Over the course of two years of working at an assisted living facility, I had the opportunity to work with many folks who had reached the final stages of their life journey.  One resident, who I will refer to as Frank, told me something that continues to bubble into my studies in some form or fashion.  I visited with Frank each week, and although the purpose was to provide him with company, I believe I gained just as much from his presence as he might have from mine.  Frank suffered from some cognitive deterioration, and often we held the same conversations each time we met.  He usually sat with me on the back patio of the facility, his favorite spot to “smoke a ciggy,” or cigarette.  His stark blue eyes gazed into the Kudzu-infested forestry that cuddled most of the region.  Frank’s green flannel shirt hung loosely on his boney frame, and his jeans were rolled up to his ankles to show off his fancy dress socks.  He was a veteran from the second World War, and although he occasionally spoke about his time on the battlefront with a cheery tone, his eyes told the truth of the horrors he had witnessed.  We often talked about the one thing that he missed the most: his recently deceased wife.  As he pulled from the stub of his third (and final, as the facility only allotted him 3 per day) ciggy, he turned his head towards me and said “you know boy, love changes.  Love changes you, and love changes too.  The older you get, the more you realize how little you know about love.  Sometimes I feel like I have forgotten what love is, and that scares me, boy.  That scares me a lot.”

Currently, I am undergoing a course that dives into the underpinnings of emotion, learning, and memory.  As someone who has worked with people suffering from degenerative diseases such as Alzheimer’s, I was drawn to learn more about how emotional awareness, or empathy, can be affected as our cognitive faculties begin to fail us.  Yes, I realize that love and empathy can be quite different.  Yet, the mechanism for one’s internal experience of love, fear, and understanding are intertwined in the mid brain.  A study by Hargrave, Maddock, and Stone (2014) concluded that the degradation of certain brain regions may help explain why patients with Alzheimer’s may have difficulty identifying images of emotional expression, including joy, fear, and pain. The deterioration of neural connections and brain regions that come with Alzheimer’s disease would, of course, have repercussions across the board of functioning. However, for this deficit, the amygdala, orbitofrontal cortex, and hypothalamus were noted by the researchers as being indicative of this difference (see also Rolls, 1991). As these centers play a crucial role in emotional processing, including love and empathy, this effect may be explained by a loss of the ability to experience a sympathetic response with the image. In other words, perhaps the image does not evoke some sort of mirror-neuronal activation that comes naturally to the healthy brain, and thus the image does not carry the same meaning for the participant with Alzheimer’s (see Gallese, Eagle, & Migone, 2007).  Thus, the experience of love and empathy may be different for someone suffering from this illness.

Although the treatment of Alzheimer’s disease currently escapes our field, perhaps these results have implications for those of us in clinical settings. For example, perhaps we might be more aware that our conveyance of empathy through posture and facial expression may not so easily be detected by clients with this illness. I can imagine that a client who does not feel heard and understood may grow impatient or irritated with the clinician, and thus perhaps we must find other ways of showing connection. This may involve a primary assessment to determine what faculties are still functional. For example, perhaps visual word processing may still be in-tact, and thus the clinician may use a whiteboard or notepad to write messages that communicate to the client.  I often used a whiteboard to communicate with residents who were deaf or suffering the early signs of cognitive deterioration, such as with Frank. Perhaps psychological clinicians, in particular, must learn to be persistent in finding ways to seek appropriate methods of communication with their clients, particularly those who suffer from cognitive disorders.

– Kyler Shumway


Gallese, V., Eagle, M. N., & Migone, P. (2007). Intentional attunement: Mirror neurons and the neural underpinnings of interpersonal relations. Journal of the American Psychoanalytic Association, 55(1), 131-175.

Maddock, R. J., & Stone, V. (2014). Impaired recognition of facial expressions of emotion in Alheimer’s disease. The Journal of Neuropsychiatry and Clinical Neurosciences.

Rolls, E.T. (1991). A theory of emotion and its application to understanding the neural basis of emotion. Cognition and Emotion. 4:161–190.