A story to promote empathy in dementia care

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Staff Writer Tim Mullaney
Staff Writer Tim Mullaney

Earlier this month, I was excited to learn that one of my favorite writers, Alice Munro, had been awarded this year's Nobel Prize in Literature. To mark the honor, The New Yorker republished one of her classic short stories — one set mainly in a nursing home.

The story, “The Bear Came Over the Mountain,” was the basis for the 2006 film “Away from Her.” If you haven't read the story or seen the movie, I don't want to dampen your pleasure by giving away too many of the twists. But I want to share a few thoughts about why I find this story, and Munro's writing in general, so great; and why I think this story is recommended reading for those working in long-term care.

Grant and Fiona, the story's main characters, are an aging married couple. When Fiona develops dementia, she moves to Meadowlake, the local nursing facility. The first time Grant goes to visit her, Fiona doesn't recognize him — and she treats him as if he is a new resident himself. She says:

“It must all seem strange to you, but you'll be surprised how soon you get used to it. You'll get to know who everybody is. Except some of them are pretty well off in the clouds, you know — you can't expect them all to get to know who you are.”

This is a hallmark of Munro's fiction: She is masterful at surprising the reader, in this case by reversing the roles that the characters might be expected to play. Fiona adapts quickly to Meadowlake. In spite of her dementia, she adopts a kind of caregiver role with her husband, because she rightly senses that he is having trouble navigating this new world — literally. Munro describes how he tries to familiarize himself with the building, but “the more he explored this place, the more corridors and seating spaces and ramps he discovered, and in his wanderings he was still apt to get lost.”

In fact, Grant gets so disoriented that he wonders if some pictures and chairs are getting moved around on a regular basis, but he doesn't ask the staff if this is the case. He is afraid they will think he is experiencing some “mental dislocations” of his own.

A story about a nursing home typically might be about the loneliness and isolation that a new resident experiences, but Munro shows Fiona engaged in the new routines of her life, and focuses instead on the loneliness and isolation of her husband. It's an isolation that is made worse by the way some staff members treat him. When he brings up a particular concern, these workers “treated the whole thing as a joke,” Munro writes. “One tough old stick laughed in his face.”

The story is a reminder to nursing home staff that what to them is simply routine, even a source of amusement, can seem very disturbing to a resident's family members. Grant repeatedly turns to one nurse, Kristy, who takes his questions seriously and provides him with more information than the other nurses. But it's rare in a Munro story that a character is totally heroic or likeable, and Munro shows that Kristy can be brusque to a fault. For example, Fiona at one point is in despair because her friend, a fellow resident named Aubrey, is being discharged. Kristy tells Grant, “I wish [Aubrey's] wife would hurry up and get here … We've got to start serving supper before long and how are we supposed to get [Fiona] to swallow anything with him still hanging around?”

To his credit, Grant takes this little outburst in stride. He has learned some facts about Kristy, including that she is a single mother of four, and one of her children has life-threatening asthma while another is probably involved with illegal drugs. Grant thinks, “To her, Grant and Fiona and Aubrey too must have seem lucky. They had got through life without too much going wrong. What they had to suffer now that they were old hardly mattered.”

In a Munro story, characters often do what Grant does here: They see themselves through another character's eyes. It's a way of being empathetic, of seeking to understand why people act the way they do — and, yet, Munro also shows how often we misjudge what people are really like, what they're really thinking and how they're likely to act. Later in “The Bear Came Over the Mountain,” Grant meets Aubrey's wife, Marian. He sees himself through her eyes. She would see him as “a silly person,” he thinks, “full of boring knowledge and protected by some fluke from the truth about life. A person who didn't have to worry about holding onto his house and could go around thinking his complicated thoughts.”

In short, he thinks, Marian must find him “a jerk.”

But, in this case, Grant has gotten Marian wrong, which she proves by taking a surprising and yet believable action that sets up the story's conclusion. In fact, I would say that what Marian does is the most unexpected action in the whole story. This is Munro confounding reader expectations again: In a story that involves two main characters with dementia, it's the most practical, down-to-Earth, apparently least “demented” character who does the most daring, surprising and in some ways unaccountable thing.

In long-term care, virtual dementia tours aim to foster caregiver empathy by showing just how differently people with dementia experience the world — the unique and multiple challenges they face. Munro's story, I would argue, could foster caregiver empathy by showing that despite their particular challenges, people with dementia in some fundamental ways aren't that different from people who have their full cognitive abilities: Munro's story reminds us that human beings by nature are not always consistent or predictable or logical, that we all experience “mental dislocations.”

I've used the word “empathy” a few times, and I would say it's certainly one of the key underpinnings of Munro's work. She seems to have tremendous empathy for all her characters, her characters are often engaged in the hard work of trying to be empathetic, and her stories encourage readers to be more empathetic — and you don't have to take my word for it. Reading Munro (and other authors like her) for just a few minutes improved people's performance on tests measuring empathy, social perception and emotional intelligence, according to research recently published in the journal Science.

The study prompted Elise L. Lev, a professor at the Rutgers College of Nursing, to write this letter to the New York Times:

“I once had a student who proudly told me that she never read fiction. I thought, how sad. But if I had known the results of the literary fiction study, I could have given her a scientific rationale for changing her behavior.”

If I were to encounter a student like this, I would tell her about this study — and hand her a copy of “The Bear Came Over the Mountain.”

Tim Mullaney is Staff Writer at McKnight's.

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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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