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The great unveiling

A psychiatric nurse once relayed an observation to me that I
have been pondering for the last decade.
We were working together in an inner city “dementia unit,” populated
with patients with end stage Alzheimer’s, vascular dementias, and brain
disorders of unclear etiology.
Individuals were parked in geri-chairs in institutional hallways, others
were in bed in 4 point restraints for their own protection, still others were
muttering to themselves in wheelchairs.

We were discussing the case of a particularly unpleasant
– he would swing at people as they got near him, trying to hurt them –
scratching, punching, even biting if you got close enough.  His favorite thing was to grab nurses’, or
other female staff’s, breasts or crotches.  He rarely succeeded at this, since most staff
were aware of his tactics, though he sat in his chair nearly motionless, like a
Moray eel in a reef cave, small eyes and snaggle teeth, mouth open slightly at
all times, taking slow deliberate breaths as he waited for an unsuspecting ocean
dweller to wander inadvertently into his reach.

I asked the nurse how she thought he had gotten to be so
rotten.  She replied simply, “When people
get older they become more like themselves.”

That one sentence has fascinated me ever since.  Could it be that as we age (and our minds
lose their ability to maintain the social graces we were taught), we slip into saying
things in an uncensored manner, and behaving the way we truly want to?  Or is the difference between “sweet little
old ladies
” and “mean old biddies” a matter of how much damage there has been
to their frontal lobes?

The scientist in me would like to explain away all agitation
as an organic brain disorder.  But I just
don’t think we can reduce human behavior to neuroanatomy.  The complexity of a lifetime of circumstances
and individual choices – and their interaction with personality – are soul-defining.

Perhaps age brings wisdom and life experience… or maybe it
unveils the truth about who we’ve been all along.  Either way I have a feeling that when the time
draws near for our bodies to give up our souls, we can catch a glimpse of what people
are “made of” in their final words and deeds.This post originally appeared on Dr. Val’s blog at

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5 Responses to “The great unveiling”

  1. daedalus2u says:

    It isn’t age per se, it is the decline in brain ATP that sometimes accompanies age.  It is well known that stimulents will induce acute psychosis, along with hyperpyrexia.  The hyperpyrexia is due to mitochondrial uncoupling, which lowers ATP levels by dissipating mitochondrial potential as heat (it is somewhat more complicated than that).  Low ATP then induces “low ATP psychosis”, which in men makes them violent and unpredictable (the berserker state, a survival “feature” of single combat), and makes women infanticidal (a survival feature of lactation induced metabolic stress).  Dementia itself is due to the running down of the brain when repair mechanisms are turned off to conserve ATP. 

    Of course it isn’t that simple, but low ATP from any cause will produce psychosis.  All forms of dementia are accompanied by low ATP.  It stands to reason they are connected.  Nitric oxide is what regulates the ATP level via soluble guanylyl cyclase. 

  2. Fabulousgirl says:

    “Either way I have a feeling that when the time
    draws near for our bodies to give up our souls, we can catch a glimpse of what people
    are “made of” in their final words and deeds.”

    I agree, for example before my dad’s mother passed she had a stroke and basically lived like a vegetable until her last days, on feeding tubes, urine bags, speechless etc.  My dad told me before she died she used her last breaths snoring heavily.  Which is what she had always done before the stroke.  My point is before our last days on this here earth we’re going to do something that we did in our younger years.  Like my grandmother, left us with her signature SNORING!  And was just as peaceful as she wanted to be, I thought she recovered from her stroke by her actions

  3. CharlieSmithMD says:

    Great links!

  4. Anonymous says:

    In my family we think of it as the person’s true colors coming out. My grandmother always tried hard to seem like a sweet, wonderful woman so that everyone would love her and idolize her, but those of us close to her in the family knew that she was a mean, manipulative person who thought everyone was out to get her, and that everyone was there to serve her. Now that she has dementia she treats the nursing home staff like trash — her real personality has come out because she no longer cares about looking good to others.

  5. StevePocetaMD says:

    In the neurology dementia world, I tell spouses all the time that with Alzheimer’s “people become more like themselves.”  I thought they were my words !  I’m glad someone else has the same observation.  Our usual explanation is that the higher centers of brain cognition are largely inhibitory.  When they go, what’s left are the more basic functions, ruled by lower centers.  For people who have had to inhibit their anger, paranoia, distrust, etc, they cannot do so anymore.  But at least one-half of the time, in my experience, the demented person could be quiet, kind, funny, or loving.  Why the core is different in person to person….or if it is a matter of the pattern of the dementia….I don’t know.  

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