Anger without Reason

Because her eighty-year-old father had been diagnosed with Alzheimer’s, a friend of mine helped her parents move from their home to a nursing home.  Her parents had had a long and compatible relationship, but now her father railed at his wife and treated her unkindly.

“I want a divorce,” he shouted at her one day in the nursing home.

Hurt and mystified, she packed her things  and went to live with her daughter.

“Why are you leaving?” he asked as he watched her head out the door.

My friend’s mother was astounded that her own husband was so uncomprehending.  My friend was trying to understand.  I assured her that her father’s behavior was not unusual.  He was trapped in a world he could not make sense of; he felt fear.  Everything and everyone seemed to conspire to confuse him.  He lashed out against the confusion.

I understood how my friend’s mother felt being on the receiving end of the lashing out. My hardest lesson was to learn to accept unreasonable anger directed at me.  Dan and I argued during our nearly forty years of marriage, not always gently, but on both sides there was an attempt at rationality, a recognition of lines we would not cross.  By early summer of 1997, Dan’s anger was escalating.  He would push or shove me and verbally abuse me.   My tolerance diminished.  I needed time to get away.  I hired Liz for fifteen hours a week.

Liz, a person I had hired to at times stay with Dan while I took a break, was on hand to help when our private road association held its annual meeting at our house.  All went well until near the end of the event when Liz had to leave.  Dan became upset and stomped around amongst the guests.  In order to calm him I gave him his camera and urged him to take some pictures—photography was one of his passions.

He marched away down the driveway, and as I tried to bring him back, he hurled the camera to the ground.  The embarrassed guests quickly said their goodbyes and left.

Thrown objects became a regular feature of our life:  a plate of food was thrown so hard that it gouged the floor, a watch hurled at me left a gash in the bedroom wall.

“Why?” I asked Liz.

I expected no answer, but she gave me one:  “Because these things frustrate him.  Suddenly he doesn’t know how to use them anymore, doesn’t know how to tell time on the watch, doesn’t know how to work the complicated camera.”

She was right, and I tried to change my behavior.  Dan had for years kept daily records of the weather, and now I helped him enter the data each day on the computer. When he became restless during the process, I stopped the activity.  I didn’t want to. I didn’t want to admit that Dan had lost another skill, another part of who he was. I was having a hard time accepting the reality of his condition. I wanted to believe that if he would just keep trying….

I had  taken a baby step toward coping with his increasing anger, but I was a long way from being able to accept his anger. When he grabbed my wrists, I would break his grasp using strong force and angrily tell him, “Don’t do that.”  He would respond by pushing or shoving. If I then touched him to move or to direct him, he became more agitated and violent. My anger escalated his anger.

By late summer of 1997, I was desperate, and Dan was a threat to me. Taking him for a drive would calm him, but my anger was with us.  I would make stupid threats.

“I am going to have to send you away if you don’t stop this, etcetera, etcetera, etcetera….” which, of course, escalated his anger.   He would open the car door and slam it as we drove and even try to grab the wheel.

The hospital social worker facilitated the meetings of an Alzheimer’s caregivers’ support group. I called her during one of Dan’s tantrums. “What should I do?”

“Call the police,” she said.

I envisioned the police coming and dragging off a kicking, biting, screaming Dan and locking him up—and then what? How would things change when they let him go? I suspected he would be more angry.

A woman at the support group at the hospital had taken her husband to a care facility that dealt with violent people. She told of his being put into a straight jacket every evening when he “sundowned”

(Better understanding of Alzheimer’s’ behavior  has led to more effective responses when dealing with aggressive behavior such as sundowning, a  term describing a common syndrome in Alzheimer’s patents where they become more agitated at sundown. I read that sundowning indicates the person is either thirsty—perhaps dehydrated—or tired, and I found offering drink or rest did alleviate the agitation. )

I did not take the social worker’s advice and call the police nor did I send Dan off to a lock-up facility where he would be put in a straight jacket.  I repeatedly took him to the hospital emergency room where he was given medication to temporarily calm him.  He was then sent home because the hospital had no secure area in which to place Dan to prevent his wandering away.

After repeated trips to the hospital, the social worker and Dan’s doctor were encouraging me to look for a place to put Dan.  The social workers’ mantra was “Caregivers just don’t know when to let go.”

In the Fall of 1997, a trip to the hospital led to a positive solution.  The young doctor on duty suggested that Dan be admitted to the regional hospital’s mental health center where a psychiatrist and Dan’s neurologist could evaluate him.  The doctor believed that medications could control Dan’s aggression and make it possible for him to continue living at home.

The regional hospital was one hundred miles away.  We drove there one sunny morning, and Dan was admitted to the mental health center.  Both of us were interviewed by the psychiatrist and several of the Center’s staff.

“What caused the anger?” I was asked, and felt defensive—as if I had caused the anger.

Dan’s anger was usually a surprise to me and was not triggered by abuse or aggression on my part.  However, what slowly dawned on me as I detailed our interaction was that I did play a role by the way I responded.  Neither the psychiatrist or the center’s staff ever told me I had erred in returning anger for aggressive behavior, but I was led through a process of looking at the dynamics of the interaction between Dan and me.

Dan spent more than a week at the mental health center.  The first two days my guilt forced me to drive the two hundred miles round trip to see him.  The third day I stayed home.  The time at home alone was a gift.  I slept and slept.  I visited Dan again on day four.  He tried to convince me to take him home, but my guilt was far less than the relief gained by the respite from twenty-four-hours-a-day care.  The emotional support I was receiving from the Center’s staff strengthened my resolve.

Dan was put on two drugs that seemed to work:  Respiradahl for aggression and Paxil for anxiety.  On the eighth day, Dan was able to come home.

Our time apart had given me time to think.  I told myself I must separate the anger caused by the disease from Dan the person.  We often tell our children, I don’t like your behavior, but I still love you. I realized that I was giving Dan his emotional cues and that all of my emotions were being reflected back to me tenfold by Dan.

Over time my anger was replaced by understanding. I didn’t deny my own feelings of anger, but I tried to stay relaxed and calm, be patient, redirect Dan’s attention, and find a way to gain Dan’s cooperation.  If he grabbed my wrists when I was helping him dress,  saying matter-of-factly, “Don’t hold my wrists, that hurts, please let go so I can help you button your shirt,” usually convinced him to let go.  Tone of voice was all important. A silly or humorous comment or action from me often eased tension.  He loved silliness and jokes.

Life would never be what it once was, but thanks to the medication and my own increased understanding, our lives were stable.

Note: Dan developed a twist in his back, although he did not seem to be in pain.  He seemly could not stand up straight.  After months of physical therapy we happened to have a routine follow up appointment with the psychiatrist. He noted Dan’s decisive tilt and lowered the dose of Respiradahl which solved the problem.