Dementia is an umbrella term for a decline in mental ability severe enough to interfere with a person's daily life. Dementia can take the form of Alzheimer’s disease, vascular dementia, Lewy body or any number of other pathways toward malfunction, but in the end, the problem is a brain disease that renders the person unable to function normally. Trying to argue with someone who has a brain that is not capable of logic or accurate memory is not only futile, it’s unintentionally cruel. Thus, the practice of validation. Validation is the practice of agreeing with what the person thinks is true. Validation is generally the most compassionate and effective form of communicating with – and providing care for – a person who has dementia.
Prior to the mid1980s, accepted psychiatric theory was that people with dementia had to be re-oriented. In other words, the people needed to be brought back into the real world – meaning the real world as we who do not have dementia see it.
They were wrong
My dad had dementia brought on by surgery that was meant to correct the effects that a World War II brain injury. Tragically, the surgery failed and Dad came out of the operation with severe dementia. I, a completely uninformed person when it came to dementia, became Dad's primary caregiver.
There was little public information on the topic and the Internet was not what it is today. I simply did what seemed obvious and natural. I tried to help Dad feel good about himself. If that meant bending or stretching the truth by creating a medical degree for his wall - since he was certain that before the war he had finished his work to become a medical doctor- well, so be it. I saw no harm in going along with what he thought to be true.
Eventually, a psychiatrist saw what I was doing and gave me a good talking to. I was to re-orient Dad. Bring him back to reality. I needed to stop this nonsense right now!
After the doctor left Dad’s nursing home room I mentally shrugged and continued doing what I was doing. It was obvious to me that Dad’s reality was as real to him as mine was to me and I wasn’t going to create more misery for him by arguing.
Thankfully, around that time, many doctors were gradually becoming more accepting of the work of Naomi Feil, a social worker who developed an approach to dementia called validation. Once her approach was adopted by the psychiatric world as the gold standard of dementia care, I was suddenly considered brilliant. The new doctor couldn’t imagine where I’d learned about this new method of caring for people with dementia. He was really impressed. Once again, I mentally shrugged. All that mattered to me is that I helped Dad live a life with more serenity.
Validation easier for some than others
Because I tend to have a whimsical mind, validation was natural for me. When Dad told me I needed to write the mayor about bringing an elephant to the new zoo, I wrote the letter. I then wrote a letter from the mayor to Dad thanking Dad for his help. To me, there was no harm. Dad felt good. The mayor wouldn't know unless I told him and wouldn't mind anyway. It was win/win.
Validation can have its difficult moments, however. Many people run into issues with people who want to see their long deceased spouse. How do you handle that with validation?
You simply say something believable and then move on. If the husband once traveled, you could tell the wife that he’s off on a trip but she’ll see him soon. Or even that he went to the store but he’ll be back before long.
No matter what your answer may be, the question will be repeated endlessly. When someone tells me that it’s condescending to tell their parent a “lie,” I ask them if they would prefer to have their mom repeatedly grieve her loss as if it were fresh each time you tell the her that her husband is dead?
To me, validation is not condescending. It’s not even lying. It’s the kindest, most respectful thing we can do for our loved ones with dementia. Rather than repeatedly telling them that they are wrong – when in reality they are right because their brain’s reality is different than ours – we validate them as human beings. This validation also helps soften the effects of the stigma many feel over having a brain disease.
Some call these twists of truth “fiblets.” I simply call them compassionate answers. When we can’t say something is true because their version is too terrible - such as when my dad thought that there was a war going on in our community - all we can do is say that whatever happens, we are there to keep them safe. Then we can try to distract them.
What we can avoid doing is pummeling their self-image by repeatedly telling them that they don’t know what they are talking about. We can validate them as people with feelings. We can enter their world where their truth is real and help them live there with some peace. We all need validation. The need is simply more obvious when someone has dementia.