Well....I'm not sure if we take this as our answer....or what. I've mentioned here several times that we were preparing to ask FIL's primary for an initial cognitive assessment. Brief history - he is a raging narcissist - and I know there are some here that think that term is overused. In his case - this is not an exaggeration - this is 100% truth. He is an abusive narcissist and always has been. This is not new behavior.
Recently, he needed to sign some paperwork and was asked to provide a doctor's note stating that he is of sound mind. His primary doctor has provided this. Not only provided it but used the words "perfect cognition" His primary did not perform any cognitive assessment - even the initial basic stuff. He has been his primary for a number of years and his portal documentation always basically says the same thing after his visits - patient is pleasant and neurologically aware. However, in most of his appointments most of the talking is between the doctor and whomever attends the appointment with FIL, with the doctor addressing FIL only when needed.
So we are now concerned that we have hit a brick wall. And we are second guessing ourselves. Is it possible that a personality disorder could skew his decision making skills so much that it could look like dementia to us? His doctor has rarely if ever seen that side of him. He is 100% able to keep up the image of sweet little old man for the amount of time it takes to see his doctor for less than an hour. He has never seen the abusive narcissist that we see.
Have we been so far off base?
Some examples just for context.
- Is it his narcissistic mind that leads him to answer unknown numbers and engage with scammers - thinking he can outscam them? Even though we have told him that they are potentially voice printing him, even though we have told him there is literally no reason to answer unknown numbers, HE tells us he can fix them.
- He will sell his soul for free stuff - my SIL has walked in to hear him giving out his home address for free stuff - because - again we have told him a million times - that they aren't going to do it - but in his mind he is the ONE person they are going to give the free stuff to.
The list goes on and on - ad nauseum of things that we have thought were poor decision making due to age related cognitive decline or potential dementia - but now with this we are second guessing ourselves. Could it really be the narcissism? Seriously? I'm having so much trouble wrapping my head around it. We know he is an over the top narcissist - he literally checks every box - but is that really what we are dealing with?
Or are we overreacting to a form letter with no actual assessment behind it and should we still pursue getting him assessed anyway?
I'm just so confused now.
If FIL becomes non ambulatory, he will need care beyond what AL will offer. Yes, some will take him and the cost will be astronomical and the care will be lacking, be on the watch for that. A needs assessment by an impartial third party will direct the level if actual care required. I don't trust a facility to do a needs assessment, they benefit financially from greater needs, just MHO.
Some states will allow the caregiver child to remain in the house after placement. There are rules and regulations about how this can be accomplished, have your SIL do the research or help her. This could help ease some of her stress with dealing with her abusive dad. Knowing what happens to life would be reassuring to me, so I imagine it would be for others.
Are they not able to work and get out from under him?
As far as the rest, I'm not privy to a lot of the details so I really don't know the answer.
What we have basically all agreed to is this - if the other shoe drops and the worst case happens- AKA he cannot stay in that house and there is literally no choice but to send him to a SNF - meaning he can't physically get out of the bed to walk to the bathroom - which is all that he literally has left - the ability to get out of the bed and walk to the bathroom and back or the car and back for drs appts (he transports from the car via scooter and cannot walk more than about 30 feet with the walker) that they will have to find other accommodations - there will be no choice because the house will have to be sold for his care. Other than that we stay out of their arrangement right now.
Back when I did a 'step in to help' it quickly slid into a pit of never-ending-needs. (The Bottomless Bog I decided to call it). The more I did, the more was needed. I asked for professional PT feedback once or twice - can they actually do this/that? Yes they could. Especially when I was not there. Hmm. Intentional or not? Personality or brain dysfunction? Hard to know. Whatever the reason, I was up to my eyeballs & needed to get out.
Now in that case. The One-with-Needs was being propped up to live their *farce of independence* by Helper #1. I was helping the One, plus ensuring Helper #1 could help.
A Social Worker called what I was doing *enabling the enabler to support the farce*.
Please don't take offence! But by helping your SIL, could this also be enabling the enabler?
I was asked "what if you just stopped?". Indeed. I eventually gave notice & did. Not to dump or abandon but to open the door to reality & other choices & solutions.
Now if you set some new boundaries with SIL eg "Going forward, I will do ABC but I am no longer willing to assist with XYZ" what will happen? SIL gets new choices & consequences. To do more (hope not) or do same pushing FIL hti have new choices & consequences. (Often it is A. hire & pay to age in place or B. move into an AL).
Real change may depend on SIL (& BIL/Bro?)
"Because they are not in a place where they can leave"
This.
What barriers prevent this? Funds? Ability to find housing? Work?
It may have been a good *social contract* to live with FIL/provide some care for housing. But it may have expired. No longer works. Sometimes a little care is fine, but if the needs are great, it prevents maintaining a paid job & therefore skews the whole thing into unsustainable.
I can already see a difference in our health when we engage and when we don't. And I can certainly see a difference in my mental health when I disengage. It certainly helps to have this place to talk things through. And it is a good reminder that the choices of other competent adults don't necessitate my involvement. I tend to get overinvolved and I'm up to my eyeballs before I realize I don't need to be. As you call it, the Bottomless Bog. I "mom" people that need to stand on their own feet. And its time I back off and let them figure their own stuff out.
Has he got family/other etc at beck & call jumping or has he burned though them all yet?
Dh and I live an hour away and are not involved in his day to day care, but are emotional support persons more than anything I suppose. We try to help as much as we can because we know it is mentally and emotionally overwhelming for SIL. If we had our way he would be in a SNF. But our way isn't getting us very far so we are trying to find a happy medium of supporting them while maintaining our mental and physical health. Because they are not in a place where they can leave and as long as they are there he isn't going anywhere.
And as far as anyone else...the 4 of us are pretty much it...he has alienated most others. The grands will do the wave and nod on holidays. His one long distance sibling keeps in touch- easy enough to do every once on a while but even they admit if they lived nearby it would be too much. He will go through his phone contacts every once in a while to see who picks up. Frequent flyers include the daughter of an old friend who doesn't know that side of him and the old housekeeper who has to take his calls to get her Christmas check- even though she hasn't worked for him in over 5 years....
Someone mentioned that he's lonely. I'm certain he is. When you have burned every bridge, sabotaged every relationship and denigrated every person you have come in contact with once they no longer proved useful to you.....you tend to be lonely....
Yes I also think aging may bring more narcisstic tendencies in some elders.
Yes I believe family or those that know the person well will notice changes in behaviour well before their Doctor does. Especially if seen infrequently. Especially ++ if person is well spoken, good vocab, dressed well, fine manners etc. The Grand Old Dame or Gent can present as VERY cognitively intact for the length of an appointent.
Yes, a neuro/psych exam will shed real light on ALL cognitive abilities. Holes in reason & judgement are uncovered. Oh yes long term memory can be top, short term memory even not too bad, but judgement or spacial awareness can be impaired.
Another thing - even quite impaired people can still be deemed capable to make decisions regarding "their own health". The Doc may even know something is quite 'off' but also knows how low the bar is so signs off as *capable*. (Although *perfect* is a weird word choice to use imho)
I think that maybe where you are?
This gets you a big headache. Also gets you membership to the club: The *awaiting a crises to get real change* club. Welcome.
And don't believe people here on this site who tell you that the word 'narcissist' is overused and blah blah. THEY haven't been dealing with YOUR FIL, so unless they have firsthand experience with him, they have no way of knowing what PD he suffers from or doesn't suffer from. The thing about NPDs is that they're so very charming to others and devilishly horrid to their own family members. Covert is their middle name, which is how they've been getting away with murder for so long. Not all of us have sweet little old ladies & gents for parents. Snicker.
Wishing you the best of luck getting to the bottom of this dreadful situation.
One example re the phone calls - yes bc narcissists exist on the attention of others - it’s like their life blood to find abd create ways to obtain it so whenever the phone rings he sees it as an opportunity to gain attention - important to note this isn’t the normal need that all people have done human contact and connection- narcissists require almost a constant stream of attention and when it’s not they will stir up abd manufacture conflict, pretend to be sick etc to get it.
Narcissists memory and cognition isn’t affected - they’re very calculated abd aware of what they’re doing although they’re manipulative so they can present themselves as if they don’t know what they’re doing or play dumb or pretend not to remember etc
They met with her then called me in alone.
They documented she’s a schizophrenic and told me blatantly to “have nothing to do with your mother! She hates you and voiced it with a grin.”
They saw through all her BS.
They more trained to draw it out.
I did place her, and HER attorney told me to pay myself (keep a journal) $50.00/hr. ✅
I was glad for $25.00/hour, but I wasn’t going to argue.
I popped in to give checks for her hair to get done and other needs, but kept my emotional well-being away from her.
Geriatric psychiatrist 👁 will set you free-
Hugs to you and I mean it-
If you want a good place to start on Jamison's books try An Unquiet Mind, A memoir of Moods and Madness.
So, if you speak up in front of mom, she'll get angry? How is that a bad thing, that the doc gets to see her level of denial?
To my way of thinking, being able to act as you please in front of a parent is one of the hallmarks of adulthood.
Your first suggestions were helpful; thank you. I was going to wait until we saw how things went, as maybe it can all be explored in the appointment - we only get ten minutes here - and then phone if more discussion were needed.
In the end, I felt plain speaking was best. In front of the person, directly to the professional. "I am concerned about X". Then the Professional takes over. Asks the appropriate questions, at the appropriate level. I'm sure it varies, but I have been happy with how this has gone. I have also seen how easily they recognise denial or lack of insight.
I do understand wanting to avoid unpleasant situations - especially if loss of trust follows. But I kind of wish I had been straight up from the start. Just say it kindly, but say it how it is. Eg I am concerned that her memory/incontinence/anxiety is getting worse. It seems to be effecting daily life in these ways...
I decided it was not my role to always protect other's feelings. They are free to feel how they wish. But if I feel I have a duty of care to report real problems, I will.
My mother now has advanced dementia with multiple health issues. But it was her failing health that brought her to the hospital where the dementia was initially identified. I also think the there was no one that wanted to take the responsibility for saying the “D” word and it took a staff that was skilled in treating dementia to identify and provide proper support and treatment.
If you could get him assessed, then by all means do so. Having that piece of paper in hand won’t make managing his affairs much easier. He will still be the mean cruel person you always knew and maybe worse. You will still go through periods of self doubt and questioning your decisions. You will feel guilty. But just go with your gut and stay strong. You will need to be the bad guy. My mother made many bad financial decisions that I am now cleaning up. I am still the target of her anger and violence - that will never change. My mother always made stupid and bad decisions so I can’t say whether the mental illness or dementia brought about bad decision making. Right now it doesn’t matter.
Knowing what I know now, I would be deciding what your personal goals are in the role of his caregiving and managing his affairs, and how much you can realistically handle emotionally and physically. I would consult an elder care attorney to get some basic advice. The consultation fee is worth it. Dealing with a cruel narcissist is draining. I have said before that if I had known, I would have let a state guardian take over the role. Good luck with this very challenging situation.
If he isn't doing anything except talking to the scammers, let him talk.
If he is giving out the home address, install some security cameras. This is fairly inexpensive to do nowadays, like 8 cameras that record and have audio for less then 500.
If all of you stopped jumping when he barked, you would all be able to deal better.
He gets his needs met and he can stuff his wants. If he complains, ignore him or tell him to stop.
It is a real advantage that he is immobile, what's he going to do if you walk away? Yell? So what, let him yell. Call the police? So what, call the police, maybe that would pull the trigger on placement.
He is a complete jerk, doesn't matter why, NPD or dementia. Knowing doesn't make the behavior easier to deal with, I know.
My husband told me to treat everything with my dad as his dementia. It didn't really help me, he was still a jerk to deal with.
Help her learn to say no. Help her to not jump because he hollers. Help her to learn that she isn't his personal doormat and it is okay to stand up. Help her to understand that her dad is a horses backside and he will never appreciate her, even if she sets herself on fire to keep him warm, he will be a jerk. She or none of you can change him but, you can change how you respond to him. Cover each others back, create a united front and just start providing his needs and then disconnect physically and emotionally. Don't tell him what's up, if he says anything, ignore it, don't respond no matter how nasty he gets. It may actually get his attention, if not, you guys aren't being abused by him.
You know that he thinks he doesn't need any of you and he is the one doing a favor. So give him what he thinks the reality is.
Whether it's dementia or narcissm is really not a big change in how he'll be treated. Mom makes outrageous statements and truly is not living in the now. She can be handled and as long as you don't try to clean for her, she's fairly pleasant. She also won't part with a dime to buy into a scam, and gives only small amounts to charities and that's always in $5 bills, so we don't worry. She does carry a lot of cash all the time, but she never goes anywhere, so we've chosen our troubles.
Really, even with dad's medical records, there isn't much you can do, except be aware that a certain amount of his behavior is just what it is, and you can't change that. Stay on top of what's going on, but sounds like you really just want a diagnosis so you know what you're dealing with.
He also sounds really good at getting others to do for him--so he's a little sneaky, but you cannot change that.
You CAN change where you choose to live. I can barely handle a 30 minute visit with mom every other week. Living with this personality disorder is beyond what I could handle. Good Luck, going forward.
If you choose to stay and do what you can then really that is your choice. I doubt there will be any thanks or any reward for it, nothing but fighting and losses for both you and for him. Leave him to his own devices and wish him love and goodspeed.
But the reality is deeper than that. As others here have said, adult children should never be caregivers for someone who abused them in childhood (or adulthood). Boiling it down he had way too many years to get in their heads and create a sense that they owe him care and both my DH and his sister have a deeply ingrained need to please their dad that is very difficult to break through. We are working on it and the longer this goes on the easier it is to convince DH that he and I have no debt here whatsoever.
But your question of why is an excellent one and I ask myself that every time I get involved. I tell myself I'm helping but I wonder. I have distanced myself considerably outside of research and being a shoulder to cry on. I've stepped out of most of the active involvement. I don't engage. Frankly I avoid him if at all possible.
And you are absolutely correct. I stay involved by my own choice. If I had any power in the situation -he would have been moved out of the house and into a skilled nursing facility 3 years ago when his care became too much for 4 people to manage together. The level of care he needs physically is too much. The mental stress is ridiculous. And DH and I can avoid it whenever we want because we don't live there. I think that's why I haven't cut it off entirely. I don't want to see my SIL just fall apart entirely. I know if she did and they left the answer would be simple. He would be left to his own devices and APS would be called because we would not be stepping in to facilitate/prop him up - or he would be moving to a SNF. But it's the interim of what happens to my friend and sister that worries me the most. I'm not overly worried about what happens to him sadly - he will survive it just fine and come out smelling like a rose - but she is the one that will end up paying for it one way or the other and that's the sad part. They moved in temporarily in a bad situation and I think they went from the frying pan to the fire.
I merely advocate for people to get an actual medical diagnosis done by a qualified psychiatrist.
A general practioner is about the last person qualified to make that diagnosis, but I suppose it's a place to start if necessary. Have you shared your concerns directly with the doctor? Have you asked his doctor privately to do a cognitive assessment? Have you documented his behavior with videos you can share with him?
When my mother was alive, I would send an email to the doctor with a list of things we were concerned about, so she was prepared when the appointment came. I'd do it a few days in advance to ensure she received the information in time. HIIPA laws prevent the doctor from discussing his medical business with you, but it doesn't prevent you from bringing up concerns with him.
I don't think my mother would agree to see a psychiatrist and it's probably too late now anyway; dementia is now more of a problem for her than the narcissism.
What we ought to be focusing on, surely, is why so many (usually but not always) women of that generation are suffering from this disorder and what can be done to help them and prevent it from affecting others.