The warning signs had been there for a while: confusion, forgetfulness, disorientation. But when my father-in-law, known affectionately to me as Elvis, came for a visit six Christmases ago, it was clear that there was a serious problem. Diagnostic tests confirmed that he had Alzheimer’s disease.
So we shuffled bedrooms (not a simple feat in a household of eleven), and prepared a cozy place in our home for Grandpa Elvis. My husband and I were determined to do what we could to keep Grandpa with us—both in the physical and mental sense—as long as we could. Keeping him around physically didn’t turn out to be a problem: he didn’t have the wandering tendencies of many Alzheimer’s victims. But keeping him with us mentally proved to be a challenge.
My husband, Steve, and I decided from the start that we would always ground Elvis in the truth. After all, that was how we had raised our ten kids: we never told them lies, not even about Santa Claus. If Elvis said the President was Eisenhower, we’d remind his that it was Obama. If he thought the white stuff outside his window was the sand of Tucson, we’d inform him that it was the snow of Chicago. If he complained that the plane to Jerusalem had remained on the tarmac too long, we’d gently explain that he was in his bedroom.
Steve and I believed we were doing Elvis a great service by grounding him in reality this way. We figured the longer he knew the month and city he was in, the longer he’d have access to his mental faculties. The price for this reality therapy was quite high, though.
For one thing, Elvis would get angry when he was corrected. That anger would flit from the topic at hand, (“Where do YOU get off telling ME I don’t have choir practice tonight?), to other grievances (“Why does my dinner arrive so late everyday?”), and never get resolved.
Our corrections served as constant reminders of his mental decline, and that horrifying, bleak thought made him angry.
Further, to fight back, Elvis would become obstinate. In trying to cling to his mind and will, he would tenaciously hold to his decisions, no matter how absurd they were. This was never more evident than in his resolute determination not to change his clothes. This is a real (and typical) conversation:
Me: Elvis, I think you’ve forgotten to change your clothes today.
Elvis: I don’t need to.
Me: Elvis, you really do need to. You’ll develop a rash.
Elvis: Where I come from, the babies change themselves.
Me: Elvis, babies don’t change themselves. And you’re not a baby.
Elvis: That’s right, I’m 42 years old.
Me: No Elvis, your son is 42 years old. You’re 82.
Elvis: No. I was born in in 1932. That was ten years ago. That makes me 42.
Then he shuffled out of the room angrily, with no intentions of changing.
As each scene like this played out, Elvis seemed even more removed from reality. And he became angrier. And more stubborn.
Then one day I listened on NPR to a story of a married couple who were both stand-up comedians. The wife’s mother had developed Alzheimer’s and moved in with them. As they described their journey, it sounded very familiar. They were experiencing the same resentment and intransigence with their mom as they tried to correct her back into reality.
Utterly frustrated, they decided to make a change. They resolved to do what improv comedians do: they stepped into her reality. If mom saw a bunch of monkeys swinging in the trees, they saw them too, and asked where the bananas were. They said that in the improvisational comedy sphere, this was called “Yes, and…” Whatever one comedians says, you say, “Yes, and…” and build from their world. When they switched from “No, you’re wrong,” to “Yes, and…” their mom’s life changed.
No longer was she angry and frustrated. She wasn’t embarrassed and feeling stupid. She would have delightfully funny conversations with her daughter and son-in-law, and, by the end of them, admit that they were fanciful. She was actually closer to reality from having wandered into fantasy.
This sounded so appealing to me; I wanted to try it with Elvis. But I had this little problem: the truth. I really don’t like telling lies. I didn’t think I could condone it.
But then I go to thinking, when my sons were little and tied sheets around their necks to create superhero capes, I didn’t reprimand them. I’d drop down dead on the kitchen floor when they shot me with their paper towel tubes. When my little daughter donned my heels and jewelry and introduced herself as Mrs. Delicious, I didn’t remind her of the name on her birth certificate. I invited Mrs. Delicious for a cup of tea.
Elvis didn’t need to be forced back into reality. Like a preschooler using make-believe in an attempt to make sense of a confusing world, he needed someone to join him in his fantasy.
I realized this wasn’t lying; it was imaginary play. I decided to try it out. Here’s a real live conversation, using my “Fantasy Therapy.”
Elvis: Well, I’ve thought long and hard and I’ve finally made up my mind.
Me: What have you decided to do, Elvis?
Elvis: I’m going to run for governor.
Me: Wow! Are you going to run as a Democrat or a Republican?
Elvis: I haven’t quite made up my mind.
Me: Well, you know, Elvis, voters really like to know which party you’re running in.
Elvis: You’re right. I’ll have to decide.
Me: You know what else voters like? They like when candidates change their clothes.
Elvis: Good idea! (with a mischievous sparkle in his eye) One question: do candidates get a free dessert with lunch?
Me: Only the ones who have changed their clothes.
Grinning, Elvis shuffled away to change.
I think Grandpa knew in his heart of hearts that he wasn’t really running for governor. But he invited me into his fantasy, I joined him there for a while, and he was happy. He didn’t feel the need to obdurately cling to an assertion or doggedly argue a point. He didn’t even complain about changing his clothes.
My husband and I have shifted our paradigm regarding caring for an Alzheimer’s patient. Our job is no longer to laboriously force Grandpa’s mind into the here and now—a state rife with reminders of his decaying body and deceased loved ones. We see our task now as giving Elvis a good send-off as we join him where his mind takes him.
Some days we are in sunny Tucson volunteering at the hospital. “Yes, and look at that saguaro over there.” Other days we’re in southern Indiana at confirmation class. “Yes, and have you remembered your Catechism book?” Occasionally, we get to fly over to Europe. “Yes, and what will we see at the Louvre?”
Our “Yes, and…” improv tactic has changed Elvis from an angry old man into a playful explorer. He’s no longer humiliated by his mistakes, but enjoys our companionship on his flights of fantasy, and becomes compliant while we’re there. If Elvis is happier, we are all happier.
Yes and… when do we go to the Riviera? It’s cold here in Chicago!
You can find more of my books and DVDs at my website, stronghappyfamily.org.