My mother has in recent months slipped over the edge into mental non-competency. Before Christmas my brother Charlie moved her from her home in the San Francisco Bay Area down to visit over Christmas with him and his life partner Claire, then New Years Eve got her settled into a small, pleasant 24 hour care home ten minutes from his home.
She is not happy about this, but then she wasn't happy at home for the past few months, where she believed strangers were invading her home on a nightly basis, causing her "papers" to disappear, moving things that she "knows" were on the table, and turning her gas heater off in the night causing her to get cold. She told me one day, that the doors and windows were all locked so the people must be crawling in through tiny cracks in the roof and ceiling. Sometimes she would say that she hadn't seen them, just heard them, but she knew they were there, because how else could one account for it getting cold - someone had to have messed with the heater - or for the papers not being where she'd left them. But other times she would describe in detail things the people she had seen, what they'd looked like, what they'd done and what she'd said to them.
As a sociologist the workings and mis-workings of the human brain are not within the scope of my professional expertise, that's the realm of psychology. However, I've been reading and thinking about the problem, and think that I have a plausible hypothesis for what is happening in her brain.
An example from my own experience today will help illustrate: I came home early from work today because it was snowing heavily and predicted to get worse. There were no students coming in for advising, and most of us left early. I've been a bit sleep deprived recently, so when I sat in my recliner to watch some cable news punditry, not surprisingly I dozed off several times between the interminable discussions of what may or may not happen tomorrow in the Iowa Caucuses. At one point, I was awake enough to know that my husband John had come out to sit down and watch a little with me, and that we exchanged a few words about the Iowa Caucuses. But then I drifted off and had an extremely vivid dream of an extended and lively conversation between John and I about some of the candidates. It seemed very real, and I was quite annoyed with John because instead of answering me himself, he kept playing a recording of Newt Gingrich saying something absurd. When I was roused from my nap by a cat pouncing on my lap (happens a lot at our house), the vividness of the dream lingered and seemed like something that really happened.
But I knew immediately that it had not really happened; first of all my husband was no longer in the room with me, and I know for a fact he doesn't have a fancy silver iPad that he can play video of Gingrich on, and that he'd never record anything by Gingrich anyway, much less play it over and over. I quickly was able to check the very real seeming conversations and interaction of my dream against a list of things that I knew about reality, and immediately classify the experience as a dream and "not real".
But my mother, suffering from dementia, no longer has the ability to reality check in that way. For her all things are possible - so if she "sees" something, or "hears" something while dreaming or dozing, it is real. As a sociologists/anthropologist I know that there are human cultures that do treat dreams as having the same reality as waking experience, and in those cultures, the entire family and village would be supportive of her experiences, accepting them as valid. But in our culture, everyone is telling her that there are no people living in the battered metal shed in her back yard, no people coming into her house and changing the heater settings, no people coming in and taking photos of her in bed and making movies out of them. She is hurt and angry and sees a conspiracy against her because she says "I know what I see!" And believes that everyone else, the neighbors, her care takers, her son, who all tell her that there is no one there, are in a conspiracy against her.
So I remind myself that she was not happy at home and had not been happy for a long time, when she complains pitifully about how "awful" the care home is, and how the owner of the home doesn't want her there and doesn't want the care workers to do anything for her, and that the workers will get in big trouble because they gave her a shower today. Which she loved, but since she loved it, she won't ever get another one.