So, What’s the Alternative to Drugs?

This writer supported the psychiatric approach for 20+ years by referring to and working in many geropsychiatric hospitals, but as the research starting coming out showing the antipsychotics did little for (other than sedate) people and he started looking for alternative treatments.  Basically, it comes down to distracting the patient by providing interesting activities with plenty of social experiences to keep people from drifting into their internal world which (due to dementia) is typically an empty fearful place.  If someone feels “normal” because they know what is expected of them, where they should be, they are not puzzled by the situation they find themselves in, and there is a comfortable routine–then agitation does not occur, and no drugs are needed.

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In Pennsyltucky, where this writer is from, everyone lived in little row houses with a tiny cement porch in York, PA. You know, the ones with the two metal chairs shaped like metal flowers that, sort of, rock back and forth. Well, when grandma woke up confused every morning, we’d help her dress in her best frock and do up her hair and put her on one of those chairs on the porch. She’d have a cool glass of ice tea next to her, and she’d watch all the people going about their business on Queen Street. Folks would stop and chat about the weather, her attractive appearance, etc. and she could fully comprehend and respond to that conversation. She would not recognize her neighbor of 90 years she grew up next door to, of 90 years, that she grew up next door to, but they chat every morning. In short, grandma felt normal, as she was not confronted with
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new fangled tasks she couldn’t figure out. No one pushed her to walk down to the park and meet new people. She’d come in exactly at noon for lunch, watch a repeat of her soap opera and then sit a spell on the porch in the evening watch the folks come home from work and school. She’d be tired at the end of a productive day, where there were no triggers to make her feel confused or out-of-place and thus we saw no agitation. She slept through the night and woke up to begin the routine again.

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In Sum
When a patient shows “psychiatric” signs and symptoms like depression/anxiety and/or psychosis should we treat that with psychiatric drugs? When we see agitation should we turn to sedating drugs? Maybe, we should think that these “symptoms” as signs of boredom and insufficient stimulation to a person whose mind has become limited in the ability to self-motivate and self-intiate productive behaviors leading to an end goal. Maybe, we should start thinking about increasing external sources of social stimulation and structured, scheduled activities to productively engage that person with the social environment. To avoid further retreat into an increasingly spare and empty internal world. Just, maybe…

Here’s a typical row house for those of you who don’t know. Note the added elegance of astroturf on top of the cement porch. We call it a “stoop” in Pennsyltucky, by the way.
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