Friday, March 18, 2016

Therapeutic Lying

Alzhimer’s is not an easy disease to deal with. I remember watching my Great-Grandfather, confused, throwing out accusations at nurses and family. It’s hard on the caregivers, and you’d better believe that it’s hard on the person who has it. Alzheimer’s isn’t the same thing as the romanticized version in books and movies. It’s painful, exhausting, and often taxes emotion and mental emotions more than anything else.

I had the privilege of working with Alzheimer patients from the very beginning. I was a CNA at an assisted living specifically for Alzheimer and Dementia patients, and from there on out, it became one of my passions.

I’ve talked to many people over the years who have some issues with one of the recommended therapies for Alzheimer’s patients: Therapeutic lying.

Therapeutic lying doesn’t mean lying to the patient about their cares or about the situation. In most cases, the patient (or family member) doesn’t live in our reality necessarily. I’ve had many patients believe they’re sixteen years old, or twenty, or even five. They think they’re a mother, waiting for their kids to come to school, or an engineer, directing the maintenance department.

As odd as it might be for caregivers or family, their reality is as real to them as ours is to us. How would you feel if you were talking to a husband, a brother, a daughter, and every time you said something, they’d argue? Telling you that you’re crazy and that what you’re seeing, what you’re feeling is wrong?

Let me give you an example:

One of my patients, Carl*, was admitted at the same time I started working in the facility. He was a vivacious man, happy, energetic, and he loved to flirt with the female staff. He loved to laugh, and he always had a smile on his face. I loved working with him, to feel his energy. He had Alzheimer’s, and he was confused. During the day, he would ask where his wife is. I’d been taught that for Alzheimer’s, you step into their reality. Something like:

“Where’s Deborah?*”

“I don’t know.” Glance at watch. “It’s about three o’clock. Do you think she’s out picking the kids up from school?”

“Oh, yes, you’re probably right.”

Conversations like this help to calm the patient down. It helps them believe that they’re not missing someone, or that something bad hasn’t happened. Carl’s family, however, did not approve of lying to him, and they insisted we always tell him the truth. I overheard a conversation between Carl and his family, and it about broke my heart.

“Where’s Deborah?”

“She’s dead, dad.”

“Dead?” Carl began to sob, long, loud tears. “How? When did that happen?”

“A year and a half ago. You were there, remember?”

No, he didn’t remember. It’s part of the short term, the first thing that goes when someone has Alzheimer’s. He remembers his wife, how much he loves her. He does not remember she’s dead. As staff, we weren’t allowed to use thereptuic lying, and each time I had to tell her she’s dead, it broke my heart even more. His family even went so far as to hang signs in his room, over the phone, by the door.

“Remember Carl, Debora’s dead. You can’t call her.”

In three short months, Carl became depressed. I know what you’re thinking. He’s confused, he doesn’t remember. So why would he get depressed? Here’s the thing I’ve learned over years of working with Alzheimer’s patients.

They don’t remember events. They don’t remember names or faces, but they do remember how they feel. They may not know why they feel angry, or sad or confused, but it lingers. The longer a person is depressed and upset, the more it sticks with them. Poor Carl was reminded, over and over again about his wife’s death. He grieved each time like it was the first time he’d been told. Soon, he stopped walking, and then he stopped eating. Finally, he refused to get out of bed.

His family blamed us. They said we weren’t doing enough for him. He was removed and put into a different nursing home.

The lesson Carl taught me was a powerful one. Each experience we make for our patients, each word we speak, is going to make a difference. They may not remember in the distant future, but they will remember how you make them feel. It’s the reason why some patients naturally bond with certain nurses and CNAs. They don’t remember why, but they know that they can trust that person.

As terrible as it sounds, therapeutic lying is necessary. They don’t always live in our reality, and we don’t live in theirs. But that doesn’t mean we can’t help them make sense of what they’re living, and what they’re experiencing.

For more information on therapeutic lying, go to:

*Names have been changed