Behavior
Emotional Reciprocity or Fairy Tales Do Come True
We don’t see things as they are, we see them as we are. – The Talmud
​
My mother’s complaints and issues (“They won’t shave him!” “This one won’t iron!” “Will they ever send someone that gets here on time?”) while transitioning to a new caregiver service were driving me past the point of patience. What seemed to me to be nit-picking comments were actually indicating the underlying issue—she was not in control. She had to relinquish every detail about who was coming, and the only issues she could arrange were the times for the caregiver shifts. She had to train them, tell them exactly how she wanted things done, show them where everything was, make sure they did the tasks in a particular order, etc.) It was exhausting.
But it was also indicative of the underlying fear she had about not being in charge or able to oversee everything. If we are not in charge, we tend to feel out of control ourselves. Not only had her relationship with my father reversed—she was now providing for him and not vice versa—she had to now find a way to care for him through someone else she did not know. Or trust. Or have confidence in. This, of course, brewed an increase in anxiety. She needed to know who was coming for the next shift. And would they be able to do what she asked? And if they could do it, would it be to her satisfaction? Her patience was running low.
Anxiety is very much present in the dementia dyad. The dementia client feels anxious and out of synch. Concentration is difficult, and tolerance of changes in routine and caretakers is low if not inexistent. Heaven forbid there should be additional noise and conversation while the new ‘intruder’ is shown what to do. And how frustrating, as a grown man, it was to have someone assist you to dress, undress, shower, help you to the toilet, prompt you to drink, and do all the personal care activities that daily living requires. Plus, the new caretaker is understandably a bit nervous (anxious?) about doing a good job and remembering the nuances each client has for care. Anxiety begets anxiety.
Hence the concept of emotional reciprocity. Whatever emotion presented in the body language or tone of voice of the caregiver is conveyed to the individual with dementia. It does not matter if we try to cover or disguise these feelings with a smile that is not genuine. The underlying emotion is transferred regardless. A simplistic way to explain this concept would be one of my mantras: Mirror, mirror on the wall. I get what I dish out after all. Sounds silly, but it’s true.
If the individual caring for the dementia client is angry, the dementia client picks up those emotional cues and underlying messages though tone of voice, body language, volume of speaking, length of messages used to communicate, etc. (Think of the last time you were angry. You probably made a short statement about your anger such as “I’m pissed”, or “I’m mad”, a noticeably short communication that conveyed your emotional state at that moment.) The one with dementia will mirror that emotion. If the caregiver is anxious, the dementia client will be anxious, too. The currently demonstrated emotional state in the caregiver will be conveyed to the dementia client. This in turn causes the conflict cycle to begin. Let us go over an example.
John will not take his pills and his wife is frustrated. She huffs and raises her voice to tell him he MUST take his pills and is obviously agitated. John digs in his heels. He is frustrated by this tone of voice. He might not be exactly sure about what his wife is upset about, but he knows this is not a good situation. He continues to resist taking the pills. John’s wife gets more irritated, goes into the kitchen and makes noise with the pots and pans. Both are upset. And the pills still have not been taken. John and his wife are involved in the conflict cycle. The tug of war over the pills continues. For John, he remains in control and has gotten some attention out of the interaction, even if it is negative. His wife has only gotten angry. Mission unaccomplished.
The explanation for why this occurs is quite simple. Our emotional brains remain intact for the most part throughout the course of dementia. Our ability to read social cues is fundamental to our survival. John’s wife needs to see her role in the problem in order to address it. It is the same concept in Alcoholics Anonymous. How are we contributing to the behavior?