Saving Face: Preserving the “Person” in Alzheimer’s Disease
Image credit: Saving Face by Merrie Stringall Irwin
The face. The most clearly-recognizable human part. That flag unfurled which bears our identity to those who would see and know us. So important is the face that large portions of our brains are involved in facial recognition and interpretation.
But what do we do when the face no longer speaks? Many of us who have encountered Alzheimer’s disease ask this question.
We train all senses to glimpse some fleeting flame of the one we knew (in the way we knew them before). Rejoicing in each momentary return, we resolve to try even harder tomorrow.
Harsh reality shows that we can’t get what we long for, no matter how hard we strive. The person with Alzheimer’s disease can’t be brought back in the way we knew them.
We can’t reignite the flame to again share in its glow. Does this mean the light behind the eyes has gone out? Emphatically, no!
It becomes critical for us to broaden our concept of “face.” For the ancient Greeks as for later generations, “face” might have meant the façade or mask over what lies beneath.
When we mentally visualize a familiar face, our minds produce the collective experiences through which we know the person. This happens despite the morphed façade, the altered mask created by Alzheimer’s disease, and helps us to still genuinely see the person we know and love.
In truth, we help this person “save face” through making a gesture in our minds by which we intend to preserve their dignity and honor.
How do we translate our mental images in such a way as to build them up? We do this through strengthening our relationship with them, entering into their world as totally as we can and validating them there, then bearing to them the banner of their true face in the mirror of ourselves.
When we still see clearly who they are to us, when we train our eyes to peer past the unspeaking façade of Alzheimer’s, we bring about the translation of our mental images into actions which build up the personhood of those with Alzheimer’s disease.
First, we must act as their memories. Then, we must validate that which is good, essential and true, so we promote dignity and quality of life. We must reconstruct their face within our consciousness by knowing them as completely as we can.
By showing that face back to them, they recognize it as their own.
Validate your loved ones as they are now. If we validate only who they were in the past, our efforts to up-build will abase who they are in the present. We must partner with them in their ever-changing reality and appreciate who they are.
We must help them preserve personhood. We must help them save face.
Even though Alzheimer’s disease affects verbal ability, the person still has much to say. Minimally affected by the disease, the heart and emotional self of the individual seek expression.
When the enduring self is liberated, the person’s “face” becomes enlivened. We caregivers must help our loved ones find their most natural expressive avenues.
As an essential element of person-centered care, the expressive arts (art, music, poetry and other literature, dance and drama therapies) represent an important means of self-expression in those with Alzheimer’s disease.
Combined with reminiscence, these therapies have been shown to improve communication, foster relationships, elevate mood, reduce agitation and adverse behaviors, and give respite for caregivers.
Overall, they promote dignity, improve quality of life and foster personhood. What more could we seek to do for our loved ones than this?
I am reminded of the powerful photograph of the World War II soldiers hoisting the “Stars and Stripes”over Iwo Jima. We caregivers need to raise the flags of persons fighting Alzheimer’s disease.
Just as every American gazing upon that poignant image feels inspired to symbolically lend a hand, so the ones with Alzheimer’s disease, drawn by their own raised banners of personhood-preserved, find courage to be themselves again.
Bearing the banner. Saving face. And, with wounded hand clutching wounded hand, we will lift each others’ banners to the skies.
Daniel C. Potts, MD is a noted neurologist, author, educator, and champion of those with Alzheimer’s disease and their caregivers. He was chosen by the American Academy of Neurology as the 2008 Donald M. Palatucci Advocate of the Year, serves as an AAN national media spokesperson for Alzheimer's disease and other forms of dementia, and is a faculty member at both medical schools in his home state of Alabama. Inspired by his father’s journey through Alzheimer’s disease and his mother’s dedication to caregiving, Dr. Potts seeks to provide hope and support to those in like circumstances.