Some Thoughts On Relating to People with Dementia (in a philosophically complex way with little scientific rigour & research)

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Throughout my experience working in various dementia-specific units, I have been perplexed as to how some people remember things about me. What they don’t remember about me is my name, or where I come from. But they do remember my face and rituals in relating that we go through.

Whilst I have been doing a considerable amount of reading into the complexities of Neuroscience and the symptoms and causes of PTSD (or C-PTSD), I am constantly amazed at how our bodies remember things, or react in certain ways which are then interpreted (rightfully or wrongfully) by our mind; either from bottom-down or bottom-up. For myself, I have found in the last few years a bubbling to the fore of past traumas, or what I perceive as learned patterns of reacting that have largely been unconscious. The excavation of these old adaptations has been painful, yet rewarding – sending me on many new paths to understand myself and others. But I then got thinking about workplaces of the last few years: the dementia units that I’d worked in in various aged care facilities. I’d noticed something interesting around how my interactions with those with dementia were primarily physical, or embodied – not the space of information or verbal communication.

Verbal and Non-Verbal Language

You might ask, don’t we always relate that way? Well, yes. But think about much of our relating – we normally think of it as based on transmitting information verbally. We ask questions, share stories. But when you have a diagnosis of one of the myriad forms of dementia, those ways of relating become challenging. Someone with dementia may have great difficulty stringing together a narrative, or follow logical trains of thought. Sometimes you can ask a question and get an answer that is completely unrelated. We also talk about the idea of ‘body language’ or ‘kinesics’ but it is like a subset, or finds a place secondary to information. Yet it is believed that communication is 20% verbal and 80% non-verbal (1).

When someone is given a diagnosis of dementia, their senses are heightened (2). Therefore sounds, sights, smells, touch, and sight is dramatically effected. Sometimes there is a sensitivity to how you are perceived that may go beyond how you would normally interact.

Body Memory

Body Memory is a new concept to me, but basically it suggests that the body itself can also store memories. These particular kinds of sensory memories are triggered by pain, discomfort, tension or arousal (3). Thus, when someone hears a sound or experiences a sensation, the body may rush to remind them of a particular way to react. These kinds of memories are believed to start even as early as when inside the womb (4). Although it appears that many articles relate body memory to negative outcomes, I don’t see how this couldn’t include feelings of pleasure and desire.

Such concepts have been on my mind because I have recently listened to James K. A. Smith’s book Desiring the Kingdom. Although this book was not related to what I’m saying directly, it addressed some of the issues that plague much of the way we perceive contemporary education, and our understanding of human beings generally.

Part of our modern understanding, or ‘pedagogy’ in Smith’s terms, is that we find ourselves as basically minds in a body. It is based on the Cartesian Dualism established by Descartes, that posited that we are primarily minds or thinking things. (This is where much contemporary thinking goes in terms of creating things like modern notions of gender identity, divorced or undetermined from the physical self. See Love Thy Body by Nancy Pearcey). Education then is framed by depositing information into minds. Compared with Christian scriptural teaching, which finds God creating the world as good, and what we understand about Jesus in the Incarnation, we find a conflicting view of the world that places mind (or mind/soul) and body together to form our self. What we get out of this is that our bodies are not just perceptions, but actual things that are really there that are deeply part of who we are. This conception of self is quite frequently in league with modern notions of self as it posits a more determined conception of self, rather than the self-determined version of self.

This Biblical conception of mind and body together, provides good grounds theologically, that are supported by what some of the science suggests about this means of relating. We truly are intricately designed beings!

My experience.

In my interactions with one particular lady with dementia, I noticed that over time that she’d trained herself to know that if she shook my hand, I’d tickle her palm with my middle finger. The routine was as follows: I would extend my hand and she would act hesitant to shake it, but sometimes she’d forget about this. When I was ‘successful’ in my little tricks, she’d recoil in shock and laugh. I’d pretend that I didn’t know what was happening either, saying ‘What was that?!’ Afterwards we’d have a laugh together. But how peculiar that she recognised this action in relation to me? This lady doesn’t know my name, but does recognise me as the man who does that handshake. Her body has created a memory around this.

It wasn’t only with this individual, but with others that somehow my face exhibited similar responses, a way of relating that, although extremely repetitious, provided a way of relating. This was then followed by a particular physical response/way of relating – either a handshake, a rub of the arm, or a laugh, or a conversation about something they felt was related to me. This all seems pretty common sense: we usually shake hands or greet people that we love with a hug, right? But people with dementia need us to think more carefully about our interactions, or the ways that we relate to them. It calls attention to the things we take for granted, and a need to think deeply on the philosophical and theological grounds for how we perceive our interactions with ourselves and our relationship with ourself. It may even mean that we need to overemphasis the (appropriately) physical ways of interacting as the verbal becomes increasingly challenging. John Swinton writes in Dementia: Living in the Memories of God a personable and meaningful presence in interacting with dementia sufferers is what is required. They live from moment-to-moment, whereas our minds are always set on the future on the next task or meeting. (Also, as a piece of writing that is haphazardly thrown together, I may even just be regurgitating what he wrote in his book. Perhaps it has finally dawned on me! Cheers John.).

What am I trying to say?

I think that this all points towards a more embodied or intentionally physical way of relating to people with dementia. It also suggests that the body can still learn things, or be trained in new ways. When people we know or others develop a diagnosis of dementia, we know that there are still ways of relating or perhaps a need to rethink those ways of relating. It is clear how we think about these things when the question is posited: would you rather lose your mind but have your body? or lose your body but have our mind? We nearly always go with option B.

In our society of ‘hurry’ and schedule, our nurses are almost hamstrung into a space of little personal or embodied interaction with their clients – quite symptomatic of how we treat people in modern, dualistic sense! This embodied sense fits more with how we are, and may allow us philosophical grounds for slowing down to support people with dementia not just in their basic physical needs, but interaction that is physical/non-verbal in a meaningful way. It’s little wonder that the most successful nurses appear to engage through being meaningfully present.

It also supports the notion of a Christian understanding of the self – as both mind and body together – without one necessarily prized over the other. It will be interesting to see where neuroscience goes in this field and how it supports the Christian conception of self and its intricacy. God has made us fearfully and wonderfully! This view, I believe, gives back a whole frontier of dignity to the person that the modern view tends to disfavour, with its high emphasis on the mind.

Jesus Christ also gives us the example of one who not only dealt primarily with people’s spiritual condition of sin, but also reached out to touch those with physical infirmities (Matt 8: 1-2, Mark 7: 31-37, to name a few).

This is not a bad example to follow.







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