I think we are possibly facing a crossroads at this juncture in sorting out the best way to support my wife. There is little doubt that her presentation is changing. Her energy levels seem to be diminishing with tiredness a constant factor of her life. In addition, her world is shrinking and she lacks any real interest in anything apart from her immediate surroundings. When visitors call she puts on a ‘hostess mode’ and shows a polite interest in their presence. Clearly her emotional memory is intact and when pressed she shows an interest in other members of her family: particularly when they are around. However, when they are gone it is really a question of: out of site out of mind.
I accept that the above paragraph is conjecture. It is purely based on my interpretation of her behaviour and actions. Perhaps, she has just forgotten how to keep in touch with family members or it has become too difficult following stroke. Consider this: she decides to phone one of her sons; she has never remembered phone numbers; she can’t remember where her glasses are; she can’t find our phone book: she doesn’t remember how to use the phone; she doesn’t like phone calls. None of this bodes well for keeping in touch and she is reluctant to receive incoming calls.
So you might ask why don’t you help her to make or take calls? The simple answer is that I do and often witness her coming off the phone tired and distressed. There is a simple reason for her not enjoying phone calls: they remind her she has dementia. Her memory is so poor that she is unable to answer questions that are a part of any phone conversation. On many occasions I have listened in on her calls as I going about my daily tasks. I have heard her telling all sorts of tales that are complete fabrications (confabulations) of what she has been doing. The person at the other line is spun a host of activities that have never taken place. Now where am I taking all of this I’ll explain……………..
There is a danger of my wife’s current patterns of behaviour being seen as low mood; even depression. On occasions she gets very anxious about things and her agitation is apparent. Dementia is hosted in Mental Health where locally the Medical Model is popular: psychiatric rather than psychological approaches are predominant . Early on her journey the Memory Service suggested they could help her if she had ‘low mood’: in fact they grilled her on that subject. A few days ago someone asked her ‘if she was happy’ and she is suspicions about their enquiries.
My wife is in denial about the consequences of stroke. Her recovery has been incredible but the damage to her eye sight and short term memory will remain as a legacy to the events on the last day of February in 2014. We both feel that there are dangers ahead with this focus, yet again, on mood. There is one simple question I would ask: with all that has happened to her in the last eighteen months would we be expecting her to be feeling over the moon?
I have already alluded to the shortcoming of antidepressants and the questionable theory of chemical imbalance. Even greater dangers are present with using such medication where the individual has dementia as Irving Kirsch has outlined in this short article. The other problem is that my wife is hypersensitive to various types of medication and introducing any further tablets is risky. I am therefore hoping that when the Home Treatment Team visit on Friday their suggestions for support will come from a Psycho Social Model: It’s Good to Talk!