How can I have hallucinations

Dealing with delusions and hallucinations: Recommendations from science

Delusions or hallucinations are challenging symptoms that caregivers of people with dementia frequently encounter. This article investigates the question of which framework recommendations for dealing with these symptoms can be found in nursing science.

"Losing a delusion makes you wiser than finding a truth." - Ludwig Börne

When dealing with delusions and hallucinations, the following questions essentially arise in professional nursing:

  • Should one get into the delusion of a person to be cared for or not?
  • Should one expose hallucinations as such or not?
  • Should one lie or not when dealing with delusions and hallucinations?

In this article I want to show you what findings and general recommendations exist from nursing science on these questions. First of all, however, the question arises as to what is the difference between delusions and hallucinations.

Here are two examples:

Delusion

“A woman I care for thinks I'm her granddaughter. She cannot be dissuaded from that. If I tell her that it is not me, she gets angry and insults me as a 'stupid thing' who wants to make fun of her grandmother. When I play along, it is easy to look after them and we both have a lot of fun together. Am I allowed to do that?"

hallucination

“One resident regularly sees rabbits on her bed. I then pretend to drive them away. She is then mostly satisfied and can sleep. But that didn't work last week. We had to take her to the hallway with the bed. Then she slept there. "

Scientific literature on delusions and hallucinations

If one looks at the scientific literature on the subject of delusions and hallucinations regardless of the clinical picture in which such a psychotic experience occurs, one finds the following: Apparently, science largely agrees that in the case of people who do not suffer from dementia, one under no circumstances goes into delusions of those affected. For example, in the standard work “Textbook Psychiatric Care” (edited by Dorothea Sauter), individual recommendations such as: “Do not get into the delusional world of patients.” However, such instructions have not been developed explicitly for dealing with people with dementia.

But how does it look in practice?

Going with the madness as a solution?

The scientific expert opinions on this question are relatively wide apart. This is made clear again in the Federal Ministry's “Framework Recommendations for Dealing with Challenging Behavior in People with Dementia”. Erwin Böhm (1990), founder of the “Psychographic Nursing Model” and Sven Lind (1995) recommend going into the world of delusions to resolve situations triggered by delusions and hallucinations. Sven Lind recommends using a broom to “drive away” imaginary marmots seen by the dementia patient.

This recommendation by Lind, however, gets a bitter aftertaste against the background of his concept with the decisive criteria “Effectiveness (effectiveness), efficiency (profitability) and practicability (feasibility)”. If practicability and efficiency in Lind's sense are decisive, so-called “quick” solutions, which under certain circumstances only serve the welfare of the caregiver but not the person affected by dementia, the door and the gate are open.

Person-centered care acts differently

Approaches in the care of dementia patients that are widespread in Germany are approaches such as “Validation according to Feil” (1999), the “Integrative Validation according to Richard (IVA) (2000)”, the “Mäeutik according to Cora van der Kooij” (2007) or the “ Person-centered approach according to Kitwood ”(2000). These approaches refer to a large extent to the psychologist Carl Rogers (1902–1987), the founder of the client-centered approach in psychotherapy (Rogers 1983). What these approaches have in common is an appreciative and “real (truthful)” way of dealing with those affected.

In this context, this means that going along with the psychotic experience is not used if possible, as it contradicts the Rogerian principle of authenticity and truthfulness. Simply put: its reality is not my reality. In practice this means that one does not reach for a "lie" and pretend to see the same thing as a hallucinating victim.

In this sense, it would be another form of lie if the resident who wanted to go to work were told that the train to work had already left and that he could now go to bed again.

All of this contradicts such a person-centered approach. The proposed approach would be to fathom the feelings of the person with the psychotic experience in contact with the person, to appreciate them and to reach him in this way and to work with him on the essentials behind the symptom.

"But if there is a way, you as a person are part of the way with your attitude." - Detlef Rüsing

Conclusion: is everything allowed?

We know of both positive and negative examples of both approaches (“follow along” and “person-centered action”). But if we are honest as scientists, we have to admit that there is no scientific evidence of superiority for either way. This means first of all that nobody is to be demoned who goes either way. Does this then consequently mean that there are no indications whatsoever as to which way is the right way? Does this mean everything is allowed?

Not even close! For example, many caregivers report that they feel “bad” when they lie to someone just to get them to go to bed. On the other hand, it's the quick, simple lies that happen to us quickly. This includes the note that everything is free if a resident absolutely wants to pay for his meal or the in-house hairdresser. It is the unnecessary lies that we caregivers sometimes tell so quickly so as not to get involved in long - perhaps depressing - conversations.

There is currently and probably not in the future a silver bullet for dealing with delusions and hallucinations in dementia. But if there is a way, you as a person are part of the way with your attitude. And to science: it is time to act and to support practice. The “correct” way to deal with delusions and hallucinations is a real practical problem that many people have ignored for too long.

Detlef Rüsing is a nursing scientist and heads the DZD Dialogue and Transfer Center at the University of Witten / Herdecke. Rüsing also has many years of practical experience in the care of the elderly and the sick: he worked there for over 16 years. His focus is on theory-practice transfer. He is also the editor of “care: dementia. Journal of Professional Care for People with Dementia ”. Contact: [email protected]

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Further literature and internet sources:

  • Federal Ministry of Health (Ed.) (2007): Framework recommendations for dealing with challenging behavior in people with dementia in inpatient care for the elderly. Berlin: BMG. Also freely available online from the following source: https://www.bundesgesundheitsministerium.de/fileadmin/fa_redaktion_bak/pdf_publikationen/Forschungsbericht_Rahmenempfänger_Umgang_Demenz.pdf.
  • Feil, N. (1999): Validation. A Way to Understand Confused Elderly People. Munich: Reinhardt.
  • Kitwood, T. (2000): Dementia. The person-centered approach to dealing with confused people. Bern: Hans Huber.
  • Lind, S. (2007): Care for people with dementia. Basics - strategies - concepts. Bern: Hans Huber.
  • Van der Kooij, C. (2007): Dementia, Communication, and Body Language. Integrative Validation (IVA). In: Dementia and Care. Tackenberg Peter, Abbot-Zegelin Angelika (ed.). Frankfurt: Mabuse.
  • Rogers, C. (1983): Personality Development. Psychotherapy from the perspective of a therapist. Stuttgart, Velcro-Cotta.
  • Sauter, D .; Abderhalden, C .; Needham, I .; Wolff, S. (2004): Textbook Psychiatric Care. Bern: Hans Huber.

Source of the title photo:

Photo: Seebube / www.flickr.com