Thought this was an interesting read and some might enjoy it.
NY Times, February 14, 2011
Shedding a Protective Cocoon, Woven by Delusions
By MARC E. AGRONIN, M.D.
The woman described the sensation as a delicate flicker, like a moth
trapped in a small gauze bag. She ran her slender fingers repeatedly
over the spot in her slightly distended abdomen and said, Doctor,
right here.
Sometimes, she told me, the flicker gave way to a more forceful kick
that rippled beneath her hand and then spread like a warm tide over
her body. She felt contented and soothed as she imagined the baby
growing inside.
I was tempted to smile, but I kept still. An actual pregnancy would
have been international news: the woman was 83 years old, recovering
from a hip fracture and pneumonia. But her delusion was not unique.
Indeed, our nursing home was having something of a baby boom.
Just the day before, another woman who had recently suffered a stroke
insisted that she had given birth to twin boys, who were now crying in
the adjacent nursery. I reminded her that she was 90, but my words
were no match for the force of her belief. She looked at me blankly
and called again for her babies.
Her husband, distraught, begged me to consider some pharmacologic
remedy. But I was struck not by any mental suffering on the womans
part, but by the opposite.
In the face of terrible losses and confusion, her mind had found
refuge in imaginary children. Their coos and cries brought comfort and
hope.
Pseudocyesis, as delusional pregnancy is called, is neither common
late in life nor a normal response to aging or illness. It is a form
of psychosis, and it can lead to severe anxiety or disruptive behavior
that must be treated.
But it is too easy to see pathology in what may actually be a
protective mechanism in the aging brain. What a psychiatrist might
call a symptom held deep meaning for each woman, and prompted them to
focus on recovering from severe illness.
In each case, I had to act in the opposite direction of my instinct as
a doctor. Medication might have only sedated them and even taken away
a protective cocoon. Instead I let time do its work: the delusions
faded, and physical and mental recovery took hold.
Such examples are relatively rare and, one might argue, easily
romanticized. But they hold a larger lesson about the aging brain.
What we perceive as a brain in flight or decline, disengaging from the
world or tumbling into a netherworld of oldness, might actually be a
more selective, creative and wiser brain.
The paradox is that even as the normal aging brain loses capacity
across numerous discrete skills memory-processing speed, verbal
reasoning and visuospatial ability, to name a few it is
simultaneously growing in knowledge, emotional maturity, adaptability
to change and even levels of well-being and happiness.
I witnessed this common phenomenon in a couple I know well. The woman
is a sharp and active 82-year-old who only recently retired as a
social worker. Her new husband, now 92, was a World War II bomber
pilot and retired marketing genius who always prided himself on his
mental discipline and physical stamina.
Recently he began to complain bitterly of creeping short-term memory
impairment and a general slowing of his motor functions. Both factors
can bring him great unhappiness. During a recent meeting, however, I
pressed him on his complaints, asking, Is that all there is to
growing old decline, slowing and loss?
His bride interrupted and told how their relationship was unique
because of old age, in many ways deeper and more intimate than either
had experienced as younger people.
Even as his memory declined, she said, his emotional maturity and
wisdom had increased, opening perspectives and relationships he had
never had before. Here was old age and an aging brain acting as a
force that added even as it took away.
In telling this tale as a relatively young doctor who works primarily
with older individuals, I could easily be accused of painting an
overly rosy picture of what I want growing old to be.
If so, I plead guilty. But I do so in the spirit of the gerontologist
Thomas Cole, who suggests that the ways in which we look at old age
begin to constitute its reality.
We will all grow old, and despite the inevitable changes we do have
choices. Indeed, growing evidence suggests that the aging brain
retains and even increases the potential for resilience, growth and
well-being.
I have seen this lesson lived in my friends, loved ones and older
patients, whether free of illness or fettered by it. I saw it in the
two older women whose imagined pregnancies brought needed hope at a
time of threatened despair. Their fervent wishes, though unattainable,
allowed them to achieve something better.
Similarly, we can all hope for a vital and meaningful old age for
our elders, ourselves and our children. In the end, we may actually
get what we wish for.
Dr. Marc E. Agronin, a geriatric psychiatrist at the Miami Jewish
NY Times, February 14, 2011
Shedding a Protective Cocoon, Woven by Delusions
By MARC E. AGRONIN, M.D.
The woman described the sensation as a delicate flicker, like a moth
trapped in a small gauze bag. She ran her slender fingers repeatedly
over the spot in her slightly distended abdomen and said, Doctor,
right here.
Sometimes, she told me, the flicker gave way to a more forceful kick
that rippled beneath her hand and then spread like a warm tide over
her body. She felt contented and soothed as she imagined the baby
growing inside.
I was tempted to smile, but I kept still. An actual pregnancy would
have been international news: the woman was 83 years old, recovering
from a hip fracture and pneumonia. But her delusion was not unique.
Indeed, our nursing home was having something of a baby boom.
Just the day before, another woman who had recently suffered a stroke
insisted that she had given birth to twin boys, who were now crying in
the adjacent nursery. I reminded her that she was 90, but my words
were no match for the force of her belief. She looked at me blankly
and called again for her babies.
Her husband, distraught, begged me to consider some pharmacologic
remedy. But I was struck not by any mental suffering on the womans
part, but by the opposite.
In the face of terrible losses and confusion, her mind had found
refuge in imaginary children. Their coos and cries brought comfort and
hope.
Pseudocyesis, as delusional pregnancy is called, is neither common
late in life nor a normal response to aging or illness. It is a form
of psychosis, and it can lead to severe anxiety or disruptive behavior
that must be treated.
But it is too easy to see pathology in what may actually be a
protective mechanism in the aging brain. What a psychiatrist might
call a symptom held deep meaning for each woman, and prompted them to
focus on recovering from severe illness.
In each case, I had to act in the opposite direction of my instinct as
a doctor. Medication might have only sedated them and even taken away
a protective cocoon. Instead I let time do its work: the delusions
faded, and physical and mental recovery took hold.
Such examples are relatively rare and, one might argue, easily
romanticized. But they hold a larger lesson about the aging brain.
What we perceive as a brain in flight or decline, disengaging from the
world or tumbling into a netherworld of oldness, might actually be a
more selective, creative and wiser brain.
The paradox is that even as the normal aging brain loses capacity
across numerous discrete skills memory-processing speed, verbal
reasoning and visuospatial ability, to name a few it is
simultaneously growing in knowledge, emotional maturity, adaptability
to change and even levels of well-being and happiness.
I witnessed this common phenomenon in a couple I know well. The woman
is a sharp and active 82-year-old who only recently retired as a
social worker. Her new husband, now 92, was a World War II bomber
pilot and retired marketing genius who always prided himself on his
mental discipline and physical stamina.
Recently he began to complain bitterly of creeping short-term memory
impairment and a general slowing of his motor functions. Both factors
can bring him great unhappiness. During a recent meeting, however, I
pressed him on his complaints, asking, Is that all there is to
growing old decline, slowing and loss?
His bride interrupted and told how their relationship was unique
because of old age, in many ways deeper and more intimate than either
had experienced as younger people.
Even as his memory declined, she said, his emotional maturity and
wisdom had increased, opening perspectives and relationships he had
never had before. Here was old age and an aging brain acting as a
force that added even as it took away.
In telling this tale as a relatively young doctor who works primarily
with older individuals, I could easily be accused of painting an
overly rosy picture of what I want growing old to be.
If so, I plead guilty. But I do so in the spirit of the gerontologist
Thomas Cole, who suggests that the ways in which we look at old age
begin to constitute its reality.
We will all grow old, and despite the inevitable changes we do have
choices. Indeed, growing evidence suggests that the aging brain
retains and even increases the potential for resilience, growth and
well-being.
I have seen this lesson lived in my friends, loved ones and older
patients, whether free of illness or fettered by it. I saw it in the
two older women whose imagined pregnancies brought needed hope at a
time of threatened despair. Their fervent wishes, though unattainable,
allowed them to achieve something better.
Similarly, we can all hope for a vital and meaningful old age for
our elders, ourselves and our children. In the end, we may actually
get what we wish for.
Dr. Marc E. Agronin, a geriatric psychiatrist at the Miami Jewish
