The Darker Side of Caregiving: Recognizing the Warning Signs of Abuse

Every person deserves to live in an environment that is both physically and emotionally safe. However, for some patients with cancer — especially those who are over the age of 60 – that is not the case.

“Although there are limited statistics regarding the specific intersection of cancer and caregiver abuse, there has been research on caregiver abuse within other groups, which are similar to, or frequently overlap with, those affected by cancer,” Madison Brock, LMSW, a social work counselor at MD Anderson Cancer Center said in an interview with CURE.

In fact, according to the National Council on Aging, about 1 in 10 Americans over the age of 60 have experienced some form of elder abuse, with 90 percent of these incidents occurring where the perpetrator is a family member. Two-thirds are children or spouses.

Brock describes abuse as “the systemic use of tactics to maintain power and control over an individual” — this can be emotional, psychological, economic, sexual and/or physical means.

“Abusive behaviors may be subtle at the beginning of a relationship, but tend to escalate over time and intensify during significant life events where reliance on an individual in a relationship increases,” Brock said. “This makes a cancer diagnosis a particularly vulnerable time for the escalation of abuse due to the factors such as an increased reliance on a partner or family member for basic needs (financial, medical, emotional, etc.).”

Essentially, Brock said, a cancer diagnosis is not what causes abusive tendencies to develop. Rather, it amplifies the venue through which a caretaker can express these behaviors. It is important for patients to know and understand the signs.

Know the Warning Sings

“Each and every relationship should be built upon mutual respect of each other’s boundaries, open communication, trust and honest, dignity and respect, as well as emotional and physical safety,” Brock said. “When a relationship does not have those components, it is important to look for red flags and warning signs which may indicate reason for concern.”

Brock noted that warning signs include:

• “Responding to the patient’s cancer diagnosis in a self-centered, minimizing or even dismissive way (e.g., they focus on how the diagnosis is affecting them and look for sympathy from others).
• Not acknowledging the patient’s fatigue and/or increased need for rest. The caregiver may purposefully wake the patient from naps, prevent resting and/or assume that patient can resume normal household chores before fully recovering from treatment.
• Making negative comments about changes in the patient’s appearance during treatment and/or after surgery.
• Forcing the patient to consent to a treatment that is not wanted or deny treatment that is wanted/needed.
• Depriving the patient of medications or communication devices.
• Using the cancer diagnosis as a reason to prevent the patient from interacting with loved ones.
• Excluding the patient in financial decisions that relate directly to the patient’s income.”

Brock continued, “What’s important to keep in mind is that there are no exact behaviors which distinctly indicate the presence of an abusive relationship, but instead, looking at the behaviors in the context of: ‘Is this behavior a pattern?’ and ‘Has the behavior escalated over time?’”

What to Do in an Abusive Situation

If a patient feels that he or she is being abused, it is vital to have a safety plan, including steps to keep oneself both emotionally and physically safe.

“Safety plans are relevant whether or not you are ready to leave an abusive relationship, and can be made with help from your mental health provider, medical team, trusted friend or family, or by reaching out to a local or national abuse hotline,” Brock said.

To reach the National Domestic Violence Hotline, patients can call 1-800-799-7233.

“This is a subject which is absolutely not talked about enough. Everyone has the right to a safe and supportive relationship, especially those with cancer,” Brock said.