Psychiatry Networks

Frank and Angela are another dreamy couple with a bit of reality thrown in - dementia.

Frank starts the story this way: “I was 18, Angela was 22, and it was a “fairy tale” romance - love at first sight. She was wearing a red dress and standing with her sisters. I decided to pursue her, even if she was an older woman.”

59 years later they are still very much in love. They still enjoy “going for rides,” around Utica, NY, and beyond. They prepare and consume healthy meals together. But Angela’sdementia sometimes causes problems.

The toughest times for the Tofani’s are the mornings. Angela awakes with fear and confusion, and Frank calms her down, but he also “gets upset.” He admits to losing patience with Angela and having his own health issues to worry about.

I met Frank and Angela in Utica. Frank wanted to show me their “saving grace;” an adult day services program at the Resource Center for Independent Living, where he drops off Angela 5 days a week 8:30-3pm. Angela looks forward to this routine. She tells me she loves sitting at the table, chatting with “the girls” and welcoming new people.

Meanwhile, Frank gets some time to decompress, pay bills, do grocery shopping, and attend to his health issues (kidney dialysis is looming). When he stops in to check on her, he gets a glass of orange juice and everyone welcomes him. In observing the workers, he is inspired by their warmth and patience, and that reinforces that what he is doing is right.

The bonus: this caregiver respite is paid for my Medicaid. Frank says he is not exaggerating when he says this place is the best thing for their health and marriage. Case in point: One day in July Frank had a stroke while he was home paying bills. Angela was at the adult day center, so he didn’t have to worry about her. He got himself to the hospital and the staff took Angela to her sister’s at the end of the day.

As a caregiver myself, I can relate to the need for breaks. I know the importance of social connections. And one thing I look for in a care institution is personalized client-centered care. Finally, keeping a loving couple together is perhaps most important.

A similar situation emerged with my grandfather, whose girlfriend was diagnosed with Alzheimer’s. Gramps tried very hard to care for her, but he finally had enough of the forgetfulness, the lost items, and the confusion. He found Linda an Alzheimer’s care facility and now visits her there.

Frank’s history and options are different. After 59 years of happiness, Frank wants to live with Angela as long as possible. “Maybe someday she’ll have to go into a care facility, but for now we’re together, and this place is our saving grace.”

Let’s face it, care networks matter tremendously when it comes to protecting autonomy. But I hadn’t considered the role adult day care may play, especially for working class Americans who qualify for Medicaid.

Thanks Frank and Angela, for helping me to see that Adult Day Services can enable autonomy and “aging in place,” and that love can persevere, despite the obstacles.

In my role as a relationship therapist, I’ve begun prompting couples to ask their partners, “Would you like to be the person that I’m asking you to change into? Would you like to be the partner that I want you to be?”

This type of inquiry quiets the tired back and forth, right and wrong ping ponging that gets us nowhere. It’s not uncommon to ask your partner to make changes in their beliefs, attitudes, or behavior to accommodate your wishes. Very often, though, this is met by an entrenched resistance from the person being asked to change. You should ask yourself if you’re resisting simply for the sake of resisting, or would the requested change be consistent with your own growth and personal evolution?

If what is being requested seems authentic and resonant with your growth, and you are nevertheless resisting, then you might want to pay attention to why you’re digging your heels in. If you’re caught up in the power struggle and keeping a scorecard of offenses, the path to amicability remains obstructed; the larger picture is surely being missed.

The goal of winning in a relationship is absurd. That would guarantee unhappiness. Reflect on whether you’d rather be right or whether you’d rather be happy. One tends to preclude the other. Relationship battles often resemble the up and down of a seesaw ride. If one of you is up, the other is necessarily down. You may take turns in the up position, but you’re unlikely to find the balance that brings about a sense of harmony in this zero-sum equation. The shift we should seek is seen as a win-win situation – both people come out on top. In fact, this is the only pathway to a congruent, if not blissful, partnering.

Releasing the need to defend yourself – and subsequently abdicating the silliness of right or wrong – really enables a more reflective consideration of the changes being requested, or perhaps demanded, by your partner. If the modification sought would assist in your personal growth, then you should embrace it. It’s a win-win. You’ll grow and perhaps improve the energy of your relationship. While it’s disappointing if this doesn’t happen, you’ve still at least moved forward in your self-actualization. To that extent, you are removing yourself from being the problem. Should you find yourself in this position, you may discover that the old battle masked deeper underlying issues that may now arise.

The conflict over change, although often substantive, is at times simply a safe, if not frustrating, way to express hostility. You might ask your partner or spouse, “If I make the changes you’re asking for, will you feel the way you’d like to feel about me?” This question may reveal whether there are deeper issues – usually emotional – that need to break through and enter the discussion.

Much of our defensiveness surrounding others’ impositions that we change has to do with our own sense of self and identity. “There’s nothing wrong with me” is a revealing statement, in that it demonstrates an insecure and fragile ego. It’s not a question of whether there’s something wrong with you as much as it’s about whether you’re seeking to evolve further and please your partner – provided that you’re not acting from fear or inauthenticity. There is a direct correlation between one’s openness to change and their self-esteem. If your self-worth feels tentative, you’re more likely to defend against change. On a differing note, though, people should never simply succumb to the demands of others if they are coming from an angry or controlling energy.

Relationship success requires quieting your defensiveness and developing a resilience founded upon the healthy spirit of a co-operative alliance. If you try to be the best you can be for the other, and remain genuine and true to your own growth, you can accurately say you are doing everything you can to make your relationship prosper.

“The primary visual cortex is right at the back of the brain and lies mostly on the inside of the two hemispheres. This is the first point in the cortex where signals arrive from the eyes vis the thalamus. these signals are retinotopically mapped- that is, a signal from a particular point on the retina is sent to a corresponding point on the primary visual cortex.” pg 35 Rita Carter

The Temporal Lobes
At the very front of the temporal lobes (the temporal poles), knowledge acquired from all the senses is combined, along with emotional tone. Pg 21 Rita Carter