One Clinician's Search for the Person Behind the 'Dementia'

Article excerpt

It was a sunny Saturday in San Francisco when I arrived for my first day on the job. I had no idea how my personal and professional life was about to change. A clinical psychologist, I was just starting my rounds at Hayes Valley Care, an innovative assisted living facility founded by Nader R. Shabahangi. The facility is one of the AgeSong Senior Communities that won the American Society on Aging 2006 Business and Aging Award for small businesses.

Within minutes, I met James Eddy, one of the older residents. An 89-year-old African American, Mr. Eddy walked with a cane, which he used to threaten anyone who tried to stop him from leaving the facility. One day, for example, he hit Pablo, a tall staff caregiver who tried to make him understand that he couldn't leave.

NEW TO DEMENTIA

Mr. Eddy seemed disoriented at times, looking left and right, seeming to look for familiar cues and asking, "Where am I?" Although I'd been a therapist for 25 years, I had little experience with agerelated dementia. Moreover, being a foreigner, I was a stranger to American culture, to this facility and, most important, to Mr. Eddy's world.

In his thick Texas accent, Mr. Eddy kept repeating how hard he worked. I thought about why this particular memory remained after the other memories of Mr. Eddy's life seemed to elude him. When I got old, would I-as a workaholic-remember only my working hard? What a scary thought.

"Aren't you retired, Mr. Eddy?"

"Yes, but I still work pretty hard," he replied. "Don't you see how hard it is?"

Over time, I listened to Mr. Eddy rant and rave about what a hard worker he was, and I wondered about his condition. I did not get it.

Between Mr. Eddy's heavy Texas accent and my Mediterranean one, complicated by his repetitious statements and hearing loss, communication was a struggle for us. Rarely in my professional life have I felt so inadequate.

I had many questions and few answers: How could I help Mr. Eddy put his work life behind him? How could I help him relax-and at the same time assist him in seeing reality more clearly? How could I do my job, the job I'd been doing for the past quarter-century?

FEELING INSECURE

As a clinician in the humanistic tradition, I wanted to try meeting Mr. Eddy where he was. But where was he? I located his chart and read it with interest. I understood the medical terminology, the diagnosis: Mr. Eddy was afflicted with a 290.43-the clinical code for vascular dementia. He had had several strokes, and suffered from severe hearing loss.

Although I was well versed in many types of mental illness, I felt insecure about my ability to treat dementia. I decided to do some research: I read books in an attempt to demystify the subject. More important, I knew, was to try to establish a therapeutic relationship with Mr. Eddy. I wanted to help him understand and cope with his reality, to comfort and help him find meaning in this phase of his life.

While doing my research, I was struck by how little science knows about dementia. I found plenty of descriptions of the physical symptoms at different stages. But mostly I gleaned a sense of how impotent the medical profession feels in the face of this rapidly spreading phenomenon.

According to the American Medical Association, dementia is associated with memory and thinking impairmentproblems with vocabulary, abstract thinking, judgment and physical coordination-that lead to a decline in social skills and an increase in confusion, all suggestive of brain disorder. Those afflicted with dementia may also suffer from apathy and depression, delusions and hallucinations. In general, this condition, which can strike at any age, progressively gets worse and is irreversible. Some dementia disorders respond to treatment, but many do not.

I felt burdened rather than enlightened by all this information. None of what I read accounted for Mr. Eddy's intense look, his formidable presence. …