Both Sides of the Fence

How to make people crazier

Posted by Christine McLaughlin on Jan. 23, 2010 | 21 comments

Age, illusions, war, economy

I had entered through the front door not but thirty minutes earlier.  Preparing to exit I was certain I had returned to the same place.  There was the same gas fireplace, the same television and the same bookcases.  There were mostly the same residents sitting there too.

I could see the great outdoors through the windows.

Pausing for a second or two I'm thinking - where the heck did the door go?

I can't get this out of my mind: blogger Tom Gaertner's experience with his father's new assisted living environment. The older gentleman had moved because it was no longer safe for him to live alone. He'd taken up "exit seeking behavior," also called "elopement" or wandering, which gets you in trouble in northern winters, especially if you live on a highway.

An aide piped-up – Son; it’s directly in front of you.  Painted to match the bookcases.  See it?

Aha!  A secret passage through the bookcase.  I get it.  

But I don't.

Imagine yourself confused and frightened, compelled by something you don't understand to keep moving, to get away. Then you find yourself in a room that defies the rules of the universe, or at least architecture, as you have known them throughout your entire conscious life

A room with no exit. Jean Sartre, the famous French existentialist, wrote a play about that. No Exit from a  room with no doors -- and no windows, no mirrors, and lights that are never turned off -- was hell, and the people who occupied the space each other's unwitting tormentors.

No one knows why some people with dementia wander. The responses range from medication to using trompe l'oeil, or fool-the-eye artistic deception, to hide the exits. According to one respected medical journal, "visual agnosia, the inability to interpret what the eye sees, may be utilized as a tool in managing wandering behavior of Alzheimer's patients."

Something about that's not right. I asked a friend, Steph Kilen, about the practice. She works with Action Pact, a Washington Heights-based business that creates culture change in institutions that house and care for older people. The idea is to create real homes.

Steph said:

There are so many things about the institutional model that make people crazier. So many things are so unfamiliar/unnatural and un-normal that a lot of the natural cues are missing and it is harder for people to figure out what to do. Hiding things from people (even, having the kitchen "hidden") is really confusing. How can you settle down and want to stay anywhere (in a long-term sense, but also in regards to dementia-type "wandering") when a place doesn't seem like any place that you have ever lived?

You don't have to have to move into a secure facility to feel the anxiety of being in an institutional model room with no exit. People far smarter than I have wondered whether Afghanistan is a dilemma with no exit. Or whether there's any exit from saving financial giants that are too big to fail, and grow larger as we feed them.

I don't know the answers. But I do know that if you keep telling people the reality of their experience isn't true, if you keep replacing doors and windows with pictures of them, they aren't going to feel any better about being there.

They'll just keep looking for the crack to open the door. Sometimes, trying to get out of there is the only thing that makes sense.

Note: Yes, I know "crazy" is an inappropriate term to use for dementia. But it's not for politics, and I'm using it here because I think you know what I'm talking about.