Part I – Validation with Verbal “Alzheimer-type” Populations
Typical case history:
Neither Harry Albert nor his wife, Mary, paid attention to me, sitting, watching them in their tattered living room. Cracking under the strain of living with her 86 year old husband, diagnosed, “Alzheimer’s dementia,” Mary had asked me to help. Harry muttered out loud to nobody and everybody, his rasping voice, insulting, accusing:
“There she is! I see her sneaking around behind me. That old woman has got to go.”Harry sat straight at his desk, pounding the floor with his cane. His eyes narrowed, darting left to right, his paunch protruding, his lower lip pursed, chin jutting.
“Lady, will you please get the hell out of my house and let me write. My editor needs this story today. You are a pain in the ass.” Then, without warning, he turned to me, snickering, “Tell the old bitch that she’s a pain in the ass.”
“Harry, I am your wife. Your editor is dead. He died 8 years ago. Look at your typewriter. You’re typing without paper.” Mary’s voice cracked, like a broken record spinning with no one listening.
“Because you stole my story. Ten pages. You know how long it took me to write ten pages?” Harry roared, threatening with his cane. To me, he explained:
“She has a nerve. Bossing me around. The old hag. Won’t let me finish my story. She’s stealing my pens, so I can’t write. Where’s my red pen. The one I always use? Where did you hide it, old woman?”
Mary glared. “I didn’t hide your pen. Look under your mattress. There are 12 pens stuck under there, where you hid them. And 19 more in your dresser.”
“Liar. Thief. Get out of my house or I’ll throw you out.” Harry pounded his cane vehemently, emphasizing each word. Mary gave Harry a dirty look. “Fine.” Glancing at her husband in disgust and me in defeat, she slammed the door. “The nerve of her, stealing my pens and then saying I hid them.” Harry swiveled his desk chair to face me.”Good riddance!”
Harry was never mentally ill. During the depression, he learned to melt tiny pieces of lard to make soap for his mother. He sold newspapers to augment his father’s income. He went to night school. His parents praised him because he worked hard. For Harry, work meant being loved. Work meant being.
An accomplished journalist, he had authored two books and numerous journal articles. His wife and three children reported that he was a good father and husband, but never openly revealed his anger or love, nor was he demonstrative. He minimized disappointments. Normally neurotic, he devoted most of his waking hours to work. When life soured, he worked.
I knew that Harry Albert could restore some of his self-worth through Validation. This 86-year-old man represents thousands of old-old people with whom I (Naomi Feil) have worked since 1963. (Feil, 1967, 2002, 2003). I knew their families well. I’ve studied their life histories. Most were productive, successful, with families and businesses. None was diagnosed with a mental illness.
Each one was unique, but they all had in common one personality trait. They had never faced strong emotions: adolescent rage at punishing parents, fear of failure, panic when age sours life. They found no way to strike back at old age. They never learned to look the opponent in the eye and roll with the punches. In the words of Erik Erikson, (Erikson, 1950, 1978), they “stagnated.”They could not generate new activity. They clung to outworn social roles. They had never learned to grieve and rage, and then adapt. They had never learned to be flexible and orchestrate their lives to find new keys to play when old ones rusted.
They never took courses in aging. They failed the first course in living: learn to trust yourself and others; know that you are worthwhile, unconditionally, even without a job; despite loss of recent memory, eyesight, hearing and mobility, you have an identity as a human being.
These old people had never learned to face painful reality. They had, since childhood, swallowed painful feelings. In old age, when damaged brain cells no longer keep the mind and body in control, stored up emotions spill. To understand the shift in behavior, the Validation worker looks not only at brain damage. Validation theory, a holistic model, also looks at the old person’s life. Combinations of physical, psychological and social factors expose the meaning behind behaviors of very old people. Freud, humanistic psychologists, and biochemical researchers (Rogers, Erickson, Maslow, Barrell & Price) hold that deep emotions, when suppressed, can become toxic, producing pain. When expressed to an empathetic listener, painful emotions lose their strength, and often dissipate. Very old human beings who have buried emotions from childhood to old age, hurt. Finally, subconsciously, they long to vent.
Now, to wrap up loose ends, they enter a final life struggle that Validation theory calls, “Resolution.”The Validation worker respects their struggle, and does not diagnose them as “paranoid,”or “hallucinating”. Rather, these very old people arehealing themselves. In old age, they struggle to dump a backpack of emotions they have lugged for 85 years or more. Validation Practitioners the world over, have reported that strong emotions dissipate when validated. Verbal Validation helps the old person lighten his load. The Validation Worker (VW) listens with empathy. When an 85 year old woman, who has led a productive life, who was never mentally ill, shrieks in fear because she sees a man under her bed, the Validation worker knows there is a good reason behind her panic. She may have been raped, abused, or needs to express suppressed sexual feelings. At age 85, she uses her mind’s eye to picture the man that hurt her when she was 8 years old. When her emotions are expressed, acknowledged and validated with empathy, she is relieved. Often, within 6 weeks, her fears expressed, lessen. Within three months, with Validation, she may no longer see the man. (Feil, “Communicating With Alzheimer-Type Populations”, 1988, Video & DVD)
VERBAL VALIDATION: IN PRACTICE
To build trust with Harry, I began “Re-phrasing,” with empathy. (Feil, 2002, 2003). I had to feel Harry’s anger. I listened closely, never mimicking, but picking up Harry’s tempo, voice tone and his key word: “Riddance.” I called him “Mr.” Harry Albert did not grow up in a generation that called a stranger by his first name.
“Mr. Albert, you want to get rid of her?”
“She stole my favorite pen. Why she steals my pens, I don’t know. She can’t write a sentence you can read. What’s worse, she bosses and nags at me day and night.”
Harry’s mother bossed him. His three children told me that their father was afraid of his mother. Always a “good boy,” he had never rebelled. He obeyed. Mary has become the target of Harry’s swallowed anger. In Validation theory, Mary, his wife, is a “symbol” of his mother. A symbol is an object, like Harry’s pen, or a person, like Mary, in present time, that substitutes for someone or something from the past. His pen symbolizes his lost writing ability. Damaged recent memory, inability to focus, and painful arthritis rob Harry of his identity. He can’t accept his physical losses. To be a worthwhile human being, Harry must write. As a young man, he had never faced his fears of failure. In old age, he blames his wife for stealing his writing ability. Unable to say, “I can’t write, but am still worthwhile,” he hoards pens to hold onto his sense of self. He accuses Mary of stealing. Mary is the reason that he can no longer write!
When Mary faced him with an intolerable reality, by showing him the pens he had hidden in the night, Harry became furious. His denial surged. Deep down, in a pocket of awareness, Harry knew the truth; that he had hidden the pens himself. The more Mary argued and insisted, “Harry, you hid the pens yourself,” the more Harry fought: “I did not! You hid them to spite me!”
This old man can not handle reality. It is too painful. But, the VW does not lie by saying, “Yes, I hid your pens.”The old person can spot a lie. Knowing that he is being patronized and manipulated, Harry will not trust the liar. The validating relationship must be genuine. But, the VW does not argue: “You hid the pens yourself.”Old human beings in “Resolution”, who have never been honest with themselves, need to hold on to familiar defenses: blaming others when things go wrong and suppressing fears. When confronted with reality, they feel attacked, and will fight back with fury. At age 86, when each day means another loss, Harry cannot risk losing his equilibrium to gain insight. He cannot change.
The Validation worker accepts the old person where he is.
Many months later, Mary learned not to ar