Book Review: After the Tears ...

Earlier this month, Health Communications published a revised and expanded edition of Jane Middelton-Moz and Lorie Dwinell's 1986 popular classic, After the Tears: Helping Adult Children of Alcoholics Heal Their Childhood Trauma.

This new edition has been almost entirely rewritten to reflect new information regarding trauma, posttraumatic stress disorder (PTSD), delayed grief and newly-discovered brain physiology. Entirely new chapters include those on resilience in children of alcoholics, ACoA's as parents, ACoA's in the workplace, acceptance and forgiveness, and spirituality for ACoA's.

Not surprisingly, the first of the new chapters to catch my eye was one entitled, A Pain Too Deep: ACoA's Taking Care of Elderly Parents. Here, Jane Middelton-Moz describes an issue common to many adult children of trauma - that of caring for elderly parents who have not cared well for you. While for some, therapy and personal growth in the intervening years have meant that parental caregiving is an opportunity to give back, lovingly, to parents who did the best they could, for many, "... the task can be especially daunting ... (when) navigating a minefield of emotional hurts and abuse from the past". Jane goes on to say that -

Adult children frequently end up caring for elderly parents who were not there for them in their growing up years, and who were sometimes physically and/or sexually abusive to them as well. Many alcoholic or codependent parents had lives that resulted in chronic PTSD, and they often were not appropriately cared for themselves as children. As a result, many were suffering from their own developmental losses while raising their children. They may have been neglectful, clinging, dependent, abusive, controlling, ill-tempered, or demanding parents who not only were ineffective as parents but demanded to be parented as well. As a result, many Adult Children also suffered from PTSD most of their lives. Within this framework, these Adult Children are then commandeered one more time to take over the care of their parents physically and emotionally, and for some, to rescue them financially as well; all of this while being their parent's primary caregiver.

Many of the Adult Children who are responsible for elderly parents are themselves in their sixties or seventies and are taking care of parents in their eighties and nineties. For many, this is the time they believed they would finally be able to relax. They have achieved some level of financial security and career satisfaction and often have new and improved relationships with siblings and parents. This tests their limits and can cause some ACoA's to revert to earlier roles and painful interactions with both siblings and parents. While some elderly parents who need care may have gone through recovery, others may be as emotionally difficult as they ever were - or may even be worse. (p 218-219)

Why does all this matter? Because in many jurisdictions, including British Columbia, a Guardianship Act or similar legislation legally binds adult children to the care of their dependent parents. Understandably, when unresolved trauma is in the mix, such situations can hold the potential for elder neglect or abuse and they call for case-by-case assessment and adequate support from knowledgable case managers before a parent is placed in the care of an "unrecovered" adult child.

Another seldom-acknowledged observation made in this chapter is that adult children of alcoholics can find themselves caring, not only for their own children and for their parents, but for adult siblings who have "fallen by the wayside" as the result of their own childhood wounds. When this situation is combined with a lack of psychological separation from family members and an enhanced empathy for others' suffering, (both products of traumatic families), it can lead to a caregiver burden that is on a fast track to burnout and compassion fatigue.

Jane and Lorie offer a number of self-care recommendations for ACoA caregivers including:

• 1. Developing the ability to define yourself and to set caregiving limits. (This is often best done with the support of a therapist who has expertise in treating both caregiving and childhood trauma issues.
• 2. Not expecting siblings to behave differently from their usual roles and patterns under the stress of a parent's illness or infirmity. (Families almost always revert to their original patterns in the face of serious stress.)
• 3. Remembering that you do have a choice regarding how much caregiving you are willing to undertake. (You may not be able to change your family's response, but you can change your own behaviour.)
• 4. Planning ahead and formally scheduling self care time. Making it a priority.
• 5. Giving yourself the gift of support. (Many adult children develop a protective counter-dependence that can cause them to feel shame regarding their natural need for support.) Consider seeking a good therapist or 12 Step support group. If you can't leave home, join an on-line support group run by a reputable organization.

This practical and readable volume has been a gift to ACoA's for almost 25 years and the new, expanded version will enlighten and promote the healing of a whole new generation of adult children.