Care and Feeding of a Delusion

Lots of people suffer from delusions. That guy in the jacked-up truck believes his morning rush is more pressing than yours, so he cuts you off without a signal. Charlie Sheen thought he was a warlock full of tiger blood, though he now seems less convinced. Dementia, however, produces powerful delusions that complicate caregiving in a million ways.

When considering the delusions that have troubled my mom, I’ve searched for patterns that could help me fight back. From what I can deduce, the recipe for a persistent delusion begins with a tiny shred of truth. She never has delusions about being rich or having a summer Christmas. Something unpleasant kicks it off. It could be as simple as a stranger speaking harshly or an appliance malfunction. Her disease embraces this bad moment. Instead of erasing the thought — as it has so many other memories — dementia embroiders a complex tapestry around it. Suddenly, instead of one unpleasant incident (which a healthy person might forget after dinner), the little scrap of unhappiness gets stitched into a vast pattern of disturbance that echoes without cease. After the mind has done so much work to grow a small fear into a giant, reality cannot win without a fight.

For a while my Mom believed that the occasional leak in our faucet meant that we were about to run out of water. She was afraid to use water, afraid we wouldn’t be able to take showers. Then she thought the toilet would overflow. Her fear of using the toilet pushed her to stop drinking water. The circle of magical thinking spiraled into a very dangerous practice of willful, self-dehydration. Fortunately this particular fear has now receded — but not without patient effort on my part.

Experts in the field warn that caregivers should not be confrontational when challenging a dementia patient’s way of seeing. The disease often limits their insight about their behavior. When you get pulled into an argument over the facts, you may end up expending your scarce energy without ever changing their actions. In the case of Mom’s water phobia, it took nearly a month of calm re-direction to defuse the power of her obsession. Whew!

Today I am thankful that her terrors have subsided. When she is calm and clear, she is a joy to be around. Her happiness is at least as infectious as her distress. I know we will face a slew of other strange suspicions in the future. I just hope Halloween won’t trigger any weird fears that can’t be erased by some candy.

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