Table of Contents
I am a medical journalist.
For 15 years, my job has been to translate the complex, often sterile language of science and medicine into stories that people can understand.
I’ve written about oncology wards, surgical theaters, and genetic research labs.
I thought I understood the landscape of illness.
I thought I had the right words.
Then my father was diagnosed with Alzheimer’s disease, and I discovered I knew nothing at all.
The conversation I remember most clearly is the one I kept losing.
It was about a doctor’s appointment.
“Dad, we have to leave in ten minutes,” I said, standing in the doorway of his study.
He looked up from the newspaper, his brow furrowed.
“What for?”
“For your appointment with Dr. Evans.
The neurologist.”
A flicker of confusion, then a wave of defensive anger.
“I don’t have an appointment with any Dr. Evans.
Nobody told me about it.”
My own frustration, a hot knot in my stomach, began to tighten.
“Yes, they did, Dad.
I told you this morning.
And yesterday.
It’s on the calendar.” I pointed to the large-print calendar on his wall, the appointment circled in bright red marker.
I was armed with facts.
I had evidence.
He squinted at the wall, then back at me, his eyes clouded with a mixture of suspicion and hurt.
“That’s not my writing.
I don’t know anything about this.
Why are you always trying to push me around?”
The conversation devolved from there, a circular, painful dance we had performed too many times.
I presented logic; he countered with a reality that was, to him, just as solid as mine.
I showed him the appointment card; he insisted it was a mistake.
I reminded him of our previous conversation; he accused me of making things up.
It ended, as it so often did, with him agitated and retreating into a wounded silence, and with me locking myself in the bathroom, sobbing with a helplessness so profound it felt like I was drowning.
My professional skills, my ability to research and explain, were utterly useless.
The standard advice I’d read—to gently correct, to reorient, to tether him to the present—was not just failing; it was actively causing harm, shredding the connection between us one factual argument at a time.
This article is the story of how I unlearned everything I thought I knew.
It’s a journey that begins with a single, loaded word—”senile”—and the world of misunderstanding it represents.
It’s about discovering the profound difference between a person’s mind and their brain, and realizing that when one is failing, the other can still be reached.
It’s about my painful, frustrating, and ultimately transformative journey from being a fact-checker for my father’s reality to becoming a librarian for his feelings.
It’s the story of the Two Bookcases.
Part I: The Problem: The Weight of a Word, The Failure of Logic
To understand where my approach went so wrong, I had to first understand the flawed paradigm I had inherited—a framework built on a foundation of fear, misunderstanding, and a single, damaging word.
My personal struggle was not happening in a vacuum; it was the direct result of a century of cultural and medical baggage that had taught me to see my father’s condition as a failure of his mind, rather than a disease of his brain.
The Ghost in the Word “Senile”
The word “senile” haunts our understanding of aging.
Its journey through language reveals a slow poisoning of perception.
When it first appeared in English in the 1660s, its meaning was neutral, derived directly from the Latin senilis, meaning simply “of or relating to old age”.1
This, in turn, came from
senex, “old man,” the same root that gives us words like “senior” and “senate”.1
For two centuries, to be senile was merely to be old; the word described a stage of life, not a state of disease.
The shift began in the 19th century, a period of rapid medical classification.
By 1851, the term “senile dementia” was in use, and by 1882, the word “senile” on its own had acquired the connotation of being “infirm from age” and mentally weak.1
This was more than a change in definition; it was the medicalization of old age itself.
Cognitive changes were no longer seen as a possible variation in the human experience but as a pathology inherent to the aging process.
The word became a convenient, but lazy and dehumanizing, shorthand.
It implied that memory loss and confusion were an inevitable and shameful consequence of getting old, rather than the symptoms of specific, diagnosable brain diseases.4
This linguistic fossil of a flawed medical model is the root of so much caregiver pain.
The word primes us to see a failing person, not a person with a failing brain.
It became a catch-all for any cognitive decline in older adults, used colloquially to dismiss and diminish.5
To call someone “senile” was to write them off, to suggest a global incompetence that was both pitiful and irreversible.6
Today, the medical community has unequivocally abandoned the term.
It is recognized as vague, non-clinical, and deeply offensive.6
Modern medicine requires precision.
A doctor doesn’t diagnose “fever”; they diagnose the infection causing it.
Similarly, a doctor no longer diagnoses “senility.” They use specific terms for distinct neurological conditions: Alzheimer’s disease, Lewy body dementia, vascular dementia, frontotemporal dementia, or Mild Cognitive Impairment (MCI).4
These are not normal parts of aging; they are diseases.4
Yet, the ghost of “senile” lingers, shaping our instincts and informing our disastrously wrong-headed communication strategies.
Fighting a Battle of Realities
The cultural baggage of “senile” informed my every instinct.
Subconsciously, I had absorbed the idea that my father’s confusion was a character flaw, a stubborn refusal to accept reality.
I saw it as my job to correct him, to be the anchor of fact in his sea of confusion.
I was following an unwritten, unhelpful playbook that so many caregivers are handed.
I relied on reasoning and arguing.
“Dad, we just talked about this.
Look at the calendar.” This approach, which feels so logical, is often the first and most damaging tool we reach for.
It assumes the person’s brain can process logic in the same way it once did, and when it fails, it leads to immense frustration for both parties.10
I corrected his mistaken beliefs.
When he would talk about his mother, who passed away a decade ago, as if she were waiting in the next room, my first instinct was to say, “Dad, Grandma is gone.” I thought I was helping by orienting him to the truth.
In reality, I was forcing him to experience the grief of her loss anew, each and every time.12
I questioned his recent memory.
“Don’t you remember the grandkids visiting this morning?” This question, seemingly innocent, is a cruel test that a person with dementia cannot pass.
It doesn’t jog their memory; it only highlights their deficit, causing embarrassment and shame.11
The emotional fallout was devastating.
For my father, these interactions led to increased agitation, anxiety, and withdrawal.
He was being constantly told he was wrong, that his reality was invalid.
For me, the caregiver, the result was profound burnout.
I felt lost, angry, and consumed by guilt.13
I was pouring all my energy into a strategy that was not only failing but actively making things worse.
This feeling of being at one’s wit’s end, of following all the “rules” and only creating more conflict, is a tragically common theme in caregiver forums and support groups.15
I was trapped in a cycle of correction and conflict, and I couldn’t see the way out because I didn’t understand the fundamental nature of the problem.
The problem wasn’t my father’s logic; it was his brain.
Why You Can’t Argue with a Changing Brain
The turning point for me began with a shift in perspective from psychology to biology.
Dementia is not a state of mind; it is a physical disease characterized by the progressive death of brain cells, or neurons.18
While a healthy brain loses some neurons with age, the loss in a brain with dementia is widespread and catastrophic.18
To understand why my fact-based arguments were failing, I had to understand which parts of my father’s brain were being attacked.
Imagine the brain has two different, crucial departments for memory.
The first is the Hippocampus.
Tucked deep in the temporal lobe, the hippocampus acts like the brain’s diligent filing clerk for recent information.20
It takes in new experiences, facts, and events—like a doctor’s appointment or what you had for breakfast—and processes them for short-term recall and storage as long-term memories.22
In Alzheimer’s disease, the most common form of dementia, the hippocampus is one of the very first areas to sustain damage.19
Abnormal proteins—beta-amyloid forming plaques
between neurons and tau forming tangles within them—disrupt communication and eventually kill the cells in this region.19
The filing clerk, in essence, is being slowly erased.
The second department is the Amygdala.
Located right next to the hippocampus, the amygdala is part of the brain’s ancient limbic system.
It is the fortress of our feelings, the seat of our core emotions: love, joy, fear, anger, sadness.22
While the hippocampus deals with the
what and when of an event, the amygdala processes the feeling associated with it.21
Critically, in many forms of dementia, the amygdala and the emotional processing centers remain relatively resilient and functional for much longer than the hippocampus.26
The emotional core remains intact long after the factual filing system has begun to decay.
Herein lies the neurological mismatch that was at the heart of my struggle.
I was using my fully functional hippocampus to send fact-based, logical messages.
I was trying to communicate with my father’s hippocampus, a part of his brain that was physically shrinking and losing its connections.28
The communication channel was broken.
My attempts to reason with him were as futile as shouting into a disconnected phone line.
The devastating, yet liberating, realization was that the only reliable, open channel was the emotional one: my amygdala to his.
His words about the doctor’s appointment might not have been factually true, but the
feeling behind them—of being confused, controlled, and disrespected—was 100% real and valid.
The problem wasn’t him.
It was my entire communication strategy, which was built on a faulty assumption about how his brain could, and could not, work.
Part II: The Epiphany: The Two Bookcases
My breakthrough didn’t come from a medical journal or a neurology textbook.
It came in the stale-coffee-and-shared-tears atmosphere of a caregiver support group in a church basement.
I was there because I was defeated, convinced I was a failure as both a daughter and a journalist.
I listened as others shared stories that mirrored my own—the same circular arguments, the same frustration, the same heartbreak.
Then the facilitator, a gentle woman who had cared for her own husband for years, stood up and said, “I want you to imagine something.
I want you to imagine the mind is like a bookcase.”
Discovering the Analogy
She asked us to picture a tall, somewhat wobbly bookcase standing next to our loved one.
This, she explained, is the Factual Bookcase.
It represents the hippocampus, the brain’s center for facts and biographical data.26
- The Top Shelf: At the very top, right by their head, are the books of the most recent memories. What they had for breakfast, the conversation you just had, the fact that there’s a doctor’s appointment this afternoon. These books are new, placed precariously on top.26
- The Middle Shelves: Further down, at shoulder level, are memories from their 60s—retirement parties, the birth of a grandchild. At their knees are memories from their 20s—their wedding day, their first job.29
- The Bottom Shelf: At the very bottom, near their feet, are the oldest and most foundational books: childhood memories. The smell of their mother’s kitchen, their first day of school. These books have been on the shelf the longest and form the base.30
“Dementia,” the facilitator said, “is like a constant tremor that rocks this bookcase.” As it shakes, which books are the first to fall off? The ones at the very top.
The most recent memories become disorganized and lost.29
This is why a person with dementia might not remember what they ate for lunch but can describe their childhood home in vivid detail.
As the disease progresses, the shaking gets worse, and books from lower and lower shelves begin to fall and scatter, creating confusion about time and place.30
Sometimes, when they try to put a book back, it ends up on the wrong shelf, mixing up timelines and realities.27
Then she delivered the part that changed everything.
“But that’s not the only bookcase,” she said.
“Imagine a second one.
This one isn’t tall and wobbly.
It’s short, wide, and built of solid oak.
It’s almost impossible to tip over.”
This, she explained, is the Emotional Bookcase.
It represents the amygdala, the brain’s resilient emotional core.26
This bookcase doesn’t hold the
facts of what happened; it holds the feelings associated with those facts.
It doesn’t hold the memory of the wedding day, but it holds the book of love and joy felt on that day.
It doesn’t hold the memory of a specific argument, but it holds the book of anger and hurt.27
While the Factual Bookcase is made of flimsy wood and is easily shaken by the tremors of dementia, the solid oak Emotional Bookcase is incredibly sturdy.
The books of feeling are much safer and remain accessible for far, far longer.27
A New Mission: From Fact-Checker to Feelings-Librarian
In that church basement, the world shifted on its axis.
The Two Bookcases analogy was more than a clever metaphor; it was a new operating system for caregiving.
It handed me a key to a door I thought was permanently locked.
I suddenly saw the futility of my old approach.
My entire mission had been to frantically scramble after the books falling from the wobbly Factual Bookcase, trying to shove them back onto the top shelves while yelling, “See? This book belongs here!” It was an impossible, exhausting, and deeply frustrating task for both of us.
The analogy gave me a new mission.
My job was no longer to be a fact-checker.
It was to become a feelings-librarian.
My role was to stop pointing at the empty, chaotic shelves of the Factual Bookcase and instead, to pull up a chair, sit with my father, and gently ask him about the beautifully preserved, deeply meaningful books on his sturdy, solid oak Emotional Bookcase.
This cognitive reframing was profoundly powerful.
First, it externalized the disease.
It wasn’t my father who was being difficult; it was his wobbly bookcase.
This simple shift dissolved so much of my anger and replaced it with empathy.
Second, it provided a simple, actionable mental model for a complex neurological reality.
I didn’t need a PhD in neuroscience; I just needed to remember which bookcase I was trying to access.
Most importantly, it changed the goal of our interactions.
The goal was no longer the impossible task of restoring lost memories.
The new goal was the profoundly possible task of connecting with preserved emotions.
This moved our entire relationship from a deficit-based model, which constantly mourned what was lost, to an asset-based one, which cherished what remained.
It was the key to ending the arguments, reducing my burnout, and finding my father again, not in the world of facts, but in the world of feelings.
Part III: The Solution: The Art of Compassionate Communication
Armed with the Two Bookcases analogy, I returned home not with a sense of dread, but with a sense of purpose.
I began to learn that my new, intuitive approach actually had formal names in the world of dementia care: Person-Centered Care and Validation Therapy.
These are not just techniques; they are philosophies built on a single, revolutionary principle: stop trying to force the person with dementia into our reality, and instead, step into theirs with empathy, respect, and curiosity.32
Principles of the “Sturdy Bookcase” Approach
The core of this new approach is to listen for the underlying emotion or unmet need that is hiding behind the factually incorrect words.36
A behavior is a form of communication, especially when words begin to fail.37
If my father said, “I need to go to work,” the
fact was that he had been retired for 15 years.
The feeling, however, was a need for purpose, for routine, for the dignity of having a job to do.
The old me would have argued with the fact.
The new me learned to respond to the feeling.
My first real success story with this method felt like a miracle.
One afternoon, Dad was pacing, agitated, repeating that he was late for a board meeting.
The old argument was bubbling up on my lips.
Instead, I took a deep breath.
I centered myself.
I thought: What book is he reading from his Emotional Bookcase? The book of purpose.
The book of responsibility.
“It sounds like you have very important work to do, Dad,” I said calmly.
He stopped pacing and looked at me, his shoulders relaxing slightly.
“Yes.
Very important.”
“Well,” I said, gesturing to a basket of clean laundry, “I have a really important job here that I could use some help with.
Could you help me fold these towels?”
He looked at the basket, then at me.
A moment of clarity passed over his face.
He nodded.
“Yes.
I can do that.”
For the next twenty minutes, we stood side-by-side at the kitchen table, folding towels in a comfortable silence.
There was no argument.
There was no agitation.
The board meeting was forgotten.
I hadn’t corrected his factual reality; I had validated his emotional need for purpose and redirected it to a task we could share.38
This simple interaction, which transformed a moment of potential conflict into one of connection and peace, was more powerful than a thousand correct facts.
It was proof that the Two Bookcases model worked.
The Compassionate Communicator’s Toolkit
Validation Therapy, developed by social worker Naomi Feil, provides a practical toolkit for accessing the Emotional Bookcase.36
These techniques became my daily practice, the tools I used to build a new kind of relationship with my father.
- Center Yourself: Before you react, pause. Take a deep breath. Consciously let go of your own need to be “right.” Your goal is connection, not correction. This internal shift is the essential first step.39
- Listen with Your Heart, Not Just Your Ears: Pay attention to the non-verbal cues. What is their tone of voice, their facial expression, their body language telling you? Often, the truest communication lies there. Strive to listen for the meaning and feeling that underlie the words.40
- Rephrase and Reflect Their Emotion: A powerful way to show you understand is to gently repeat their feeling back to them. “It sounds like you’re feeling scared.” “You must really miss her.” This verbalizes their emotion, which can reduce their anxiety because they feel heard and understood.39
- Reminisce Using Their Cues: When they mention a person or a time from the past, see it as an invitation. Use it as a doorway to their long-term memories—the sturdy books on the lower shelves. Ask gentle, open-ended questions like, “Tell me about your mother. What was she like?” This honors their reality and taps into a source of rich, preserved memories.35
- Use a Calm Tone and Gentle Touch: Your non-verbal communication is a direct message to their Emotional Bookcase. Speak slowly and clearly in a low, reassuring tone. Where appropriate, a gentle touch on the hand or arm can convey warmth, safety, and affection more powerfully than any words.40
To make this shift concrete, I began to think of my interactions in terms of a simple “before and after.” The table below became my mental cheat-sheet, a guide to transform moments of conflict into opportunities for connection.
| The “Wobbly Bookcase” Approach (Focus on Facts – Often Unhelpful) | The “Sturdy Bookcase” Approach (Focus on Feelings – Compassionate & Effective) |
| “Don’t you remember? I just told you that.” (Questions recent memory, causes frustration) 10 | “It sounds like that’s on your mind a lot. Let’s talk about it.” (Acknowledges the feeling, offers connection) 44 |
| “Your mother died 20 years ago. She’s not coming.” (Corrects the fact, can cause fresh grief) 12 | “You must miss her very much. Tell me a favorite memory of her.” (Validates the emotion of longing, invites reminiscence) 39 |
| “There’s nobody stealing your things. You just misplaced them.” (Argues with a delusion, increases paranoia) 12 | “That must feel so scary to think someone is taking your things. Let’s check that they’re safe together.” (Validates the feeling of fear, offers reassurance) 11 |
| “What did you do this morning?” (Open-ended question that can feel like a test) 12 | “I was just remembering that beautiful song you like. Shall we listen to it?” (Leads with a concrete prompt, focuses on present enjoyment) 35 |
Building a World of Emotional Truth
This philosophy extends far beyond verbal communication.
It’s about intentionally creating an environment that speaks directly to the Emotional Bookcase, fostering a sense of safety, joy, and well-being.
This became a central part of my caregiving strategy.
We filled our home with music from my father’s youth.
Even when he struggled to find words, he could hum along to a familiar tune, a process that can unlock memories and positive feelings.35
We created a “memory box” filled with old photographs, his army medals, and a favorite worn-out baseball glove.
Looking through these items together became a calming ritual, a way to reminisce without the pressure of a direct question.47
We established simple, predictable routines.
A consistent schedule for meals, walks, and quiet time helps reduce anxiety and confusion because it creates a world that feels safe and familiar.47
The goal of all these efforts is to build a world where the person is validated for who they are in the present moment.
It is a world built not on objective, factual reality, but on the profound and enduring power of emotional truth.
It is about creating an environment where they feel loved, valued, and secure, regardless of what their Factual Bookcase looks like on any given day.
Conclusion: The Feeling That Remains
The journey with dementia is, undeniably, a journey of loss.
There is no escaping the grief that comes with watching the Factual Bookcase become emptier over time.
Books fall, pages scatter, and entire chapters of a life can seem to vanish.
To deny that reality is to deny the pain that caregivers and their loved ones experience every day.
But the Two Bookcases analogy taught me that this is not the only story.
The solid oak Emotional Bookcase remains.
It holds the essence of a person, the core feelings that have defined their life.
While the fact of an event may be gone, the feeling it created endures.
I think about this every time I visit my father now.
We might spend an afternoon listening to his favorite Glenn Miller records.
An hour later, he may not remember the fact that we did this.
That particular book has already fallen from the wobbly shelf.
But I know, with a certainty that has become the bedrock of my caregiving, that the feeling of joy, of contentment, of connection, of being loved—that book has been carefully and securely placed on the sturdy oak shelf of his heart.
And that feeling remains long after the details have faded.
For anyone walking this difficult path, our most important task is not to be the frantic, frustrated guardians of a crumbling factual library.
It is to be the loving, patient readers and co-authors of the emotional one.
We must learn to stop asking “Do you remember?” and start asking “How do you feel?”.
In doing so, we discover that the most profound and lasting connections are made not in the realm of what is remembered, but in the sacred, resilient realm of what is felt.
And that is a place that dementia, for all its power, cannot easily touch.
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