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Since my dad's stroke he's become more and more angry and verbally abusive with me and my mom. Especially my mom. We just got back from an overnight at the hospital where he was sweet as pie to all the staff, but as soon as they left, the verbal onslaught continued toward me and my mom. After asking him why, he said if I'm not nice to them they won't bring me Tylenol. So can he literally switch it on and off? He's really being abusive, or just can't help it?

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Has he been evaluated by a geriatric psychiatrist or neurologist for Vascular Dementia after the stroke?
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From flintrehab website;
Anger Due to Grief;
When stroke survivors must cope with their losses, they will often go through the 5 stages of grief. These stages include denial, anger, bargaining, depression, and acceptance. Sometimes the anger phase will last for a few days; other times it can last for years.

How to cope with it:
Since anger is a stage of grief, the only way out of it is through it. The stages of grief don’t usually occur in order, so it’s possible to go from anger to acceptance with the right mindset.

Anger Due to Post-Stroke Depression;
Sometimes anger is a symptom of post-stroke depression, which affects more than one third of all stroke survivors. Some of the symptoms of post-stroke depression are anxiety, hopelessness, pessimism, lack of interest, insomnia, irritability, and anger.

How to cope with it:
When anger is a symptom of post-stroke depression, the best way to cope with it is to first address the issue of post-stroke depression.

Anger Due to Brain Damage;
Lastly, anger after stroke could be the result of brain damage if the part of the brain responsible for behavior was damaged by the stroke. In this case, biological impairments in the brain could be the cause of angry outbursts or other intense emotions.

How to cope with it:
When anger is out of your control, it’s a good idea to explain to family and friends that your behavior is due to brain damage caused by your stroke. Loved ones will be extremely forgiving of any emotional outbursts if they know that you don’t mean it.
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I hope this helps.
I've had stroke patients who could not express themselves except to use swear words.
Please read up on the symptoms of post stroke. The more you know what to expect, the better you'll understand your dads behavior.
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Er. Withholding pain relief would be abuse of a pretty serious kind. I do not think your father was in earnest with his explanation of how he managed to be pleasant towards the nursing staff. Or I certainly hope he wasn't.

Your father's anger and abusive language may be expressions of depression, or pain, or other after-effects of the stroke. Report them to his doctor.

As for your suspicions that he can be nice when he tries - 🙂 - well, maybe he can; but what about the effort it costs him to manage it? What needs focusing on far more is his general mood, and the possibility of lifting whatever is causing him to be unpleasant most of the time.

I'm not at all saying that you and your mother just have to put up with being offended or insulted, but I'd do a bit more digging to find out the reasons behind his behaviour.

I'm assuming he wasn't always like this?
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Sounds like he can help it, to be able to articulate that if I'm not nice they won't give me what I want. I would use this to get his attention and say if you're not nice to mom she won't...if you're not nice to me, I won't...there is NEVER an acceptable excuse to be abusive to people, we all have our days but, come on dad enough is enough. Hold the hard line on this, he obviously feels entitled to be ugly with you and mom, time for him to learn that abusive behavior doesn't get you anything but a view of your backside leaving until he can be civil. I'm sure this is a hard trial for him, as it is for you and your mom but, he only makes it harder on the two of you.  I would tell him if he can only be nice in a facility then that's where he will go if he doesn't stop being abusive. I have complete empathy for hard trials but zero tolerance for abuse that obviously can be controlled.  Does he have a clergyman you can call in? 
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