It was hard, at first, for Jim Mangi to tell his wife what she wanted to hear.
Mangi’s wife, Kathleen, was beginning to lose her memory as a consequence of what turned out to be Alzheimer’s disease. Like other people in that situation, she sometimes slipped back into her past or became confused about her surroundings.
“At the beginning of the journey, I didn’t know any better than to tell the truth all the time,” says Mangi, now 74, who lives in Saline, Michigan. When his wife asked about her sister, for example, he’d remind her that her sister had died. “And then after Kathleen had wept for a while, she came right back to me and asked me the same question and I did the same thing. What a terrible thing to have to do.”
That’s why many caregivers and their advocates have come to embrace a practice they consider a less terrible thing to do: therapeutic fibbing, a euphemism that basically means lying to people with dementia or other cognitive impairment when it can give them calm or comfort.
“I’ve had many times when I needed to confront the question of whether I was going to be a truthful person or a loving person because I could not always be both at the same time,” says Mangi, whose 73-year-old wife is now in a memory care center where he visits her for several hours a day.
“A person with dementia is in a different world. Their reality is different,” he says. “Nothing we can do or say is going to bring them out of the reality they’re in. In that sense, if she felt her sister was still alive, who am I to tell her that it isn’t true?”
Fifteen years after his wife first showed Alzheimer’s symptoms, Mangi says he’s recognized that “many times the most loving thing to do is not tell the truth. I consider it to be a loving lie.”
A new approach
Now many experts in the field are refining their approach to therapeutic fibbing, beginning with the name. They talk today about “creative communication techniques,” which include diverting the attention of people with cognitive impairments, or distracting them.
Instead of lying outright, says Maureen Beck, a gerontological nurse practitioner at UTHealth Houston’s Center for Healthy Aging and assistant professor at McGovern Medical School, “you can start a different conversation. You redirect them to a memory or to a task, get them busy, get them moving.”
Mangi’s wife, for instance, “used to ask, “Where’s my daddy?’ ” he says. “And I would say, ‘Well, he’s not here right now,’ which has the virtue of being true. And then I would go into, ‘He used to work as a telephone lineman, right?’ And we got into a conversation. It was a connection rather than a correction, and that made all the difference.”