Self-neglect: a practitioner's view

Aging,  Spring, 1996  by Wendy Lustbader

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Once the elder has given a substantial amount to the exploiter, the relationship tends to solidify into three intractable beliefs: (1) that the exploiter is a true friend, (2) that other people misunderstand and wrongly treat this person, and (3) that the person would not be able to make it without this vital help. Efforts to dislodge these beliefs tend to be met with ardent denials. To admit that this "friend" has had motives other than affection would be equivalent to admitting that one has been a fool. Such an admission becomes all the more difficult the more money and caring one has squandered.

Interventions in these situations tend to require a great deal of delicacy, especially at the later stages. Unless the exploiter makes a mistake and does something to puncture the older person's trust, negative statements about the relationship by family members and professionals may only drive the older person deeper into the exploiter's grasp. A better approach is to speak sympathetically about the "friend" and to learn which manipulations are being employed and whether any inconsistencies can be revealed. It may be possible thereby to offer observations that awaken the older person's doubts or at least spur further scrutiny: "Gee, she seems to come around quite a bit at the beginning of the month, just when you get your check, and then you don't see much of her."

Tragically, ending the exploitation often requires shattering the older person's illusion of being cared about and being important in someone else's life. In these situations, family members and professionals may find that forcing the collapse of the illusion is not worth the pain and humiliation the older person experiences. Instead, they may resign themselves to the continuation of the "friendship," concluding that exploited people have the right to perceive such relationships in the way that pleases them. Unless the original feelings of loneliness and uselessness can be addressed through another, means, it may be more humane to permit such relationships to run their course than to intervene.

Untreated Mental Illness

When self-neglect results from untreated mental illness, the person's self-destructive behaviors cannot be considered voluntary and therefore warrant different responses than those described above. Community mental health centers in some areas have outreach programs in which home visits can be made by mental health teams. Getting the person on the proper medication may spur self-care, along with ongoing case management in which the person is assisted with managing the activities of daily living. In the absence of home-based mental health services, such individuals tend to fall between the cracks. Adult services workers cannot assist them because they lack access to the necessary medications. Mental health workers cannot assist them because they are bound to the office. Occasionally, an adult services worker or volunteer who is able to make home visits on a regular basis may be able to win the person's trust enough to serve as a bridge to mental health services. Once the relationship is solid, the older person may be willing to go to the mental health center for treatment if accompanied by their advocate.