So, you're going to see your mother.
She has dementia -- maybe Alzheimer's, maybe something else -- but anyway even her doctor agrees it's dementia.
She lives with your sister -- about which you feel both guilty and relieved.
When you see her, things hardly ever go well.
"Hallo, Mom," you say, "How are you?" "Oh Vera!" she answers.
"I'm so glad to see you!" The enthusiasm is nice, but you aren't Vera.
Vera's dead.
She was Mom's older sister.
Been dead for nearly forty years now.
Already you don't know what to say.
Then she makes it worse.
"Vera, have you seen Sam? He must have gone duck-hunting.
" Sam is your Dad.
Was your Dad.
Okay, is your Dad but now he's dead, like Vera.
Been gone about five years now.
That's why Mom is living with your sister.
Now you're wondering what you should say and this is exactly what makes you not want to visit your mother.
Okay, so this where dementia etiquette comes in.
If you know the person you're visiting isn't always, or ever, sure who you are, begin by briefly and matter-of-factly introducing yourself.
This isn't weird, not when you're dealing with dementia.
It's sensible and you'll soon get used to it.
"Hi Mom, I'm your daughter Riva, how are you doing today?" would be a nice way to start.
Because, you see, your mother isn't forgetting you as a subtle way to tell you that she doesn't love you and that you've always been a very unsatisfactory daughter.
No, she has dementia.
That's commonly what people with dementia do.
They get lost in time and therefore lost in identification of others.
And it usually makes some kind of sense too.
We forget that people with dementia often live in other time zones.
Maybe for an hour, a day, forever.
It is effective memory that anchors us to day, date, time.
When that kind of memory fragments, then people with dementia may have no inner recall of what year this is, where they are and therefore who you are.
If you don't believe this, remember when you were on vacation for that two weeks in Hawaii? On any given day, you might have had trouble knowing exactly what the date was.
And you don't even have dementia.
The time zone thing is a really interesting part of old age reconciliation with personal life story.
Most elders spend a lot of time remembering and thinking about a much earlier time zone.
It is very typical for even the most present of elders.
They think about their early years, with family, in the family place, going over the things that happened.
Those times when you surprise your grandmother deep in thought, she is probably deeply considering that past.
You could always always ask.
This is not empty dwelling in the past.
This is the great journey of old age.
It is the journey of reconciliation, of finding peace and forgiveness before death.
There is nothing morbid or weird about it.
All of therapy is about that same journey, but without the awareness that death is after all guaranteed.
In that great life review, people can let go of what cannot be changed, they accept what happened and forgive themselves or others.
From their long experience of life, they finally understand.
Interestingly, those with dementia also do this.
Not as logically or as ordered, because they have dementia and fragmentation of memory function.
However, whatever the state of your memory, you are never NOT the person to whom your life happened.
An old woman who was abused as a child will often still have the startle response, the fear of the dark, the disturbing nightmares.
An un-nurtured child now grown old, will still be un-nurtured.
Life doesn't un-happen because memory fails.
We aren't just a head, we human beings.
We are all of our being.
So, when your Mom presents you with the past, how can you be comfortable there? Well, first, know that you can't fix Mom.
You can't hold back her illness or future decline.
That means you aren't obliged to drag her back into the present, this year of 2010.
And, by the way, you won't succeed in doing that anyway.
When you try to tell elders with dementia, living in the time zone of when they were sixteen, that this is 2010, they'll be convinced you're crazy.
They'll look at you as if you were both in that movie "Back to the Future".
So, since you can't put the time zone right for them, why not just join them there? Listen to their stories, ask questions, nod and smile politely -- oh, for goodness' sake, just enjoy yourself.
By the way, when they call you by the name of your long-dead aunt, they actually are saying, "I know you're family, I know we're close, we belong to each other.
" It is we caregivers who have to get over our ego demanding that we are always known, recognized, acknowledged, given the right name.
The interesting thing about the time zone shift is that often a person with dementia living in a different time zone gets everything right.
They know who was there.
They use the right names for them.
They know who wasn't there.
And any event belonging to the future is simply not known.
It was this observation that alerted me to the fact that there was actually something important and real going on.
If it was just the meaningless synapse blip of dysfunction, it would not be accurate or meaningful.
The memory work takes people to the place where reconciliation needs to happen.
Sometimes, thank goodness, it takes people to joy which they want to re-experience.
Most often, however, it takes them to trauma, loss and pain.
Typically, it's childhood and adolescence -- that same area you and your therapist talk about.
We go the zones that need our work.
That isn't an intellectual choice.
It's where the inward emotional pressure pushes us to.
Exactly the same for the person with dementia.
They return to the place where emotional work is needed to help them heal.
"How many times," asked one man at a workshop I was giving, "do we listen to my father telling us about his little brother drowning before his eyes when he was ten?" It wasn't really a mathematical question, of course.
It was about endurance and loss of patience, of feeling that this was time wasted bringing up something that no-one now could help.
But the whole of therapy is about the story being told, with a supporting witness.
In dementia, as in life, we sometimes do our very best work by just standing with someone as they recall a time when they suffered alone or in silence or unacknowledged or abused.
So, what people repeat in dementia often tells us what is still unappeased.
That means they have to tell that story until it no longer needs to be told.
This may happen within their lifetime, or they may be repeating it to the day of their death.
We can only listen and support.
"Gee, that must've been terrible, Dad.
I'm so sorry, " would be a good response.
As often as necessary.
Usually we caregivers only get irritated because we're already under lots of stress.
It's not usually really the behavior, it's us.
It's us not feeling good, not resting enough, being alone and frightened with the burden.
Sometimes, however, what people repeat may just be a little brain tag that represents something else.
"When is your father coming home?" "Did you got to work today?" "Has the cat been fed? Repeated over and over, these make family members crazy.
However, although the repetition is very annoying, maybe it can tell you something.
A woman who asks about her mother, is also saying she feels unmothered.
In the words of a spiritual, sometimes they do feel like motherless children.
Because people with dementia are needy and lost and lonely and, as old as they may be, they need what a mother ideally could give.
Patience, acceptance, an "uh-huh" or a "yes, honey".
Just, as, letting them be acceptable just as they are.
Because they don't have a lot of choices about that.
Recognize that this is a person with dementia doing their imperfect best to reach out.
One family was being made very angry about their mother saying the same thing over and over.
I suggested they tried ways to defuse their own stress and tension about it.
In the end, they came up with a family betting pool and the person who got nearest Mom's score for the day would get money from everyone else.
Very silly, but heck, whatever works kindly is fine.
With questions you prefer not to answer -- as in "Where's my mother?" requiring the factual answer "Dead!" -- it's fine to evade, avoid, re-direct attention, offer a bribe in the form of good food or even bad food or start up some different activity.
Take Mom for a drive, go for a walk, pet the dog.
I never lie to people with dementia but I'm fine with carefully applied evasion.
The great thing about them is that you can practice until you find what works, because they won't remember but you will.
And that is true of many things in the dementia relationship.
Bring order to your own inner emotional turmoil by making lists, noting down what works, bringing a variety of entertainment with you from lotions to DVDs and paying attention to the other person more than to yourself.
Often, if we give ourselves away like that, we get something meaningful back.
Visiting doesn't need to be a big deal.
It's very okay to sit on a sofa beside your family member, wrap an arm around them and watch some dumb TV.
It's only about what closeness you can bring to your time together.
Good luck.