Posts Tagged ‘Exploring Realities’

Alternative Realities II

Friday, February 4th, 2011

In December I wrote about alternative realities and how an experience that I had gave me a new perspective on how a dementia patient may feel.  I continue to ponder how to meaningfully connect with those who have Alzheimer’s, other dementias or simply altered realities for any number of reasons, be it mental or physical.   It is such a difficult issue.

My husband is basically healthy at the age of 67.  After we met, 16 years ago, it took me quite some time to realize that his hearing was impaired.  I often worked with hard of hearing clients but there were usually clues that prompted me to speak up.  Sometimes people would; speak loudly themselves, or lean forward to hear me, or watch my lips, or ask me to repeat myself.  My husband was soft-spoken and seldom indicated that he had not heard me but finally I realized he often had not understood what I said.  I made adjustments as to how I talked with him.  I spoke more loudly and avoided talking to him in the car or in noisy places to help our communication.  Several years ago I discovered that, not only was it difficult for him to hear conversations, but there were some things that he did not hear at all, (not just my nagging).  High pitched sounds like birds shrilly singing or the jingle of the cat’s collar were completely absent to him.  What a shock it was to realize that he couldn’t hear them at all!  That was his reality while mine was full of sweet songbirds and the jingling warning that the cat was underfoot.  They are very different realities.

The truth is that, even though we may have been in an identical situation to someone else, our realities may be very different.  We have all heard stories of police interviews with witnesses to the same crime who have very different descriptions of suspects and accounts of what actually occurred.  Are they all lying?  I don’t think so.  They are sharing their interpretation of the episode.  Each account is very real to each of them.  Comparing my husband’s experience to mine may have similar results.  His account may not include the cat entering the room, if he did not hear it, or the birds singing, while mine might.  Many things affect our experience or reality.  Stress, sensory deficits, hormones, pain, drugs, denial, prejudices, education, culture and many other things can shape our perceptions resulting in varied realities.  When I first entered the nursing profession many years ago, “reality orientation” was the therapy that we were taught to use with confused patients.  Well, if a healthy, normal adult is waking from anesthesia after surgery, it may be useful to use such techniques to remind the patient where they are and what is happening.  That technique is not likely to work, however, on a person with advanced Alzheimer’s, I discovered early in my career.   There is a much wider gap between realities and “reality orientation” is not the bridge that is likely to help span it.  Respect, laughter, music, love, and touch may be more effective in such cases.

Reality is an anchor that we hold tightly, whether we have dementia or not.  Reality’s truths keep us from drifting away.  They support our beliefs, values, religions, and political views.  What do we have left if we cannot trust our realities?  How can one function in life if they cannot trust what they remember, or what they see, or what they have been taught?  Without these realities, we have no solid ground to stand on but sand shifting below us.  When we insist to a family member with Alzheimer’s that their reality is not actually true, they may feel fear, anxiety, concern or anger.  It might be so threatening to them that their denial would kick in.  They may be incredulous, as we often are, that we do not see things the same way.  The Alzheimer’s patient’s reality may be quite different from ours and we, of course, know that theirs is wrong.  In truth, they are no more wrong than we are.  Their reality is very real to them, as my husband’s reality and mine are.  It must be even more difficult that they know and trust us.  How can they reconcile that, especially with dwindling cognitive and coping resources?   I don’t believe they can, but as caregivers and family, we must.   Every day, family and caregivers struggle to bridge these reality gaps.  The best we can do many days is simply to respect those different realities.  Ultimately, I think the goal is to share realities.  As family members know, it can be extremely powerful to experience those moments!  Sometimes we must wait for our realities to intersect.  It may only be for a moment so we must be prepared and vigilant in observing for them and then cherishing them when they happen.  It is even a sweet moment for me when my husband hears the cardinal singing outside our bay window!