Cognitive Dysfunction or Emotional Dysfunction?

There is a difference between “emotional dysfunction” and “cognitive dysfunction.” For those caring for an old-old, it’s helpful to understand the difference. My mother suffered from emotional dysfunction. And though it hurt my ego, it’s a pattern I was familiar with, and it was not going to change—she was more of who she had always been. It was her emotional dysfunction, not her cognitive dysfunction, that pushed my buttons. I could help her cope with the cognitive dysfunction, but that she didn’t seem to appreciate my efforts was her emotional dysfunction. And I couldn’t change that.

A post from the front line during my caregiving days.

I’ve been feeling that I’m living crown-over-slippers in the Cinderella syndrome. My mother doesn’t seem to understand or appreciate my contribution to her living. Why is that?

Well, I’ve had an epiphany. Living close to an old-old has heightened my awareness of my own immortality. The day will come when I can no longer do what I can do now, and that’s a bit of a freak out; like being the ghost of Christmas future. But what of my mother? She has my youth in her face day in and day out, reminding her of what she can no longer do; the ghost of Christmas past.

I watch my own children in the prime of their lives—raising children, boundless energy for friends and activities, and home improvement without fear of back injury and knee pain; a whole future ahead of them—and I understand a bit what my mother sees. But, unlike me, she has nothing ahead.

I ran across some information online about “emotional dysfunction” and “cognitive dysfunction.” For those of us caring for an old-old, it’s helpful to understand the difference.

My mother suffers from emotional dysfunction. And though it hurts my ego, it’s a pattern I’m familiar with, and it’s not going to change. As our parents age, it’s likely their emotional functioning will become more of what it has always been.

Cognitive dysfunction is another rabbit, and is new to all of us. It demands a new kind of response, and it’s not going to be perfected overnight. The only way to deal with it is to take it as it comes. And just when I figure it out, it changes again. How do I deal with that? Imperfectly. I make mistakes, which pushes her familiar emotional dysfunction buttons and my childhood outrage buttons and we go into battle mode. And then we forgive each other and ourselves and move on.

My mother’s frustration with old age doesn’t manifest in anger often—she is not a person given to emotions, remember? But she is angry, she must be. Her body is failing her. She can’t see, or hear, or depend on “normal” bowel function. She can’t dig in the dirt or change a light bulb or cook her own dinner. It’s outrageous! And here I am: young, active, capable. And in her face day in and day out, reminding her of days long gone, never to return. Reminding her of all she can’t do. Maybe even doing it better than she ever did it. Is she proud of me? Damn straight she is. Will she tell me? Never. Why? Lifelong emotional dysfunction. I’m beginning to see how this works.

It’s her emotional dysfunction, not her cognitive dysfunction, that pushes my buttons. I can, and am, helping her cope with the cognitive dysfunction. That she doesn’t seem to appreciate my efforts is her emotional dysfunction. And I can’t change that.

Like a child who acts out at home, but not at daycare, or an adolescent who holds it all together at school, but is alternately sullen and outraged at home, the frustrated and fearful elder lashes out at caregivers. They feel safe to let down their guard with the person closest to them. Is it appropriate? No. Is it okay? No. Is about the caregiver? No. Is it crazy-making? Yes. Is there anything to be done about it? Was there anything to be done about the toddler or the teen? It ended when they outgrew it. My mother’s will end when she dies. But I can learn to cope with it.

▪️  Time away. I realized before I started this gig that my life still needed to be about me. I’ve been here three and a half years now, and I have clung steadfastly to that resolve. My mother has occasionally challenged it, thinking I’m not earning my room and board. I take trips (but not guilt trips), I have a regular day away each week, I have coffee with friends, I spend time with my grandson (and miss the far away ones). And I have been known to assure my mother that I am earning my keep; and much, much more.

▪️ Get help. A few months after my arrival, when I realized this was not going to be the one year commitment I made, but that it would be until, well, the end of time—her time, hopefully not mine—we hired help. We are lucky she has the resources for that, my sisters and I certainly do not; but there are also volunteers and seniors’ programs, one only need look. And the parent doesn’t have to like it. I didn’t agree to “do it all,” and I’m not going to. I’m just not.

▪️  Engage in and take time for interests. Whatever they might be. Stay relevant to yourself. Follow your curiosities. You won’t get this time back.

▪️ Let go of expectations. I came here thinking there would be emotional recovery. Maybe it happens for some parents and adult children, but I think it’s most unlikely, and then only if the parent is deeply sunk into dementia. We don’t change our spots; certainly not in old age. Lose the glass slippers and pull out the hip waders, there is deep shit ahead. And put blinders on that tiara.

My mother depends on me now, like I used to depend on her. It’s a radical change. And I do just about everything wrong. It’s how it is. And, of course, it’s not how it is. It’s her circumstances that are wrong, not me; it’s her circumstances she is angry at, not me. We are doing well enough, my friends. And even Cinderella got her paradise in the end.

When I Am An Old Woman

Daughter on Duty, January 2015

Mama—whose ENT told her this week she was close enough to 99 to call it that, since she will be the next time she comes to have her ears cleaned out—is fond of telling me what I will understand when I am her age. I will understand what it’s like to be old. What it’s like to lose control over things. What it’s like to lose your independence. What it’s like to feel guilty that I didn’t do more for my mother. Because she wishes she had known all those things so she would have done more for her mother. Then she wouldn’t have spent the past two-and-a-half decades feeling guilty for whatever it is she feels guilty about.

My sisters and I have all pointed out to her that her mother was difficult. That she did the best she could and she has not one thing to feel guilty about. We have wondered why the lesson she learned was not how to be more grateful for everything her daughters do for her. But this post is an exploration of what I hope I understand at 99 because of this experience, rather than what she wants me to learn.

1. It is not all about me. Nor should it be. It would be nice, of course! Don’t we all want it to be all about us all the time? Get over it.

2. If salting my food makes me happy and knocks a day off my life, so be it. In fact, be grateful if it does.

3. There is no cure for old age. Let doctors save their time for the young with life ahead and treatable maladies. *

4. If my child wants to live in my home to care for me, and I can’t talk her/him out, give them the house. Adapt to their decor, their belongings, their organization; or pretend to. Get over it and be grateful to still be in my home, if that is what works best for everyone involved. (See number one.)

4-1/2. Talk her/him out of it.

5. Move to a small dwelling, on a bus line, or walking distance to a grocery store, library, coffee shop if I want to be independent. Otherwise don’t complain about not being independent.

6. Complain to a friend, or a therapist, or a minister, or a tree, or the cat about my children. Not to my children.

6-1/2. Have a cat.

7. Treat a paid caregiver as a companion, not as hired household help.

8. Treat an unpaid child as a partner, not as hired household help.

9. Don’t treat an adult child like a not-adult child. I may think my child will always be my child; but glory be, thanks to me, or no thanks to me, they have grown up. Let them be grown up. They might even know stuff. Gasp. I might even have taught it to them.

10. There is more than one way (my way) to do everything. Some might even be better than my way. Gasp. If it’s not, keep my mouth shut unless asked for advice.

11. If someone fixes my dinner for me and all I have to do is sit down and eat it, just say “thank you.”

12. Don’t feel guilty for what I didn’t do, for mistakes made, for words said, for words not said. Just say, “I’m sorry,” even if the only person I can say it to is myself. Then let it go.

13. Seek information before making accusations. Then skip the accusations. Who needs that shit?

14. Own up to being forgetful or confused. Put a big ol’ sign on the bathroom mirror, “Remember, you forget stuff!” Let it be okay that my child is the keeper of memory. In fact, be glad for it. Say “Thank you for keeping track of the details! I’m old! I can’t remember shit!”

14.5. Say “shit” a lot. Except in the #15 usage.

15. If I can’t see or hear or walk or sleep or poop, assume everyone knows that. Don’t tell people every time I open my mouth. See number one.

16. There is always someone worse off than I am. If there is not, and I deal well with my worst-off status, I win!

17. Realize that we are all interdependent all our lives. Let that be okay. There is no independent and dependent.

18. Don’t be 99. Don’t make getting old the end all, be all. Save up pills. Or something. The oldest person doesn’t win shit.

19. Give this list to my children to read to me when I am old. I’ll probably need a reminder.

20. See number one.

My mother is teaching me so much! Just not what she thinks she’s teaching me.

* I have a different feeling about #3 in 2023. Doctors need to care more about elders—mostly they just need listening skills. But all the rest are still spot on.

Potato Carrot Cabbage Soup

I had rarely cooked with cabbage before moving in with my mother, but she kept buying it and I kept looking for recipes to satisfy her soup passion. This one is super easy, which was my passion.

Ingredients:

4 large carrots, thinly sliced
2 large potatoes, thinly sliced
1 large onion, thinly sliced
1/4 medium head green cabbage, thinly sliced
2 cloves garlic, smashed
6 cups chicken or vegetable stock
1 tablespoon olive oil
1/4 teaspoon dried thyme
1/4 teaspoon dried basil
1 teaspoon dried parsley
1 teaspoon salt
ground black pepper to taste

Directions:

Combine the carrots, potatoes, onion, cabbage, garlic, stock, olive oil, thyme, basil, parsley, salt, and pepper in a stock pot over medium-high heat; bring to a simmer and cook until the carrots are tender, about 20 minutes. Transfer to a blender (or VitaMix or use immersion blender) in small batches and blend until smooth.