The Power of Suggestion

THE POWER OF SUGGESTION: MY DAD AND ALZHEIMER'S

[Note: The following story was originally published in the Meridian Institute News (Vol. 5 No. 2, March, 2001)]

    The following excerpts come from a healing story submitted to Meridian Institute from a woman who was a participant in one of our residential research programs.

    "Dad was 79 when the "official" Alzheimer's diagnosis came.  Mother was 72.  Prior to this determination we had been seeing more and more symptoms of dementia — forgetfulness, confused thinking, vagueness, lowered frustration tolerance,  disorientation as to his surroundings and events, to time, to his loved ones and others, and to his not being able to distinguish between fantasy and reality..

    "Looking back it's remarkable to me that throughout the course of this progressive disease, Dad, in his essence and in his character, never disappeared.  His humor, his wit, his honesty and integrity could not be erased in spite of the inevitable changes occurring.  So even though he frequently did not know who he was or where he was, Dad was still essentially Dad.  Besides, even if he didn't know, we knew who he was and we never forgot. Then too, I wonder at times whether this kind of continuity could in some way be a result of using ongoing suggestive techniques with him.

    "Dad was still Dad when the time came for nursing home care.  None of us wanted this to be a solution for him, but the reality of our limitations and the increasing demands of his home care made it a necessity.. It was at the nursing home that I began using bedtime suggestive techniques.  Dad may not have remembered who I was, his daughter. But he became accustomed to hearing the familiar, gentleness of voice with its soothing messages of love and care; and became used to feeling the reassurance of physically being touched and massaged on his back and arms. He visibly would relax into a grounded, calm place — tension easing from his taut body, strain receding from his face, and breathing becoming regular and rhythmic.

    "These positive suggestions were given to him nightly at bedtime, preferably as he was falling asleep.  Although, it was not always possible to catch him at that moment, consistent repetition over time seemed to stabilize his daytime behavior, allowing for his being more responsive and cooperative to redirection when he was distressed or unreasonable.  For, as the disease progressed he was becoming more challenged to understand what was happening in his environment, around him and in him. For example, he would do inappropriate things like entering other resident's rooms without invitation and sitting beside them on their beds.  While he did nothing harmful, it was a disturbing intrusion for the residents.

    "Sometimes he would become perseverative and frustrated when he'd be unable to do something like open a locked door that needed to stay locked.  Staff noted how Dad more readily responded to their walking him through such moments when suggestion was being utilized.  Suggestion seemed to be playing a vital and sustaining role with Dad in his daily life.  And coincidentally, an added benefit was given to me, the suggestion-giver. The suggestive process also calmed me, helping me cope better with this disease afflicting my dad.

    "The content of these simple verbal suggestions began with helping to locate him in time and space, i.e. telling who he was by reminding him of his name and how Mom, my brother, and I loved him and how God loved him and was strengthening him to manage his illness and that God's angels were probably standing nearby to protect him and keep him company.

    "Orienting continued by describing him as a good person who provided well for his family as husband, father, son; and who took very good care of all his friends, customers, employees, and others.  More locating occurred by naming his nursing home and specifying why he was living there, calling his illness by name and giving a short statement about the illness as one that makes for confusion and forgetfulness. And reassurance was given that he was doing a great job at handling it and underscoring specific ways he was doing that.  Options were given to encourage his capacities to know and feel he was loved, to experience relaxation and have freedom from fear in body, mind and soul, and to support the idea that he could choose to be helpful and cooperative with others."


[NOTE: Here is the full text of the letter from which the excerpts were taken for the newsletter article.]

    Dad was 79 when the "official" Alzheimer's diagnosis came.  Mother was 72.  Prior to this determination we had been seeing more and more symptoms of dementia — forgetfulness, confused thinking, vagueness, lowered frustration tolerance,  disorientation as to his surroundings and events, to time, to his loved ones and others, and to his not being able to distinguish between fantasy and reality.  At times he saw me as his cousin from a younger period in his life.  I think I did resemble her.  Sometimes I'd remind him gently that I was his daughter Karen and he might remember.  And sometimes I'd let it pass, if it seemed it would only be creating further confusion and frustration .

    My parents and I lived 150 miles apart.  Fortunately, I was frequently able to travel from Pittsburgh to Erie in order to help out.  The majority of his care involved Mom, of course, plus two women assisting her on alternate days.  These helpers grew to love him as if he was their very own.  They along with Mom and I showered him with attention, humor, patience and affection for the 6 years that he remained living at home before his transfer to the nursing home where he lived another 6 years.

    Looking back it's remarkable to me that throughout the course of this progressive disease, Dad, in his essence and in his character, never disappeared.  His humor, his wit, his honesty and integrity could not be erased in spite of the inevitable changes occurring.  So even though he frequently did not know who he was or where he was, Dad was still essentially Dad.  Besides, even if he didn't know, we knew who he was and we never forgot. Then too, I wonder at times whether this kind of continuity could in some way be a result of using ongoing suggestive techniques with him.

    Dad was still Dad when the time came for nursing home care.  None of us wanted this to be a solution for him, but the reality of our limitations and the increasing demands of his home care made it a necessity.  And when Dad moved, Mom also moved — into the Independent Living area of the retirement community in order to be near him.  For her it was a hard separation to no longer be together under the same roof.  And though she was still in close proximity, her pain around his being in a nursing home blocked the regularity of her visits.  I stepped into that void she left as primary caregiver for Dad (when I was in Erie), secondary to the nursing home.

    It was at the nursing home that I began using bedtime suggestive techniques.  Dad may not have remembered who I was, his daughter. But he became accustomed to hearing the familiar, gentleness of voice with its soothing messages of love and care; and became used to feeling the reassurance of physically being touched and massaged on his back and arms. He visibly would relax into a grounded, calm place — tension easing from his taut body, strain receding from his face, and breathing becoming regular and rhythmic.

    These positive suggestions were given to him nightly at bedtime, preferably as he was falling asleep.  Although, it was not always possible to catch him at that moment, consistent repetition over time seemed to stabilize his daytime behavior, allowing for his being more responsive and cooperative to redirection when he was distressed or unreasonable.  For, as the disease progressed he was becoming more challenged to understand what was happening in his environment, around him and in him. For example, he would do inappropriate things like entering other resident's rooms without invitation and sitting beside them on their beds.  While he did nothing harmful, it was a disturbing intrusion for the residents.

    Sometimes he would become perseverative and frustrated when he'd be unable to do something like open a locked door that needed to stay locked.  Staff noted how Dad more readily responded to their walking him through such moments when suggestion was being utilized.  Suggestion seemed to be playing a vital and sustaining role with Dad in his daily life.  And coincidentally, an added benefit was given to me, the suggestion-giver. The suggestive process also calmed me, helping me cope better with this disease afflicting my dad.

    The content of these simple verbal suggestions began with helping to locate him in time and space, i.e. telling who he was by reminding him of his name and how Mom, my brother, and I loved him and how God loved him and was strengthening him to manage his illness and that God's angels were probably standing nearby to protect him and keep him company.

    Orienting continued by describing him as a good person who provided well for his family as husband, father, son; and who took very good care of all his friends, customers, employees, and others.  More locating occurred by naming his nursing home and specifying why he was living there, calling his illness by name and giving a short statement about the illness as one that makes for confusion and forgetfulness. And reassurance was given that he was doing a great job at handling it and underscoring specific ways he was doing that.  Options were given to encourage his capacities to know and feel he was loved, to experience relaxation and have freedom from fear in body, mind and soul, and to support the idea that he could choose to be helpful and cooperative with others."

    Some of Dad's successes at being cooperative provided him with some nice experiences one of which involved the Nurses Station.  The Nurse's Station was a large square area sided with 4 chest- high walls of built-in counters.  It was like a hub of a wheel.  The spokes of this wheel were the four hallways of the nursing home where residents had their rooms.  While Dad was still ambulatory,  he'd won the heart of some of the staff.  The Nursing Director, who resembled how Mom looked when younger, particularly took a liking to Dad and he her. Frequently he could be seen sitting comfortably in the station next to her, watching her work at her desk and keeping her company.  He looked at home.  It was reminiscent of how Dad would do this with Mom when they worked together in their business.

    Sometimes at the station he'd be doing his own desk work.  Even though he couldn't read or write anymore, he'd be shuffling through and looking over papers and other items that we'd brought for him and were stored there under a counter.  Perhaps it gave him something familiar to do and allowed him to feel useful for something.  And it allowed staff to make use of a comfort zone to interest him when distraction was needed.  A key word to help redirect Dad from some difficult moments was to ask for his help on some project. He'd be right there.

    There were a number of occasions that occurred with Dad that demonstrated his capacity for cooperation when cooperation was needed to manage threatening situations.  In those instances he could use the pathways that had been built through the long term use of suggestive messages to access beneficial solutions.

    One of those instances was a time when Dad was ill. He'd had a running fever which was now spiking and it was necessary to draw blood samples to help in the diagnosis and treatment of it. I was with Mom in her apartment when the charge nurse called late in the evening requesting permission to do this procedure.

    An inner prompting directed me to be with Dad.  It was 11 pm when I entered his room.  Two men (the lab technician and a substitute nursing aide new to the floor) and three women (the charge nurse, medication nurse and a nursing aide) were positioned around Dad as he lay in bed.  They ignored my presence and seemed displeased I had come by. Dad looked uneasy and a bright florescent light glared in his eyes.

    I stood back from them and watched quietly. They were getting ready to hold Dad down to keep him from making any random movements that could interfere with the procedure.  Although  Dad physically had reached the point in his disease of being basically immobilized, he still had movement ability in his forearms, hands, head, and face.  He could also move his mouth, but he could not speak to us with words.

    Without verbally explaining to Dad what to expect (some staff mistakenly believe that Alzheimer's renders its hosts as incapable of feeling anything so there's no point in taking their needs into account), they restrained him.  Dad, startled, physically exploded — fists, arms flailing out.  He struggled to move his immovable torso.  His mouth was pressed into a thin line and his chin jutted out determinedly.  With every ounce of his strength he tried to fend off those he likely perceived as assailants.

    Observing this battle to subdue him, I stepped forward, mustering a calmness and confidence I didn't feel.  I called out firmly, "WHoa!  WHoa!  Hold on here for a minute," as I walked to stand beside his shoulders and head, close to the place where I usually speak his bedtime suggestions.  Situated, I commented,  "Dad'll be more responsive if we talk to him and let him know what to expect."  And with that I uttered a silent prayer that Dad would cooperate and show just what he was capable of doing.

    All eyes except Dad's stared at me with seeming disapproval at my intervening in their business.  But I reminded myself that Dad and his well-being were my business too.  I didn't see the need for this procedure to be frightening and violating.  And in that uncomfortable silence, I began talking to Dad.  His arms and fists were crossed over his chest defensively, his reddened face a mask of stubborn defiance.  He looked at me distrustfully, a result of the intrusion that happened.

    "Dad, it's Karen," I said and touched him with the soft, caring hands he'd felt many times before. "I'm here, Dad, with some other folks who want to help you ……….. You've got an infection and a blood sample is needed ………. You know what that's like ………. You've experienced that other times before ……. In fact you used to tell Rob [my brother] and I it was like a pin prick.  So Dad, you're job now is to relax and to help these folks help you ……… So, Dad, ………………. easy does it, …………. easy does it.

    I continued giving him slowly drawn-out suggestions that gave him time and space to process and do them. I suggested that he release ………. and ………. soften …….. his arms ……. his fists ………. that he relax ……… relax, ……….. releasing, ……….. releasing ………….. I continued gently coaching  as the tension in him began to fade and his arms rested comfortably at his sides.

    With that, I introduced by first name the technician who was beginning to feel congruent with this new process and direction.   And with that, the charge nurse looked me in the eyes with profound relief, saying she believed the staff's services weren't needed any longer at this point.  The technician and I both nodded affirmatively.  And with that, each of the staff quietly moved one by one from the room.

    The lab tech began the procedure.   I suggested, "Dad, you don't have to stay in this room.  You can let your mind take you to some favorite place.  You can go to the Lake (he loved Lake Erie) listen to the waves, feel the sun on your face, and enjoy the sky so blue, blue, blue."  By now Dad was totally relaxed and attentive to my voice.  I continued, "In fact Dad, you could shut your eyes and go to sleep."  With one last look at me, he turned his head away and closed his eyes with a definite click.  He slept through the entire procedure without a flinch while the technician drew 3 vials of blood from one arm and 2 vials from the other.  When I left, Dad was still sleeping a restful sleep.

    So what to make of all of this?  Here lay Dad with dementia and significant cognitive impairment and whose main way of communicating was to blink his eyes for a yes answer and to not blink his eyes for a no answer.  Here lay my Dad who was able to hear, understand and respond to suggestions given him to have a situation ease.  He was able in conjunction with verbal suggestions and in a short space of time to be transformed from combative behavior into behavior that spoke of peace and gave him rest and sleep.  The  situation that started out to use force was able to be disarmed and to become one of comfort and kindness.  Here am I, grateful for the the mysterious power of suggestion and I think Dad would be too.  In closing, a footnote to consider.  Dad was able to interact auditorily despite the fact of his hearing aids not being worn during the above episode. Maybe, an impact of suggestion for him was to learn to listen through the ears of his soul.

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