"Therapeutic Fibbing" and Dementia?

Hi everyone. I’ve posted about my mother in other sections of this forum before. But today I started wondering about something that I have had to consistently do latey to calm her down. My mom has a neurodegenerative disease that is very much like dementia, with the only difference being that it progresses at a much more rapid pace. There is no cure and no treatment to slow it down. Her symptoms have gotten very severe lately; she doesn’t recognize our home, and so therefore, she continually asks me to let her walk back to her house…which doesn’t exist. Her parents (my grandparents), passed away about fifteen years ago. However, she now believes that they are still alive and well, and that I am holding her hostage and keeping her from seeing then. Every evening, her hallucinations and delusions will escalate - I think the correct term for it is called sundowning - and she will attempt to escape from the house. Some days, telling her that her parents passed away years ago makes the situation much worse. She screams, tells me I am deceiving her, and lately in her fits of hysteria, she tries to pull her hair out. So I have begun telling her that I called her parents up and let her know that she is okay and safe to be in our house.

Is it wrong to lie to her like that? Is it sinful to lie under these circumstances? I have always had an open and honest relationship with my parents. I feel absolutely terrible to not tell the truth, but it does seem to calm her down more than anything else I have done before. I am not sure how else to handle it, other than continuing to reassure her that she is safe at home with me. I’ve tried playing music that she enjoys, giving her some sweet treats to distract her, putting on sitcoms so she can relax and laugh, etc. But as her condition worsens, not much is working. I guess they call this “therapeutic fibbing.” Maybe I am being overly scrupulous, but I just want to know if this might be considered sinful? Thank you all and God bless.

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My grandmother had dementia. Eventually, explanations and fibs weren’t sufficient and attempts at reassurance were pointless. In other words, it’s a very temporary solution.

I would suggest talking to your Priest and joining a support group. Obviously consult with her physician concerning the hallucinations and paranoia.

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Firstly, I’m deeply sorry for your situation. I lost my dad twelve years ago and can only imagine you watching the decline of your mother. I admire you for caring for her with such love.

I like your term ‘therapeutic fibbing’. The truth is…not the truth in your mother’s mind. You are acting with charity by matching ‘the world’ to her inner truth to help her have the best quality of life possible given the circumstances. When she acts out as you describe, she’s terrified and psychologically flailing. Your ‘therapeutic fibbing’ helps her to find something to hold onto.

May God return to you the blessings a hundredfold of your current sufferings and dedication of care you’re giving a parent.

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Therapeutic fibbing aside, if it’s as bad as you describe, you need a whole lot of outside support from experts and professionals

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You are treating your mother with kindness and charity with your responses. My mom went through a similar situation just a few weeks ago when she was in the hospital. She wouldn’t drink the water to take her pills - they put something in the water - it’s a conspiracy… My sister said she had some water from home in her car. She went next door and got a cup of hospital water, entered the room a few minutes later, and gave mom the water. Mom was satisfied. I’m sorry for what your mom is going through and the tremendous pressure it puts on you. I’ll keep you both in my prayers. I found singing hymns would distract my mom when she was real bad - music memory is one of the last things to go.

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Oh my goodness, that sounds like such a hard situation. Sending good wishes your way.

The “therapeutic fibbing” is likely calming her down, reducing her stress level, and preventing her from doing something harmful to herself (like pulling her hair or worse). It seems like it’s helping with the safety in the situation.

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I’m sorry you are going through this. It must be difficult. I’d agree you will likely need serious and professional help soon.

Since you have asked, I will tell you that it is always wrong to lie. It perverts the faculty of communication. Despite what many will tell you, this is Catholic morality - even though it is uncomfortable.

However, it might be plausible that what you are doing is not actually a real use of the faculty of communication due to the mental deficiency of your poor mother (as communication requires rational reception, at least of some kind), and therefore it cannot actually be lying, but that is not clear. I would suggest being more creative with your reassurances - with something that is either true in some way (“I talked to them. You need to be here tonight,” which is true, assuming you actually have ever spoken with them - and you could draw a lot of content from this kind of use of language, using anything they ever said or did as “matter” for reassurance - I hope that makes sense) or to use something altogether non-communicative, like the efforts you’ve been doing to distract her.

I will pray for you both.

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I had a patient who didn’t want me to change her Depends because she didn’t have any money on her to pay for it.
I told her the company was giving free samples and then she let me change her.:slightly_smiling_face:

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When my 2 year old niece wants me to feed a cookie to her doll, and she gets in a state of panic that her doll will starve, it is not a lie to pretend to give dolly an Oreo.

You are doing the same thing on a far more intense scale. Prayers for you.

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Lying requires two things: an intent to deceive, and a subject with the right to know the truth.

Your mother may theoretically have a right to the truth, but her truth is no longer true. She is already deceived by her own faulty intellect. Your statements to her are made in all charity, to help her keep that imaginary world together.

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I work as an STNA/CNA and have been working the dementia/lockdown unit in a nursing home consistently. I frequently have to do the same things, usually many times a shift. I have wondered (and admittedly do still wonder, despite the advice I have been given) whether it is a sin to lie under these circumstances. I think there is a vast difference between this situation and the sin of lying. Though it is not necessarily good to tell something that isn’t true, in this case you are not intending to withhold something from someone who has a right to know. People with these mental decline problems cannot know, it’s like the capability to know is just gone.

If it is true that stealing a candy bar from a millionaire would be venial matter while stealing a poor woman’s only dollar would be grave (to reference a common example used to illustrate the difference between mortal and venial sin), I think that same logic can be applied here to. Even if this was a sin, which I do not think it is, the effect would actually help the person being lied to, rather than hurt them, and so it could only be venial at most I think.

The end, which is to help the person, is good.
The means of lying to a person who does not even have the capability to comprehend the truth is neutral, I think. That italicized bit is what makes it neutral. If you were lying to someone who did have the capability of knowing the truth and had a right to know, then it would be bad. But that is not the case.

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I don’t think this is sinful. Your preist could tell you for sure. I worked for years in a residential facility for adults with alzheimers and other disabilities. I came up with lots of creative things to reassure residents who were very confused and not in touch with reality anymore.

In a training I took for working with those who have dementia I was told it is not productive to try to “reason” with them when they are upset(in your case, that your grandparents are deceased and your mom can’t go there). It is better to distract or to say something to reassure them, which you said you are doing. Routines are very helpful as well.

There are medications to help with the effects of dementia, but they are not cures. Maybe your mom’s doctor could go over some of those options with you.

You and your mom will be in my prayers.

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I can’t give any advice from a moral theology point of view but as an unbeliever who try to avoid lying I would not see this situation as lying. What you are doing is similar to acting in a play. You do not intend to deceive, you intend to bring a benefit to the people watching by letting them use their imaginations to take themselves to ‘a different place’.

Interesting topic.

Given that a person with advanced dementia may not reliably distinguish reality and truth, the OP’s question revolves around what it truth to a person in a state of dementia?

Is a lie being told in an attempt to deceive them (in a negative sense)? Seems not.

Perhaps it’s like a doctor saying “now this won’t hurt” instead of “this is going to hurt like pain you’ve never felt before, but only for a minute”?

As a former caregiver who has dealt with people with advanced Alzheimers, no, you are not sinning by fibbing to calm down someone who is hysterical because of hallucinations and delusions. That can be the only way to safely manage them and restore their peace of mind – and yours.

I took care of an elderly Alzheimers patient in her home, where only she and I were present. She kept saying the “people upstairs” were making too much noise. There was nobody up there, of course, but to ease the situation, I played along. I went to the bottom of the staircase and yelled up to the imaginary folks, “Hey! Quiet down up there!” That satisfied her, and then I distracted her attention elsewhere.

She was sitting on her sofa one day and informed me that the mirror in the cabinet across from her was on fire. I placed a damp towel over it to smother the imaginary flames.

In situations like that, you have to play along. You can’t reason with someone, or convince them they’re wrong, when they aren’t in their right mind.

Is that a soul-killing endeavor though, playing along? Does it not get difficult to playact with someone who is not in their right mind, does it mess with your own sense of reality or what’s appropriate? We often assert that people with, e.g. gender dysphoria should not be humored but disabused of their delusions, and now we’ve got situations where the caregivers are giving into the delusions to keep the peace. It makes sense to me but it still seems inconsistent.

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