Abstract

Ann, a 73-year-old widow who lived alone in a small North Carolina town, consulted me because she felt she was too self-absorbed. Ann is a retired social worker and spends much of her time with her 44-year-old schizophrenic son, Fred, who has been repeatedly hospitalized for acute psychotic episodes. About five years after I undertook the care of Ann's son, her older sister became acutely depressed, later suffering a stroke in her early 70s. With the help of a daytime home health aide, Ann cared for her sister while continuing to work full time. Five years after her sister's death, Ann's husband was diagnosed with pancreatic cancer; as with her sister, Ann remained as the primary care giver, providing hospice-type care for her husband throughout his illness. Soon after her husband's death, Ann retired and undertook a number of volunteer activities. She was 64, in good health, and looking forward to a period free from the major care taking activities which had dominated her life, when she unexpectedly experienced a negative change in her mood.