I was walking past Mr. K, last week, at an assisted living home, and he told me the news: “Menachem, I’m the president.”
“Really?” I said.
“Yup, the first Jewish president.”
How to respond to a statement like this is a quandary that confronts me regularly in my work. After all, the Torah tells us to stay far away from sheker, lies. Yet we social workers, in the course of helping people in all kinds of settings, are often faced with such ethical dilemmas. In fact, the Maryland Board of Social Work Examiners, which licenses and monitors all Maryland social workers, requires every licensed social worker to take ongoing education classes in “Ethics.”
There are all kinds of ethics classes out there, but since my interest is in aging and senior issues, I’m always on the lookout for a “senior-themed” ethics class. I found it. Charlestown, a gigantic and gorgeous senior community in Catonsville, was offering one for free! I couldn’t pass this up. The presenter was Jennifer FitzPatrick, an aging expert (and, of course, a licensed social worker), and her topic was “Therapeutic Fibbing.” What’s that? I couldn’t wait to find out.
This class was not only for social workers but also for nurses, nursing home administrators, and assisted living managers. About 200 people attended. Charlestown is home to about 2,000 residents! They have independent living units, rehabilitation, assisted living, and nursing care. And boy can they throw a continuing education class!
But back to therapeutic fibbing. What’s a therapeutic fib, and is it ethical? Okay, as you may have guessed, it is basically lying. Lying!? We are frum Jews! We follow the Torah, so lying is never allowed. But wait a second – could it sometimes be right? Well, let’s return to my encounter with Mr. K, the Jewish “president.” What would your response be?
Before I tell you what Jennifer FitzPatrick said, let me ask you another question: Do we lie to our kids? I’m not talking about lies like, “Tell the telemarketer that your Mommy isn’t home.” I’ve heard many a mussar shmooze decrying such statements that teach our kids to lie. I’m talking about questions like, “Abba, what happened to the three missing boys?” or, “Mommy, what’s beheading?” These are questions that require a thoughtful response on our part.
Here’s what I learned at Charlestown: There are different approaches in how to respond to an individual with dementia. One is called reality orientation. This method emphasizes the importance of honesty, and the value in consistently portraying the truth. So my response to Mr. K’s announcement might be, “Mr. K, you are a great man, but you are not the president; the President is Barack Obama.
Another approach is called validation therapy, which was developed by social worker Naomi Feil. This approach focuses on the underlying message that the person is trying to relay. So the response to Mr. K might be, “Mr. K, do you want to feel powerful? You are powerful in so many ways.” So it really gets into the psyche of person, and tries to connect with him on that level.
And then there is therapeutic fibbing. According to this approach, the response to Mr. K would be “Mazal tov, Mr. President.”
Which answer is correct? And what can this teach us about dealing with our children, or others with whom we may not always want to share the uncensored truth?
According to FitzPatrick, the bottom line is that we want to benefit the person we are talking to. So, of course, different situations will call for different responses. Individuals with only mild dementia may appreciate being told the truth. They might still have insight into their memory loss and find comfort in being told the truth.
Someone with severe dementia, however, may not appreciate being corrected. The goal would then be not to argue; an argument could end up creating a power struggle that could not be resolved. FitzPatrick quoted Dr. Peter Rabins, an expert on Alzheimer’s disease at John Hopkins, as saying, “If the person is smiling, keep doing it.”
How does this translate to dealing with our children? It suggests that how we discuss things with our kids depends on many factors: their age, maturity, and level of anxiety, to name a few. Emes (truth) is of paramount importance. It is the seal of Hashem. Yet we know that even Hashem changed the truth for the sake of shalom between Avraham and Sarah. We want to be sensitive to our children’s needs and address their questions honestly yet not harm them in any way while doing so.
Well, the class certainly got me thinking. Toward the end of the program, some participants let the speaker know that her time was up, that the program was supposed to end at 11:30!
“But we started late,” explained Ms. FitzPatrick. “We need to be here for the full
