I'm writing this from the cafeteria of St. Mary's hospital in Montreal. My grandmother is undergoing day surgery for a tumor in the bladder, a minor procedure. I didn't bring my computer, but I brought a notebook, and my intention is to transcribe these thoughts with only minor editing.

Sometimes I feel as if I'm making myself a victim of the situation, since I don't know how to deal with it. I transmute hostility into stress, thus traumatizing myself in the process. How is it that a weakly 90 year old woman can traumatize a man in his prime age?

From the outside it makes no sense, and a couple of women who described emotional abuse by their partners did not get much sympathy from me at the time. I would think, without saying: how is it that you lost your own frame of reference of reality? How is that you did not remove yourself from the situation? Now I understand.

Trauma is an unpleasant memory that emerges unwillingly, and it would come back again and again as a topic of conversation. After a couple of times I would ask: "Well, what would you do differently this time?" and they would say "Oh, I recognize the pattern now, I would never get involved with an abusive person again", and I would think surely there is something in the chemistry with the other person that brings out the worst in their partner, by avoiding the abusive pattern they are avoiding personal growth.

Now I understand the abused person lives under a different reality, that a sick mind sees only the worst in us, and we then become what the abusive person is seeing.

My grandmother thinks I'm clumsy. I might accidentally kick her walker, this is met with a roll of the eyes and a snort of exasperation. This makes me anxious. I'm carrying her coffee and in my nervousness I spill a bit on the table. What are you doing? she says in the most annoyed voice, grabbing the coffee from my hand saying "Jeez, if you want to do something right, you have to do it yourself".

After a couple of times repeating variations of this pattern, you start being nervous just at being with her, thus transforming into the negative image she has created of you. Through her interactions with other caregivers, I have seen that putting up a fight just ends up badly. In her dementia, she never concedes that she is being unreasonable, and minor events can blow to catastrophic proportions if not handled with her needs in mind.

Up until now I have resorted to absolute non-reactivity. It requires me to numb myself, and at the end of the day I'm utterly exhausted. I am still exploring if this is the best way to react, it is certainly the way I have learned to cope with it so far.

I feel like writing out all her forms of emotional manipulation and abuse is victimizing myself. So, as I asked other people, what can be done better? What can be changed in these patterns? I dwell on this and see I do not have an answer. I need external help in answering these questions. The compounding effect of her emotional state, her compulsions and her dementia, makes things particularly challenging.

I've read so much conflicting advice. On the one hand, never argue with someone with dementia. On the other, don't allow them to step over you. I think I must bring these questions to an expert, but I must state them clearly.

  1. What do you do when a person asks for help, but then is inevitably frustrated by the help you provide?

    Clue provided today: My grandmother asked for a pink shirt. I went into her closet and brought one out for her to see. Argh, not that one! she said rolling her eyes. "I'm going to need more hints if you want a specific one grandma", [exasperated sigh] "it's the pink one with long sleeves and white stripes, of course". As her mind caves in , she seems to be losing her Theory of mind and thus expects her to know what she means with insufficient information.

  2. What do you do when the person uses any form of emotional or physical hurt as a form of currency? (i.e. you lightly step on her foot and she howls in pain demanding immediate care).

    Clue provided today: I often forget to turn off light in the closet. Extremely annoyed, she lectures me that we pay a lot of money for electricity and all that jazz. I usually answer "yes grandma". Today I said "Oh sorry grandma, I know you've repeated this to me a hundred times, I was in a rush and forgot again, I'll pay more attention". This left her satisfied. It's more about the importance you give to her. Stepping lightly on her foot and then ignoring it is a perceived lack of respect and she will want to submit you.

  3. How do you suggest changes to the environment which would vastly improve the quality of their life, but the person refuses any change at all?

    Clue provided today: say an expert recommended it. She has a constellation of "advisors" she trusts and will not take common sense from anybody. If she asks at what time she must take her antibiotic, say "the pharmacist said it needs to be with your breakfast and with your dinner". If you say you read it on the instructions, she will not trust you.

  4. Is there a case for pushing back, even if you know it will get you nowhere? In other words: will the person perceive the boundaries of your character? Or is it better never to argue?

  5. When the person is constantly trapped in negative thinking patterns, and will only speak badly of other people (changing the subject does not work in this case), assuming changing the subject does not engage the person, what do you do?

I'll reach out to a support group to put forward these questions. These seem to have straightforward answers, but from my personal experience, and perhaps developed helplessness, I find them vexing. I feel many of these frustrations would be removed if I first had a trusting and respectful relationship with my grandmother. Alas, I have tried everything to please her to no avail.

On the contrary, I feel like I have rewarded her meanness, reinforcing the patterns of abuse. By abstracting the relationship into a manageable problem I feel myself being utilitarian, deep down I know the answer is always love. She might have the image of a clumsy free-loader living in her house for free, but at the same time I have the image of a decrepit and bitter woman whose mind has rotten to the point that she can't realize that she's a monster.

I feel that, as long as we hold these images of each other, no significant progress can be made. I must hold myself to higher ground instead of festering in despair, barely holding my head above water.

The operation went perfect, and today (the next day after writing on my notebook) I find myself with enough hope as to try improving the situation.