Mirror Images

Happy Valentine’s Day to all those who are celebrating love with someone dear.
This was an exciting week for us at Hippocampus Headquarters as we shot a training video for our Brainy Day Program. The anticipation of seeing the final video is mixed with eagerness and hesitation; hesitation seeing what the camera captured as well as eagerness seeing what the camera captured. It can be intimidating seeing yourself, which led me to think about one of the challenging behaviors that can be experienced by those with advancing dementia – that of seeing themselves in the mirror and thinking there are strangers in the home.
Care providers have had the difficulty of dealing with this behavior in various situations and sometimes, if the individual has trouble with communication, it may not apparent why they are thinking an unfamiliar person is in the room. Sometimes it can add to the reason why a person refuses to take a bath, or get dressed or undressed. It can manifest itself in fear to enter or exit a room because “someone is watching.” For some people, it prevents them from going to bed and being able to sleep. Depending on the light in the room and reflection in glass, even pictures hanging on the wall can suggest that there is someone else present.
There are so many ways that the brain can be affected when a person is diagnosed with Alzheimer’s disease or another form of dementia that vision can play tricks, depth perception can be skewed, and the ability for understanding that the reflection is just a reflection may be more than the person can comprehend.
For some people, the reflection becomes a “friend” and someone they embrace for interaction. Care providers have reported the person in their care talking to the image they see in the mirror and feeling comforted. In those instances, there is little harm in allowing the action to continue. It is wise to make the doctor aware and be attentive in case the circumstances change, but as long as it is a positive experience there is little reason to intervene. Trying to convince the individual with dementia that the reflection is not real can be energy draining and futile. It isn’t always easy to balance accepting that this is what the person sees while not “feeding” the illusion that there is another person actually there.
The most effective way to make this happen is through validation. We addressed validation before in other posts but to reiterate, validation is going to the person’s reality rather than trying to convince them to come into yours. The best way to do this is to talk feelings. Listen to what the individual is saying pertaining to the image in the mirror and then “read back” to them what feelings you hear them expressing. For instance, if they see the person in the mirror as a friend, then make a blanket statement like. “I know how much my friends mean to me. It’s good to have friends, isn’t it?”
If the reflection is causing disturbing behaviors or reactions then it might be helpful to cover the mirrors with cloth so the figure cannot be seen or take the mirror down altogether. This is especially true in the bathroom. There are not too many people in the country who would feel perfectly comfortable getting undressed or taking a bath or shower with a stranger in the room. To the person with advanced dementia, it can be impossible for their brain to realize that they are looking at a likeness. Attempting to explain it can be just as frustrating for the care provider as it is for the person with dementia. And it becomes a good time to question whether or not it is worth expending the energy. I have always advised that there is only so much energy to spend in a day. If it is negative energy which leaves you both exhausted, save it for the most important issues. Cover the mirror and see if it alleviates the problem or lessens it somewhat.
Mary Ann