Constructed Guilt

An Alzheimer's diagnosis can elicit a mess of grief-fueled attempts to shift responsibility to others, and a particularly sad aspect of the disease happens when the patient blames his or her primary caregiver for...everything. This can happen even to good and Godly patients, but it is perhaps more likely if the individual has experienced discord with a spouse or other loved one over years of time. Here is a word of warning for all of us who suspect the future could hold a diagnosis of dementia; work hard to forgive. People who go into Alzheimer's disease with unforgiveness or unresolved anger intact can become a menace to those they love. 

Dementia patients lose the ability to draw accurate conclusions from environmental cues, and when a  patient's perceptions are also canted by an assumption that the caregiver is guilty of wrongdoing, disease-riddled logic may conclude that sarcastic and vindictive responses are justified. Patients who hold bitter resentment toward their caregivers can cause emotional damage.

Sometimes caregivers assume blame where none exists in order to excuse a dementia patient's hurtful words and attitudes. There is probably a more correct psychological term, but I call this "constructed guilt." It happens when our loved ones' bitter anger toward us as caregivers is so painful that we construct guilt for ourselves to explain their attitudes. We do this because it is easier emotionally to believe that we brought some of the harsh treatment upon ourselves than to feel we are hated without reason. In Alzheimer's, grudges from the past become mangled and garbled. Patients are no longer certain why they are angry or with whom, and it is the primary caregiver who is likely to receive the cumulative detritus of resentment, anger, and blame.

Releasing guilt can leave a caregiver feeling more vulnerable; it seems safer to say "I don't handle caregiving situations very well and that's why my loved one is having a bad day," than, "My loved one feels hateful toward me just because I'm me!"  But it is better to give and receive forgiveness on a daily basis and then deal with the suffering caused by being the recipient of anger as the Bible directs: "Therefore let those who suffer according to God's will entrust their souls to a faithful Creator while doing good" (1 Peter 4:19 ESV). 

Here are some ideas that may help when dealing with an angry dementia patient:  

--Keep yourself clean of resentment, bitterness, and anger. Bring your sorrows to the Lord on a daily basis. Ask forgiveness and forgive.

--Don't stop praying for your patient.

--It can be nearly impossible to redirect a dementia patient who is angry, but it's worth a try--a tasty snack, an entertaining movie, or physical comforts such as a warmed blanket or sweater may distract. The primary caregiver is often the target of the patient's irrational anger, and so calling a friend or co-caregiver to take over for awhile can help defuse out-of-control emotions. Gauge the level of anger and use your knowledge of your patient to help you decide what course of action to take--and pray.

--Understand that even if venomous words and actions are truly directed at you (as opposed to being misdirected due to confusion about your identity, or simply a symptom of the disease) it doesn't have to devastate you.  If your patient is a loved one, this takes time and effort.  Practice not being devastated, and remember that the Lord's love for you will not waver.

--If don a mantle of excessive care and kindness, you will risk being mocked; if you engage in a shouting match you will affirm your patient's suspicion that he/she is the wronged party. A relatively neutral and matter-of-fact demeanor is best.  Don't allow the patient to elicit strong negative emotion from you.

--Watch your body language. Do not communicate anger. School yourself to keep your caregiving interactions gentle and friendly, even if you are being berated as you comb hair, help the patient into a sweater, etc.

--If the patient is safe, don't hesitate to leave the environment until you feel calmer. Call a friend or co-caregiver to take over for awhile when you need time to recuperate. 

 Of course there are no perfect caregivers, and in any human interaction there is most often wrong on both sides. That is why we must seek the Lord daily and pray "...forgive us our trespasses, as we forgive those who trespass against us."