Lying or confabulation? - AgingCare.com

Lying or confabulation?

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My 80-year-old MIL lives about five hours from us. She has some kind of dementia, although she's never been formally diagnosed, as she is "too busy" to see a doctor.
Basically, she has memory problems. For instance, she asked me in a recent phone conversation if I'd ever been to her house, even though I've been there many times. She also asks the same question over and over, seemingly having forgotten the answer.
MIL has never been a good listener, as she is a classic narcissist who only cares about herself. If the conversation isn't about her, she tunes out. She's always been that way, but she's gotten much worse in the last five years or so.
Lately, she's starting to accuse my husband and me of saying preposterous things to her. She interpreted my husband telling her that we want her to stay in her house as long as she's capable of caring for herself and the property (which is large, BTW, consisting of a three-story house, a rental cottage and a studio/garage with upstairs living quarters) to mean that he intended to send her to a nursing home ASAP. Her screams and ranting, complete with cursing and tugging at her hair would have done credit to a lunatic. No matter how my husband explained that he'd said nothing of the sort, she kept insisting that he apologize immediately. We got her diverted into talking about her favorite topic (herself, and how intelligent and beautiful she is -- she's a former college professor and she used to be very attractive, but now she looks like Gollum in a white wig. Her narcissism is indeed breath-taking.)
Next, she accused me during a telephone conversation of threatening to have her arrested because she hadn't filed her income taxes. All I'd said was that she was over a month late in filing, and if she didn't do it soon, she'd get another letter from the IRS like the one she got last year that sent her into a tailspin because she thought it meant she would lose her home. She has loads of money, but she's become fearful lately about her finances, Her way around that is just not to pay some of her bills.
What I wonder is, does she really believe we threatened to put her in a nursing home and have her arrested, or did she just dislike hearing about topics that troubled her, and she shut down and became paranoid?
Her hearing is fine. I'm disturbed that she gets so worked up, and seems convinced that we're out to get her. We've never done anything to make her think that way.
I'll add that there's quite a bit of mental illness in her family. Her mother was a paranoid schizophrenic, and my MIL definitely has delusions of grandeur. The reality in which she lives has never been reality as the rest of us know it. Could her lifelong "loopiness," as my husband generously calls it, be getting worse, or is she deliberately lying? She's always been a master triangulator, and she says odd things about other people, often of a sexual nature, that I find hard to believe. Could she just like slandering people and creating distrust among her extended family?
Does anyone else have an angry, narcissistic parent who makes incredible accusations? How do you handle it?

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Your mother sounds a lot like all 4 of my parents who are all narcissistic and all have some form of dementia. It is a lot to deal with, needless to say. The issues are complex. The memory problems are compounded by the fear and anxiety of loosing control and the shame of being discovered as incompetent or incapable. The best approach has been for me to be gentle but firm with them. Less reasoning and more validation of their unspoken frustrations and fears. Less confronting about the facts and more redirecting to interesting or fun topics of conversation. Get the ducks lined up; Medical assessments, Financial matters, will, POA, ideas about other living places. When the time is right ever so gently move in those directions. Read as much as you can about care taking people with dementia. It doesn't matter what her diagnosis is, she is suffering and needs support.
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Thanks, Billyboy. The thing is, she's always been a shameless liar. We've caught her in some whoppers over the years and God only knows how many lies she's told that we haven't found out about in her ongoing campaign to keep my husband and his two brothers suspicious of each other. It's like some over-the-top telenovela with MIL in the starring role as the scheming, wealthy matriarch who's committed to controlling her sons by sowing seeds of mistrust between them.
Her recent lies are clumsy, compared to her former convincing ones, so I'm guessing that dementia is taking the edge off her game.
As for getting her to a neurologist, she's very worried about her memory and that may be the key to getting her evaluated. She's a highly educated woman with a PhD in English literature, but she has virtually no knowledge of medicine or physiology. I don't think she knows that there's no cure for what she has. The idea of a nice doctor who may be able to restore her memory may be irresistible to her.
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She's not lying--the disease causes strange behavior. Jeannegibbs' comment was on target. Use any pretense to get her to a doctor and someone else to get the doctor's report. I have 40 years experience with a mentally-ill family member and a wife who has had Alzheimer's Disease for five years. There are 48 kinds of dementia so she needs to see a neurologist at some point.
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The section of the Baker Act that would allow her to be involuntarily committed for a psychiatric evaluation doesn't apply in the state where she lives. She's still cunning enough to hold it together in front of strangers, provided she isn't provoked. She might still be able to pass a competency hearing at this point, but six months to a year down the road, who knows? Our plan for now is to let her run around loose until something major goes haywire, as it's certain to do, eventually.
As for demons, there's no evidence that they exist, although it's certainly an exciting concept.
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Both are in place. My husband's a lawyer. Unfortunately, she refused to put her property where she lives and her other properties in trust for her children, and with the look back period, there's little chance she'll stay out of a nursing home for five years, even if we got her to sign today, which she won't because that would mean a loss of control. Control means a great deal to her. Fortunately, all her children are doing well financially. I just hate to see how her lack of cooperation will impact on her estate when she goes to her reward, which she says will be "just like a big barn."
Honestly, I keep my friends in stitches with quotes from my MIL. She's (fortunately) one of a kind.
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She's 80, she - she herself? - knows that she has some form of dementia, she was a bit wobbly to start with and now she's really frightened: the way she twists your words - from 'independent as long as possible' to 'imminent incarceration in a nursing home'; from 'need to file your tax returns' to 'call the IRS down on your head' actually reminds me of politicians' interpretations of their opponents' statements. A grotesque distortion of what was actually said or intended.

Well. Does it matter at this stage what is going on her head? There will be time to be specific about that later on, when her doctors are considering treatment. Meanwhile you need to get a handle on her affairs before they go completely belly-up. Start moving towards a declaration of mental incapacity. Find a good, specialist lawyer and take advice.
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On top of getting her to a doctor I suggest an Elder Law Attorney. She needs both a medical and financial POA, especially since she owns that much property.
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It sounds like classic narcissistic behavior and personality disorder that has been going on forever and only gets worse with age. It is extremely difficult to deal with this sort of behavior. My mother had similar issues and was delusional. She also made sexual comments and accusations about people that were outrageous. Before my mother lived in NH; I dealt with this sort of behavior on an on-going basis as did my poor father.

She most definitely needs psychiatric evaluation - which from how you have described her - she will defiantly resist. She says she is "too busy" to see a doctor. My MIL was like this and it took emergencies to get her to go. I truly empathize with you and dealing with this.

When my mother would get combative or make nasty accusations, etc. I would say it is time for me to leave if I was visiting. If on the phone, I would cut the conversation short. Anything to not enable the behavior. Or just constantly changing the subject in order to change the mood. Medication really helped my mother and she resisted taking it. When there is a mental disorder like this; it is necessary and life changing. Hope you can get her evaluated. Hugs and take care.
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If you had told this story and not mentioned her age or the question of dementia, I would say that her behavior very much follows the lines of schizophrenia. She is creating her own reality, common in this illness. It is very very hard to separate psychosis from dementia though. If she doesn't agree to go, you need to play hardball. Before she calls the police and accuses you or your husband of something very serious, and you are unable to convince her to willingly see a doctor, you really should have her forcibly evaluated (using the baker act). This will protect both you and her.

Angel
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Don't suggest "finding out if there's anything he can do to help improve your memory" Get her into a doctor's office on some other pretext -- need a health baseline, need a tetanus booster, need to check something that was done in the past ... use your imagination. Do alert the doctor ahead of time of your real concerns.
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