Dementia and the Hidden Workings of the Mind
January 16, 2023
In this thoughtful debut, Kiper, a clinical supervisor at an Alzheimer’s caregiving organization, digs into the tortuous effects of dementia for sufferers and caregivers alike When Kiper decided to spend a year as a live-in caregiver for a 98-year-old man with dementia, she’d expected his behavior to be mercurial. What she didn’t count on were her reactions, including anger and sometimes buying in to his delusions. Drawing on neurological research and her experience counseling caregivers, Kiper zeros in on the dilemmas that arise when patient and caregiver “unknowingly collaborate in misinterpreting” dementia. Caregivers, for instance, often feel patients are capable of self-awareness even though they know otherwise. Elsewhere, Kiper explains that caregivers often don’t detect dementia in loved ones even when it’s “staring them in the face,” as it conflicts with their “internal model of reality.” This becomes especially tricky when the condition’s emotional symptoms (anger, confusion) are mistaken for a normal part of a difficult relationship. The author’s clear reasoning skillfully illuminates psychological concepts, and her poignant experiences bring them to life, sensitively broaching issues of free will, identity, and loss. Those dealing with dementia will find solace in this compassionate investigation of the human mind.
February 1, 2023
A clinical psychologist offers a thoughtful, philosophical view of dementia. More than 55 million people around the world have dementia disorder, writes Kiper, a number that is expected to grow threefold by 2050 with an aging population--and that will incur costs in excess of $2.5 trillion. The numbers are meaningful, though they tell only a sliver of the story. In her clinical training, writes the author, she and her colleagues worked through "the dispassionate lens of quantitative analysis," with the clinician serving as a detached, impersonal observer and dispenser of dogma. Kiper's work as a caretaker, however, had given her a more sensitive view. One of her patients, a Holocaust survivor, "wanted it both ways: to be completely independent and yet receive constant attention." The phenomenon is common, and the symptoms that accompany declining mental function are sources of frustration, familial tension, and profound unhappiness. Yet, because at least in the early stages the patient appears to be more or less normal, whatever that is, "we're puzzled when dementia patients do not seem particularly diminished," so that the caretaker or family member is tempted simply to try to change the person's behavior so that they don't, say, misplace the car keys. Both the brains of the afflicted and the brains of the healthy are engaged in a kind of mutual incomprehension. As the husband of a woman with Alzheimer's wisely said, "People talk about my wife like she has a problem. But it's me. I'm the one with the problem." We all have problems, Kiper suggests, if only because we try to avoid the anxiety of disorientation and dislike unpredictability, the hallmarks of dementia. The author suggests that therapy should include ordinary conversation, by which "we create and acknowledge the possibility that clarity, meaning, and connection exist even when there appears to be only strangeness and futility." A humane approach to the silent epidemic of cognitive decline.
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