It is hard to believe that about five decades have gone by, but yes, it was in the mid-1960s that Paul McCartney recorded “When I’m Sixty-four” on the Sergeant Pepper album. Legend has it that he wrote those words as a teenager, when his own father turned 64. In any case he was in his mid-twenties when the album was released. When the lyrics say, “will you still need me, will you still feed me when I’m sixty-four?” They reflect a verse in the book of Psalms.  There we read, “God, do not forsake me when my strength fails, do not cast me off” (Psalm 71:9). 

These words come to mind when working with people whose minds are diminished or compromised because of conditions like Alzheimer’s or similar kinds of dementia. Their perception of reality, of the here-and-now, and of where they are at this moment often does not correspond to real-in-the-moment experiences as we know them. I remember well visiting what is now euphemistically called a Memory Unit, and having a resident come up to me with some agitation in her voice. Let’s call her Judy. She knew that she recognized me, I was a familiar and trusted face. With some anxiety in her affect, Judy said something like,

“Can you please get me to the bus stop? I need to get onto the Colfax bus. I know that my mother will be waiting for me.”

It was tempting to stay in my reality and to reply to her, “Oh, Judy, you are remembering something from years ago, decades.  You were a child then; you are a mature adult now.  Further, your mother died forty years ago …” Yet, what would that have been accomplished?  A more confused Judy, as well as her having her relive the sadness of her mother’s death. It would mean a questioning of who and what she was, where she was, and where she was now living. Fortunately, I had been trained in Validation Therapy, a concept developed by Naomi Feil (b. 1932, see bibliography). Said simply, one validates the beliefs of the cognitively compromised person before you. Said metaphorically, you cross over the road to meet the person where he/she is, you deal with that person’s reality.

Our role as professionally trained spiritual care providers is to offer appropriate empathy, compassion, and a sense of responsiveness. We are not there to “cure” the person, much less to show them that their thinking is muddled. 

We are comfort-givers, emblematically giving the person a suitably safe hug, reassuring them, and addressing their well-being. We are an empathetic presence for them, meeting them where they are, and then finding ways to relieve their anxieties. We endeavor to know when to keep silent, and when to speak a word that will assure them of our affection and concern.

Contributed by David Zucker