Island Treasures 'Treasure Chest' with Judy Cornish

Another 'Island Treasures Treasure Chest' bonus episode.  In this episode we revisit "Skills Retained: Strengths-Based Approach to Dementia Care" Season 2, Episode 13 featuring Judy Cornish.

Judy Cornish is the founder of the DAWN Method - a strengths-based approach to dementia care.  From the treasure chest we hear about two sets of thinking skills: the sensory and the rational thinking skills.  We examine dementia through the lens of the disease or medical model and compare that to viewing dementia through the experiential or functional perspective. We also hear about mindfulness and mindlessness and how important it is to recognize the skills our loved one still has and how to supplement the ones they may be losing. 

Learning about this strengths-based, person-centered approach to dementia care can help provide a more positive experience for both the caregiver and their loved one.

Transcript

Thank you for tuning in to the Island Treasures Podcast.

We value the insights shared by our guests and hosts, but it's important to note that their personal experiences are intended to inform and encourage, and not to replace professional, legal, or medical advice.

With that, we are ready for today's exciting episode.

Hi there, I'm Alison van Schie, host of the Island Treasures Podcast for Caregivers, and in this segment, I will be sharing some nuggets of wisdom, or shall I say treasures, from the Island Treasures Treasure Chest.

Today, we're revisiting an episode from Season 2 called Skills Retained, Strengths-Based Approach to Dementia Care, which features Judy Cornish, founder of the DAWN Method.

This episode was brimming with treasures, treasures to help caregivers learn about this positive approach to dementia care. So let's open our treasure chest and get started.

Most of us get involved with dementia care because we have a family member, a loved one, who begins to experience it.

But that wasn't what happened for Judy. She'd moved to a small town and met one of her neighbours, who had recently been diagnosed with dementia. Then she met more.

I was gifted with the experience of being befriended by so many people who courageously, with so much courage but also so much determination, tenacity, and intelligence, continued to figure out how to do their best day after day, even though they

were losing some of the most crucial cognitive skills, the ones that we all rely on to get through the day, every day. They were absolutely my teachers, but they're my heroes.

Yeah, they are, yes. The more she worked with folks living with dementia, the more she learned from them, and through her work, she started a business and a positive approach to dementia care called the DAWN Method.

I wanted to communicate with DAWN that there is a way to work with dementia, because dementia does not take away all of our skills.

It takes away some very specific skills, and so the message of DAWN is to teach families, professional caregivers, people working in facilities or corporations or agencies to teach the pattern of skills kept and skills lost.

You know, DAWN is, it's a vocation for me. It was like a job I was giving them, and to me, it's giving them voice.

And what does DAWN mean?

It's an acronym for the Dementia and Alzheimer's Well-Being Network carefully chosen so that it would communicate hope and the beginning rather than that message of, woe is me and you, there is nothing we can do and craziness is going to take over

our lives. That is not what it must be.

Communicating hope and learning so much about dementia, which Judy shares with us.

If you're looking at dementia from the perspective of disease, what type of dementia is my loved one experiencing? Now we're talking hundreds of possibilities, including combinations. Any number of diseases could cause dementia, not just Alzheimer's.

Any number of life events, a traumatic brain injury, a bad reaction to chemo, a bad reaction to anesthetic. All of these can also cause dementia to begin. It could also be caused by a lifestyle.

We're now seeing research that tracks too much processed foods, and particular processed meat is a link to dementia. Also, there's various combinations of drugs and specific drugs that raise the incidence of dementia.

So right away, that's almost too much to even think about when you're trying as a family member to think about what their experiences are going to be as they move forward now that they have this diagnosis.

Well, that's a lot to consider, and we're looking at it from a medical perspective.

Now, the next thing you have to take into account, if that's your model, disease, now you have to start thinking about which parts of the brain are affected for your loved one with that particular type of dementia.

Okay, now it's even more complicated. I'm getting confused. And if it's my loved one, I'm beginning to throw my hands up.

I'm overwhelmed. But that's not all that will matter. You also have to take into account.

Your loved one's personality. And that's not all. You also must consider your loved one's life experiences.

There's four factors affecting the path or the trajectory of a person who's experiencing dementia. If you look at dementia from the perspective of disease.

There's so much to consider when your loved one receives a diagnosis of dementia, especially looking at it through the disease model. Let's see how Judy views dementia.

So that's not what I did, because I wasn't educated in medicine or even psychology or any of the related fields. And so to me, being a mere lawyer, all I know from my law degree is there's going to be a pattern to the facts.

And if the person comes into your office and they sit down in front of your desk, and you're the lawyer, and they come to you with a problem, they will start telling you what they think the problem is, and they'll start telling you facts.

And the lawyer's job is to continue to ask questions until they've got all the relevant facts. And once they've got relevant facts, facts are relevant because they fit into a pattern that meets a law.

So what my training as a lawyer told me is, if I'm trying to help somebody get through the day, and I'm seeing emotional reactions, I'm seeing behaviors, I'm seeing them do things or not do things, and it doesn't make sense to me, it's because I

don't have enough of the facts. And so I need to learn more. I need to back up, look at a bigger picture, and continue to look for relevant facts or a pattern.

Now, as somebody who has really wanted to be a linguist and wanted to be a professor of language, not a lawyer, I also know the primary rule of language acquisition.

And that is when we learn a second language, the errors we make when we're trying to become fluent in a second language, our errors are determined by our previous language, our first language, and our errors are entirely logical.

So once again, when I start spending time with people who are experiencing dementia, and I see them do something that doesn't make sense, deep down, I know that the human brain does not make illogical errors. It's programmed.

And so whatever looked inexplicable or crazy to me at that moment, really wasn't because I knew it was logical. And that meant I just didn't have enough facts to see the pattern. So do you see this changed it?

I was choosing to not look at dementia from a medical perspective. I was choosing to look at dementia from the experiential or functional perspective. I wasn't, as a doctor, saying, what's wrong with this person?

Oh, it's a behavior. The person's body isn't changing. They don't have tumors or broken bones or open sores.

No, no, no. The only thing that's changing is the behavior. Then that means I am forced to look for treatments that will change behaviors.

So that's your medical framework of addressing dementia.

And there is no way to avoid the focus on what's wrong with the person, new behaviors, and trying to change those behaviors when we don't have treatments, anything other than psychotropic drugs or mood-altering drugs or locking doors.

If that's our treatment, we're not addressing the real problem, what's really going on. And so you have to step back and say, is this really working? Is it possible to solve the problems presented by dementia by using a medical model?

It isn't. It doesn't work. It's expensive in dollars and it's expensive in pain, emotional pain for the caregiver, because it just gradually takes you apart.

Day after relentless day, as your loved one begins to experience more and more and more emotional pain themselves. So the medical model isn't fixing. It isn't solving.

It isn't curing. It isn't treating. It's not successful.

But if you step back and look at dementia from the experiential model, then it works. And that is what the DAWN Method is. Let's not believe that our loved ones are losing their minds when they experience dementia, because they're not.

What they're losing is very specific. They are losing one set of thinking skills. But we human beings have two complete sets of thinking skills.

Our primary set gathers information through our senses, through our exposure to our environment, right? Everything you see, hear, taste, touch, smell, it's giving you information about what's going on around you.

And you are receiving all of that information fully in the moment, in present time, without filter.

Here's an example of the experiential or sensory skill set that Judy described.

Like you picture yourself, you walk into a room and there's a painting on the wall. As soon as your eyes hit that painting, as soon as you see it, you're like, oh, I love that. Or, oh, I don't like that.

Right? It's instant, no filter. It's just, that's beautiful to me, that's not beautiful to me.

And then we have another set of thinking skills. So here's your second set of thinking skills. It's the one that Western society prizes and believes is the best.

And it's not, it's actually just a set of tools and it's secondary, but it's called your rational thinking skills.

And here's an example of how our rational thinking skills impact viewing that painting.

So here you are, you see the painting and you go, oh, I like that. And your companion says, why? Right?

Okay, now your second set of thinking skills kicks in and you say, well, you know, because I really like the way the hills are kind of shaded and the way the artists made the distance look more blue and I suppose it's that pretty color green.

I like the colors and I really like landscapes. And you know, then the artists did a great job of those those clouds. That's your rational thinking skills.

We start out with both sets of thinking skills.

You've got both sets.

However, if you begin to experience dementia, you will eventually lose those rational thinking skills. And they are skills. They are tools.

They are not the essence of you. You will not lose yourself. You will lose your ability to communicate because rational thinking skills includes language, verbal language.

You will not lose the ability to read non-verbal language. You will always be able to read my expression the moment I walk into your presence. You will always be able to tell, especially if you're partners, if you've been together a long time.

A momentary pause, the set of my shoulders, a gesture, posture, the tone of my voice. You will read it in a heartbeat. In fact, I think we get better at it as we lose our verbal language skills.

So if we love somebody and they're experiencing dementia, it's critically important that we come to understand this pattern of skills kept and skills lost. So out of two sets of thinking skills, we lose the secondary set.

And that's why it's really important to be informed about these skills.

Strength-based care is critical. We need to understand what our loved ones are doing and will continue to do, and we need to understand what they can no longer and will become unable to do.

When we use a strength-based approach to dementia care, we can adjust our behavior to supplement the skills our loved ones may be losing.

If I'm spending time with somebody who's experiencing dementia, I've got all my antenna out figuring out which skills this person still is able to use, and which ones they're not using.

And I'm doing my best to not mislead them, frustrate them, or embarrass them. And if I know what they can and cannot do, then I don't embarrass them and frustrate them, and we get along.

Getting along with your loved one and understanding what they may be trying to tell us, we can learn through the DAWN Method.

So when I say, honey, I want to go home, or let me out of here, I'm going home. What I'm saying really is, I have lost all of my memory skills. I look at things and none of them look familiar to me.

I am unable to access knowledge of the past. And so here I am in the present moment, every three seconds, completely without past knowledge. It's all new, all the time.

That's why we say I want to go home. And what we're saying is, oh my goodness, I wish I had that feeling of being at home where I am secure and safe and surrounded by the familiar. So what should my loved one do for me?

If you're the caregiver, you know, don't try to distract me. The need to feel safe and secure and at home is the essence of us, you know. Our brains are screaming out to us four times every second from birth until death.

Am I safe? The brain never stops.

And it's your intuitive thinking skills gathering all of this information without filter and then your rational thinking skills and your memory skills identifying that sensory stimulation, what you're seeing, what you're hearing, what you're tasting.

That answers the question and says, yes, yes brain, you're safe. It's okay. You're safe.

You're in a familiar place. You're at home. And then if you understand that dementia takes away just some of our skills, not all, if we understand what they can do and cannot do.

And if we work with their skills rather than against them, they have so much to offer and so much to teach. And that's what happened for me. That's why my teachers were many, many people who were experiencing dementia.

And here's another lesson that can make a difference.

It relates to mindfulness and mindlessness.

With dementia, there really is a pattern. And it's losing one of two sets of thinking skills. It's losing one of two selves, losing the remembering self, but keeping the experiential self.

And then there's changes to our attention skills. And if you're looking at attention skills from the perspective of functioning, what you're talking about is the ability to be mindful, to choose where to direct your attention.

So if I lose my ability to direct my attention, to redirect my attention, or to maintain my attention, then I cannot be mindful.

However, the flip side of that, what I can do and what is such a benefit to someone who is experiencing dementia particularly, but we all use them all the time, is the two tools of mindlessness, muscle memory and automatic thinking scripts.

We all use them every day, all day long. And if we didn't have those two tools, we'd be exhausted by breakfast time.

If we had to think every time we wake up, your eyes open, and you're laying in bed, and you think, okay, which side of the bed am I on? Means I have to use the right side of my body to turn over, to put my feet on the ground.

Okay, I have done this, and I'm in a room, and I need to think about where I keep my clothing. Okay, let's think this through. Right?

You would have to think about every step of every task from the moment you opened your eyes. We don't do that. We do things on autopilot, thankfully.

And the reason we can do it is because primarily, we have memory skills, and we are in a familiar location.

If it's the place I've woken up for the last 20 years, I don't even really have to wake up to make it to the bathroom in the middle of the night and back into bed.

But if I'm experiencing dementia, and you move me to assisted living so I'm safer, I don't have that muscle memory any longer. And now, every time I wake up, I got to think, where am I? How do I get out of this bed?

I'm going to, oh, I'm on the right side. Okay, I'll put my feet up. Now I wonder which of these doors is a bathroom, right?

So you know, taking people out of their familiar locations does not necessarily help, in fact harms.

And we don't want to do harm. Now here's Judy with her final words from the treasure chest on her strength-based approach to dementia care.

If you truly want to lessen your stress and your guilt and your emotional pain, your anger, your frustration, your exhaustion, if that's what you want to do, you really do have to learn what the strengths of dementia are, which skills will my loved

ones keep, which ones are they going to continue using, which ones are going to be gone or are gone, and then you begin working with that. And as you begin doing that, your own emotional load will lighten. There's no easy path.

If you want to spend time together in companionship and peace without constant conflict and pain, you have to learn what's going on and support your loved one in what they can and can't do. That's all you can do. It's the only way.

That concludes this Treasure Chest segment from the Island Treasures podcast for caregivers.

If you want to send a text to the Island Treasures podcast about this episode, be sure to click the link in the show notes and watch for a reply in a future episode. Thank you for tuning in today. Take care.