Self-neglect: a practitioner's view

Aging, Spring, 1996 by Wendy Lustbader

The best that family members or professionals may be able to do is to propose options and leave behind constructive ideas. In this effort, the key is to avoid a judgmental attitude, which will only arouse the parents' defensiveness and keep them from thinking over these ideas on their own. Gentle prodding with questions is often helpful, so long as the tone is respectful: "Since you're not going to live forever, have you thought about stopping your help now so you can be there for your son when he gets his life together?" The idea that the can end the financial dependency while continuing to "be there" emotionally may never have occurred to them before. Another is: "Can you see that each time you pay his bills, he can go on denying that alcohol is causing him any problems?" A neutral, informative manner may permit these ideas to be heard.

The parents may need one further concept to inspire change: "Have you thought about the legacy of resentment you are leaving your other children? The more you allow your son to take from you, the more your other children resent him." The idea that the others will want to have nothing to do with their sibling after the parents die is a tragic legacy, precisely what most parents in these situations dread. Once it is made clear to them that this is the legacy they are creating by enduring abuse, some may feel determined to end the destructive dependency before it is too late.

Some parents find themselves ready and willing to set limits, but may feel they are unable to say no in the face of the anger or threats they are likely to encounter. In these instances, having a neutral third party, such as a bank or a representative payee, take control over their finances is often an effective intervention, so long as the parents are prepared for the adjustment period that will ensue as soon as the dependent adult child loses access to the money supply. Giving the son or daughter ample notice may ease the transition, as well as implementing a gradual withdrawal of financial support: "This month you'll get $300, next month $200, and then $100 a month for six months. After that, you're on your own." Warning the parents that there may be a period of acting out and testing the limits may help them abide while their son or daughter slowly attains a more constructive manner of living. Assisting the adult child with referrals to drug and alcohol treatment or mental health counseling may further bolster the parents' endurance as they put an end to the exploitation.

Sensitivity to the power of parental guilt is essential for helping older parents extricate themselves from destructive patterns. Parents in these predicaments tend to be burdened by remorse about errors made earlier in their lives that they fear may account for their son or daughter's lack of success in life. Parents who physically or sexually abused their children or who neglected them due to their own problems with drugs or alcohol may be especially reluctant to talk about the past. A friend or professional who hopes to assist older parents with such painful matters must be prepared to offer a considerable amount of listening. When pent-up feelings and fears are released, the process of sorting them out and making sense of what happened is both time-consuming and complex. When sufficient time is not available, it is preferable to make referrals to other sources of help than to open up the issues and leave them unfinished.