"You're not a bad daughter," I told my patient, a grown woman with children of her own.
Her body shook as she sobbed. Her 92-year-old mother was in failing health, living in an upscale assisted-living facility. Although she did not require a walker, wheelchair, feeding tube or oxygen as did many of the other residents, she complained incessantly -- about the food, uncaring family members, the brusqueness of the staff.
Julia tried to be an advocate for her mother but found it increasingly difficult in the face of her nastiness.
Then there was her mother's constant criticism of Julia's children, who never called or visited. Julia thought that they were merely doing what she would have liked to do -- but couldn't.
As a result, my patient found herself wishing that her mother would die.
The more she wished this, the more guilty she felt. The more guilty she felt, the more she called and visited. If some animals attack when they smell fear, maybe the same is true with difficult parents who attack when they smell guilt.
Whatever the case, the more Julia tried to appease her guilt, the more negative her mother became. The vicious cycle was pushing her into a clinical depression.
I clarified what I was trying to say. Many elderly parents would be appalled, but not surprised, to learn that their adult children want them to die, I said.
And equally as many adult children would be relieved to know they are not alone in feeling that way. These adult children, often in their 50s and 60s, live under a cloud that will not leave until their parents pass away.
For them, there is no such thing as good news -- not when their mother or father is chronically ailing or, worse, in good health but with a bitter or negative disposition.
A sudden physical decline may trigger sadness or possibly a fear of the child's own death, but a turn for the better can seem to delay the inevitable for a person already in physical, psychological or emotional decline.
"Why feel glad to get six more months, just to have to go through the same process again?" they may ask themselves.
I told Julia that these thoughts are normal. Watching a parent become weaker, sicker or more enfeebled is stressful, of course, but most adult children can bear that.
It's when that parent becomes vicious, hostile and resistant to help that stress crosses over into distress. Then, the goal of assisting the parent to have the best life possible is replaced by the goal of relieving one's own distress.
If a parent's attitude and behavior don't improve, the child wants an end to the suffering. That can only come when the parent dies.
The desire for a parent to die sooner rather than later can escalate to a point of obsession. At that point, it can take all of an adult child's energy to keep such a death wish from wreaking havoc -- making the child truly wish that a parent takes a turn for the worse and is closer to death.
That was the threshold Julia found herself facing when she came to see me. She spoke at length of the frustration and exhaustion caused by overseeing her mother's care.
How, she asked, could a good daughter think such awful thoughts -- especially after the many things her mother had done for her and her family over the years?
I stressed that her feelings didn't mean she didn't love her mother. Nor did they mean she really wanted her to die. They simply meant that she wanted resolution -- to put this chapter behind her.
Furthermore, I told Julia that I thought she loved her mother deeply and that those feelings, not guilt, was what caused her to visit so frequently.
What she didn't love or like was how her mother's negativity had so completely taken over her personality and reduced her to a bitter, angry shell of a person.
Julia continued to visit with the hope of seeing the positive sides of her mother somehow show through.
When Julia realized not just intellectually, but emotionally, that she did love her mother but resented her behavior, she felt emboldened to stand up to her mother in a way in which she had been unable to in the past.
On her next visit she confronted her: You're my mother and I'm always going to love you, for as long as you live and beyond, but if you continue to act as negatively as you are, I'm not going to like you. And if I don't like you, I'm going to visit you less often and shorten the amount of time I spend with you at each visit.
What I will not do is let myself become so angry and so dislike you that I stop visiting all together. Before I do that I will shorten contact to minutes per week and check in more with the staff about you than visit with you.
I am asking for your help in making the best of the situation -- being respectful and kindly toward others and showing the dignity that I know you are capable of.
Julia's mom heard the resolve in her words and did what bullies often do when called on their behavior in a firm, no-nonsense way. She listened. What's more, she changed for the better, and Julia was able to replace the "death wish" she had been harboring with the true desire to visit her mom.
Like others who are exhausted by caring for a physically or emotionally ill parent, she eventually found solace in realizing that the thought is not the deed, that she was not alone in such feelings and that she was not a bad, or even, unloving child.
She simply wanted to love her mother as she had been, not resent her as she did.
Mark Goulston is an author, speaker and psychiatrist in Santa Monica. He can be reached via www.markgoulston.com.