Dementia, Emotional Contagion, and the "Caregiver's Mask"

A person holding a mask

Your mother with dementia has asked the same question for the tenth time in an hour. In a moment of weakness, you answer in an irritated tone. The next thing you know, your Mom is angry and then starts crying. You feel horrible…

Emotional contagion. It sounds like a plague or epidemic. It occurs when people mimic the emotions that they see in others. The science of emotional contagion has discovered that this is a known phenomenon in humans and other primates. The part of the brain called the amygdala is attuned to non-verbal cues. Mirror neurons also play a role, enabling people to reflect emotions.

Researchers have found that emotional contagion is increased in individuals with mild cognitive impairment (MCI), as well as Alzheimer's disease. Scientists at the University of California San Francisco's Memory and Aging Center conducted a study in 2013 which showed that emotional contagion increases linearly as MCI and Alzheimer's disease progresses.

Emotional Contagion and the "Caregiver's Mask"

In my own interactions with my Dad, I saw emotional contagion in action and it made me reconsider how I communicated with him. Our relationship shifted from one of open communication based on honesty to something different. It felt like I had to put a filter between us and carefully consider what I told him and how I conveyed it.

I was recently reading the book "Myths of Leadership" by Jo Owen. This sentence resonated with me: "When things go awry, how do you react then? It's at these times you need to wear your mask of leadership: project the style which you want your team to follow."

I believe that this principle can be translated to the world of caregiving. When we wear the "caregiver's mask," we project the emotions we want our loved ones to experience and try to minimize their distress, while suppressing the frustration, sadness, or anger that we may be feeling inside.

The caregiver's mask is a double-edged sword, however. We use it to prevent agitation in our family members, but I think caregivers must also recognize the personal toll it can take. I found it painful to see my relationship with my Dad change – I could no longer share my problems and concerns with him and ask for his advice. I couldn't be open about my emotions.

Tips for Caregivers

I like Dr. Andrew Budson's recommendations for communicating with people with dementia. In particular, I like two points:

  • Remember that the truth is relative. What you perceive as the "truth" may not be what your loved one sees as the truth. Try to see things from their perspective and operate in their reality. There's no value in imposing your world onto a person who no longer understands that realm.

  • Live in the moment. In general, this is a good principle for everyone, regardless of their health. In the context of caregiving, it can be frustrating to discuss current events or the news with someone with dementia. A better approach is to find a topic or activity that is immediate – for instance, I used to bring library books with photos of animals or nature scenes when I visited my Dad. We could look at the pictures and talk about them without stress.

I would also add that although emotional contagion has a negative side, it also has a positive aspect. Just as individuals with dementia or Alzheimer's are upset when they see people exhibit negative emotions, they can be delighted by positive emotions in others. I used to joke around with my Dad and sometimes act silly to make him laugh.

Addressing the impact of emotional contagion isn't limited to individuals with memory issues. Caregivers must also look in the mirror and take care of themselves. It can be emotionally draining to suppress your emotions and to convey calmness and reassurance. Find a trusted relative or friend to confide in. Caregiving is difficult work, especially when it comes to lost relationships. Don't be afraid to seek help for yourself from a therapist or mental health professional.

Photo source: Unsplash