Mild Cognitive Impairments (MCI or NCD)

I am writing a chapter about counselling people with mild cognitive impairments:  Working with people with mild neurocognitive disorders (mild NCD) or mild cognitive impairments (MCI)  for a book: Theory & Practice of psychoanalytic psychotherapy in dementia.  Eds Sandra Evans, Jane Garner, Rachel Darnley Smith  (Association for Psychoanalytical Psychotherapy in the NHS, older adults section)

This is an introduction I wrote for the book, though I’ve since replaced it.

  • My memory’s not as sharp as it used to be. Also, my memory’s not as sharp as it used to be.
  • Two elderly couples are chatting. One of the men says: “We went to a great restaurant last night.” “What’s it called?” asked his pal. He racks his brain, then he says: “What’s that red flower you give to someone you love?” “A rose,” his mate says. “Rose,” calls the man, “what’s the name of that restaurant we went to last night?”

We joke about memory loss, particularly as we get older and find ourselves having an increasing number of ‘senior moments’, but this joking is a response to real anxieties, real grief and fear of future losses.  As with any other health symptom, there may be a long period between the onset of problems and any attempt to seek a diagnosis from anyone else.  During this time, anxieties can creep into consciousness, only to be pushed out again as soon as possible, to return in the dead of night when light and companionship no longer offer distraction.

Early symptoms of cognitive impairments bring with them not only the practical problems of the symptoms themselves (which might in fact be relatively minor), but also worries connected with their symbolic and social meaning.  As the jokes imply, minor memory problems do not hinder living, but they presage a time when life can be seriously interrupted: from now on things will only get worse rather than better.  Even mild cognitive problems can signify that life is coming to an end, whatever the realistic prognosis; loss of cognitive capacities is synonymous with loss of a certain kind of life, and its replacement with a very different one.

It is these anxieties which affect mood, behaviour and, most importantly, relationships, which may be brought to counsellors or psychotherapists: anxieties about life and death, about loss of the self and loss of others; about the losses of others too, and concern about those who will have to care for oneself in the future.  In the face of such anxieties people react in different ways; using Melanie Klein’s distinctions, sometimes in a more ‘paranoid-schizoid’ and sometimes in a more ‘depressive position’ fashion.  Some turn their anxieties outwards, attacking and blaming those around them, either openly or just in their minds; some withdraw into themselves; some become very concerned about those they still love; others reject and fight as if they were fighting the devil himself.  Some begin to make plans for their own death. Families and friends may seek help managing the distressing behaviour which can accompany cognitive impairments – often at first not fully recognised or understood but with the power to make everyone concerned feel not only physically and psychologically but also morally ‘bad’.

Counselling can help people to discover their own anxieties and thoughts associated with MCI, to locate them in past experiences or fantasies, and to begin to place them where they belong realistically.  Grief work is often possible in the early stages of cognitive impairment, and it can help to alleviate some of the distress which accompanies fears of forgetting.  Remembering keeps people alive inside ourselves; it also keeps alive a memory of our own past selves.  In this sense forgetting means losing again people who died a long time ago – including lovers as well as parents and lost children.  In a counselling session some of the old experiences can be related and relived, bringing reassurance and comfort that something of the love and affection attached to them has been retained.

About thetroublewithillness

I've been a counsellor for people with physical illnesses for a long time now, and learnt a lot about what it's like living with your own or someone else's illness. I want to pass some of this on.
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