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Friday, November 28, 2014

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The art of listening, again and again

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It was a replay of a common interaction. I was telling my daughter a story from my past and she responded with, “I know, I know, you’ve told me that before.”

I realized what a common occurrence this sort of interaction is and explained to her, “Even if you have heard the story before, remember that it’s important to listen again because I may not remember that I told the story before and the telling of the story may have as much significance for me as it might have for you.”

I then realized how often in my geriatric practice one of the complaints by families is how often their loved one tells them the same thing over and over. They use that symptom as evidence of cognitive decline – the inability to recall what was said previously. This symptom, although common and often indicative of cognitive functional decline, is also a manifestation of the common human propensity to focus on the narrative of one’s life and to recount it as part of one’s process of self-identity and validation.  But, what is the separation between the normal attribute of recounting the narrative of one’s life and the pathology of cognitive impairment that fails to recognize the recent repetition of that story to a loved one?

The telling of stories is important. In normal relationships and conversations, we spend much effort recounting life events to others. The propensity to be repetitive is universal, as anyone in a long-standing relationship will admit. If the topics of conversation between spouses are tracked over time, we would probably find the same topics repeated in one form or another, topics related to work, interpersonal conflicts and important decisions, and about significant family members. A prohibition on the repetition of topics to be discussed would likely result in little communication.

For instance, any member of a couple usually knows the political views of the other partner. When the topic comes up in a social setting, they often patiently listen to their partner express their views to presumably a new audience (although this is not always the case) with rare rude interruptions such as: “We have heard your views before. If you do not have a new one, just stop talking.”

The challenge for those facing the extremes of repetition in a loved one who is experiencing cognitive impairment is what to do. Family members usually learn to avoid interrupting the recounting of an event with: “You told me already” or “I know,” as this may cause conflict with a denial that the conversation has taken place.

In the context of normal aging, family members may find that the retelling of one’s life narrative frequently occurs. This is one way we validate our lives, which is important as the past becomes increasingly important compared to the limited options for the future. This human need to tell our narratives is reflected in the interest by many in writing autobiographies and memoirs and in reading them. Being patient with our narrative-telling loved ones is important to them and ultimately to us.

The best recommendation I can make about this inevitable process is to find ways to be patient with your loved one and accept that even though you have heard the story before, acknowledging it and expressing an interest in it is helpful and even therapeutic to both of you.

 Dr. Michael Gordon is medical program director of palliative care at Baycrest. His latest book is Late-Stage Dementia, Promoting Comfort, Compassion and Care. His previous book, Moments that Matter: Cases in Ethical Eldercare, follows his memoir, Brooklyn Beginnings: A Geriatrician’s Odyssey. All can be researched at his website: http://www.drmichaelgordon.com.

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