You may not have thought about the difference between treatment and care. Both are necessary and needed in our lives at different times, but sometimes we fail to recognize the difference between the two and which is appropriate when. We fail to recognize that someone experiencing a condition, like dementia, needs care instead of treatment.
Treatment is for illness and injury.
When we have a health concern, we go to a doctor or surgeon for treatment. The doctor asks questions about our symptoms and discomfort, identifies the probable disease or injury, then usually orders tests to substantiate the diagnosis. Once she or he is satisfied as to what disease or injury is demonstrated by the symptoms, a treatment is prescribed.
With treatment and disease, an accurate diagnosis is very important. If we are diagnosed with cancer, for example, we want to know exactly where the tumor is, how far along it is, what areas of the body have been impacted, and what the treatment options are. Having an accurate diagnosis enables us to make educated decisions regarding treatment.
Treatments are meant to address the symptoms of ill health—that something that is wrong with us, a disability. Treatments are designed to either cure the illness or alleviate our discomfort due to the symptoms. In his book Being Mortal, Atul Gawande points out that in the United States we are very adept at diagnosing and treating diseases, but that in developing this expertise we seem to have forgotten the value and need for care. He asks us to recognize that care is required, not treatment, when we are experiencing a condition such as aging or dementia.
Care is for conditions.
When we are experiencing something that is not curable, such as dementia, diagnosis becomes less important. There is no need to identify and choose between possible treatments. When providing care, we turn our attention from disabilities and symptoms to abilities and strengths. With care, we support what the person can still do and accommodate the disabilities that cannot be cured.
When experiencing dementia, people lose memory and rational thought, such as the ability to see cause and effect, prioritize actions or needs, make plans, or envision and follow the steps in a series. With memory and rational thought losses come bad judgment and an altered sense of reality. These are the disabilities of dementia.
But dementia does not mean a total loss of abilities. We lose rational thought, but not intuitive thought. We have two psychological selves: our experiential selves and our remembering selves. We lose only the remembering self—not our ability to exist in and experience the present. When we as caregivers recognize and support these abilities (and stop expecting our loved ones or clients to do what they can no longer do) they become happier and feel safer. They begin to experience well-being rather than emotional distress.
So let’s not forget that there is a time for treatment and a time for care. Treatment is for illness and disease. Care is needed to support conditions that we must live with because they cannot be cured.
When we love someone who is experiencing dementia, we should be focused on their emotional needs and abilities, not see only the disabilities dementia causes. When we put our attention on our loved ones, we help them function successfully and feel safe and at peace.
§
