I ask her for the millionth time “Are you picking?”
She looks at her lap, sheepishly lowers her hand from her forehead and says “Yes.”
I look at her. Her forehead is scaly and aggrevated from the attention of her fingers. I know I will have to stop her another thousand times over the next few days we are away. Each time I will feel like a schoolmarmy turd and each time she will look guilty. I wish that there were another way to make her stop.
My mom has Alzheimer’s. It sucks. Sucks hard. She has developed an almost OCD like habit of picking any and all rough patches on her 85 year old skin. Once she picks the offending blemish to the point of bleeding she will quit on that spot, at least until it develops a scab and then she will start again. The result is a kind of cycle picking from spot to spot, such that she is either scabby, bleeding or an unpleasant combo of both. I try to be gentle, try to still her hand as it probes the usual places, but I can’t be with her round the clock. The potential for infection looms always in my mind as I try to keep her from proceeding. This once Emily Post etiquette fiend will pick anywhere anytime, including a public dinner table, disposing of the scabs to the floor. I know that’s a stomach turner – right? If I ask her to cease and desist at least until I’m done eating, she cannot. Moments after agreeing, I will see her hand wander back to wherever it was removing offensive scabs when I asked her to stop. Sigh.
When she first started this behavior, I attributed it to all manner of things. My mom is full of deep self-loathing as the result of feeling unloved by her mother. She never has discovered that she is worthy of being loved. I can still see it in her eyes - that expectation that I will leave, that I will find her unlovable. As if that were even a remote possibility. I saw the picking as a self-punishment for that, or as a way to make the external world match her interior dialogue – that she is ugly and unlovable. As if she could be anything but beautiful. That thought made me feel sad, made me more determined to demonstrate that she is both beautiful and lovable regardless of her inner dialogue or exterior damage.
After that I told myself that she picked because she hated what was happening to her (until recently she has had an amazing self-awareness about her disease) and that on some level she hoped to pick herself out of existence piece by piece. She wouldn’t be “a burden to anyone that way and people could go on with their lives”. It pained me to think this might be true, that she somehow didn't feel entitled to be here or to my time and attention. So I lavished more attention on her.
It didn’t help. Nothing did. The picking continued.
In my efforts to understand where she is and what to expect in the future, I am learning a lot about AD. That desire to understand has brought me face to face with many of my own demons. AD patients become simpler in their thinking. Not more complex. Those thoughts above? Those are pretty complex and twisty thinking. They are mine and not hers. It’s my BS, my projection, my observer nature filling in imaginary details to gloss over the fact that I don’t know diddly squat. Observer run amok. Ouch.
Her picking vaguely reminds me of a friend whose daughter suffered from trichotillomania – a disorder that results in pulling out one’s own hair, generally eyelashes or brows. Her daughter was absolutely normal in every regard, charismatic and smart, except for this one thing. She outgrew it, which is good because she really is quite gorgeous. It’s an anxiety disorder, which makes me wonder if the picking is some kind of anxiety disorder as well. That there is some kind of self-soothing that happens while she is picking - like giving in to a tic or checking to see that the oven is off for the third time. Who hasn't done that?
Maybe it’s even simpler than that. (One thing I am learning to accept is that with AD it’s all about simpler.) If asked, she will tell you she doesn’t like rough things. Her entire palate and habits have changed so dramatically in the last year that I can no longer predict what she will like or no. So maybe the picking is related to textural perception, one of the most rudimentary ways that we experience the world from our infancy onward. We develop relationships to textures we like and those we don't.
That I understand. I have a friend who falls in love with handmade cups because of the way they feel in his hands, because of the texture. I too have textural preferences. Unlike my mom, I love fluffy, hairy, fuzzy objects. Peaches, dogs, angora yarn is all delicious. I don’t mind rough skin which is her bug-a-boo. But I do mind bumps - ingrown hairs, zits, boils, whatever - and have been known to attack them with a sharp object. Is that really so different? Probably not. The biggest difference is that I can imagine the possible negative outcomes from my behavior, infection, MRSA, other nasties. She seems only to understand that it feels good and so she does it.
The truth is I don’t know why she picks and I never will - not really. It's all just me trying to unravel the riddle of why she behaves as she does and that particular puzzle has been ongoing since birth. I doubt I will solve it, so it's more a gentle musing than active puzzling these days.