Maternal wounds & attachment

When She Needs You Now

By Dr. Donetta D. Quinones, PhD, LMHC, LPC  ·  11 min read

The shower chair arrives flat-packed, with an Allen key taped inside the flap and a diagram of a person who is not your mother.

You assemble it on the bathroom tile at 9:40 on a Thursday. The rubber feet go on backwards the first time. Down the hall the television is up too loud because she says it is up too loud. There is a Medicare appeal on the kitchen table with a deadline in your handwriting.

You are, it should be said, extremely good at this. You have always been good at this.

The chair takes eleven minutes. You sit on the closed lid of the toilet for another twenty.

The reversal

The person who did not come is now the person who cannot come. And you are the one who has to.

You spent a childhood needing an adult to take charge, and the adult did not, so you became a person who takes charge. Now the woman who could not manage her own life for most of yours is being handed to you by a stranger with a lanyard who wants to know whether you are the primary caregiver. There are two boxes. Neither says it’s complicated.

Everything you had made peace with comes back as a task list. Pharmacy. Insurance. The shower chair. The specific yogurt.

The task list is not the hard part. The task list is the part you can do.

How many of you there are

The 2025 AARP and National Alliance for Caregiving report counts 63 million Americans — about one in four adults — who provided care in the past year. Forty-seven percent are caring for a parent or a parent-in-law. The average caregiver is 50.6. Sixty-four percent report moderate-to-high emotional stress. Fifty-six percent felt they had no choice about it.

Hold that last one.

A word on hours, because this is where caregiving numbers get abused. You will read that the average caregiver provides twenty-something hours a week, and it lands like a sentence being handed down. The 2020 survey did find a mean of 23.7 hours. It also found a median of 10 — a large group doing a few manageable hours, a smaller group doing a second job, roughly a third under eight. If you are at sixty, the average is not comfort. If you are at six, it is not evidence that you are a fraud.

The finding this rests on

In 1990, Pauline Boss — with Caron, Horbal and Mortimer, in Family Process — studied seventy people with dementia and the relatives caring for them, and asked what predicted depression in the caregiver. They measured the obvious candidate, how far the disease had progressed. They also measured something odder, which Boss called boundary ambiguity: experiencing the person as psychologically absent while physically present. Not knowing whether she is in the room.

Severity of the disease did not predict caregiver depression.

Boundary ambiguity did. So did low mastery, the sense of having no control over any of it.

Now the part the study does not cover, flagged clearly as mine. For those families, boundary ambiguity was new. It arrived with the illness. There was a before.

For some of you there was no before. You have been sitting across from a physically present, psychologically absent mother since you were four — thirty years of unpaid practice, no name for it, not one casserole. Now a neurologist has produced a diagnosis and the world has turned sympathetic about a condition you have managed since primary school without credit. Some people find that unbearable. Some find it, in a way they are ashamed of, clarifying.

When the parent is the one who hurt you

Kong and Moorman studied 1,001 adult children caring for a parent in the Wisconsin Longitudinal Study. 18.6% disclosed childhood verbal, physical or sexual abuse; 9.4% reported neglect. Those with abuse histories reported significantly more frequent depressive symptoms — specifically when the parent they cared for was the parent who harmed them. Not caregiving in general. That parent.

In 2022, Kong with Goldberg and Moorman found a mechanism. Childhood maternal abuse predicted depressive symptoms in the adult caregiver through reduced emotional closeness in the current relationship. Not through the memory. Through the present-day distance between two people, one of whom is now getting the other one dressed.

The caution comes with the finding: the paternal pathway was null. Run on fathers, the same analysis did not reach significance. I am reporting something about mothers and will not let it quietly become something about parents.

And the honest limitation. When Pinquart and Sörensen compared caregiver groups across 168 studies, spouses showed more depression and burden than adult children did. If my argument were adult daughters have it worst, the evidence would say no. The argument is about relationship history, not about being somebody’s child.

The most useful number here

Richard Schulz and colleagues asked 1,397 caregivers whether they had felt they had a choice about taking the role on. About 44% said no. Then they controlled for how much care people were providing, the relationship, the condition and the demographics — and lack of choice still independently predicted distress and strain.

Two people providing identical care. Same hours, same tasks, same difficult mother. One experiences it as something she chose; one as something that happened to her. The second is measurably worse off, and the difference is not the work. The 2025 national data agree: among caregivers who felt they had no choice, poor mental-health days ran to 8.0 a month against 4.5 for everyone else.

That is not a finding that your suffering is optional, and it’s all in how you frame it is the kind of sentence that makes me want to throw a book across a room. It is a finding that perceived choice is powerful, and that most people have never examined whether theirs is accurate.

Obligation deserves more precision than the genre gives it. Pan and colleagues pooled twelve studies in 2022: stronger filial piety was associated with less burden, at a correlation of −.23, while filial obligation showed no significant relationship at all. A value you hold behaves protectively; a demand other people place on you does not. Duty you own is load-bearing. Duty that owns you is not.

One correction, because people are frightened by a statistic that does not hold. The claim that caregiving kills you traces to a 1999 JAMA study by Schulz and Beach of strained, co-residing spousal caregivers aged 66 to 96: relative risk 1.63, confidence interval 1.00 to 2.65. The lower bound touches 1.00, and the study says nothing about adult children. In 2013 Roth and colleagues propensity-matched 3,503 caregivers to 3,503 non-caregivers and found an 18% lower death rate. Roth’s group argue the discourse paints an overly dire picture. And the circulated line that 30 to 40% of caregivers die before the person they care for has no traceable source.

Two people

Marcus is forty-three, an emergency physician in Chicago, and a composite — a pattern assembled from clinical work, not anybody’s actual life. So is Priya. Marcus’s mother had bipolar disorder, undiagnosed until he was nineteen; he spent a childhood running a household around a closed bedroom door. She has been in a memory unit for fourteen months, and on paper he has done it.

“It is objectively managed,” he said. “And I sit in the parking lot for twenty minutes before I go in and I don’t know what I’m doing out there.”

Inside, his mother is warm. Sweetly, vaguely warm — to him, to the aide, to a woman named Doris who is not related to anyone there. She calls him honey, which she has never called him in his life.

“Everyone says it’s a gift. That I’m getting a version of her I never got.” He looked at the wall a while. “It’s an actor. Doing a version of my mother I’d have killed for in 1994. And it doesn’t count, and I can’t say that to anybody, because what kind of person says that.”

Priya is forty-nine, a hospital administrator, and has told nobody how it is going. Not her husband, who lives in the house. Not her sister, who calls on Sundays and gets a report. Her mother moved in eight months ago after a fall; the plan was three months. Illness has revealed no hidden tenderness. Her mother comments on her weight and waits for an audience before saying the thing that will land hardest.

“The first sentence is the problem,” Priya said. “If I start, I have to start with my mother has never liked me, and you can’t say that at work. People think you’re being cruel about a woman in a wheelchair.”

The thing nobody prints

In 2009 Cooper and colleagues surveyed 220 family caregivers of people with dementia for the BMJ. Ordinary carers, recruited through services, asked about their own behaviour. Fifty-two percent reported some abusive behaviour; 34% reported significant abuse. Overwhelmingly verbal. Only 1.4% reported anything physical.

That is not a finding about monsters. Monsters are rare. It is a finding about ordinary exhausted people at four in the morning, and the silence around it is what makes it dangerous, because shame produces hiding and hiding is how this escalates.

In 2025, Pickering and colleagues followed 457 family dementia caregivers for twelve months and traced how a caregiver’s own childhood maltreatment reaches elder mistreatment. Two steps. Maltreatment predicted hostile attribution bias — reading the care recipient’s behaviour as deliberate, aimed, at you. That predicted emotion dysregulation. That predicted mistreatment. The model explained 36% of the variance, and the direct effect became nonsignificant once both mediators were included. Full mediation.

So your history does not reach across the decades and move your hands. It reaches your interpretation; your interpretation reaches your regulation; your regulation is what is standing in the hallway at four in the morning. Both are cognitive and emotional, which is to say both are teachable and treatable. That is the difference between people like me hurt people and here are two dials, and here is where to put your hand.

Guilt is not one thing either. Losada and colleagues validated an instrument on 288 dementia caregivers and found five separate factors, among them guilt about doing wrong by the person you care for and guilt about failing to look after yourself. Women, and people caring for a parent, reported more of it. Five is a more useful number than one, because you can sometimes tell which one is running.

Where this gets complicated

There are three options and I mean all three. You can provide the care. You can arrange the care without providing it — Marcus is a caregiver and lifts nobody. Or you can decline, which some adults choose after careful thought, for reasons including safety, and which is not the same thing as abandonment. This is not a piece about being a good daughter. I have watched all three go well and all three go badly, and nothing here recommends one.

One thing I will say flatly, because money is made on the other side of it. There is essentially no rigorous research on deathbed reconciliation. Nobody has tested whether reconciling at the end improves grief or bereavement or anything at all. Anyone promising you closure at a bedside — a workshop, a chaplain, your aunt — is selling you the idea that a scene exists which settles the account. People do get those scenes. It is not a treatment, and it is not a reason to take on four years of work.

And some readers have no options. For a great many people the answer to what if I did less is: she would be alone, there is no money, there is no one else. No article converts that into a choice.

Something to do

Twenty minutes, one sheet of paper, an end point.

Write down every task currently in the arrangement. All of it, concretely — the pharmacy run, the insurance calls, the Sunday visit, the sister you update, the shower chair, the yogurt.

Then mark each with one of three letters. M for the ones truly yours: only you can do them, or you want to, or the alternative is one you refuse. S for the ones that could be somebody else’s, or bought — an agency, a cousin, a neighbour, a delivery — whether or not you intend to hand them over. N for the ones that exist only because nobody has revisited them since the week they started. Most lists have more N than anyone expects. The Tuesday call that made sense in March.

Then pick one item and write underneath it: I am choosing this, and here is why. If you cannot finish the sentence, it goes back on the list.

The aim is not to do less. You may end up doing exactly as much. The aim is to convert an arrangement that happened to you into one you have looked at and chosen. Skip it in the first two weeks of a crisis; the acute phase is not the time.

Be clear about what is and is not established. The exercise is mine and untested — nobody has run a trial on a sheet of paper. The target is what has evidence: perceived lack of choice predicted distress independently of how much care people were providing, and perceived autonomy in the caregiving decision turns up in Kong’s 2021 review of caregiving for a parent who harmed you as one of the few moderators worth anything. That is observational, not experimental. People who feel they chose do better, which is not proof that manufacturing the feeling produces the benefit. It is still the best lever anyone has found, and one of very few you can touch this week.

If this has put you somewhere raw, it is not material to sort out alone at one in the morning. There is no deadline on the thinking, even when there is one on the discharge.

The last thing

Nobody came looking for you when you were nine. The particular cruelty of this stage is that you are now the search party — dispatched, funded and staffed entirely by yourself — for a person who never sent one out for you.

You are allowed to want someone to come looking for you while you are out there. Priya eventually said her first sentence to a colleague in a corridor, badly, in nine words. The colleague said, “Oh, God, mine too.”

That fixed nothing. Her mother is still in the second bedroom, still saying what she says. But one other person on earth now knows what Tuesday is like in that house, and that turns out to be a different thing from being alone in it.