Henry Wadsworth Longfellow said, "If we could read the secret history of our enemies, we should find in each man's life sorrow and suffering enough to disarm all hostility."
Without doubt, dementia patients are not our enemies, although they have episodes of anger and aggression. Yet, as in Longfellow's words, there is sorrow and suffering beneath their behavior that could elicit our empathy.
There Are Reasons Beneath a Dementia Patient's "Unreasonable" Behavior
There are reasons for dementia patients' bad behavior. They have the all-too-human defensive responses of retaliating when they feel threatened. If a person in the throes of dementia feels cornered and disempowered, and their autonomy and very being feel violated, they will lash out. We all do.
It may be difficult for a person living with dementia to understand why he or she is being confined, talked to like a child, deprived of the ability to drive, buckled down with restraints, or forced to undress, toilet or be bathed in front of strangers. Imagine how temperamental any person would feel if she or he was not allowed to get even a cup of coffee!
Caring for people with dementia involves seeing things from their point of view. As Susan Macaulay, a blogger who recounts her journey through her mother's Alzheimer's, says, "When Mom exhibits responsive behaviors which appear angry and/or aggressive, there's usually a perfectly reasonable and rational explanation for it-from her point of view."
Getting on their Side
Taking the dementia patient's point of view is important. Teepa Snow has thirty years of occupational therapy experience. During an episode by a patient of anger, aggression, or non-cooperation, her method addresses the frightened and frustrated person inside the dementia. She recommends using the words like "I'm sorry" to explain things: "I'm sorry; I was only trying to help," I'm sorry I made you angry," "I'm sorry I treated you like a child; I didn't mean to."
Snow also notes that during full-blown anger incidents, it is important to keep one's hands down (not even using a "Calm down" gesture with the hands raised "pacifically"). Other body language that she recommends includes getting at or below eye level with the person to help reduce their fear that they may be overpowered or dominated. Physically getting on the person's side can be important, such as through sympathy: "Oh, poor Laurie! Everyone's trying to come at you at once."
Doing this turns the caregiver into an ally and advocate, not a person who is trying to make "Laurie" do things she is frightened to do. Snow explains how in one full-blown incident of a dementia patient's defiance, she was able to persuade the woman to get on a gurney and even accept the restraints as protection when all the EMTs could not do so. She noted that the woman was trembling from all the adrenaline, so she gave her a blanket to soothe and warm her, followed by a hug. The woman calmed down and cooperated.
"The Cat Ignored Becomes a Tiger"
Naomi Feil, M.S.W., A.C.S.W., speaks of dementia patients' need for human connection, even if they are hard to reach. She has developed a method called Validation. Validation is empathic, sees the individual as a whole, and works to step into the person's shoes. In doing this, Feil says we can understand the reasons beneath a dementia patient's intermittent "unreasonable" behavior.
Indeed, Feil says, relying on the teachings of Freud and Jung, "The cat ignored becomes a tiger." Angry episodes are triggered when the person living with dementia feels misunderstood and invalidated.
When people living with dementia become aggressive, caregivers may ask, "What deep, underlying needs of theirs are being ignored?" Do they need validation, comfort, understanding, and an apology that things are the way they are now? Are we ignoring or not comprehending the person's very real needs to be treated with respect and dignity, as a human being?
People Living with Dementia Are Human too
People living with dementia are human beings. From their viewpoint, it is the world that has turned strange, not them. They cannot see their own disease. To them, it is other people who refuse to recognize their autonomy, their humanity, who they are inside, and what they need. No matter how they try to communicate this, it is not understood. The frustration of dementia is probably more intense for the sufferer of dementia than for the caregivers, producing angry and aggressive behavior at times.
By following these empathic approaches, we discover the human being inside the dementia. Our compassionate responses may very well "disarm all hostility."
Feil, Naomi. What Is Validation. Available online at https://vfvalidation.org/web.php?request=what_is_validation.
Macaulay, Susan. "My Alzheimer's Story," April 19, 2015. Available online at http://myalzheimersstory.com/2015/04/19/20-questions-that-help-explain-why-people-with-dementia-get-agitated-and-physically-aggressive./.
Macaulay, Susan. Teepa Snow Demonstrates 10 Ways to Calm a Crisis with a Person living with Alzheimer's/Dementia. "My Alzheimer's Story," August 28, 2015. Available online at http://myalzheimersstory.com/2015/08/28/teepa-snow-demos-10-ways-to-calm-a-crisis-with-a-person-living-with-alzheimers-dementia/.
Macaulay, Susan. "Seven Powerful Things a Care Partner Can Say to Stop Anger and Aggression in a Person with Dementia. "My Alzheimer's Story," May 20, 2015. Available online at