At first, denial can be a healthy defense against admitting that your loved one has dementia.
Denial involves not acknowledging what you see or hear and/or unconsciously negating what you see or hear. Denial helps you block the more painful aspects of reality. However, if denial continues too long, then it can be life-threatening to you and your loved one.
Here's what happened to me, a psychiatrist, and my husband who died seven months ago from Lewy body dementia.
One day he tried to cut my bangs, something he always did for me in between hairdresser appointments. We both enjoyed this ritual. Although he was an attorney by trade, he was pretty handy with scissors, knives, and other tools. I combed my hair and sat down in front of him, ready for my bang trim. With his usual confidence, he grabbed my bangs and moved the scissors toward me. My eyes were closed, but fortunately I opened them just before he began to cut. He had the angle all wrong. I was shocked as I grabbed his hand and asked what he was doing. I saw a blank stare. My husband was a gentle man and would never hurt me, that's why I'd chosen to be with him, but he was unaware of how close he'd come to gouging my eyes out. His senses of distance, danger, and appropriateness were all thrown off.
This incident -- which occurred a year into the diagnosis -- literally opened my eyes to the dangers of denial.
If you find yourself doing one or more of these things, you know you're in denial:
- Ignoring tell-tale signs such as your loved one tripping or dropping things. These actions are more than a sign of clumsiness-- they are indications that the nervous system is impaired.
- Idealizing him or her to the point where you think of your loved one as perfect or a saint who couldn't do anything wrong.
- Rationalizing his or her behavior. Saying, "It doesn't matter that she just turned on the burners on the stove and walked away without putting a pot on to boil. She'll be back in a minute." She won't, and you could have a fire.
- Allowing your loved one to walk the streets unaccompanied when you know he or she can get lost. Getting lost and losing a sense of direction is a symptom of dementia.
- Expecting your loved one to follow his usual schedule. You must adapt to the changes caused by dementia. He can't go to work as usual, as much as he might want to go. He might not even be able to get to the doctor. Consider hiring a nurse's aide or enlisting your support system to be with your loved one as much as possible.
- Letting your loved one continue to drive or handle machinery. OK, so you live in Florida or California and there is no other way to get around. Drive him or her yourself, or hire a driver.
- Getting angry out of proportion to what happened. You are suppressing your feelings when you're in denial, so your anger and many other feelings will be much more intense than usual. Once you stop the denial, it is possible to regain control of your emotions.
- Projecting your own feelings on your loved one. He might not be feeling what you think he's feeling. Take the time to sit down and talk with him at length and try to find out what he is really feeling.
If you have had an incident like the one I did, you will be forced to break through your denial. The key to your emotional health is to stay out of denial.
I recommend engaging in psychotherapy with a trusted professional, and/or joining a support group. Talking to friends and family can be helpful, but beware that they might collude with you in the denial -- they could be just as sad, confused, and disturbed as you are about your loved one's condition. Objective professionals outside of your immediate circle can help you best identify your denial and work with you on a plan for your long-term emotional health.
Carol W. Berman, M.D., is a writer, psychiatrist and artist who lives and works in New York City. As an undergraduate she attended the University of California at Berkeley; she went to medical school at NYU Medical Center. Presently she is an Assistant Clinical Professor at NYU. Her two books, "100 Questions and Answers About Panic Disorder" and "Personality Disorders," have helped thousands of patients and their loved ones deal with mental disorders. She is at work on a memoir about her husband's struggle with dementia. To find out more, read Dr. Berman's blog on Red Room.
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