I see my mother two or three times a year. Every time I come from the US to visit her in Britain, I spend a few days explaining to her how to use her TV and VCR. Now 77, she wants to be able to watch her videos but she gets very confused. To add to her problems, the UK has recently converted to digital TV, which means now she has a new remote control to struggle with. So now there's the TV remote, the VCR remote, and the Digital TV Box remote. The buttons are little and she has difficult pressing the right buttons. When she does press them, she holds them down hard for minute or so. Each time she has more difficulty learning new information, and makes the same mistakes again and again. Telling her to press the buttons gently and quickly doesn't do any good. The remotes are not designed with people like my mother in mind. Instead of words, the little buttons have little symbols on them. I have drawn much larger pictures of the remotes on pieces of paper with words explaining what the different buttons do, but these pictures don't help much. I wrote a list of instructions about how to turn on the TV and the Digital TV Box and select the desired channel, splitting up the procedure into several steps, but that's pretty confusing. I wrote another list of instructions about how to use the VCR, but after practicing for four days, she still gets confused. I doubt she will be able to watch many videos in the coming months. The whole process of explaining how to use the TV and VCR requires a great deal of patience -- generally more than I have. She was never very adept with this sort of technology, but clearly her abilities to remember and follow instructions have become worse. I tell her she needs to turn on the VCR, and she looks at me blankly. Occasionally she succeeds in playing a video, and sometimes she gets so frustrated she says she is just going to give away her video collection. I wonder why it is not possible to buy a TV/VCR combination designed for older people, but then I remember that VHS videos players aren't even for sale any more in the UK. My sister has suggested that my mother get a DVD player, but I tell them there is no way she could ever work out how to use it. Even if we could find a more user-friendly machine, my mother wouldn't be willing to pay for one, and she would get confused by having a totally new piece of technology in the home -- she is confused enough by the ones she has had for several years.
My mother's always had difficulty with technology. According to my father, forty years ago my mother had about one hundred driving lessons, and then the driving instructor gave up, saying that after a hundred lessons, she still didn't know where to put the key to turn on the ignition. She has often had problems with manual dexterity and hand-eye coordination too, yet she was able to use an electric typewriter for many years. She is able to use a telephone without too much trouble. So it's hard to know exactly what the problem is.
My mother has many skills and is able to cope on her own. She has always loved reading, and she often goes to see the latest art movies. She speaks several languages. She is often good at getting other people to help her, and she has some old friends. She had two marriages and two children. She strikes many as being full of emotion, charismatic and caring. One woman she knows recently described her as having a heart of gold.
I see her rather differently: she was rarely attentive to me or my sister when we were growing up, and in many ways has always been mainly concerned with herself. Everyone who has ever lived with her has ended up shouting at her, and on a regular basis. She makes people close to her angry with her, generally by asking what they want, and then completely ignoring what they just said and doing what she wants. Maybe she means well, but she is deeply frustrating.
She's a physically small woman, but she drinks a fair amount of wine, often starting well before lunch and going all day. Occasionally, with the encouragement and nagging of others, she cuts down a little but soon she goes back to her regular amounts. Her alcoholic father died in a psychiatric institution, a fact that she occasionally mentions, possibly with the thought that she may face the same fate. I don't know what psychiatric diagnosis she has, but I do know she takes a mood stabilizer, and has done so for nearly forty years. Her two sisters, both younger, have also had their share of psychiatric problems: one is a non-stop talker for every single minute she is awake, and made a suicide attempt at one point; the other has had significant problems with agoraphobia and depression. Their mother never got a diagnosis, but apparently she was so eccentric that her daughters would never bring their friends back home in case their mother embarrassed them.
Talking about my mother with others, I speculate about possible causes of her cognitive and emotional problems. We can come up with a long list of possible explanations: manic depression, attention deficit, learning disorders, her abusive father, the death of her mother, postpartum depression after the birth of my sister, Asperger's syndrome, alcohol abuse, Korsakoff's syndrome, decades of taking lithium carbonate on top of a steady diet of alcohol, her husbands, loneliness, Alzheimer's, or possibly some kind of brain damage. She's been evaluated by mental health professionals, but they don't invest much time in subtle diagnostic issues; she is stable on her current medication and on the occasions she has stopped taking her lithium, she has become more difficult. She is not motivated to try any other forms of treatment, and it is very hard to imagine any kind of talk therapy being of any possible use. She's not willing to make much effort to reduce her alcohol consumption. She might benefit from some kind of social services or community support, but so far she has turned down all the options available.
My mother is gradually declining in her abilities to think clearly and look after herself well enough to live independently, but she wants to keep living where she is. She keeps herself busy when she can, volunteering at a local charity store, playing cards with other people, seeing old friends very occasionally. She has a granddaughter, but she isn't really very interested in the little girl, and wonders why the girl makes so much noise. Certainly she can't help babysit or in other ways, and when my sister sees my mother with her granddaughter, it looks as if my mother never had anything called maternal instinct. So my mother spends a great deal of time alone, fretting about Princess Diana, little baby Madeline, and the latest human interest stories on the news. When I visit, I do what I can to help her, but there's only a certain amount one can do to help someone who is unwilling or unable to help themselves. As with many people with aging parents, I wonder what the future will bring, and find it hard to be optimistic. At some point, we will probably decide that she isn't able to live on her own, and then we will have to work out what to do next. We are already exploring the options.
So there's little to be done but do what I'm already doing and hope for the best. Without someone to help her, my mother will struggle on her own. She'll get out the instructions and try to work out which remote is which, and what she should do after she puts the video into the machine. Hopefully she will have turned on the TV first. There's nothing more I can do to help, at least until my next visit.
Tuesday, January 29, 2008