Last week, I promised to report on a new paradigm for approaching behavioral symptoms of dementia without using potentially harmful medications. The key for me has been to look at the paradigm shift brought about by the Eden Alternative to inform a new view of aging.
Eden teaches us that aging is not about decline. Rather, it represents a new developmental stage — elderhood — in which people assimilate life experience into wisdom and perspective. The Eden Alternative transforms nursing homes by expanding our values beyond the narrow focus of medical treatment to encompass attributes of well-being: identity, meaning, connectedness, autonomy, security, growth and joy.
We must now turn the lens to view dementia in the same manner. The biomedical model teaches us that dementia is a relentlessly progressive brain disease that brings about cognitive and functional decline. Behavioral symptoms are “problems” that must be “managed”, and people with dementia need to be kept safe through a paternalistic environment that isolates and disempowers them, then medicates the predictable results.
As Dorothea Johnson reminded me recently, Viktor Frankl taught that “an abnormal response to an abnormal situation is normal”. We can only see this if we step outside our own skin and enter that of the person with dementia, through an “experiential” approach.
This means that it’s possible to have brain damage and continue to grow and develop. It is possible to make choices and engage with life. It is possible to live in a reality that is different than ours and have well-being. And every expression we call a “behavior” needs to be viewed from that reality. If there is discord, we need to understand that the problem may well be with us and our care environment, not the elder with the symptom.
There’s more than I can summarize in one post. Your required homework is to stretch your worldview with my favorite Bugs Bunny cartoon, “High-Diving Hare”: Note how Bugs foils our paradigm by making Yosemite Sam fall UP, instead of down, and toppling the tower while the diving board remains suspended. Watch to the end, have a good laugh, then apply Bugs’ last words to the discussion above.