Fighting Alzheimer's As A Family In Conflict

"Alzheimer's dementia is unrelenting and other crises will eventually arise, often forcing family caregivers to drop their qualms, set aside guilt and accept the next phase of care."

In an early scene of the family caregiving movie, What They Had, the concerned but angry adult son (played with simmering resentment by Michael Shannon) tells his tough Irish-American father (played by Robert Forster) that he should think about the stages of his wife's dementia — open his eyes to the extent of her terrible decline with more to come. He is trying to convince his stubborn father that memory-care placement can't be avoided. The father responds with swift, thunderous dismissal: “Those stages are horseshit!”

Scenes like that one are played out in homes around the country as families of all configurations wrestle with tough decisions about how to best care for loved ones.

That father-son moment certainly hit chords for me as a clinical psychologist and former caregiver for a mother and step-father with dementia. Like many family caregivers on the frontlines, the father is reacting out of a complex mix of roiling emotions, unwavering values and long-established patterns of family conflict.

He dismissed the stages of Alzheimer's that he clearly knows, a way of denying the reality of his beloved's marauding disease — defying the contention that any simple textbook model can define who his wife of 50 years really is or will be.

And he is rejecting the notion that family members should dwell on the burgeoning catastrophe. He wants to live in the present, preserving his wife as the delightful, if forgetful, woman she still is now, leaving tomorrow for tomorrow.

Plus, the father is asserting the generational hierarchy. He is telling his pestering, disgruntled son, “You don't get to decide what happens to your mother.” He is insisting they haven't yet reached the stage where the power in their contentious relationship has shifted to the young.

These are just some of the psychological forces depicted in this movie, which is centered on the complicated loyalties of a caregiving family rather than the experience of its wife and mother (played by Blythe Danner) with Alzheimer's disease. Its plot does hinge on the excruciating decision about nursing home placement, as it does in the prolonged drama of many families struggling with dementia. The crisis begins, as it does for many, when Danner's character wanders in confusion around the community for hours before being picked up by the police. The son calls his sister (played by Hilary Swank) to fly from California to the parent's home in Chicago to help him confront their father about the need to ensure the mother's safety through moving her into memory care. The sister, embroiled in the problems of her own nuclear family, arrives with her troubled daughter.

The cast that is now assembled in the Chicago condo resembles many caregiving families in that the immediate crisis has unearthed old dynamics that have been mostly dormant in the years since the adult children left home. The father plays favorites (like most parents do, in my opinion), listening to his daughter but begrudging his son any sign of approval. Not surprisingly, there is a consequent rivalry between the siblings in which the brother resents his sister's special status and greater say in the decision at hand. The sister — a good girl who has always wanted to please her Daddy, even at the expense of her own happiness — struggles to take a forceful stand with him now to see that her mother receives essential facility-based care.

I have seen many families get locked into conflict over the decision about nursing home placement. They become stuck in stalemate and make no substantial changes for long periods of time. But Alzheimer's dementia is unrelenting and other crises will eventually arise, often forcing family caregivers to drop their qualms, set aside guilt and accept the next phase of care. What They Had captures this well.

Family bonds are tested through such passages. I've seen many families in which the old hurts are inflamed and the damage is never repaired. My own family experienced this. I've seen others in which healing takes place when family members rely on one another and love each other more through caregiving's toughest times. New growth and stronger relationships are the result.

If the latter sounds like a Hollywood ending, then you're right; this movie has one, too. But it is a wonderful hope and a small solace of dementia — that all of us engaged in this good but difficult work will overcome conflict to care for our loved one and each other.

Barry J. Jacobs, a clinical psychologist, family therapist and healthcare consultant, is the co-author of the book AARP Meditations for Caregivers (Da Capo, 2016).