Not Quite There….

By Robert F. Bornstein, PhD and Mary A. Languirand, PhD

Alison was beside herself-she'd just been diagnosed with cancer. Her friends were supportive and her treatment team encouraging, but she'd never had a serious illness in her life, and she was shaken, to say the least. Although concerned about the impact of the news on her elderly mother, Alison decided it was best to let her know about the diagnosis, and planned treatment. Her mother listened quietly, murmured some sympathetic platitudes, and-to Alison's surprise-proceeded to have a meltdown about her coffee, which wasn't hot enough. In subsequent contacts, whenever Alison brought up anything about her illness the same pattern emerged; Mom listened politely, then quickly changed the subject to something "important", like her cleaning lady's clumsiness, or problems with the cable TV signal.

Nancy loved her beachfront condo, and had put much time, effort and cash into making it the home of her dreams. Hurricane Sandy loomed, and she was forced to evacuate. She relocated to a hotel, and in the midst of chaos, drove out to visit her father and reassure him that she was OK. Although every television in the nursing facility was blaring storm warnings, he just couldn't see what all the fuss was about. A day later the storm hit, and Nancy's home was destroyed. Once again, she went to see Dad, who advised her that he'd had water in his basement during a bad storm back in the 70's, and back then it was "no big deal".

Defense mechanisms allow us to manage anxiety and upset in the face of threat, and they serve some truly useful purposes, including staving off difficult realities for a while as we figure out what to do. Woody Allen once said that rationalization was more important than sex-he couldn't get through a single day without at least one good rationalization-and in a way he was right. In most adults the active stage of a defense mechanism is temporary-a means of buying time while we work through pain and anger, fear and confusion. However, some people just cling to denial (or rationalization) long after it has served its purpose, holding reality at bay indefinitely.

The way we use defenses is part of our personalities, and as we age, it tends to become more entrenched-more rigid, and more resistant to change. What happens when age adds some mild dementia to this mix? Mingle brain-based forgetfulness with motivated denial, and you can wind up interacting with somebody who simply "can't hear" bad news. Wait a little while, however, and a congruent emotional response will emerge-often in reaction to something completely different. This mechanism is called "displacement", and it too is a fine defense; it gives you someone or something safe (like an aide, for example, or member of the cleaning staff) to be mad at. Ask anyone who works at a nursing home-complaints to all departments go up after holidays, as missing socks and lumpy oatmeal become stand-ins for pain and disappointment at families who don't come around much anymore.

Not too surprisingly, a lot of people cope with this double whammy by shielding their elderly loved ones from bad news-in part because it's easier than dealing with the blowback they receive when they do share. Others repeat their tales of woe over and over, hoping that something they say will "stick" and jolt their loved one to appropriate response.

How can you cope with a loved one who can no longer process bad news? A few options:

  • Pick your battles

    You may not want to share every little woe, but big things (like a life-threatening illness or damage to your home) that are likely to disrupt your routines significantly probably do need to be communicated, so your loved one doesn't imagine far worse reasons for your absence or atypical behavior.
  • Take what you can get

    If your loved one can distract you with happy tales of their day, or memories of better times, you may find that these brief respites from unpleasant realities actually help you. Dad might not be able to offer practical help or solutions, but he can provide a little interlude of peace in a whole lot of chaos.
  • Try to maintain a sense of humor

    You're dealing with three feet of water in the basement and Mom is sputtering mad about a stain on her favorite sweater? You gotta laugh. (After all, the alternative sucks….)

Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press. The second edition, revised and updated, was recently released. Here's the link: