Lesson 14: The Past and How much it Matters


Attention

Our past and our present coexist.


Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Identify connections between early childhood environment and mental health
  • Identify ways in which people can rewrite their life story

Teaching

Read Chapter 3 in Vaillant

You might wonder why I have stuck this particular Lesson in between lessons on "Alzheimer's and Dementia" and "Managing Behaviors and Symptoms"!

Vaillant's chapter is all about the importance of early childhood environment on later development. It is not the only factor, but we might consider that it is not uncommon for a person with minor neurocognitive disorders (dementia) or Alzheimer's to revert to the "past" as if it is happening right now. In those circumstances, the past, whatever their early years were like, are all they have.

Erikson

Long ago Erik Erikson posited that early developmental challenges (such as Trust vs. Mistrust, Autonomy vs. Doubt, etc.) which resolved on the "positive" side made it more likely that later stages will be "positive" as well...so, we might say, the person who developed a strong sense of "Trust" in the earliest years, is more likely to have "Integrity" in late life.

In the Vaillant study early environments were assessed with the following:

  • Warmth and stability of home atmosphere
  • How warm and encouraging (i.e. conducive to basic trust) and how conducive to autonomy, initiative, and to self-esteem was person's relationship with is mother?
  • With his father?
  • Did he have siblings? If so, did he enjoy supportive relationships with them?
  • Would the rater have wished to grow up in that home environment?

As we read Vaillant's accounts of good and bad childhoods, we have to consider some of the childhoods of the clients we serve in the Mental Health field. Sadly, many of these childhoods lack the very substance of what is being assessed in the questions above.

Yet there seems to be some hope. Old age can be a time to rewrite your own history. Indeed, "restorying" is one of the hallmark stages in the counseling/recovery process. It is not so much forgetting the past as much as it is rewriting its meaning.

Working with Family Members and Caregivers (including other professionals)

What the field of Mental Health brings to the situation is a deep understanding of cultural factors associated with the expectations of aging.

When we think of aging person we rarely come up with the picture painted by the symptomatology indicated above. In addition, based upon individual cultural expectations, some of these behaviors may be quite upsetting.

Some of the cultural aspects of aging we contend with when we are working with others include:

  • Beliefs about aging and the role of older people
  • Beliefs about memory changes with aging
  • Religious beliefs and cultural norms
  • Size and location of racial/ethnic communities
  • Availability of family and other caregivers
  • Perceived burden
  • Availability and accessibility of culturally appropriate health care services

Our role may be to help everyone orient towards these factors and needs in managing the care of individuals who are manifesting these symptoms.

We may, for example:

  • Teach family members about the disease and how it progresses
  • Provide materials to dispel myths associated with aging and memory
  • Identify cultural and religious needs in a family to caregivers and decision makers
  • Help professionals understand the limited availability of some family members
  • Help caregivers identify and contend with the real burden of caring for another individual

Assessment

Possible Class Discussion

Reflect on the story of Oliver Holmes. Would you have liked to grow up in that household? How does this compare to our own experiences of childhood? To the experiences of our clients? How can we help our clients rewrite their life story?