“Call Security! She is hitting us!” Nicole, behind her walker, is zooming through the hallway, surrounded by nursing staff. She speaks in a language we don’t understand well. Framed by her short silvery hair, her face is serious, focused. Her walker went straight into the nursing assistant who was trying to redirect her. A few minutes before, her walker had been hitting the leg of a seated resident. While assisting another angry elder, I observe. Nicole comes to rest on a seat nearby. I am not sure what will happen next. I make eye contact. Pointing to my screaming companion, Nicole says something like: “She is a prostitute!” I get it. The derogatory term expresses how much the endless sound is disturbing for Nicole. Security arrives in the shape of a gentle middle-aged man. He asks the nursing staff: ” What do you want me to do? –Stay next to her! She is hitting everybody!” The guard creates a gentle buffer between Nicole and the nervous and loud workers. A doctor has been called. He appears, calm on that Sunday afternoon. It was only four days ago that Nicole was admitted in this community. They have never met. To find the cause of the mysterious rage (fever? infection? pain?) he dives into her medical file. The next step would be sending Nicole to E.R. with the label: “Danger to other people”. Her daughter is called on the phone. She pleads. “Please don’t send my mother to the hospital, I am on my way. Let me talk to her.”

My shift ends before the daughter’s arrival. I drive home with a bitter taste. Is that caring? The following day, I am back at work. Nicole is still with us, eating breakfast peacefully. The staff reports to me that yesterday’s incident was a complete surprise for the family: “This has never happened before. It could be the noise and screaming. Nicole worked as a nurse in the military during WWII. Back then, the sound of screams meant being under attack.” The unfamiliar location and people, added to unusual yelling, had triggered a long buried reaction.

A few days later, I read, by chance, a few pages of Sandi Peter’s soon to be published book.  I was struck, once again, by the pertinence of Abraham Maslow’s hierarchy of needs and how Nicole’s behavior was illustrating Peter’s brilliant explanation of second level needs:

“Second-level needs concern safety. As with the biological needs, safety needs have a high priority, for example, the fight/flight/freeze physiological response.  Whenever we are faced with a situation that feels overwhelming, evokes fear or any strong emotion, this need for safety arises.  Based on our individual personality, we will choose one of these three classic responses.  These reactions are built into the amygdala, the reptilian brain that has to do with the survival of the species.  Even though most of us no longer face regularly life/death situations, the bodily response does not differentiate between types of stress.  It still elicits these primitive responses.  An elder who experiences much anxiety from family pressure to move out of his home, whether openly acknowledged or not, can lash out in defensive (fight) anger.  Family members may become offended or wonder what is wrong with him, since this type of behavior was not evidenced in earlier life.  The situation can escalate and create negative feelings and misunderstandings on both sides.  The culprit, of course, is a primitive drive that has not been recognized as such.  Such strong emotion offers a good example of archetypes and the shadow discussed earlier.  It’s as if there are these pockets of energy (archetypes) that are summoned forth when we find ourselves in heightened emotional states.  It can feel as if we simply tumble into them and are a victim of them, when in fact, our reaction to some stimulus in our life has rekindled that energy.  If you spend time around elders living with dementia, you will see this response come up easily, and for some elders, frequently. The caregivers’ task is to learn the signs of strong emotion and respect this energy.  Attempts at denial, dismissal, judgment, being rational or even using distraction are unhelpful.  Recognizing and responding to the reality of the situation for the elder and offering appropriate comfort will defuse whatever has been activated. “

I am particularly thankful to Peters for pointing out the unusual energy released in circumstances where the safety of elders is threatened. In those moments I have been amazed by the sudden strength displayed.

Heartfelt thanks for the authorization to share an excerpt from AGING MATTERS: EXPLORATIONS IN AGING, MEMORY LOSS, SPIRITUALITY AND SANDPLAY, Sandi Peters (date of publication: 2018)