Strategies for dealing with post-confrontation stress
June 25, 2020 7:13 AM   Subscribe

There's a person I need to occasionally contact. He's responsible for a lot of my childhood trauma and currently descending into what we suspect to be frontotemporal dementia, with a marked decline in empathy and increase in aggression (verbal, thus far). I'm the only person still talking to him maybe once a month, and each time I'm shaken to the bone. What can I do to make the stress pass more quickly?

Going no-contact is not an option at this point - he still has cats I care about, as well as some sentimental objects belonging to the family. Plus in the memory of the messed-up but mostly loving person he was, I don't want him to waste away in pain once the disease progresses, which requires keeping in occasional contact. The only other people who still have any emotional tie to him are his abuse victim (her not going back to live with him is my priority) and his nonagenarian mother (who it turned out he's also been abusing over the past year as his symptoms emerged), so I'm the only option if any of us needs anything concrete from him.

I have generalised anxiety I usually manage with self-taught CBT techniques, but this situation triggered panic attacks that drove me to see a psychiatrist. She agrees my general management skills are good, but added 75 mg of sertraline to stabilise me, which worked great for everyday stability and not letting the situation consume me, giving me time and space to process my feelings. I've been on it since December and I'm scheduled to discuss tapering off next week, but I just had to talk to him over the phone about veterinary care and I'm all shaken up. I've now been very distracted for over two hours, plus running to the bathroom every 30 minutes and unable to eat anything solid. I can't focus on folding more than two pieces of laundry at a time, or read a book just now. You don't want to know how long it took me to compose this question in a readable manner.

(These are all normal stress symptoms for me - after a family death for example I didn't eat anything solid for three days, subsiding on soups and yoghurt. Pre-sertraline, I would have panic attacks and mild dissociation.)

I'm doing deep breathing, tactile anchoring techniques, journaling, destressing puzzle games. I'm still untangling my emotions re: his current behaviour, grieving his old self and coming to terms with the fact he won't mellow in old age like everyone always told me he would. It's freaking hard. It can be six hours before I'm close to baseline.

What else can I do to stop these confrontations destabilising me so much? Right now I wouldn't feel safe to drive, I need to get this more in hand in case a confrontation is followed / connected to an emergency that requires me to have my act together.
posted by anonymous to Health & Fitness (10 answers total) 4 users marked this as a favorite
The way that I've dealt with this, although I don't have to deal with any of my trauma-makers currently they have still held power over me in terms of critical voices, is to understand that we're not children anymore psychologically or physically, and the portion of our brains that sought to protect us as children from danger is just that: stuck. I read The Self Under Siege recently and it addresses this neurological and psychological phenomenon. You're stuck as that child that had no choice but to be afraid and internalize that figure as terrifying. Once you understand that this person has no power over you NOW, you may start to feel less anxious around them.

For me understanding the core of my involuntary responses was immensely helpful in regaining my power and getting them under control.
posted by Young Kullervo at 7:35 AM on June 25 [6 favorites]

She agrees my general management skills are good, but added 75 mg of sertraline to stabilise me, which worked great for everyday stability and not letting the situation consume me, giving me time and space to process my feelings. I've been on it since December and I'm scheduled to discuss tapering off next week,

This seems like a poor time to do that?
posted by DarlingBri at 7:48 AM on June 25 [5 favorites]

So sorry you're dealing with this and I do feel it's important to say that, if it's possible to further reduce your contact with this person that is what I would suggest.

But in the event you have to maintain communication, the key is managing the communication to make it as structured/routine and to provide some containment for yourself as much as possible. Regardless of the content of the conversation/interaction, this person triggers your nervous system to go into overdrive. Your brain is freaking out because it doesn't feel like it has control or safety when you talk to this person. Therefore you need to structure the interactions to feel as controlled and manageable as possible for yourself. This could include: sticking to a very specific schedule ("I call X every Tuesday afternoon"); setting clear time limits for yourself ("I will stay on the phone for 20 minutes and then end the call"); establishing excellent self care practices before and after the conversations ("I will eat a nice lunch and clean up right before the call, then go for a short walk outside after the call"), and anticipating/planning ways to maintain boundaries ("if X starts to talk about xyz I will tell them I don't wish to talk about that and then hang up if they continue"). In other words, you could think about building in some buffers before/after every interaction and use whatever techniques help you feel grounded/relaxed to manage the interactions. Rather than try to "prevent" your anxiety, it might be better to think about it as "expecting and planning for" an anxious reaction. Over time your nervous system will get better at self-regulating, especially if you can build in some of these buffers for yourself.
posted by sleepingwithcats at 7:52 AM on June 25 [6 favorites]

Is it possible to have a friend come visit you during these calls (I realize that it might not be possible, especially given social-distancing rules)? Or make a plan to call a friend right afterward so you can have someone to help comfort you and calm you down?
posted by tivalasvegas at 8:11 AM on June 25

I don't want him to waste away in pain once the disease progresses, which requires keeping in occasional contact.

This is admirable and understandable, but if you have the money to hire an occasional visitor/caretaker or a friend willing to accept the task, that could help stabilize your own mental health by putting distance between you and him but still having the reassurance that he isn't alone and getting updates on his condition. Someone who doesn't have years of history with him will likely find it easier to focus on his current state and let his language and actions roll off their back.
posted by Flannery Culp at 10:10 AM on June 25 [2 favorites]

People with incipient dementia may be in a constantly irritated state because things are weird and confusing to them. Whatever music they enjoyed in youth can be a huge help in putting them is a mindspace that is happier and less confusing. Music is supposed to be processed in a different part of the brain, less susceptible to dementia, so provide them with music, ask them about music. Kids' tape player and tapes is pretty easy. My aunt had early dementia, would get on story loops that I'd heard so many times. I'd barge in, ask her about her childhood and she'd just switch tracks to a new story, repeat, until it was a story that was new or at least not painfully repetitive.

Prepare. Have a list of acceptable topics - food, music, weather, jokes. I once diverted a stupid fight by randomly asking someone in the process of moving (therefore tired, out of a comfortable environment, cranky) what they planned for drapes. My siblings looked at me as if I were addled, but Mom took the bait and the crisis was averted, at least for a while. Some fights are a well-worn rut, and avoiding the topic is a useful technique. Put a doorbell sound on, or get a bell, or an .mp3 of a barking dog or neighbor saying 'Hi.' Things start to head south and Ooops, gotta go, right now. Mildly dishonest techniques are kind of sketchy, but techniques that play the long game require growth, and people with dementia have probably stopped learning.

Compassion. As much as you can find. Listening to a person be a jerk is hurtful, but having your brain die is so much worse. thank you for being kind.
posted by theora55 at 10:42 AM on June 25 [3 favorites]

I also think it would be a good idea to ask someone else for help with this. My partner is estranged from his parents due to abuse and his mom has early onset dementia since her 50s co-morbid with other serious mental and physical health problems. His dad is also not doing great, although he doesn't have dementia. They are very far from us physically. There are times when we've had to contact them, or when they've called him mysteriously, and he wanted to see if it was an emergency.

So I do the phone calls. It pretty much just mildly irritates me, whereas it would cause him to have a panic attack or to dissociate for the rest of the day. For example, we had to call his dad to get his phone number changed over to a different cell plan, and I was the one on the phone getting the PIN to port the number - he couldn't handle it.

I would be happy to help any friend with the situation you describe, I think one phone call for 20-30min once a week is really a small ask, especially when I've seen first hand how much stress it can take off the mind of the child or family member. Your friend can introduce themselves with you on speaker, and you can say, I'm so busy with work today but I wanted to see how you are doing. My friend is helping me with everything I have to do - would you like to talk with him/her for a while? Then get off speaker. If he refuses, fine, but you made the call, and you have proof of life. Your friend can ask about the cats or other concerns and about his health in general. If you do have someone who is able to help with this, they can also be a grounding force in case of a true emergency as the person who is calm enough to drive, make phone calls or communicate with medical professionals etc. I would be willing to do that for a friend or loved one in a situation like your own.

Communication with people who have dementia is really hard, it's almost like talking to a little kid after a certain point. I don't know how advanced his situation is but the ideas above about asking him about his childhood and redirecting with non-sequiturs is good advice. Always give yourself the option of ending the conversation - oh, my friend is here/my boss is calling/my neighbor is knocking on my door/the tea kettle is boiling, I have to go.

You can't really teach someone a lesson about being polite or considerate when they might not have a clear recollection of what they just said ten minutes ago, never mind why it upset you and why they shouldn't bring it up in the future.
posted by zdravo at 12:12 PM on June 25 [1 favorite]

Can you set up some ritual or separation between your normal life and the time you have to spend on these difficult calls? Maybe you always go outside to call him, go for a walk or set up a chair in a particular part of the room. If you need to make a plan for his care or follow up on something related to him, do it in the same space. The body stores the tension and the memory and creating a BREAK between the tension and the rest of your life can help you put it down and not have it be always on your mind so much.
posted by Lady Li at 2:55 PM on June 25

If you are not currently in a living situation that will allow you to take custody of the cats when it becomes possible to get them out of there, you might feel better or be able to occupy your mind with looking into possible future homes for them.

If you think he would allow an occasional caretaker visit or even house cleaner in there, you could make sure someone reliable is looking in on the animals and make sure they're being cared for. This would be an enormous reliever of stress and anxiety for me, especially in a situation like this one where his capabilities will change but you don't know how quickly.
posted by queenofbithynia at 5:18 PM on June 25 [1 favorite]

The most powerful thing I've learned about how to deal with stress is that there aren't two responses, there are three. Fight or flight - and then freeze. Freezing is a last-ditch survival mechanism. Think: baby deer playing dead. When it's all over and they unfreeze there's usually a lot of shaking. Whichever one your response is (it's generally freeze for me, which means (emotionally) shutting down in the moment - "just get through it" type feelings), you need to do an appropriate release after. Fight it could be: jumping up and down going OOOH YEAH I WON; flight could be: hugging someone (or yourself) and being jubilant I'M SAFELY HOME NOW in however way that feels right; freeze is likely to be some sort of shaking but you might need to try a few things out. Arm and hand shaking, or leg shaking seem to be two useful ones, but sometimes my belly wants to be shaken about, which is best learned at least sitting or lying.
posted by london explorer girl at 6:56 AM on June 26

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