In the book Validation by Naomi Feil (1992, Edward Feil Productions) the author, a clinical social worker, reports on over three decades of intensive research and therapy with disoriented very old residents in nursing homes. Her theories and training techniques have profound implications for all of us when talking with the old.
According to Feil, resolution versus vegetation is the goal for those very old that have failed to achieve what psychologist Erik Erikson calls integrity. Erikson, who named stages in human development that are widely used today by social scientists, defined integrity as the merger between the actual self and the idealized self. This is achieved at the point of accepting one’s strengths in spite of one’s weaknesses (Childhood and Society, Norton and Company, 1963). In our counseling work, Erikson’s “integrity” phase roughly corresponds to what we call wholeness, or sanctification.
Ms. Feil formulates four stages in the cognitive disintegration some old people experience as they subconsciously attempt to resolve unhealed issues from the past. She analyzes how, as losses accumulate, control and connection with present reality dim. The very old merge symbolically with long ago, as distant recollections come into sharp relief, appearing far clearer than today’s surroundings.
Stage One, “Malorientation”, is characterized by rigid control over emotions, with the need to express early life conflicts in disguised forms. People in Stage One have never connected with their own pain; now they blame and accuse, project and defend, and engage in other self-protective behaviors to keep from facing their cumulative losses.
Validation therapy with a maloriented individual consists of: affirming his perception of reality without threatening his defensive system, providing a trusting relationship of nurture and respect, and offering acceptance with understanding but not judgment. This unconditional love, coupled with consideration for the person’s vulnerability (without exposing it), can keep an individual from moving to Stage Two.
In Stage Two, Time Confusion, an overload of physical and social losses has broken the “camel’s back” of denial. These people feel forced to stop holding on to chronological order, and begin retreating inward. They lose track of the present and follow memory threads instead. Root emotions from the past are triggered by contemporary persons or objects, which then become symbols of unresolved far distant grief or wounds. The old in Stage Two withdraw into primal feelings and drives like love, hate, fear of separation, and the struggle for identity.
Validation therapy during this phase basically consists of acknowledging and empathizing with their universal fears, frustrations, and agonizing sense of helplessness. The goal is to encourage them to express their intense reactions within appropriate boundaries, so we can connect emotionally with their extreme sense of loss. Successful validation therapy in Stage Two may delay the old person moving further from relationship with the outside world in Stage Three.
Individuals in Stage Two who are unable to manage their inner conflicts often retreat to Stage Three, Repetitive Motion. At this point pre-language movements and sounds are the tools that nurture the old person as he subconsciously attempts to work through unfinished business of the past. Now body parts have become symbols and movements have replaced words.
Feelings stopped up for a lifetime overflow. Speech becomes non-rational, with repetition of primal patterns like “ma ma ma ma”. Rhythmic actions like rocking bring back the comfort of mother’s arms. Fingers symbolically recreate old activities from work; voices sing but cannot talk in sentences. Some dormant speech and limited rational thinking can be restored at this time through a genuinely loving, validating relationship, preventing the slip into Stage Four, Vegetation.
In Vegetation, the very old person has given up the struggle to stay engaged in living by shutting out the world almost completely. Though response to validation therapy at this point is barely perceptible, some limited reactions like opening the eyes or speaking a single word have been elicited after repeated daily contact. People in vegetation are affirmed through touch, recognition, and nurturing as long as they live, despite the fact that they do not initiate any activity and rarely express feelings of any kind.
Depth counseling is highlighted in importance when seen in the context of this therapy for the disoriented old-old. Although the book Validation does not address closure in the presence of God, it theorizes and illustrates how unhealed pains from the distant past can contribute to the overwhelming sense of loss and progressive cognitive disintegration in some very old people. Feil’s book also eloquently demonstrates through numerous examples how, even when intellectual functioning is impaired, the heart is still calling for resolution of inner pain that has been repressed but never healed.
After 35 years of working with old people around the world, Ms. Feil compiled some common symbols used by the very old when rational processing is impaired. Listed at the end of this article, these symbols exemplify the archetypal nature of heart images, and their profound significance when reasoning is lost.
Each person’s life is a story, with the potential to be God’s infinitely creative statement about His nature expressed in history. Through story, deep truths are conveyed that could never be addressed by abstract concepts alone. At the close of a long life, the heart sees the spanning picture of one’s years across time, and cries for conclusive resolution of the narrative, with all knots unraveled and all thematic elements reconciled. The spirit of the old person longs to perceive a divinely designed pattern once and for all—beginning, middle, and end.
UNIVERSAL SYMBOLS AND WHAT THEY CAN MEAN
(Be aware that some references are explicit and sexual in nature)
JEWELRY, CLOTHING———————————–WORTH, IDENTITY
SHOE———————————————————CONTAINER, WOMB, FEMALE/MALE
CANE OR FIST———————————————-PENIS, POTENCY, POWER
SOFT FURNITURE—————————————–SAFETY, MOTHER, HOME
HARD FURNITURE—————————————-FATHER, GOD
NAPKIN, TISSUE, FLAT OBJECT———————–EARTH, BELONGING, VAGINA,
DRINK FROM A GLASS———————————–MALE POWER, POTENCY
PICKING THE NOSE—————————————SEXUAL PLEASURE
PLAYING WITH FECES———————————–EARLY CHILDHOOD PLEASURE
TYPICAL PERSONAL SYMBOLS USED BY THE DISORIENTED VERY OLD
A HAND—————————————————–A BABY
A FINGER—————————————————A PARENT, WALKING FEET, CHILDREN
TO WALK WITH
A CLOTH—————————————————IMPORTANT PAPERS, DOUGH FOR
BAKING, CHILDREN’S CLOTHES
THE ARM OF A CHAIR——————————— A STREET
OPEN SPACE———————————————–A HALLWAY AT HOME, HEAVEN, HOPE
BUTTON, PEBBLE—————————————–NOURISHMENT, LOVE
CLUCKING SOUND————————————–SAFETY, JOY
ROCKING MOVEMENT———————————MOTHER, MOTHERHOOD, SAFETY, JOY
STRONG CHAIR——————————————PENIS, MAN, HUSBAND, SEX
LOW VOICE———————————————–MALE PERSON
SPOON OR CURVED OBJECT————————-WOMAN, FEMALE SEX
SOCK, SHOE———————————————-CHILD, DRESSING A CHILD, OR A SEXUAL ORGAN
REMOVING A PIECE OF CLOTHING—————FREEDOM, DEFIANCE, SEXUAL ACT
A NURSING HOME FLOOR—————————A NEIGHBORHOOD
THE HALLWAY——————————————A STREET IN THE NEIGHBORHOOD
A WHEELCHAIR—————————————–A CAR OR BIKE
(Thoughts from THE BIBLE)
“Is not wisdom found among the aged? Does not long life bring understanding?” -Job 12: 12
“Perseverance must finish its work so that you may be mature and complete, not lacking anything.” –James 1: 4