Therapeutic Lying
Dementia Is A Surreal Experience
Being the Mayor of Crazytown has taken me to places far and near. Just recently, I was living in the 1800’s, in a growing Western town where the train tracks were just being laid, and incidents with local Indians were to be feared. I’m not sure if we owned a ranch, or I was a local bar hag, but I know I lived there. You see, a nice black and white Western movie was on our beloved TCM (no commercials—you are a God in my book), and watching the different scenes sent Mom into the world of hallucinations and fantasies, where John Wayne was alive and in his glory days—which is when Mom loved him the most.
So, what do I say when these fantasies take over Mom’s brain? What do I answer when she asks a million questions about things—and people—who no longer exist.
Enter therapeutic lying.
What is “Therapeutic Lying”?
I admit a little excitement with this topic, because it’s the first thing I think I’ve discussed that is hotly contested among medical and psychological professionals. Pretty much my entire blog is designed to give caregivers as much information—with just a pinch of laughter thrown in—to support your journey through Crazytown. There isn’t really much controversy with seeking medical treatments and prescriptions, or when to buy a walker or use a wheelchair.
This topic, though…
Controversy!
Explanation
Dementia has robbed Mom of reality more and more as she moved into severe dementia. Literally, every visit, I have no idea who I am going to find on the other side of the door. At this point, I’m not even sure they will be dressed when I enter. Therapeutic lying (or therapeutic fibbing is considered more “politically correct”) is simply the art of stepping into their world, instead of trying to drag them back to ours. It is recognizing their version of reality as having merit and substance, so that you can conduct a visit in a calm and enjoyable way for the patient.
Effective Uses
Forcing a dementia patient, or anyone with cognitive decline, to exist in our reality can be quite difficult and painful for them. Our reality can cause them to become very confused, upset, even angry or resentful. Moving into their reality allows them to exist in a calm and relaxed state, where they feel some sense of control over their circumstances. My mother-in-law, for example, had the terrifying feeling of standing on the precipice of a cliff. She could not be “reasoned with”, so the best option for Sweet Husband was to enter that world—and that fear—with her. In this way, he could more easily work with her to avoid the “danger” that she saw so clearly in her brain.
Arguments Against
Some medical and psychological professionals have some ethical and moral problems with therapeutic lying. I get it, I really do. I’m not at all a fan of lying or liars, and would never consider it in my “real life”—personal or professional. Lying, omitting the truth, softening the blow, exaggerating, whatever you want to call it is not a smart or efficient way to conduct your life, and I fully support that.
I Don’t Think I Can Convince You
If you think there is NOT a place for therapeutic lying in dementia care, this is not the blog for you. I wholeheartedly believe in this idea, and use it on a daily basis to make sure Mom’s world is calm, relaxing and as rosy as humanly possible.
And I’ll do anything to keep it that way.
So…I lie. With a happy smile.
Do I have to be honest?
I’m honest to a fault in my real life. I am proud of my personal and professional relationships, and feel that all of these communities are built on truth, respect and dignity.
This isn’t about adult Patti.
This is about Patti the Daughter. Patti the Mayor; Patti the Keeper of the Past; Patti the scared and sad kid whose mother is declining.
Reading over all of my blogs, you know that my primary function as The Mayor is to manage the transitions for my parents through their dying days. It isn’t to burden them with my problems or struggles—those years are far behind us.
While Mom is “there for me” every day when I visit—to hug, to talk, to reminisce and share snacks—Mom the legendary advice person, the ultimate mother, the keeper of all things true and holy has left the building.
Let’s be honest here—she is a beautiful shell of Mom.
A shell I am sworn to protect at all costs.
So….I lie. With a happy smile.
Therapeutic Lying Is A Shapeshifter
The great and powerful Nanny said something that I’ve never forgotten: “A liar is gonna lie and a cheater is gonna cheat. Anything else is forgivable”. She said it many times, and I’ve absolutely internalized the message. I have always known that lying is not good, and is usually not the right thing to do.
Then I had kids.
Whether they were lies of omission or lies of commission, I absolutely held things back from my kids when they were growing up. They were too young and immature to know about situations as they were happening in the adult world. Frankly, they had no right to some of the information about our family life, and I have no regrets about how I parented from that perspective.
Now they’re grown.
I won’t lie to them. I keep secrets, for sure, because my business is my own, and they have no need of every detail. But I don’t lie to them. I love and respect them enough to let them know where the boundaries are, and I keep those boundaries secure.
Now Mom is declining at a rapid rate.
So I’m back to keeping information away from her at an alarming rate. While it started with medical information, it gradually moved on to larger and more important things like finances and lawyers. While everything I’m doing is for the comfort and security of her way of life, she simply can’t participate in any of these discussions anymore. It would be absolutely cruel at this juncture to burden her with situations and things that are happening around her.
Just like my own kids, I love her too much to add to her burdens.
So I lie.. With a happy smile.
Yeah…but do you really have to LIE?
I don’t lie a lot. Actually, as we have sunk into severe dementia, the amount of actual lies has dropped to almost nothing.
What I engage in most is what is called “therapeutic distraction”. On the few occasions now that Mom asks questions I don’t want to answer, my first effort is to distract her to get her onto another topic. Distraction words fairly well with Mom, but it didn’t work at all with my mother in law, so your mileage may vary wildly on this. The hallucinations Eleanor had were so intense—and always terrifying—and you couldn’t distract or talk her out of what she was seeing. It was among the most sad things I’ve ever seen, and was incredibly difficult for Sweet Husband’s sisters to take as the months dragged on and they couldn’t find any way to help keep her calm.
Research supports their experience more than mine, since one of the worst symptoms of severe dementia is the hallucinations and terrifying visions that patients have. If that is your reality, distraction will probably work during the moderate stage of dementia, but once you have moved into severe dementia—like Eleanor—distraction won’t help you very much anymore.
My Dilemma
The funny thing is, I have more problems with “distraction” than I have about “lying”, because I feel like therapeutic distraction infantilizes Mom, causing me to treat her like a toddler who sees the cookie jar on the counter, so you offer a toy in the opposite direction. I know it sounds crazy, but, well, this is Crazytown.
Over this next week, refer to the resources at the end of this blog, and consider what your comfort level is or will be with therapeutic lying or distraction. Come back next week for my suggestions on using this method on different scenarios I have faced.
In the meantime, keep the happy smile.
THANK YOU FOR READING THIS FAR
Wow! You made it! Thank you for reading about therapeutic lying!
Hey, since you’re here! You may as well check out getting a second opinion, here, or if you’ve read that, check out more dementia problems, here! Or maybe you want to hear more about Pop, here. Or, check out our other topics here! Either way, I appreciate you!
Please leave a COMMENT about any tips you may have!! Or comment with YOUR story! Any dementia stories? Let me know!
Please, feel free to contact me or leave a COMMENT with anything you would like to hear more about! Or reach out with any unrelated questions, comments, concerns, or random outbursts of excitement by clicking here.
Oh! And don’t forget to check out my video series by CLICKING HERE!!!
Resources
https://www.caregiver.org/resource/ten-real-life-strategies-dementia-caregiving/
https://www.aplaceformom.com/caregiver-resources/articles/dementia-behaviors
https://www.pavilionhealthtoday.com/gm/is-there-a-place-for-therapeutic-lying-in-dementia-care/
https://www.alzheimers.org.uk/blog/lying-to-someone-with-dementia
2 thoughts on “Therapeutic Lying – What? Where? And When?”