Caregiving for a Lifelong Friend

Just as a terminal diagnosis can trigger an identity crisis in a previously healthy person, so becoming a caregiver can feel like being transplanted onto foreign territory. The responsibilities, the feelings and the boundaries may be shockingly unfamiliar.

A Carewell 2021 survey found that 64.9% of family caregivers are baby boomers, who care primarily for spouses or parents. But how many people are caregivers for lifelong friends? What is this little-known role about, and how can it open a doorway into a deeper dimension of friendship?

Becoming a caregiver to a dear friend is a transition that may come gradually or suddenly. During a health crisis, our former roles and communication patterns with a friend may fall away. Our aptitudes and strengths may no longer matter; our vulnerabilities, once hidden, may roar to the surface.

I spent my career as a therapist and author helping people explore their inner worlds, especially those unacceptable or forbidden feelings and voices that reside in the unconscious mind and erupt suddenly in times of transition. Carl Jung called this the Shadow or personal unconscious. When I entered my late 60's, I began to study the shadows of age, the unconscious beliefs and attitudes that we carry through the lifespan about old age.

Naturally, I wanted to apply this understanding to caregiving. So, I posed the question: What is caregiving from the inside out? I discovered that both those who care and those who are cared for may have surprising, painful, even shameful feelings and beliefs in this situation. My client Anna told me that, for a full year, she attended to a friend with cancer, taking her to doctors, buying food and listening to her struggles. When that woman went into remission, Anna was exhausted and resentful.

"She never really appreciated all that I did. She didn't thank me in any meaningful way," Anna told me.

I knew Anna well enough to see that her early childhood injury, feeling unseen and unacknowledged by her parents, had been triggered during her long year of caregiving. In her unconscious shadow, she was striving to be seen and appreciated by her friend. And, unknowingly, she had been over-giving, neglecting her own self-care and, most importantly, expecting something in return — to be acknowledged and valued.

When I asked Anna to reflect on her own responsibility for her reactions to caregiving, she saw her hidden agenda: when the friend complied with Anna's recommendations, they got along. But when the friend made different choices, Anna was offended. She admitted to me that an unknown part of her — which we called the Savior — wanted credit for her friend's remission.

As she examined these secret motives, she could stop blaming her friend and feel more accountable for her own reactions. Anna learned how to help others with more self-awareness and move in and out of caregiving more fluidly, without identifying so much with a role, such as "I'm the savior, she's the patient."

For other caregivers, a secret resentment may arise with a loss of freedom. As one man put it, "When my best buddy got sick, I lost my future."

A burning impatience may come up with the other person's demanding needs. As a female client said, "When my girlfriend was diagnosed, my life became about nothing but her. I can't cope."

For some, these shadow parts may take control: The Savior will try to cure the loved one. The Victim will feel helpless, overwhelmed, and confused. The Researcher will obsess with googling solutions. The Denier will turn away, unable to see reality. I found that it's helpful to name these parts so that we can identify them when they come up — and perhaps make different choices. In this way, caregiving can expand our self-knowledge through shadow awareness and deepen the intimacy of our friendships.

My friend Suzanne had never married or had kids, but she had a large friendship circle. When she began to complain of abdominal pain after eating, she dismissed it as a digestive issue. As the pain worsened, her doctor referred her to an oncologist, who diagnosed stomach cancer.

I took her to medical appointments, writing copious notes. I read the book her doctor had written. The Researcher in me kicked in, but more: beneath that, I secretly believed I could fix her. Some part of my shadow, the Know-it-All, had wanted to change Suzanne's diet and lifestyle, which I viewed as unhealthy for many years. This was my chance. I began to push information about organic food and non-toxic products; she resisted.

I caught my own shadow in action — and stopped trying to be her expert. When this impulse came up, I paused and breathed deeply. This was Suzanne's journey, her choices, her life. It was my job to accept her and love her in this moment.

As it became evident that chemotherapy was impairing her cognitive function and that she would not survive, I stepped in to manage her affairs. Somehow the to-do list allowed me to feel less powerless. First, I helped her to break through denial. For many months, she asserted that, like her sister, she would survive cancer. She said that, like her mother, who lived to 101, she had a long way to go.

As she grew weaker and the doctors ran out of treatment options, our conversations grew more honest: the Denier shadow was preventing Suzanne from preparing for death. I couldn't hear her wishes if she wouldn't face her mortality.

Slowly, she allowed me to set up her living trust and explore decisions about beneficiaries. I paid her bills, called the cremation company and listened to her fears and grief.

During this time, we grew more and more transparent to each other, as the defenses and masks fell away. We had always loved one another as sisters, but this intimacy was beyond roles. I call it a soul connection.

One day, I received a call from Suzanne's brother. Her family stepped in — and pushed me out. Maybe they had been in denial of her mortality themselves. Maybe they had been distracted. Maybe they heard that there was money in her estate. For whatever reason, my caregiving ended with the words, "We are her family."

Of course, I felt a mix of feelings — hurt, unappreciated, excluded, but also relief. And this complicated my grieving process. But I knew that, for decades, Suzanne's friends had been her family, and her biological family had been distant. Now they would have to face their loss along with the consequences of the choices they had made.

For both caregivers and receivers of care, emotional work with these unconscious shadow characters can move us toward caregiving from the inside out. It can lift us out of habitual roles and labels, such as best friend, patient, helper, husband, wife, father, mother, son or daughter, which can limit our capacities for generosity and empathy due to long-term shadow issues. And it can move us into the realm of soul.

When we encounter one another behind these masks, in moments of profound joining, our feelings of separateness dissolve. In those moments, we can intuit the other person's needs and give with our whole hearts.

Editor’s note: This piece was adapted from the author's book, “The Inner Work of Age: Shifting from Role to Soul.”