During the early years of Mom's mild cognitive impairment with early memory loss she remained fairly independent, living with her husband who eventually required her full-time caregiving. As those demands increased, I found that I, too, had to increase the frequency of my visits to her home be sure Mom was okay and coping with being a caregiver.
When "Everything's Fine!" But It Clearly Isn't
Both my brother in California and my sister in Pennsylvania made regular telephone calls to Mom, always asking her if she was well, taking care of herself, eating enough, exercising and getting out occasionally with her friends. The feedback from those calls was always amusing. According to my brother and sister, no matter what questions they asked of Mom, be they about her husband, her health, finances, [eating habits or exercise], Mom's reply was always the same: "Everything's fine!"
Because I saw Mom frequently, she couldn't hide the truth from me. I knew that there were some big inconsistencies between her responses to my siblings and her true reality. She was showing signs of early memory loss. It became apparent that Mom felt that by putting on a happy face and giving the appearance of handling everything well, she'd create the desired impression of being the strong, independent, self-reliant woman that she had been for most of her life. But that image existed long before her early memory loss and demands of being a full-time caregiver began to dent her armor. I saw the toll that the demands of caring for her husband were taking on her. I was aware that Mom was using various masks to try to fool people into believing that she could handle the situation.
Mom's favorite mask was that of denial. That was the mask that presented the world the face of a smiling, happy woman whose life was running perfectly, even when they were approaching levels of disaster. I've learned that the mask of denial is very popular with many older people, even those without memory loss issues.
Hiding Memory Loss to Create an Acceptable Social Image
There were other masks that Mom mentally slipped into place as needed, like when in a group of people where multiple conversations were going on all around her. In an effort to look involved as conversations swirled about her, Mom would smile and use one of her well-worn "scripts" saying things like, "Is that so"¦?" or "Really!" and appear engaged. In reality, she wasn't able to keep up with the myriad complex conversations involving more than one idea or topic at a time. Those masks often hid Mom's early memory loss weaknesses fairly well, and she often got away with appearing interested and fully engaged, even though she and I both knew the truth. That's what being in denial is and does for people like Mom.
But masks slip. When Mom met someone for the first time she would hide behind her "social butterfly" mask, using another of her "scripts" to go on autopilot and introduce herself, ask them their names, what they did, and some other typically acceptable questions. It worked like a charm"”unless these people responded with questions of their own, such as, "How long have you lived here?" to which Mom might answer, "Where?" or perhaps, "I can"˜t remember, but I think it"˜s been a long time" and then smile as if that were a perfectly complete and appropriate response to the question. For Mom, it was just part of trying to hide the reality of her failing memory"”behind the mask of denial.
Why Hiding the Truth Can Be Dangerous
Although I didn't live with Mom, a big advantage of visiting frequently and talking with her about everything, allowed me to become intimately familiar with her concerns, physical issues and personal problems. Believe me: there are things a son should not have to ask or be required to know about his mother.
Hiding behind masks to prevent people from seeing the truth is often harmless. But when it comes to issues such as wellness, nutrition and hygiene, denying the truth can be a disaster. When Mom would ask to see a doctor for some problem, I made it my business to take her to those appointments and accompany her when she met with the doctor. Why? Because Mom would slip behind her mask of denial and tell the doctor that she was doing okay for her age, that she remained active and really didn't have any major early memory loss issues, etc. In almost every case, it fell to me to advocate, explaining to the doctor the real reason behind mom's appointment. With the doctor present, I'd intentionally ask Mom very direct questions such as, "Mom, didn't you tell me that you've been having severe stomach cramps lately?" And Mom would then begin to emerge from behind her mask and tell the truth to the doctor, thereby showing her vulnerability and memory issues, but also receiving proper treatment. Without me present, Mom might have kept those masks in place only to confound the physicians who wanted to help her remain healthy.
Caregivers: Know How and When to Insist on the Truth
The use of masks cannot be permitted when dealing with doctors or other professionals. Mom often accused me of overexaggerating when I would repeat something she had said to me in confidence about a personal problem. I always ignored her protests. I decided that I would not for one minute refrain from prompting the truth from her at every appointment where it might make a difference in her health.
In those earlier years Mom used a variety of masks to support her denial of the truth of her disease. Over time I had to help Mom accept her situation and deal with her life honestly. I often found myself rereading a quote I found from Arthur Schopenhauer: "The closing years of life are like the end of a masquerade party, when the masks are dropped." And when that occurs, caregivers must be there to offer love and support as the denial gives way to reality.
Until next time, thanks for caring.