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Post-visit venting: My brother's in a geriatric psych hospital being assessed for rapidly spiraling dementia. He's terrified; I hear our mother's voice saying "Take care of your little brother." I know, I know. He's not little, and I'm old, and this dragon can't be slayed.


When I walked in his very first words were a snarled accusation---that I had given "them" the keys they used to enter his home and kidnap him. My shocked response was unhelpful---that this was a hospital and he had come here from a rehab facility. I tried again: "I know this is confusing and scary, but you're safe here." More snarling. I should've followed AlvaDeer's advice to be a gray rock. He settled down only after I agreed to "hire an attorney to sue this place."


I was so glad to see him, but now feel my visit didn't help either one of us. An ancient Joni Mitchell line: "Came in as bright as a neon light but burned out right before your eyes." That's me. Will try again in a couple of days.

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My father suffered from paranoid personality disorder all his life, but managed to cope fairly well. When vascular dementia was added to the mix, things really went off the rail. I gained guardianship and placed Dad in MC. Eventually I realized some visits didn't help either of us. Dad had a weak spot for sweets, so I always took something he liked with me, an ice cream sunday, a milkshake or smoothie, box of chocolates, etc. That usually gave me a few minutes while he ate his treat. When he would start ramping up in one of his rants, I would say "I love you but it's not good for you to get so upset so I'm leaving now but I'll be back to see you next week" and walk out the door. The MC had cameras so I could check on him without him being aware I was there and I used them. Dad died while in the hospital for treatment of his CHF; a sudden heart attack during a rant at a nurse who won't bring him a salt shaker. I'm so glad I wasn't there to witness it.

You cannot reason with a dementia brain, even to calm a paranoid rant. Some times even if you agree, the rant continues to escalate. I think our tone of voice and body language has more effect on the rant than our actual words. Reassuring your brother he was safe were the right words, but it's very difficult to remain calm yourself and keep you tone even while being on the receiving end of a paranoid's raging. When I could remain calm _sometimes_ Dad would calm down too. When I couldn't remain calm, I walked out. It's so sad, but it was the best we could manage.
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thepianist Dec 9, 2019
One of the areas I think need much more attention is the interplay between life-long mental illness and how it impacts and is impacted by dementia. In my family we are constantly wondering which is at work, the mental illness or the dementia. Dementia might need a response that is veyr different from how we need to treat/respond to a mental illness such as extreme narcissism.
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"...subterfuge and imagination..." I like your words Sheeza1! Too many people take offense when we suggest fibs or little white lies... They maintain we should tell them the truth. This is really pointless as they don't really understand AND forget it, sometimes as soon as you have said it or don't accept it! What is the point of telling them over and over - it doesn't help them and gets under your own skin!

I try to remind them that true lies are told to protect oneself and/or hurt others. Fibs and little white lies used for those with dementia are to protect them and sometimes yourself. In OP's case, telling her brother she would hire a lawyer and sue was the fib needed to assuage him. They don't always work, but it is at least worth trying - if it calms them down and satisfies, no harm no foul!
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I so agree with TNtechie: you can't reason with a disordered or demented mind. Try not to react. It will do not good. I am so sorry.
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thepianist Dec 9, 2019
You are so right and I know this but with my family member still find it hard to follow this rule.
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I worked with an ambulance service for 26 years. I probably saw every kind of dementia/mental illness combo out there. The gray rock theory is the best, didn’t always work though. And we would agree with anything they said, and promise them just about anything - if they would just, pretty please, get on the cot so we could go get them taken care of. No matter whether it was male or female, they always responded better to a female. Of course, we were strangers, agreeing to everything they said, so ....
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NeedHelpWithMom Dec 9, 2019
I get that. It’s sort of like people trying to reason with a drunk. Why? Just why? Not going to happen! Can’t reason with everyone in a practical sense.
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Sister, While explanation, for healthy minded people helps, it doesn't in this case. They are stuck in their narrative. We need to make ourselves numb. We all lose it sometimes. We're only human.

That's good you told him you'll take care of it. That's what he wants to hear. Then you can redirect. It takes creativity to come up with something on the spot. Like showing him something in the mail for instance.
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Bless you. This is an almost impossible skill to learn, I’m bunking it up repeatedly. We just keep at it!
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Logic is useless with dementia patients, but a bit of subterfuge and imagination can go a long way. You discovered this when you agreed to 'hire an attorney to sue this place'. Teepa Snow suggests we take responsibility for whatever it is that is stressing a dementia patient. My example: my mother's constant is that she is locked in the building, they have no food, no water, the place is in lockdown, something awful is happening and no one will tell us. She wants somebody to do something, they need to call the police. The first time this happened (within a few days of her being placed into care) my mother still had access to a telephone and rang me - about 2am mind you - and insisted something be done. She sounded so worried and plausible that I was genuinely concerned. Until then the realities of dementia were unknown to us. All I could think was to get her off the phone so I could phone the staff back. Not only was nothing wrong, she had gone back to bed and fallen asleep even before I had reached the duty nurse. (As an aside, my sister is a civilian in a police station. They receive many calls like this every day from dementia sufferers with access to telephones. The obvious question is: if my mother was so worried and had access to a telephone, why didn't she call the police herself? I have no idea).
Going with the flow is working for us with our mother. We agree to the most outrageous demands or concerns, then forget about them. Mother certainly does.
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Sometimes all you can do is back out and let the pros handle it, but you may find this Teepa Snow video helpful

https://www.youtube.com/watch?v=xNznZ2MnV3I
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thepianist Dec 9, 2019
Teepa is THE BEST!!! She has many imitators at this point but no one holds a candle to her.
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This is so typical and yes I’ve said the same words about a visit helping neither of us. But you were right that for a moment to enter his reality and agree to sue them. You saw how easily that worked. Reasoning and being rational just doesn’t work sadly. Go with the expectation that you will need to do therapeutic fibs.
PS..love the Joni Mitchell reference. Brilliant songwriter! Love her music
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Realanswers Dec 16, 2019
Yes, Joni Mitchell is brilliant! And agreed no point arguing..I have to find some humor in it and kinda
Just listen and go with the flow.
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Sister, maybe give it a week or so to get meds sorted out.

Great big warm hug!
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