2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

The Best We Can Do

This is a personal story told by a mental health professional. It is an easy story to tell because it is happening as I am telling it. It is the story of two women. These two women are 90 years old and have lived full and productive lives, lives consisting of a myriad of gifts, tragedy, disappointment and achievement. These two women are my mother and my mother-in-law.

I am close to both women and so I feel, very deeply, their experience of their own mental and physical decline. Aging, especially as people live longer, presents us with the ultimate psychological challenge: Watching our bodies break down, and if we have the capacity for awareness, feeling our increasing helplessness and dependency on others for our survival. Much has been written on the indignities of old age. This story is not about that. This story is about relating to people who are living it.

My mother-in-law, Sandy, suffers from severe arthritis and osteoporosis. She lives with constant pain. She used to be 5’10’. She is now about 4’6”. She has tremors and sometimes cannot summon a grip to hold on to the phone when I call her. She still lives in her own apartment with a 24/7 caregiver. She is terrified of forgetting the names of her great grandchildren. She worries that if she is too demanding, her caregiver will leave. She cries and asks me why she is still alive.

My mother, Hanna, doesn’t suffer from chronic pain, and except for her walker and the assistance with bathing she gets at her assisted living residence, is still fairly mobile and independent. She rarely leaves the residence, however, because she has an intense fear of falling. Although it is possible, she has never fallen.

The daily challenges of these two women are a regular part of daily interaction and conversation I have with my wife. We talk about them and are always thinking about how to better the quality of their lives. We buy them calendars so they can keep track of the days and clocks with oversized and illuminated faces so they can keep track of the time. We speak to their doctors and their caregivers and intervene when things start derailing. Most of all, though, we listen.

Aging brings with it all sorts of normal age-related mental phenomena. Sandy and Hannah both suffer from short term memory loss. Sandy suffers from depression. Hanna is phobic. Dependency on others makes them both anxious. What would become of them if their caregivers disappeared? These, however, are not conditions worthy of analysis. They are the cause and consequence of real and living experience: Helplessness and fear of helplessness. These are the themes of their lives and the undercurrent of every conversation my wife and I have with them. Sometimes the power of their experience infiltrates our own psyches and we find ourselves depleted by our own inability, our own helplessness in offering them escape from the circumstances of their age and of their lives.

One thing we have learned (although it doesn’t alter anyone’s reality), however, is that listening is very important. By listening I mean stepping out of my own need to be useful and effective in making things better and being there, profoundly there. I can’t call it empathy because I really can’t imagine what it must be like for them. I call it simply “listening,” and tolerating the helplessness we share, theirs a function of the ravages of time, and mine, of my own inadequacy in offering balm to their suffering.

Knowing and admitting that we cannot turn back those ravages of time, and relinquishing the instinct to want “fix” them, is what “listening” is about. Listening is acknowledging and validating their frustrations and fears. I overhear my wife saying to her mother over the phone, “We can only do the best we can do.”

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