The Ethicist: What if My Mother’s Extramarital Cravings Are Linked to Dementia?

January 7, 2018 by Joshua
in Ethicist

My series answering the New York Times’ Ethicist column with an active, leadership approach instead of an analytical, philosophical perspective continues with “What if My Mother’s Extramarital Cravings Are Linked to Dementia?

My mother is in her mid-50s, which is the time at which people can develop frontotemporal degeneration (FTD), a form of dementia she is at risk for. Symptoms of FTD include a lack of inhibition or social tact and unusual verbal, physical or sexual behavior. My father and I have at times worried that she may be exhibiting the beginnings of other symptoms. A few years ago, she consulted with a doctor, but no diagnosis was made. I think it is pertinent to note that there is currently no cure for FTD.

She has been married to my father for almost 30 years. They raised me and my two brothers, though we no longer live with them. I recently found out that my mother has been seeking sexual relations through various online platforms, and I am fairly certain that her efforts have come to fruition. I think it is fair to say that these relations have come to be because of a “lack of inhibition”; in addition, I believe that these sexual relations have included things that, for her, would have previously been considered “unusual sexual behavior.”

When I initially came upon the discovery of her extramarital affairs, I was unsure what to do. I thought that it would make the most sense to discuss this with her, in the hope that she would curb her behavior, which I think could eliminate the need to inform my family. If, however, this is a sign that she is developing FTD, I feel that it is pertinent for my family to know of the situation. If I bring this up with my family and it turns out not to be related to the development of FTD, it could cause irreparable harm to her relationship with my father and my brothers. If I choose to discuss this with only her and she is later diagnosed with FTD, I worry that the disease might have been diagnosed sooner if this behavior had come to light; yet, if there is no cure for FTD, it may not matter all that much when it is diagnosed.

I say this, however, with one caveat: My mother is the one who manages both of my parents’ finances. When my grandmother was diagnosed with FTD, my mother and aunt took control of her finances. My mother also noted that perhaps the FTD explained a few strange financial decisions that my grandmother had taken in the years before her diagnosis. If, in fact, my mother is developing FTD, it could pose a risk to my parents’ finances and thus both of their lives after my father’s retirement. So while an earlier diagnosis of FTD would not lead to a greater probability of recovery (as there is none), it may prevent her having a negative influence on my parents’ finances.

I am at a loss of what to do in this situation, as it seems that one choice would almost certainly have a negative impact on my parents’ and my family’s lives, while the other could negatively impact my parents’ financial security.

Name Withheld

My response: We’ve all experienced trying to help someone only to find what we meant to help got the other person angry, frustrated, or the like. We’ve also all experienced someone trying to help us who only made things worse.

I usually respond to letters with no questions by saying something like, “Thank you for sharing your story,” and not giving advice or commenting much more. Not commenting may sound like an easy way out of more thoughtful and helpful writing, but I’ve learned many times in coaching, teaching, and friendships that helping people who haven’t asked for it is a recipe for disaster.

My starting point for why is that what different people consider “helping” depends on their values, views, goals, and other factors that you, giving unasked advice, don’t know. For example, offering potential solutions to someone who just wants to be heard often leads to exasperation, frustration, and feeling devalued. But just listening to someone who wants advice can lead to impatience, frustration, and other emotions neither party wants.

However obvious you consider your interpretation of what the letter-writer wants, dozens of other interpretations exist, any of which the writer may have meant, or not. Acting on unchecked assumptions risks imposing your values on others, which usually provokes responses you wish you hadn’t from others.

I’ve found the best policy to keep neutral until the person clarifies what they want so I know what “help” means to them in that situation.

In this case I’ll note that I would categorize this situation as a problem-solving, not an ethics, issue. Abstract questions of philosophy won’t resolve this issue as effectively as adopting a problem-solving approach. As with most of life, each potential action has results and you want to find an outcome most acceptable to the most number of people. What helps solve problems? In this case, probably talking to people with experience, developing social and emotional skills to communicate with the people affected, empathy for how potential results will affect different people. I would start with those things before writing a newspaper ethics columnist.

The New York Times response:

FTD is one of those conditions that can be definitively diagnosed only posthumously. But a clinical diagnosis can be made with neuropsychological tests, supported by neuroimaging. The most common type of the disease chiefly presents itself (at least in the early phases) through behavioral changes; another type announces itself with difficulties in using and understanding language. The main ways you’re likely to find out that your mother has the condition is if her judgment becomes increasingly impaired and if personality changes and other deficits become obvious.

As you’re aware, no available treatments can cure the disease or slow its progression, though it’s possible to manage some of the symptoms. So if she is developing FTD, facing the truth here will be difficult for all of you. It will be especially difficult for her, not least because FTD patients don’t always recognize that they’re ill. Your pressing task is to persuade your mother — ideally accompanied by you or your father — to see a specialist. Given that your father is already concerned about her, you should be able to enlist him in his task without getting into upsetting details about her sex life.

Either way, if her behavioral changes worsen, you should talk to your father and prepare him to take over their finances and (more important) to begin to face her decline. It is in the nature of family relations that children are morally free and may be morally required to share worries about the state of one parent with the other. If she indeed has FTD, her disinhibition is likely to show up eventually in forms of eccentric behavior that can no longer be ignored.

My sister is in her 80s and lives alone in a rented apartment in a Canadian city where she moved nearly 60 years ago. Her formerly strong network of friends and acquaintances is dissolving as they age, sicken and die or lose the energy and patience to deal with her.

In my opinion, she has a hoarding disorder and the beginnings of dementia, and she has had problems maintaining her apartment to the landlord’s satisfaction. She also has trouble dealing with documents, paying bills and scammers. She never became a Canadian citizen, and her Canadian and American identification have both expired so she can no longer travel.

I am in my 70s and live hundreds of miles away in the United States. I have a husband, an adult child and grandchildren, for whom I provide a lot of child care. My sister is behind my other family in my priorities, and frankly she drives my husband and me crazy. I am not willing to relocate to Canada or have her live with my husband and me.

She has refused to give me power of attorney so that I can deal with financial institutions when she has been scammed or has neglected to pay bills. For some time, she refused to admit that she has any “memory problems” or to consult her doctor. She does not want anyone messing around in her business.

I see her a few days each year, during which I try to touch base with the last of her friends, do some cleaning and decluttering, have some fun with her and yes, nag her to make some changes. If she continues to refuse help, may I be excused from feeling guilty?

Name Withheld

My response: You described a challenging situation of increasing importance to an aging population with increasingly fragmented families but you didn’t ask about that situation. You asked about being excuse from feeling guilty, which I see as a question of emotional skill.

The feeling of guilt is an emotion. Your emotional system creates emotions to motivate you based on various factors, many under your control. You frame the emotion as something others can impose on you or excuse you from. I suggest that you adopt a belief that you can control your emotions. Many people say, for example, things like, “Others can try to make me angry, but only I can choose if it affects me.” I find such perspectives empowering and alternatives like yours disempowering.

The empowering path forces you to take responsibility for your emotions, which many don’t like, but it enables you to act on them. Placing responsibility on others may make you feel better in the moment, but believing they are in control undermines your ability to act.

My book‘s Unit 3 gives exercises to develop these skills through practice. Many who do the exercises diligently find they improve their lives incomparably more than they could have expected.

As for your sister’s situation, since I expect your feelings of guilt are hampering your perspective and ability to solve the problem, when you take responsibility for your emotions and replace the guilt with more effective emotions, I expect you’ll see how to resolve things more effectively.

The New York Times response:

Being excused by me isn’t likely to stop you from feeling guilty. You seem to have done all that you could reasonably be expected to do at this point. The trouble is that your sister is likely to cross the border into incompetence, where the balance shifts as to what your relationship demands. For now, you must respect her autonomy; once she reaches a certain stage, caring for her may involve ignoring her expressed wishes.

Early-onset dementia, a concern faced by our previous writer, poses one set of complications. But dementia among the elderly poses a broad social burden simply because it’s so common. By 2030, all the baby boomers will be 65 or older. Last year, in Canada, the number of seniors (ages 65 or older) for the first time exceeded the number of children (14 or younger). If your sister’s dementia advances, as is likely, and if she has the resources to be cared for in a residential facility (or to receive in-home care), you might want to hire a lawyer in Canada to help you manage her affairs and establish her legal identity.

If your sister received permanent residency in Canada, there are procedures for replacing an expired permanent-resident card. If she’s in Canada against the law, you’ll want a copy of her U.S. birth certificate, because Canada will have the right to send her back to the United States. Once she regularizes her documents, the authorities might let her back in, but if she was in a condition in which she needed frequent attention, it might be better if she were near you. The laws governing who can get certified copies of birth certificates vary by state. But as a sibling, you will generally be in a better position than a stranger. With the certificate in hand, you would be able to present it to United States consular officials in Canada in order to get her settled in a home in the United States. If she doesn’t have the necessary savings, she could be eligible for Medicaid as a citizen.

I’ve gone into the weeds a little bit to make the point that taking over when your sister can’t care for herself would be a major commitment. But no one else is in a position to do this, and as her sibling, you do owe her what philosophers call “special obligations.” Some people would like to think that such special obligations are binding only if they are voluntary. That’s not the case. Your sister, ornery as she may be, has someone she can expect to help her when she can’t help herself any longer. And that person, I’m afraid, is you.

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