Monday, 5 August 2013

Routes, Routines and Dementia

To anyone with knowledge of Neuro Linguistic Programming (NLP) the phrase “the map is not the territory” will be familiar, although the phrase pre-dates NLP and was actually coined by Alfred Korzybski in his work on General Semantics.

To those not familiar with the idea, simplistically, the concept is that none of us sees the true reality of the world. What we see is our perception of it through our own personal filters that are embedded within us as a part of our experiences in life, in other words, our own internal map. An example would be witnesses to an accident or crime who come up with different versions of events. The events are reality but how they are viewed depends on those individual’s experiences and filters.

Our internal maps guide us and guide our responses to the situations we find ourselves in. If there is nothing on our map to help us in certain situations we become unsure or maybe even panicky, in other words the map is our comfort zone. Yet after we have delved into the unknown our map rewrites itself to encompass this new experience and, in the same situation in the future, we are likely to repeat the actions that successfully saw us through it the first time.

Occasionally what we do may not actually be the best way to deal with that situation by we will continue to do it that way because that is how our internal map guides us and we may not bother to think of possible alternatives.

In general terms this is why change is so often difficult. We are moving into the unknown and our minds are guiding us to stick with the tried and trusted even if that is not the best route for us in the long run. That is why certain addictions can be difficult to break because the addiction has become so familiar it means moving off the chart and into the unfamiliar to break the habit.

There are, naturally, conflicting views on this theory but it does give us a useful tool for thinking about social care.

Imagine you have a map and you are using it to find your way to a specific destination, you just follow the shortest possible route from A to B and off you go, with occasional reference to the map to make sure you are on the right road. Now imagine that halfway along your journey your map changes and suddenly there is a huge blank space between your starting point and where you want to get to? How would that make you feel? Panicky? Frustrated? Angry?

How must it feel to those who have dementia when their memories, and therefore their internal map, begins to fail?

Our built in Sat-Navs help us move from task to task without having to think. Our morning routines, for example, are often done on auto pilot, yet if we suddenly did not know what we need  do we could find ourselves unintentionally missing breakfast or completely forgetting to wash. But everyone of us has a different morning routine and those different ‘maps’ could actually cause distress even when we desire to be helpful.

If I tried to impose my ‘route’ on to your morning routine you’d probably speak to me very unkindly!

Even where someone’s own map has developed a blank space trying to impose a new routine may well feel ‘wrong’ even if the person cannot articulate why that feels wrong (that can even happen to us in everyday life sometimes something doesn’t feel quite right does it? So we will question whether or not we should do it even if we can’t quite put our finger on it).

Understanding and supporting someone with dementia is not just about being able to do routine personal tasks for them. It is about understanding the complexities of the disease and how your actions might impact on people’s lives. We need to learn to be able to read other peoples maps so we can provide them with support along their own routes to achieve the goals they want