When the Truth Hurts: Lying to a Loved One with Dementia

There's no doubt about it, caring for a loved one with dementia can be really hard. One of the challenges that people often face is knowing how to respond to questions when you know the answer is going to can upset or anger. None of us want to lie to the people we love. It can take a while to feel comfortable with the fact that, when it comes to dementia, sometimes the most loving thing to do it to tell a lie.

In this post, I'll be explaining all about the reasons why lying can sometimes be the most compassionate approach.

Why Lie?

'Therapeutic lying' or 'compassionate deception' is a caregiving technique which aims to reduce the amount of unnecessary distress experienced by someone who has dementia. There is a spectrum that runs from ‘Whole-truth telling’ through ‘Looking for different meanings’, to ‘Distracting’, ‘Going along with’ and finally ‘Lying’. As we move across this spectrum the level of deception rises and we feel less comfortable; who likes lying to a loved one?

As the disease progresses, people typically get increasingly confused or forgetful. This may lead to them 'filling in the blanks' with ideas which you know to be untrue. They may have time-shifted to a younger version of themselves, be increasingly suspicious, or see things which aren't there. Instead of correcting or challenging their misconceptions, caregivers choose to provide a comforting response that involves telling a white lie.

Often, when we dig a bit deeper, when someone with dementia invents a story it actually turns out to be a coping strategy the help them make sense of their confusing world, or boost their self-esteem. When we use a therapeutic lie, we are choosing not to challenge what could be an important way of coping for them. The goal is to minimise anxiety, enhance their well-being, and maintain a strong emotional relationship with them.

When is it Okay to Use Lying?

There is no one-size-fits-all answer for this. As a general rule, if techniques from the spectrum (like distracting, or going along with them) haven't helped to ease the situation then you may want to consider using a lie. This can be a really tricky balancing act, particularly if your loved one has fluctuating realities. As a carer, it can also be difficult to feel as though you are having to frequently deny what you know to be true - especially if it is around an issue that is upsetting for you too.

As guiding principles:

• Try to approach lying from a compassionate stance (if you're feeling really frustrated it might not be the best time to use this)

• Try to understand what's going on emotionally for them and validate those feelings (e.g. "No wonder you feel like that!", "That sounds really annoying")

• Try to minimise distress and promote wellbeing

How Does this Look in Practice?

Let's take the example of the person with dementia repeatedly asking about a loved one who has died. In this case, the whole truth might be really brutal. Imagine finding out that someone you love has died for the first time, over and over again. You might have tried taking their mind off it, but it keeps coming up. What could you do?

First of all, try to think about why this might have started and what is going on underneath it.

If you think they are asking for the person because they want some comfort then maybe you could say "Is there something you wanted to ask them? Maybe I could help?".

If you think they just want to reminisce, how about saying "I can tell you really care for them. Can you tell me more about them? Or show me some pictures?".

If they are getting really agitated and it's causing strain for the both of you, then you might want to use a more direct lie like "They are out now".

You will know the person you care for best, and so it is important to use your judgement about when is the right time to introduce a lie.

Conclusion

Caring for a relative with dementia can be incredibly hard work at times. Therapeutic lying is one tool in the caregiver's arsenal to provide comfort and emotional support. By understanding when and why to use this approach, we can improve the quality of life for our loved ones while maintaining the relationship that connects us. Remember, sometimes a kind and loving lie can be the most compassionate choice of all.

Author Bio:

Dr Emily Shah is a Clinical Psychologist specialising in Neuropsychology. She works in the NHS and in private practice, offering in-person appointments in North-West England and online consultations across the UK.