Skills Kept and Lost to Dementia
This table displays the skills kept and lost to dementia. We already covered “mindfulness” and “mindlessness” in Step 4. Once you begin to understand what a person with dementia can and cannot do, you will be able to avoid offending them and embarrassing them by asking them to use the skills they no longer have. It does not come naturally to us, though. The DAWN Method classes and books will walk you through all of the DAWN tools that can help you to gradually change how you interact with your loved one.
|Skills Lost to Dementia||Skills Kept with Dementia|
|Rational thought||Intuitive thought|
|Remembering self||Experiential self|
Why DAWN focuses on the loss of rational thought
Dementia came into my life as it does for many of us—when someone we love gets it. For me, it was a neighbor who had Alzheimer’s and was becoming too forgetful to manage entirely on her own. Her children lived elsewhere and would have to move her into a care facility unless they could find someone to check in on her and help her with errands. I had just moved to Moscow and volunteered because I wasn’t working and didn’t want her to have to leave her home of many years just because she was becoming a little forgetful and confused.
Within a few months I was helping half a dozen seniors who were living on their own with mild cognitive impairment or dementia. They were all very different people—they had been housewives, professors, ranchers and scientists in their earlier lives—but they all needed help with the same sorts of issues and were all emotionally distraught. During that first year, I kept trying to find a pattern to what they could and couldn’t do so that I could do a better job of meeting their needs and keeping them safe, and be able to teach my staff to do the same thing.
I also saw my clients experiencing emotional distress and knew that I’d felt the same type of pain at one time in my life. I just couldn’t put my finger on it. Then one day it hit me: my clients were experiencing the opposite of what I experienced when I started attending law school.
The discomfort of losing rational thought processes to dementia & Alzheimer’s
During my younger years my studies and work were all more creative than analytical. I had studied art and music as a child, then literature and language. I had worked in marketing, graphic design, and writing, and also with people who had physical and cognitive impairments. Then I went to law school on a scholarship as an older adult. To suddenly find myself required to use only my rational and analytical thought processes, rather than intuition and creativity, was very unpleasant for me.
When I remembered my own discomfort at being forced to use my rational thought processes exclusively, I realized that I was watching my dementia clients go through the same experience, only in reverse. My clients were losing their rational thought processes and being forced to navigate daily life with intuitive thought alone.
We can help by expressing rational thought processes for them (give them a play-by-play of what is happening)
This realization dramatically changed my life as a caregiver, and the lives of my clients. I began expressing my own rational thought processes out loud for them—reciting facts, outlining steps and events, drawing conclusions—and they began to relax and feel safe. Once they felt safe with me taking care of the rational thought processes for them, our times together became joyful. Together we could savor all that is available when we use our intuitive thought processes: beauty, sensory stimulation, laughter, and emotions.
This is the premise upon which I created the DAWN Method. I discovered it first in my own life, then in my work with people with dementia. We have two very distinct thought processes, each providing us with a distinct set of tools. Dementia takes away the rational thought processes—such as the ability to recall and use facts, vocabulary, analysis, or see cause and effect—but it doesn’t take away our intuitive thought processes. When the caregiver takes care of the rational thought functions, the person who has dementia can continue to experience the best things in life: beauty, feelings, and everything our senses bring to us in the moment.
This is the DAWN Method. When we use it with our loved ones and clients, there can be great joy, despite dementia.
Keeping intuitive thought: Living happily in the intuitive world
Being “demented” doesn’t really mean being crazy. It really means to be experiencing dementia. It means to be experiencing progressive cognitive impairment. And, as you may already know from reading my earlier blogs, having dementia means losing your rational thought processes and remembering self but not your intuitive thought processes or experiential self. Dementia won’t make you crazy unless the people around you don’t understand how to take care of the rational thought processes for you so that you can enjoy living in the intuitive world.
Our intuitive thought processes enable us to recognize our own feelings and the feelings of others, savor beauty, and enjoy all the information our senses bring to us. That means we retain the ability to revel in all the best things in life—anything that is beautiful as well as our relationships with other people. In Dementia Beyond Drugs, Allen Power reports seeing people who score zero on a cognitive abilities test who, when they see a fellow resident in need, respond with compassion.
Providing support for our loved ones and clients’ rational thought processes is our responsibility as their caregivers. The bonus is that, when we do, they can relax and enjoy everything their intuitive thought processes bring them. It’s a lot of fun to spend time with someone who lives in the intuitive world.
How do we do live in the intuitive world?
Take the time to look at what Dan Cohen is doing through his program “musicandmemory.org,” and watch his YouTube clip “Alive Inside, Henry.” Music activates our intuitive thought. It is a wonderful way to spend time with people who have dementia. Learn the music and songs they enjoyed listening to at earlier times in their lives and create playlists to listen to together.
Stay in the present. If you stop thinking about the past and future, you are left with what you can see, hear, touch, feel, smell, and taste—in the present. The present is filled with sensory stimulation, if you manage to still your rational mind and pay attention. Look around. Listen. Bring something with you to share: something that tastes good or smells good, or flowers, fabrics, buttons, scrapbooks—everything and anything can provide positive sensory stimulation.
Get out and go. Do you really have to sit in the care facility? Could you not take your loved one or client out for a drive, out for a latte, to a quiet parking spot in a park to watch children play, or a bench in a crowded square to watch people? It’s emotionally painful for our brains to have too little sensory or social stimulation. If we were to be locked up in a care facility, we would be wandering, exit-seeking, and getting agitated, too.
Here at DAWN, we take care of our clients’ rational thought processes and they begin to feel safe and become remarkably happy and relaxed using just their intuitive thought processes. It’s an amazing transformation. Most of our clients still live at home alone and take part in activities in the community with us. We make sure they get so much physical exercise, social contact, and sensory stimulation that by the end of the day they are tired and ready to go to sleep. They don’t have to be locked up in care facilities. They’re not the least bit crazy, just happily “demented” and living in the intuitive world.
The experiential self and the remembering self
In his book Thinking, Fast and Slow, Daniel Kahneman explains the existence of our experiential and remembering selves. Although Kahneman is not thought of as an expert on dementia care, grasping this concept will greatly enhance your success in caring for your loved one or client as they experience dementia.
The concept of our experiential and remembering selves parallels that of our two types of thinking processes. We know that all of us have both rational and intuitive thought processes, and that some people prefer using rational thought while others are more comfortable in the intuitive or creative world.
Regardless of their earlier preferences, experiencing dementia forces our clients to live in the intuitive world and become dependent on us to take care of rational thought processes for them. When we do, they begin to feel safe and experience a sense of wellbeing.
Just like our rational and intuitive thought processes, we all have experiential and remembering selves as well. Kahneman explains our two selves by using vacation preferences as an example. He points out that some people select and take vacations for the purpose of enjoying the activities and experiences, while other people choose vacations that will provide them with pleasurable memories. The latter may frenetically take pictures when on vacation while the former might forget to take a camera along. We each have a preference for one or the other, but, once again, one self disappears with dementia (the remembering self) and the other remains (the experiential self).
What this means for dementia caregivers
Have you ever been in a care situation and overheard a caregiver say something dismissively or with sarcasm, or seen someone perform a task brusquely or without courtesy, and then excuse it with the statement: “Well, she won’t remember anyway.” I cringe when I hear or see people being treated as if they are not present, experiencing the moment, enduring what is being done to them.
Even though people experiencing dementia become unable to recount what has just happened, they still go through the experience—even without recall. The psychological present lasts about three seconds. We experience the present even when we have dementia. The emotional pain caused by callus treatment or statements occurs during that period. Our loved ones and clients’ moods and actions are expressions of what they have experienced, whether they can use language and recall, or not.
This is why person-centered, strength-based care is so critical for people experiencing dementia. They are experiencing the present. We need to not only provide support for rational thought losses, but also remember that they remain experiential beings even when their ability to recount and recall their experiences has melted away.
So be careful to safeguard your loved one or client’s experience of the present. Doing so will pay dividends in positive moods and cooperation, but more importantly, not doing so is unkind.