The Therapeutic Lie

“I’ve never lied to my husband and I don’t want to start now,” Marie said. “But when I tell him that what he sees isn’t really there, he gets agitated.

Joan said, “Harry gets really upset when he sees a lot of animals in our living room. I just open the door, shoo them all out and then tell him, ‘OK, they’re all gone now.’”

“When I’m on the phone to anyone male,” Janet said, “my husband accuses me of making plans to meet later and cheat on him. I’ve gotten so I just tell him it was my son.”

Harold added, “My wife resists going to the doctor and so I tell her we are going out for an ice-cream treat. On the way, I stop at the doctor’s, “just for a minute, to pick something up.” She doesn’t like being left alone in the car and so it’s easy to get her into the doctor’s office. They know what’s going on and so the nurse hustles us right into an exam room and the doctor shows up as soon as he can, saying, “While you were here, I just thought I’d come visit with you for a few minutes.” It works like a charm!”

Like it or not, learning to tell a therapeutic lie is part of being an LBD caregiver.  There are times when telling the truth would only make things worse. Sometimes you just need to avoid the truth, or shade it a little.  That’s what Joan did. She didn’t say, “Yes, there are animals in our living room,” but in an implied lie, she joined in Harry’s reality enough to get rid of his hallucinatory animals.  Janet actually did lie about her phone call because she knew that telling the truth would have fed into his delusions and increased his agitation.

Elvish (link) divides these therapeutic lies up into “going along with a mis-perception, withholding the truth, little white likes, and use of tricks.” Caregivers learn to use them all and most will say that it is definitely in their loved one’s best interest—to keep them from being stressed; to get them the care they need; to just plain keep peace. And no small part of the reason is to keep the caregiver from being stressed out as well. After all, when the caregiver is stressed, so is their patient.

The Family Caregiver Alliance put it this way: When someone has dementia, honesty can lead to distress both for us and the one we are caring for. Does it really matter that your loved one thinks she is the volunteer at the day care center? Is it okay to tell your loved one that the two of you are going out to lunch and then “coincidentally” stop by the doctor’s office?

Allnursses.com recommends that one use therapeutic lying when “the truth would incite mental anguish, anxiety, agitation, and confusion.”

Even people with mild dementia agree that if a person is far enough along the dementia path that they can’t tell that you are lying, and that if it is for the person’s own good, then a lie is acceptable.(PubMed)