The aged woman had stopped biting aides and hitting other residents. That was the good news.

But in the North Shore nursing home's efforts to achieve peace, she and many other residents were drugged into a stupor -- sleepy, lethargic, with little interest in food, activities and other people.

"You see that in just about any nursing home,'' said Eva Lanigan, a nurse and resident care coordinator at Sunrise Home in Two Harbors, Minn. "But what kind of quality of life is that?"

Working with a psychiatrist and a pharmacist, Lanigan started a project last year to find other ways to ease the yelling, moaning, crying, spitting, biting and other disruptive behavior that sometimes accompany dementia.

They wanted to replace drugs with aromatherapy, massage, games, exercise, personal attention, better pain control and other techniques. The entire staff was trained and encouraged to interact with residents with dementia.

Within six months, they eliminated antipsychotic drugs and cut the use of antidepressants by half. The result, Lanigan said: "The chaos level is down, but the noise is up -- the noise of people laughing, talking, much more engaged with life. It's amazing."

Now the home's operator, Shoreview-based Ecumen, has started a project called Awakenings throughout its 15 long-term care nursing homes. It's based on Lanigan's work and funded with a two-year, $3.7 million state grant.

"We saw what Eva was doing -- something everybody in the industry talks about -- and we were impressed," said Mick Finn, an Ecumen vice president. "We said, 'Hey, this is real. Can we all do this?' "

The dangers of drugs

Powerful antipsychotic drugs have been used for years to reduce agitation, hallucinations and other debilitating symptoms among people with mental illnesses.

They also are widely used "off label" to quell disruptive behavior among people with Alzheimer's disease and other forms of dementia.

Medicare spends more than $5 billion a year on those drugs for its beneficiaries, including about 30 percent of nursing home residents. Several studies have concluded that more than half are prescribed inappropriately. The drugs are especially hazardous to older people, raising the risk of strokes, pneumonia, confusion, falls, diabetes and hospitalization.

"There's a bunch of problems, not least of which is those drugs can kill you," said Dr. Mark Kunik at Baylor College of Medicine in Houston who spoke last month at the Gerontological Society of America's annual meeting in New Orleans.

Instead of looking for causes of disruptive behavior among dementia patients, doctors typically prescribe drugs to mask the symptoms, he said, because "It's the easy thing to do. ... That's true in hospitals, in clinics and in nursing homes."

Federal regulators are cracking down on homes that don't routinely reassess residents on psychotropic drugs. But use remains widespread.

"Whether you have Alzheimer's or not, there's a reason people get frustrated or upset -- pain, urinary tract infections, hunger, fear of strangers or loud noises or strange settings, maybe drug interactions,'' Kunik said. "If you figure that out, you likely can find a safer, nonpharmacologic treatment."

Treating loss with love

About 150 miles south of Two Harbors, Bernice Brockelman, 91, was snacking on cookies last Wednesday beside the Christmas tree at Ecumen Parmly LifePointes, a nursing home in Center City -- all the while alternating quickly from calm to worry to calm.

"Can I stay here tonight? I don't know where to go. Can I stay with you?" she asked Christy Johnson, the home's therapeutic recreation director. Though Johnson reassured her, she asked the question again -- and again and again.

In an effort to calm her while preparing to wean her from pills, the Parmly staff invited Brockelman into a game of Bingo and to recite the Polish phrases she learned from her immigrant parents. Then she spotted a male visitor.

"Hey, is he married?'' she asked with a sparkle in her eye.

"When she's feeling good, Mom's an outrageous flirt and she can be really funny," said her daughter, Judy Balthazor of Center City. "But often there is the repetitive questions, the worry, sometimes just being washed out. I can't wait for them to get her off her drugs."

Until the Awakenings project, few at the home knew Brockelman's whole story -- the loss of both parents when she was in high school, of her husband at age 46, then two sons, a close friend and a nephew. Found to have psychosis and dementia, she "just shut down because she had so many losses," Balthazor said.

Now, the Parmly staff is gaining deeper knowledge of 15 residents who are on psychotropic drugs and who frequently are agitated or upset. They are about to start weaning the residents from the drugs, but they've already started a range of activities tailored to each.

Some say nursing homes cannot afford to replace drugs with personal attention because it requires too much staff time.

"Our guess is that it will take the equivalent of two extra people at each home, spread across all job categories," said Finn, Ecuman's vice president. "Can we afford it? We think we have to, because it's the right thing."

Brockelman, who lived nearly all of her life in northeast Minneapolis, loved to bake, so now she helps make bread and cookies. She danced and was physically active, so she walks with an aide and taps her toes to polka music. A devout Catholic, she attends several weekly church services. She plays Bingo with aide Jenna Miller and sometimes other residents.

"When [you] understand who Beatrice has been in the past, you know her a lot better in the present," Miller said. "With the Awakenings project, I have permission to spend the time I need with Bernice so she feels safe and loved."

http://www.startribune.com/lifestyle/health/111326224.html?page=1&c=y



Fundamental Attribution Error as an Obstacle to Empathy in Psychiatry
by Lee Sykes, Greater Manchester, United Kingdom

According to Wikipedia, "In social psychology, the fundamental attribution error (also known as correspondence bias or attribution effect) describes the tendency to over-value dispositional or personality-based explanations for the observed behaviors of others while under-valuing situational explanations for those behaviors." 

The fundamental attribution error is a cognitive bias. It over-emphasizes the individual’s personal characteristics while playing down situational factors as explanations for the individual’s behavior. This has very important implications in the social world. However, this bias is magnified within psychiatric settings, including mental hospitals, where individual behavior is often blamed on the person’s personality disorder or mental illness rather than attributed to stressors and other factors in the surroundings.

In the mental hospital setting, for example, individuals often feel shamed or humiliated by the treatment they receive. When they react angrily, their anger is blamed on their "disorder" rather than on the provocative treatment.

This leads to comments in the medical records such as the following;

'Joe got extremely angry and demanding. Then so and so said they feel like they are being targeted.''

''Jane has a personality disorder. Can't be trusted to behave, and possibly sounds delusional. Maybe the medication needs to be looked at.'

As a result of these false attributions, little or no empathy is displayed toward Joe or Jane. This compounds or worsens the situation. The patients are seen as "difficult." The staff develops negative attitudes toward them and may even withdraw in fear from them. The potential for a therapeutic relationship is negated.

Attribution errors are reinforced by diagnoses. The diagnosis is incorporated as a characteristic of the person regardless of the patient’s current presentation or mental condition. For example, previously psychotic patients may become symptom free; but if they get angry about a situation, their reaction or behavior will be explained away and attributed to ''being schizophrenic'' or whatever other label has been applied. The fundamental attribution error in psychiatry extends from personality traits to the diagnosis that the individual has been given. Instead of the staff or therapists showing empathy toward the individual who is experiencing anger, the anger is misinterpreted as a sign of impending relapse.

Instead of these false attributions, which create a barrier to empathy, we need to put ourselves into the shoes of the individual and ask ourselves the following kinds of questions:

· What would most people feel or believe in the current situation? What would most people do?

· What would I think, feel or do under similar circumstances?

· What else is going on? Are there other factors of which I am unaware?

Empathy is the cornerstone of therapeutic interaction, and awareness and reduction of cognitive bias will strengthen empathy and increase the focus on the individual’s actual experience as oppose to his or her presumed characteristics or diagnoses.

Lee Sykes works for 5 Borough's Partnership NHS Trust based at the Cavendish Unit, Leigh infirmary, Greater Manchester, UK.



Dr. Breggin's Empathic Therapy, Education & Living Conference Coming Soon!  --Sign Up Now!

Our first Empathic Therapy, Education & Living Conference is open to professionals and to the general public. It is going to be a very innovative, informative, exciting three days and we hope all of you will come.  Peter and Ginger Breggin are eager to meet you and to share the inspiring work and approaches being developed.   Already we have over 100 folks attending.

Come see what all the excitment is about.  Meet new and fresh faces in the reform arena and hear from many of the most experienced and expert individuals as they discuss the many better ways of helping others and ourselves to survive and even thrive after emotional crisis or overwhelm.  Please go to our Empathic Therapy website to join our reform organization today and to sign up to attend this event.   

Sign up here!~



Very best,
Ginger Breggin
Executive Director
Center for the Study of Empathic Therapy,
Education & Living



WARNING -- Most psychiatric drugs can cause withdrawal reactions, sometimes including life-threatening emotional and physical withdrawal problems. In short, it is not only dangerous to start taking psychiatric drugs, it can also be dangerous to stop them. Withdrawal from psychiatric drugs should be done carefully under experienced clinical supervision. Methods for safely withdrawing from psychiatric drugs are discussed in Dr. Breggin's books, Brain-Disabling Treatments in Psychiatry: Drugs, Electroshock and the Psychopharmaceutical Complex (New York: Springer Publishing Company, 2008) and Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime (New York: St. Martin's Press, 2008).


Peter R. Breggin, MD is no longer affiliated with the Center for the Study of Psychiatry, informally known as International Center for the Study of Psychiatry and Psychology, which he founded and led from 1972-2002, and Dr. Breggin is no longer involved in its conferences.

Copyright 2011
Peter R. Breggin, MD