It is well known that people with dementia may become violent. It is seen almost as normal, to be expected. My question is, why? What does the violence mean? Is it because the person is frustrated, and wants to hit out, which is also normal and happens in families. Or is it more evident, because the person becomes uninhibited in the expression of their feelings and there is a loosening of the usual constraints on behaviour? so that the function of the regulatory superego is diminished (do we know then in what part of the brain that may be located?) and the managing ego becomes much weaker, giving a frightening freedom to primitive emotional responses – dementia is the final triumph of the id?
Anna sometimes rejects help, forcefully. I am thinking of this, because her long-term and trusted carer, Anne, has a nasty bruise at the moment, and I find this shocking, surprising, worrying. We have people helping us to think about this:
‘As well as reassurance that there is no malicious intent by the carers towards her, I wonder if it might also be helpful for her to hear you set a boundary about what is acceptable …. I think we need to try and help her engage that part of her which wouldn’t hit out, as much as she is able.’
The thing is, I tell Anna when she is out of order, but this is also when she is out of control of herself. So, when I say, don’t do that, don’t hit me, or kick me, whatever it may be, she experiences what I say as itself a violent act. The question, who is doing the hitting? is reversed, so that she will say, Anna/Tim hit me, and will call out for help as is she is the one who has been attacked. I don’t think this is a trick to shift the blame –she finds the setting of boundaries to be an aggressive act.
Last night, the evening carer backed off and I took over – it got difficult and so I said, you don’t do that, and immediately the situation got much worse. And she said, you’re like Anne. And then I got bruised. If someone hits you, you must feel anger, so any response, however calmly done, is an angry response.
If you say to Israel or the Hizbullah, don’t do that, we know that they also see this as an aggressive act. So we are talking here about universal rules of engagement, where war is diplomacy by other means (or is it the other way round?)
Last night in the end we had a boxload of tears.
‘You’re not going to kill me?’
And as I withdrew my forces and sat across the room, ‘If you are going to be all right, I can be with you.’
And finally: ‘I thought I was dead.’
Much like the Middle East.