
“Being a caretaker takes a toll.”
At whatever stage you are at in your life.
They never had a course in high school about grief and death. How do we approach things like grief and death? There’s no playbook on this, and I was grieving. I knew things were difficult, and luckily, I have had help throughout my life in terms of a safe place to talk about some of this stuff. I’m going to be okay for my family and my patients, but a lot of people tough it through. They feel like they have to take on the burden.
Shay’s Experience With Caregiving Responsibilities
Tough it through or compartmentalize. Fake it until they make it. That was my experience. I was fake until you made it girl. My grandparents became my responsibility, and my grandmother had Alzheimer’s. When we had her go into a facility, all of a sudden my grandfather fell apart. Like he was super ill, and none of us knew. He had COPD, which we knew, but we didn’t see how sick he was until he wasn’t caring for her. That’s pretty typical of a caregiver giving everything to this other person and leaving nothing for themselves.
I found myself caring for him and realizing, hold on, let’s slow down and think about what it is that I need. Because I had three kids at the time. Three young kids and so they needed something from me. My spouse needed something from me. My grandfather needed something from me, and I had to get to a place of saying, “Somebody, someone help me.” I had this lovely woman who was a friend of mine, who’s a therapist, and she said, “Let’s have coffee.” I said, “I don’t need therapy for this. I realize that I’m in a stressful time in my life.”
Self-Care Strategies
She said, “We are going to have coffee.” and she was treating me but she was right. I was so busy caring and trying to make sure all the things were done and trying to make everything look great that I didn’t realize how bad I looked, how frazzled I was, and how fried I was. I started with some meditation and daily time that I was investing in myself. I started getting up earlier so that nobody else was awake, and these were simple suggestions that she had made on how to care for yourself in those times. Do you have suggestions or ideas or things that you did to care for yourself or things that you recommend to other people?
Knowing you long enough, Shay, I know that whenever there’s a problem, you are going to volunteer yourself and you are going to go after it and solve that problem. There are a lot of people like that around, but it is especially tough when you are dealing with the health and well-being of a loved one. We can’t be objective, and so we get very much, even as mental health professionals, emotionally wrapped up in this.
It can be all-consuming. Smart people know what they don’t know, and so when you get to the place where you are trying to figure stuff out for yourself, think about getting an expert to help you process. Your therapist probably has seen this scenario a million times, and you are going through it maybe for the first time, maybe for the second time. It’s never easy dealing with the health and well-being of a family member.
There are so many conflicts that can come out in a family system when someone is sick or dying, and arguments between siblings. In my case, I had to struggle with this concept of the Chinese tradition of having to take care of your elderly, and whether or not you are doing it well enough. This concept is so entrenched within the Asian community. It’s incredibly difficult to talk out of that concept sometimes. Having a sense of obligation, and not wanting to fail, are very difficult burdens to take on. I recommend that if someone’s feeling stuck as a caregiver, or feeling burdened, find a therapist who’s gone through this type of scenario a million times so they can help you navigate your way through this, as opposed to trying to figure everything out yourself.
It’s also hard to see there’s a lot of guilt and shame when you are taking care of someone if you ever do anything to invest in yourself during that time. At least, there was for me. There was this time of, “I should be doing this instead of going to get a massage,” or whatever those things were. The spa is the answer to a lot of things.
Those little things help you preserve yourself and be able to care for yourself. If you start neglecting your well-being, and your own needs, you’ve got to start thinking, “What am I suffocating as well?” and, “Do I have to stop a little bit?” There’s guilt involved. You play a critical role, but if you are so far down the rabbit hole, you may need help at some point, and you won’t be able to help others.
Make sure that you get the help you need regardless. Take the shame component out of this, and be able to acknowledge that you need a little help. There’s a lot of anxiety associated with taking care of somebody. There are a lot of emotions, and it’s okay to see a mental health professional to talk or to have coffee with friends.
It’s hard to recognize sometimes, when you are in those high-stress situations, that you are becoming desensitized to the things around you. That’s a warning sign that you do need some help. If things are something that will make someone else gasp, but you let it roll off like water off a duck’s back, there’s a problem. Here’s your sign.
There’s a problem if you are crying watching an antidepressant commercial. There’s a problem when you are not laughing at anything and can acknowledge that this is problematic and that you’re burned out. Now you need to get some help. That may be better for everybody else around you.
One thing I noticed about myself when I was caring for my grandfather is that things that my kids would do that normally I would find funny or enjoy with them were annoying. I wanted them to stop. I recognized that I was becoming pretty abrasive with them because I had no bandwidth. I had nothing left. It wasn’t pouring anything into me, it was all going straight out to someone else. I also think that’s something people should look out for.
When you crumble, there are casualties around. Your kids may not be used to this person. “Why is she all of a sudden screaming and cranky over those silly jokes?” For those redundant jokes. Being able to take feedback from other people instead of getting defensive. I have a family who’s very open about talking to each other, and I took feedback from my wife. I took feedback from my kids so that I could still operate within a certain lane where I’m not going to be a casualty to other people, but I’m not going to displace anger on other people because I’m stressed out about taking care of my father. It’s important to be able to recognize that other people are not trying to be critical of you, but are giving you some warning that, “You are not acting like yourself, and being able to take that feedback and not get so defensive about it, but do something about it.
“It’s important to be able to recognize other people not trying to be critical of you but to give you some warning that you’re not acting like yourself and be able to do something about it.”
Recognizing too that this, for most people, is not a short game. It’s a long game. To be able to sustain and maintain over the course of time, you have to have that go-to, whether it is a spouse, a professional, or someone that you can talk to, download what’s going on, and help you stay grounded and stay well is essential.
Vulnerability And Practical Self-Care Tips
If you are not a person who’s open to vulnerability, get a therapist. If it’s hard for you to reveal to your friends the struggles that you may have and think about the weight of carrying that burden of caretaking, and you can’t, you have to be tough and can’t tell anybody how vulnerable you feel. It’s like being on an island in the middle of the Pacific and feeling like there’s no rescue in sight, think about what a burden that creates for a person. Having someone out there, even if it’s a therapist that you hire once a week to talk to, even if you get nothing out of it, have someone there who’s on your side, who can reach out to you if you are in trouble. It’s priceless.
Let’s also talk about some practical things. I told you, I would get up early so I could have that time by myself, meditate for the day, and focus. I probably hit 200 golf balls 3 or 4 times a week because I didn’t have time to play a full round of golf. I could go to the range. Those kinds of things are equally as helpful, or was that maybe my way?
Everybody has different ways of dealing with stress, and you want to try to unplug yourself from obligations. It’s an obligation. Let’s face it. It’s an obligation to take care of somebody. Sometimes, I get that people like to go and have a round of golf to unwind, but sometimes they take that round of golf a little too seriously because there’s a measure to it. It becomes something that you have to be plugged into. Try to figure out something that removes you from having to think about performance having an extra burden of having to perform. Go to the spa and don’t feel obligated to listen to the problems of the massage therapist and offer solutions.
It is okay to say, “Please don’t talk to me.”
Being able to set limits with yourself about how much you can accomplish realistic limits so that you don’t feel like the next thing that’s going to be saddled with is going to be the thing that’s going to take you down. Make sure you have some limits set. Make sure that you understand what activities would unplug you from the obligations that you typically think about.
Make sure you have people that you can reach out to, whether it’s a therapist or a friend from across the country who’s not critical. A lot of times when we reveal vulnerability, we feel like people may criticize us, so find that safe space where you can be vulnerable, discuss your weaknesses, and not feel like someone’s going to judge you. Have that person around and get into meditation, get into yoga whatever works for you in terms of activities that would unplug you from having to think about the obligations.
Take time for yourself, maybe a little bit every day, to give yourself some structure about that. If it’s not every day, every other day. Something that you can look forward to where you’re not saddled with the burden and I use the word “burden” because it did feel like a burden. It’s okay to admit that. I wanted to micromanage the care for my father, but I knew it was a burden. I recognized that it was a burden and it was okay. Sometimes people feel like, “If I say that it’s a burden, then somehow I’m betraying my family member,” now it is, and being able to talk about that.
It’s acknowledging it for what it is and being able to take some action steps for yourself. This is such a great topic that is overlooked a lot by so many people because we are so busy providing care, and as professional caregivers and problem-solvers, it is something that you find yourself on that side of the coin all the time.
It’s a discussion that needs to continue to be had. We have a lot, even with our team here, even with our therapy team and our providers that work so diligently with our clients. There are times when it’s like, we are going to take a break and we are going to celebrate with you. We tend to have dessert around here quite a bit. We celebrate birthdays and we celebrate things, but so even in the midst of the stress and caring for someone else and helping someone get to their ultimate goal, you still have to take those times to celebrate small things and to pause and not make it about that person. Let it be about something more normal.
This is a great environment to work in because we have birthday cakes almost every other day.
They are very healthy.
I’m not going to comment on that. I eat it if it’s in front of me. I do think that so many families go through this struggle and they don’t realize the impact of caretaking on them. I try very hard, because of my experiences, and now, I try hard to think from the family’s perspective. I do include them in my thoughts because whenever I get a client, it’s not just the client who’s struggling. It’s everyone around who has been through this adventure a week, a month, six months, a year and they are exhausted as well. A lot of times they are relieved that a family member is getting help and that they can hand this off to professionals.
It provides a little bit of respite for them.
It’s like me trying to figure out pancreatic cancer. I don’t know how to explain to you my years of using psychotropic medications in a five-minute lecture. I don’t know how many papers you have to read in order to get some of the I would say like almost algorithms and diagrams that I have in my head. It’s hard to provide that, but I encourage all the clinicians to think not about the autonomy of the patients, but the struggles of the whole team behind a patient getting help. Family members who have gone through this suffered as much as our clients. It’s a whole system that’s been disrupted by an illness. They’re casualties of the illness.
I appreciate you joining me for this discussion and for sharing some of your story. Any final thoughts on understanding the human condition from Dr. Frank Chen?
The simple thought is that don’t be afraid to seek out a therapist or a psychiatrist. If you’re smart, you wouldn’t try to fix a car with black smoke coming out of the tailpipe, and it’s a fairly complex job. Why would you try to fix mental health issues?
“You wouldn’t try to fix a car with black smoke coming out of the tailpipe. It’s a fairly complex job. So why would you try to fix mental health issues?”
Thank you. That’s a good one. If you’d like more information on this topic or if you’d like more information on J Flowers Health Institute, you can reach us on our website at J Flowers Health, or you can call us at 713-783-6655. I would like to remind everybody that there are numerous places where you can find our show. YouTube, Apple Podcasts, SoundCloud, Spotify, iHeartRadio. Please feel free to tune into any of those to see our upcoming episodes and share on social media if you think somebody would benefit from seeing this. We also want to remind you that a clear diagnosis is key to getting the best treatment possible. We are always happy to help with that. Hope you have a wonderful day. Thanks for joining.
