Hurtful Words and How Caregivers Can Cope

caregiver mental healthIt’s no easy task to care for an individual suffering from Alzheimer’s or dementia, but when that person starts using hurtful words to interact with you, the level of difficulty can quickly escalate. It’s human nature to take rude or mean words personally and feel that the individual is consciously attacking you verbally. In the case of those living with a form of brain change, however, that’s simply not true.

By understanding what’s really going on in the person’s brain, you’ll be able to gain a much greater sense of tolerance, and learn how to respond to his or her behavior rather than react. It all comes down to realizing that the brain is undergoing significant changes as it declines due to disease. In particular, dementia affects the parts of the brain that produce language, enable you to express yourself, interpret threat perception, and control your impulses. Any one of these issues would cause personal interaction to be challenging, but combining all four can create a perfect storm.

As dementia progresses, the ability to produce language decreases. Interestingly, while lifelong vocabulary may begin to be lost, forbidden words (such as profanity, vulgarity, racial slurs, or insults) are often still retained by the brain. Imagine, for instance, that a person suffering from dementia gets angry or distressed because you misplaced their glasses. S/he may no longer have the ability to communicate a complex sentence such as, “I really wish you didn’t move my glasses because now I can’t find them.” Instead, what might come out is a derogatory term or insult, simply because that is the only language available at the time.

Additionally, as the parts of the brain responsible for threat perception are heightened, and as the ability to control impulses to say and do things in the moment are compromised, the stage is set for any number of surprises. Even the individual may be caught off guard with what s/he says. Everybody has experienced situations where we have said something we immediately regretted, usually caused by feeling stressed or threatened. When dementia is added to the mix, it’s very understandable why unexpected things come out of peoples’ mouths.

Once it’s more obvious why hurtful words are being used, it becomes easier (though still not easy!) to cope. The first step is to set expectations for yourself. If you are taking care of someone with dementia, it’s almost inevitable that s/he will say something that offends or hurts you at some point. It’s okay to accept your natural reactions of feeling hurt, shocked, angry, or resentful. After all, you’ve been doing a lot to support this individual, and certainly didn’t deserve to be treated that way. Also, you may have never heard profanity come out of this person’s mouth before, and suddenly it’s being directed at you! These are all human reactions and are acceptable to feel initially.

The key becomes learning how to respond with wisdom and maturity rather than react in the heat of the moment. Take some deep breaths, and remind yourself that the person living with dementia most likely can’t help it. Realize that shouting back at the person or returning unkind words will not help the situation and will actually make things worse. Point out the emotion that you sense in the individual, such as, “I understand that you’re unhappy and that what I did to try to help didn’t work.”

Start doing some detective work to figure out what the person’s unmet need is that is causing him or her to react. Find out if s/he is in pain or experiencing some other physical discomfort, such as needing to use the bathroom or being overtired, hungry, thirsty, hot, or cold. The need may also be emotional in nature, such as feeling lonely, sad, angry, scared, or unimportant. By focusing on what you can do to provide support rather than focusing on the hurtful words themselves, you’ll be developing an essential skill of being an effective caregiver.

Most importantly, take care to preserve your relationship with the person for whom you’re caring. Don’t allow unkind words or interactions to sever the bond. By understanding the reasons behind the behavior, you can hopefully get beyond the initial hurt and move forward. If you need to, you can share the experience with someone else, or discuss it in a caregiver support group (such as to get perspective and be able to process your emotions. And remember – if you happen to react inappropriately, don’t beat yourself up. Just learn from the experience and practice greater awareness the next time it happens.