Inner Critic or Outside Voices: Judgment Can Weigh Heavily on Caregivers

Suppose you’re one of the more than 59 million caregivers in the United States caring for an adult over 18. In that case, it’s likely at some point on your journey you have questioned one of the thousands of decisions you’ve made daily or encountered suggestions from a loved one (including the one you are tending to), a physician or even a stranger’s advice on how you should be doing something differently, or daresay, better, for the person you know best.

Several years ago, I left Minnesota to visit my octogenarian mom in Florida and quickly discovered that while she sounded fine and looked healthy over FaceTime, her cognitive skills were in decline. For example, she forgot to pick me up at the airport, couldn’t remember how to get home once she arrived, and had a level of paranoia that would require a prescription to quell. I returned home to gather my belongings and moved closer to her to assess the situation and figure out the best plan for Mom and our family. Though convinced it was the right thing to do, my internal narrative and external soundbites were not always helpful, and certainly not healthy.

Caregivers can be their own worst enemies when making choices that are simply the best of the worst — hearing other dissenting voices can further diminish one’s confidence. This type of negativity only feeds into the physical and mental health of caregivers. According to the recently released Caregiving in the US 2025 Research Report, 64% of caregivers cite emotional stress and 45% note physical strain. More staggering are the percentages of those who pass away before their person, with some studies starting at nearly 20% and rising to more than 60% when a spouse is supporting their partner.

Between the state of caregiving in the U.S. and the unending public opinions available online, caregivers need kindness and support from themselves and others in so many ways. Here are several strategies to minimize criticism and judgment, and why doing so is crucial not only for one’s own well-being but also to the person being cared for.

Caregivers feel all sorts of emotions – anger, sadness and exhaustion (and yes, even joy at times). However, negative feelings may lead to a sense of guilt. Inner criticism and guilt often work hand in hand in a vicious cycle, its origins going as far back as an individual’s early years. An inner critic may stem from one or more childhood experiences, from being a perfectionist, or due to exhaustion with additional responsibilities.

With the recent release of Emma Heming Willis’s new book, “The Unexpected Journey: Finding Strength, Hope and Yourself on the Caregiving Path,” much attention has been given to “judgment.” For example, “How could she move Bruce out of the house?” Or “What will her children think down the road?” Caregivers ruminate enough on their own without having the invited (or uninvited) barrage of other people’s impressions.

In Willis’s book, Arlene Schollaert, family services director of Amazing Place in Houston, Texas, writes, “Guilt is actually a normal part of being a care partner. In fact, if you didn’t feel guilt, it wouldn’t be normal. It’s how you process the guilt that matters.”

When Stephan (his last name is being omitted for privacy), 53, learned his 80-year-old mom had Alzheimer’s, he made the gut-wrenching decision to place her in memory care near where he and his wife live in Minneapolis. “I dreaded bringing her to the facility, so I planned every detail, setting her room up with furniture and photos beforehand, but nothing prepared me for the swearing and anger Mom lashed out at me when we arrived. I wondered, ‘How can I do this to my mother?'”

It’s important to understand that while no two caregiving situations are the same, many of the questions caregivers ask are — these tend to focus on the choices we’ve made, the trust we’ve lost in our decision-making skills or the feeling that we’re not doing enough. Maybe one of the questions below sounds familiar.

Should I bring in help or do everything on my own?
How can I be at my teen’s swim meet when I should be caring for Mom? 
What if I’m at yoga or a doctor’s appointment, and something happens to my wife while I’m gone?  

And the one Stephan and countless others have asked themselves…“Am I doing the right thing?” 

Jaime Capone, 55, from San Fernando, California has been a mom and full-time caretaker for the past 26 years to her daughter with severe autism who still lives at home. Capone and her husband knew immediately that something was very wrong with their baby girl. “My daughter is extremely aggressive, and that has been our biggest cross to bear,” she said. One of Capone’s darkest times was during her daughter’s teenage years, when hormones and a new prescription incited such violent behavior that Capone had to sleep in her car down the road.

On Day 4 of this specific episode, the Capones made one of the hardest parenting decisions and had their child committed to a psych ward for a brief period. “There’s never been a lower time in my life, and I still don’t feel good about it, but it had to be done.” Capone offered others advice, “You can keep questioning, but you will lose yourself if you dwell on your decisions.”

Capone constantly reminds herself how strong she is while knowing, “Every decision I make is the best for my person.”

For many caregivers, seeking advice and hearing other perspectives are welcome (at times) as they sort through options for the individual they’re supporting. However, whether it’s a well-meaning friend, family member or a fellow support group member pushing their own agenda instead of listening when needed most, people should feel free to “Pull the plug,” advises Teepa Snow, an occupational therapist, dementia educator and founder of Positive Approach to Care. Taking on opinions that don’t serve you is a recipe for setting your inner critic aflame. “It’s OK to step away from a relationship or a community that is not helpful,” Snow said.

Snow suggests a phrase care partners consider using when it’s clear you and another person are not on the same wavelength – “Wow, it sounds like we are in wildly different places in our journey.” She explained that “Wow” is a wonderful word to preface your reaction, as it allows you to exhale and succinctly state that you are not aligned.

Similarly, Willis included a section in her book titled “Have Go-To Responses,” which discusses the benefits of being prepared for topics you may prefer to avoid rather than getting caught off guard. As a caregiver and coach myself, this is excellent advice in removing emotion and planning for the inevitable. Practice a few simple phrases that offer a quick answer and a redirect to a different subject. Or don’t answer a question, instead saying something like, “I’d rather not talk about it now…how are you doing?” as a perfectly acceptable response. Snow often reminds care partners, “People who are not on your specific journey do not get a vote or a say.”

“I’ve known caregivers who’ve lost their lives literally,” said Rosanne Leipzig, MD, PhD, vice chair emerita for education at the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York and author of “Honest Aging: An Insider’s Guide to the Second Half of Life.” “Some caregivers won’t do anything for themselves, feeling guilty it takes time away from their person, whether it’s going to their own doctor appointments or exercising at the gym.”

According to Leipzig, care partners need to understand that wearing themselves out will ultimately affect their health. “Stress can make you crazy,” she stated. Behaviorally speaking, Leipzig explained stress presents itself in numerous ways whether it’s overeating (or not eating enough), turning to alcohol, drugs or cigarettes, or being cranky, as examples.

Of course, any of the above can manifest as physical ailments, ranging from simple aches and pains to ulcers, and can even impair your memory and cognitive skills. Leipzig added, “In my experience, people’s immune systems don’t work as well under stress, making them prone to diseases. Being a martyr doesn’t help anybody.”

In fact, previous research in Science Direct showed a “significant, reciprocal relationship exists between patient and caregiver emotional distress.” Experts found that high levels of caregiver distress can impact a patient’s long-term adjustment, anxiety levels, or may inadvertently affect the quality of care they receive due to a caregiver’s difficulty in administering medications or because their own health is now suffering.

Trusting yourself, developing thick skin, turning a deaf ear or laughing off others’ judgment is easier said than done.

To help manage his questioning and accompanying guilt, Stephan began seeing a therapist when he noticed his mom was misplacing items, losing track of time and was experiencing mood changes, well before her official Alzheimer’s diagnosis.

He recommends finding a trained professional with experience dealing with similar issues, as they can share what’s possible on the road ahead for both you and your person. “Working with my counselor helped me to accept there was no cure for my mother, reevaluate what’s important and improve my trust in myself. For me, if I’m able to create moments where my mom is free of worry and safe, I know I’m having a successful day no matter what anyone else may say.”

Where therapy is vital for understanding the roots of feelings and behaviors, coaching focuses on the present, and it provides actionable steps to help you move forward. Snow offered two suggestions for boosting your confidence:

1. Find someone who can affirm how well you are doing.

2. Consider two of your caregiving successes and reflect on the reasons these worked well.

“Celebrate what is working well while practicing the art of letting go of what isn’t, even if it’s just for a moment,” Snow suggested.

In my case, each morning, I repeat a positive mantra and spend a few minutes journaling, focusing on an attitude of gratitude between the complexities of caregiving. However, you choose to release the weight of criticism, know this: you are your person’s person for a reason, and you are doing a great job.