Memory Loss

Many years ago, when I was a new psychologist in long term care, I worked with a woman whose Multiple Sclerosis had impaired her memory to the point she couldn’t remember where she was. I gave her an ID holder with her room number to wear around her neck, but she forgot to look at it. She complained she hadn’t eaten all day, while having crumbs from breakfast on her face.

I approached her for a session one day as she was finishing the last bites of her meal.
“Hi Sally. Would you like to talk for a while?”
“I can’t. I’m hungry.”
“But you’ve just eaten. See, here’s your plate, you’ve eaten everything.”
“But I’m still hungry.”
“Do you remember in science class, when they taught us that the satiety center of the brain takes twenty minutes to register that we’ve eaten?”
“Oh, yeah!” Sally was an intelligent woman, and her memory held strange pockets of information.
“Well, if we talk for twenty minutes, the time you’re waiting to feel full will go faster.”
Pleased, I wheeled her into the multi-purpose room, moving some chairs around so we’d have space, and settled in to talk to her.
“So, how are you today?”
“I’m hungry.”
And that was the end of that. I learned not to attempt a session with her if she was in one of those moods.

Sally also complained that her room was not her room.
“But look! These are photos of you on the wall.”
Sally shook her head.
“These cards are addressed to you. They’re from your sister.”
“No, this is not my room,” she insisted.
“Well, perhaps we can just sit here for a while, and talk about some other things.”
“No. I have to get out of here. This isn’t my room.”
Sighing, I decided to try an intervention that sometimes works with people with dementia. “Okay, Sally. Let’s go then.” I took hold of the handlebars of her wheelchair and pushed her down the hall. We went up one way, and down another, around and around, in a very convoluted manner. Finally, I pushed her back through her door.
“Here, Sally, this is your room.”
“We didn’t go anywhere. This is the same place. This is not my room.”
And that was the end of that.

I felt there were reasons she didn’t think it was her room. Sometimes people have paranoid delusions where they believe that everyone has been replaced by exact replicas, so no one can be trusted. I wasn’t sure if she believed her room had been replaced in a similar way, or maybe there was some type of plot where everyone was telling her this was her room when clearly, to her, it wasn’t. Sometimes these symptoms respond to psychiatric medication, but often we just have to work around fixed delusions.

On the other hand, perhaps the problem was more psychodynamic in origin. Maybe her complaints had more to do with feeling like she shouldn’t be in the situation she was in at all. “This is not my room. This is not my life.” Maybe “I am hungry” meant she felt she wasn’t getting the love she needed and she felt empty inside. Perhaps if she were able to express this pain, she would feel less distressed in general.

But Sally was too confused to address these issues and eventually I had to admit that, for all my efforts, we weren’t really getting anywhere. I left her to work things out with the nurses and aides, who had long experience with dementia patients and their own, more directive, ways of handling confusion.

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