Understanding Belligerent or Disruptive Behaviour
The primary responsibility of the facilitator is to the entire group, made up of individuals. A careful assessment of belligerent or disruptive behaviour should be made to determine what the underlying cause or message may be. Oftentimes, such behavior is a communication of want or need. Dementia patients, for instance, often cannot understand or communicate their needs.6-13
Belligerent Communication 6-13 In early 1998, Rosa suddenly became belligerent again. She grabbed Anna and Jorge, pushed them, and hit them. “At first we didn’t know what to think,” Anna recalls, “but then we realized that she only acted that way before mealtimes. We soon realized that it was her way of communicating that she was hungry.”
Instead of giving her three meals a day, they switched Rosa to six or seven snacks, and she calmed down. There is Still a Person in There , Castleman et al., p62
Belligerent or disruptive behaviour
I was briefed by an activity director of a day center on the fears of a client who was feeling threatened about the closure of her care facility and an imminent forced move. Unsure of her future, Marianne was feeling unsettled, helpless, lost, and afraid. 6-14
Offering Empathy 6-14 Even in those situations where another person is completely enmeshed in the web of a suffering mind and is not receptive to help in re-perceiving the situation, we can be of comfort. We can offer our own empathy, our own experience, our own understanding of how it feels when we suffer: the resistance, tension, fear, withdrawal, self-pity, doubt, the utter separateness. This compassion will guide our helping hand to appropriate gestures: a simple word of friendship to cut through the isolation; a gentle neck massage to ease the tension; a tender hug or touch to convey love; a meeting of the eyes for a moment beyond it all. How Can I Help?, Ram Dass, p87
I spoke with her, telling her that I understood that she might have to move. She speaks in whispers, head down, so I sat on the floor to encourage eye contact and facilitate lip reading.
I made no attempt to tell Marianne that I understood what she was going through, or to reassure her that everything would be all right―that was impossible. I did, however, offer connection, a listening ear, and later a vehicle to transcend her worries—music. 6-15
Modulating with Music 6-15 Music has a direct effect on specific physiological processes whose functional variations are indicators of anxiety, tension, or stress. Biomedical Foundations of Music as Therapy , Dale Taylor, p103
During the rhythm recess mid-way through the program, I brought up the subject of losing one’s home. I spoke of my own fears when I was forced to move from my home of ten years because I could no longer negotiate the stairs. A dialog began with others sharing their own experiences and what they did, or would do, when faced with a wrenching move. Marianne was able to voice her fears through the voices of her colleagues. I challenged them to guess the next song. I sang “All” (no aha!); pause then “I” (no aha!); pause then “Want” (presto the connection is made.) The group began drumming and singing “All I want is a home somewhere. Far away from the cold night air.” It is a dreamy song, inviting and soothing.
Then came the guessing game. What song did I sing after I moved to Marin and kept getting lost all the time? It took another hint or two before Eddie sang out: “Show Me the Way to Go Home!” The rest of the program brought related songs to sing and drum to such as, Happy Trails to You and Bye Bye Blackbird. I was able to come up with the songs after a few minutes thumbing through Creating New Rhythms with Old Songs — my resource book containing hundreds of songs shown with applicable categories such as travel and home.
Mrs. Li and Me
After a regularly scheduled drum circle at a skilled nursing facility, I was seated on my rolling chair, mopping my face. I did not initially notice when Mrs. Li, an elderly woman with a cherubic face, rolled over to me. She had been silent during past programs, either by choice or circumstance.
Mrs. Li rolled her wheelchair up to me as I sat mopping my face; then reached toward my head. I sat, curious about what sort of dialog would result.
She wordlessly wiped my brow with her hand. She continued to pat my head and brow in a caring and caressing manner. I assumed she was expressing concern about how over-heated I appeared. My eyes closed while I enjoyed the moment. 6-16
Reflexive vs. Reflective Brain Processing 6-16 Cognitive problems can arise out of external sensory information or internal mental processes. Most incoming sensory information is initially processed through the thalamus into two separate response systems:
1. We have a relatively slow, analytic, reflective (primarily cortical)system to explore the more objective factual elements of a situation, compare them with related memories, and then rationally respond. It’s best suited to non-threatening situations that don’t require an instant response—life’s little challenges.
2. We have a fast, conceptual, reflexive (primarily subcortical) system that identifies the dangerous and opportunistic elements in a situation, and then quickly activates powerful innate or learned automatic response programs if survival seems problematic.
This fast system developed to respond to imminent predatory danger,fleeting feeding, and mating opportunities. Our emotional/attentional systems thus are primed to quickly note (for example) any loud, looming, contrasting, moving, obnoxious, or attractive elements that signal potential danger, food, or mates, and rapidly signal the information to our solution systems.
... The rapid superficial analysis of the fast system often leads us to respond fearfully, impulsively, and inappropriately to situations that don’t require an immediate response. Stereotyping, prejudice, regrets, and apologies are but one of the prices we humans continually pay for this powerful survival system. Worse, the neurotransmitter or hormonal discharges associated with fear can strengthen the emotional and weaken the factual memories of an event if the stressful situation is serious and/or chronic. We become fearful of something, but we’re not sure why, so we’ve learned little from the experience that’s consciously useful.
I would therefore suggest that we simply use the terms reflexive and reflective to describe our response patterns.www.alite.co.uk/readings/brain_and_mind/brain_and_mind1.htm
It was as if I was back in my mother’s care. Wresting myself from that place of pleasure, I realized that I had, in fact, abandoned my responsibilities and adopted the role of a child. The program was over, but I was on the job until I left the premises. I was lucky that day. I later learned of Mrs. Li’s violent physical attacks on others.
Since her attacks were without (an understood) provocation, she was treated by family and staff with caution. The activity coordinator later apologized for not arming me with information about Mrs. Li’s violent behaviour.
Understanding staffing shortages that are pervasive throughout the health care delivery system, I learned that it is up to me to ensure my own safety and the safety of the participants. I was reminded why a staff-person should always be in attendance and learned how easy it is to slip from a role of responsibility into a reactive position.
While unloading percussion equipment for a program at an adult day center, I learned from the Activity Coordinator that Saul had recently been diagnosed with cancer. His distress and pain were obvious, yet he had not been told of the diagnosis. Since Saul did not speak English, my focus for that day, and future weeks, was to distract and apply the salves of pleasure, music, and activity. 6-17
Drumming to Distraction 6-17 It is well known that there cannot be two overlapping patterns of neural activity simultaneously. Even though the human brain contains a hundred billion nerve cells, no two patterns may overlap. In other words, there is a bottleneck of attention. Attentional resources may be allocated to only one entity at a time. A Brief Tour of Human Consciousness , V. S Ramachandran, p52
Saul’s drum acted as a recipient of his emotions—it was as if he was beating the pain into his drum. 6-18
Competitive Inhibition 6-18 ....The primary receptor of pain is called the nociceptor, which responds to stimulation such as intense pressure, extreme temperature, burning sensations and more....When you hit your knee on a desk, you probably rub it to make you feel better. Why does rubbing a spot reduce the pain rather than aggravate it? Because the act of rubbing sends a second set of tactile signals to the brain. As the brain is finite and will have to pay attention to both signals at once, the second stimulus leads to a reduction in the perceived severity of the more intense first one. This concept is called competitive inhibition. A User’s Guide to the Brain, John J. Ratey, p87
He was not told to stop his incessant pounding, at least initially. 6-19
Escaping Into Our Musical Shelters 6-19 Music can help eliminate pain by serving as an imaginary sanctuary – a safe haven – from pain. It helps reduce stress and tension, and elicits relaxation. It triggers endorphins, and helps our minds create sound images so we can temporarily escape into a “painless world” sheltered by the imagination. Music functions as an “interpreter,” translating pain “waves” (sensations) into healthy,“sound” energy or vibrations. The Tao of Music , John M. Ortiz, p32
My early reaction was one of concern, patience, and increased attention. As the weeks went by, I found my tolerance waning as I struggled to balance his pain against the needs of other group members. My response to Saul’s repeated calls for help eventually shifted from heeding his cries, to coping with his outbreaks and disturbances as they affected us all. I had to make a choice. I reluctantly refocused my attention on the larger group.
Guilt and frustration came with that decision; guilt that I could not give what I felt Saul deserved as his right, and frustration that I was helpless. I had become a secondary victim of Saul’s circumstances. 6-20
The Quality of Empathy 6-20 The link between our reaction to our own pain and the quality of our empathy for that of others needs to be examined carefully. The more we understand it, the deeper, freer, more naturally compassionate our response to the pain we all experience at one time or another. How Can I Help?, Ram Dass, p74
With those feelings came self-castigation. How could I feel resentment toward someone in such obvious need? I take the memory of Saul with me into my possible future. Not knowing the path that Parkinson’s disease will take me down, I dread the possibility of similar shifts in my relationships with others—that transformation of reaction and my attendant fears of isolation. I constantly juggle my craving for stimulation and community with my reluctance to be a bother to others, knowing that looking after my needs means shifting them away from their own intentions and goals.
The answer to this dilemma is to have caregivers whose primary focus is to attend to my physical needs. Although a caregiver can free my friends and family to attend to emotional ties, this solution is dependent on financial viability. Even with the luxury of a personal aide, it is critical for caregivers to maintain a veil of protection and distance. Without vigilance, this veil can harden into a wall, shutting out pain,connection, understanding—and me.
Equipment - Overview & Aesthetics
Audio-Visual Clues with Music
Enforcement vs. Invitation
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