Dealing with (Money) Delusions

From barclaylittlewood.com

I have been asked "What are delusions and hallucinations?” 

Technically, delusions are false beliefs and have a common theme and are paranoid in nature.  Hallucinations are episodes when the patient sees, hears, smells or feels things that aren't there.

It is believed that the long term use of Parkinson’s disease medication causes delusions and hallucinations. Hence, these tend to worsen over time. Delusions and hallucinations are so vivid that they can cause distress to both the patient and the caregiver.

Anna is also affected by both delusions and hallucinations (in addition to disorientation and vivid dreams).

In this post I am going to concentrate on his delusions around money and how we deal with them (I will cover hallucinations, disorientation, and vivid dreams in other posts).

Anna's delusions around money revolve around 2 themes:

1. Not having money – Anna is worried that he does not have money. No money to pay for his daily needs like buying food and paying servants' salaries.  No money for medical expenses. He often thinks that he is in a government guesthouse or hotel and does not have the money to pay the rent.
2. Money has been stolen – Anna has a recurring delusion that “money in a brown leather bag” has been stolen.  He believes that this money has been taken by someone in the house; the attendants or the servant.  He has grabbed at attendants’ trouser pockets to see (feel) if the money is there and has asked attendants to empty their pockets. 

Why These Delusions? 

Tho’ delusions are thoughts or beliefs that aren't based on reality, I believe that Anna’s money delusions are rooted in personal experiences.

Anna grew up in a very poor household. His father was a village school teacher.  My grandfather, Tatha, had 10 children – 7 girls and 3 boys.  Anna has often told us how, when there was no food to eat, they would tie a wet towel around their stomach and go to sleep at night.  The wet towel kept the stomach from aching with hunger and helped them sleep.  

From good-for-nothin.blogspot.com

Anna thinks that he has lost money.  Lost money in not making investments when he should have; lost money in selling assets.  Tho’ we have told him many times, in his pre-Parkinson’s days, that these are notional losses, he continued to believe that these were real losses. 

Anna has been a victim of fraud. He was defrauded of money by a bank. Tho’ it took me over 6 months of work to get the money back, it affected my parents badly – after all, banks are safe places and should not be the perpetrators of fraud, as we believed they were in this case.

Anna is worried about me not working a regular job with a regular income.  And that there is an additional strain on me – what with having to look after 3 elderly people.

How Can We (The Caregivers) Deal With Delusions?

Depending on the strength of the delusion, i.e. how intense / disturbing the delusion is, we can do one or more of the following:

1. Play along: When the delusion is not distressing Anna too much, I just play along.  So, I tell him that the “brown leather bag” is with me.  That the money is safe and not lost. That for his safety, there is no money in the house and that all spending cash is with me.  Often this calms him.
2. Ask why: If the delusion is not mild or continues for some time, I often ask Anna why he is thinking about money.  Is there something that he wants to buy? Often, I find out that he is concerned as he has not seen his pension account passbook or because he believes that a lot of money is being spent on him. I spend a lot of time explaining to him how we manage the basics for him - house rent, salary of all help, doctor’s fees, food, etc.
3. Reassure Often: Every 12 – 14 days, I try to show Anna his bank account balances.  There is very little change between time periods, but seeing his bank account balance helps.  Often he forgets that he has seen his passbook a couple of weeks ago. Sometimes there is confusion as he believes he has more money than there is in the account. Finding the right balance of sharing is the key.
4. Distract: When the delusion is intense, and none of the 3 points above work, the only option left is to distract Anna’s train of thought.  I find that taking him out of the house helps.  A sightseeing ride in the car, a trip to a mall or market, or a long wheelchair ride, all help. I find that at the end of a “distraction” Anna is tired and will want to take a nap.  When he wakes up, the delusion may have ended but is likely to return over the next few days.
5. Deny / Contradict: This is the last resort.  So when Anna grabbed for the contents of the attendant’s pocket, I said firmly “No, Anna!  You cannot do that.  If you want to see what is in his pocket, I can ask him.” Anna did not respond.  I politely explained the issue to the attendant, who understood, and emptied his pockets.

Instances of delusion can occur at any time.  I have, over a period of time, taught Anna’s household to recognize and respond to Anna’s delusions.  They, and I, are still learning, and I believe, will continue to do so, as each delusion is different in its own way, both in context & content.  Added to this, is the fact that, how we react is based not on a mathematical formula but on how we interpret the situation.

None of this is easy.  None of this can be planned for. None of this is predictable.  So its learn-as-you-go doing the best we can.