Judd Matsunaga
Those with Alzheimer’s and other memory disorders often live in the past, where they find comfort in memories of loved ones who are no longer alive and events that happened during their happiest years. That’s why forcing an elderly parent (or spouse) to abandon their version of reality and join our “real world” can cause confusion, pain, anxiety, fear and anger.
So, dementia care experts often recommend a technique called “therapeutic fibbing.” It helps you step into their current reality and spare them unnecessary upset and distress. In many ways, this technique is similar to telling a friend that you love the gift they gave you, even if you don’t actually like it. Telling the absolute truth in that case doesn’t change the situation and would only hurt your friend’s feelings.
For example, let’s say your dad, who is suffering with Alzheimer’s, repeatedly asks where mom is even though she passed away six months before. Since your parents taught you to always be truthful, you reply, “Dad, mom passed away six months ago.” Each time you will see his face absorb the painful shock that the truth provokes. Telling the truth could be cruel. How many times can you tell the truth and watch a loved one suffer the same loss again and again?
Instead, caregivers may be able to avoid anxiety attacks, agitation and intense distress by omitting some or all of the truth, i.e., therapeutic fibbing. You might respond, “Dad, mom is fine. In fact, she told me to tell you she’s meeting with friends and will be home later in the day.” For people who are cognitively impaired to a level where they cannot absorb or process information well enough to understand it, therapeutic fibbing is a way to avoid upsetting them in ways that serve no purpose.
Therapeutic fibbing, however, is somewhat controversial and goes against the moral principle of honesty. Yet, when the reduced cognitive ability of dementia patients is taken into account, most gerontologists believe that the benefits of therapeutic fibbing often outweigh the cons. This practice may be described as the caregiver entering the dementia patient’s world, which may even strengthen the bond between a senior and his/her caregiver.
Amy D’Aprix, developer of the Home Instead Senior Care Alzheimer’s CARE Training Program, said, “Once I was asked if a daughter-in-law should tell her mother-in-law, who had dementia, that her son had just died. I said, ‘Yes, she deserves to be told, once or maybe twice.’ That’s because the mom deserved the right to be sad or grieve even if she couldn’t retain the information. But more often that, that simply feels cruel” (Source: Washington Post, “Is It Okay to Tell an Alzheimer’s Patient a White Lie? March 17, 2018).
D’Aprix is adamant that therapeutic fibbing is not the one-size-fits-all answer. She also recommends that caregivers consider these other strategies:
- Try changing the subject.
Instead of lying or getting into an argument, redirect the person to a new topic.
- Empathize. Listen for the emotion driving the patient’s behavior and validate it, rather than argue with the facts. For instance, if the person is angry or agitated, acknowledge those feelings as real, which they are, even if the object of their ire is not.
- Do not try to force patients to see things through your eyes. They simply may not be able to do so, and any efforts may lead to greater agitation or suffering.
- Accept their reality even when it differs from your own. If your loved one is OK and not in danger, let them be in their own world.
Jason Karlawish, co-director of the University of Pennsylvania Memory Center, prefers calling this approach “loving deception.” He says whether or not to lie is about intent, reminding us that “the moral role of the caregiver is to respect the person’s sense of identity and self.” He strongly advises that “the default is the truth and that the mere fact that the truth may be painful isn’t sufficient to avoid it. Only if the patient cannot process and make sense of a particular truth is it OK to lie.”
The Washington Post article also quotes Mary Kay Mahoney, gerontologist at Bella Villaggio Senior Living in Palm Desert, Calif. “Therapeutic fibbing is all about meeting that person in their reality,” she said, “because no matter how hard you try, you cannot change a person’s dementia or Alzheimer’s disease. So, what do you do? What is the most loving thing to do?”
Mahoney believes therapeutic fibbing is the best option for families and caregivers to communicate with their loved ones with memory disorders.
According to the Alzheimer’s Assn., it is “important to put oneself in the shoes of your loved one and acknowledge how frightening” their situation must be. In her memoir, “Floating in the Deep End,” Patti Davis, daughter of former U.S. President Ronald Reagan, devotes a chapter to what she dubs “creative lying.” She recalls a few instances in which lies made him less flustered or worried about skipping an obligation.
“During one of these episodes, my father believed it was morning, and he needed to go to the office. We told him that the office called and said he didn’t need to come in because it was being fumigated, so no one was going to be allowed in,” Davis wrote. “He accepted that, and shortly afterward, forgot about going to the office.” Creative lying kept him calm, satisfied and grounded in their reality.
Davis offered a consolation for caregivers struggling with this choice. “Lying in the service of kindness is not a punishable offense. In fact,” she said, “I suspect it earns us karma points” (Source: www.beingpatient.com, “The Pros and Cons of ‘Therapeutic Lying’ in Dementia Care,” Feb. 11, 2022). In caring for someone with dementia, white lies or bending the truth can help keep the peace.
In conclusion, at the end of the day, the debate continues. Ultimately, there no one “right” approach.
Most caregiving experts can agree on one thing: No one should be judged for how they manage each day caring for someone with dementia. There will always be a balance to strike between the difficulty of lying to a loved one. You should do whatever you can to reduce the stress and challenges for both you and your loved one.
Judd Matsunaga is the founding attorney of Elder Law Services of California, a law firm that specializes in Medi-Cal Planning, Estate Planning and Probate. He can be contacted at (310) 348-2995 or judd@elderlawcalifornia.com. The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Pacific Citizen or constitute legal or tax advice and should not be treated as such.
