The flow of information about the functioning of the brain is stunning and exciting.  The “emotional brain” is now being examined by neuroscientists in probing and revealing ways in numerous magazines.  In Newsweek, September 22, 2008, Dr. Michael Craig Miller, wrote a scintillating article titled “Sad Brain, Happy Brain.”   

Of course the Miller article is somewhat complex and interlocks with assumptions and knowledge beyond my expertise.  But two ideas struck me as I recalled what sometimes came through to me as my mother’s stubbornness or passive-aggressive behavior.  Dr. Miller described the body’s fear system as being managed by two brain structures called amygdalae.  These systems help us know what to be afraid of, help us remember this data, and respond in ways to protect ourselves.  These fear systems help people scan for and recognize fear in the faces of others.  The part of Dr. Miller’s case that gripped me most was this: “People with damage to the fear system lose these skills. The world is more dangerous for them . . . and the world seems less compelling to them because their “excitement anatomy is impaired.” 

Did my mother change, or did I?  She had never been passive-aggressive in the classic sense, expressing negative feelings in indirect, obstructive, and even destructive ways. But her pattern had changed as Alzheimer’s robbed her of more and more of herself.  We were confused about the “resistant” behavior that seemed to attach itself to sometimes predictable situations, and in which she seemed immune from our distress. 

I now believe that her behavior was in response to a number of her life dynamics, among them:

1.   Her recognition of her loss of independence, 

2.   A need to maintain control of “something,”

3.   Impaired “excitement anatomy” (ref. Dr. Michael Craig Miller),

4.   Fatigue and loss of will to engage essential activities, and

5.   Inability to comprehend what is going on other than that she is ill. (I don’t believe our mother was willfully trying to hurt or punish us.) The neurotransmitters in her system just weren’t working properly.  

When you face such frustrating behaviors, think about what may be happening, and perhaps redefine his/her behavior and adjust yours. Life could become easier for everyone. 

1.   Though the caregiver must have a reliable routine, which generally is good for the Alzheimer’s patient, keep a flexible mindset. If he/she won’t swallow the pill, don’t get into a tug of war; approach again later.  

2.   Stay as relaxed as possible; remember your loved one does not feel as compelling as you do about life, certainly not about a fixed schedule.

3.   Try to figure out what time of day is best for tasks that seem to produce resistance.  The problem may be fatigue level or hunger.

4.   Sometimes a detailed verbal explanation of what needs to happen is very good.  But your own words and body language could convey dread, anger, or anticipated resistance.  To the extent possible, stay calm, supportive, and low-key about the activity. Talking too much may cue up the negative behavior. 

5.   Invite the loved one to activities with a gentle, declarative statement, not in a question format. 

6.   Approach the “dreaded activities” in a by-the-way manner.  Casually lead him/her to the bath, or commode, or bed, etc. when you just happen to be in the neighborhood. 

7.   Start reinforcing positive behaviors with a treat.  This may be offering your presence and discretionary time, a snack, listening to music together, or taking a brief walk – anything you know will be perceived as special. 

In all your work with your loved one remember Dr. Miller’s amazing statement about our brains fear system being able to scan for fear in the faces of others.  Though your loved one’s fear system maybe impaired, what is he/she seeing in your face?  Does what he/she sees set up one of the few defensive skills left, the art of passive resistance? 

Mother was visiting me, and we had plans to take her to meet Mary, another daughter, at a set time 150 miles away.  Everything was on schedule.  Mother cooperated . . . that is, until I suggested she take one last bathroom break before we left.  My fear mounted as she lingered on the commode.  We had been down this road many times, not only around commode experiences, but bathing, taking medicine, getting out of her chair to dress for bed, eating a meal, etc.  These episodes sometimes stretched into hours.  Her barricade around her independence was impenetrable.  The mood would hit her without apparent cause. 

On this occasion, she was resistant, ignored my pleas to come with me, was apathetic in the face of my concern for our trip, and frankly seemed to enjoy her control of the situation.  Tension was mounting.  Mother outweighed me by forty pounds; I could not lift her off the commode.  But after forty minutes of this “sit off,” I approached her again with the statement, “Let’s go meet Mary.”  She said “Okay” in a happy lilting tone.  We went on our way, and the trip was delightfully seamless for the next 150 miles.