Behaving badly? – part 1

The new dirty word of health and social care

‘Mrs X in Rm 22 is bellowing out again’, ‘They often call out, that’s dementia’, X I told you I’m coming – just be quiet for a minute’

(2021, Commentary from team members identified using the Quality Interactions Schedule[1] at three deidentified services caring for people living with a dementia | Meaningful Care Matters)

I often find myself wondering why and how the word ‘Behaviour’ is associated with negative connotations in health and social care settings.  Is this a new dirty word? I absolutely agree that the term behaviour can be something which is considered derogatory for a person living with a dementia or mental illness, it is not a word we associate with person centredness due to its polarizing nature.  Unfortunately, the term behaviour has been coined by health care workers from the days of highly task focused institutionalized care.  Sadly, this remains a current narrative all too often experienced.

Behaviour as a term to describe adverse behavioural expression remains shocking at best whilst being demoralizing and stigmatizing for people living with mental health problems or dementia at worst. 

Do you agree?

Well, a simple search in regulatory reports for health and social care (seniors care) by regulators indicate this is common.  Then there is the media (too often we simply dismiss this as being sensationalist reporting not considering the full truth, but the truth is always in the middle), Royal Commission findings and the stories from family members.  I am disappointed to say as a Senior Executive I too could rationalize these to be ill-informed and not fully reflective of truth.  I know better and am ashamed this was my attitude.  Once I truly understood what person centredness looks, sounds, and feels like, I always faced the reality we could do better and saying sorry we got it wrong was no longer enough.

We can’t blame our teams or staff in this as it is sign of wider cultural norms. Person centred cultures need to be real, authentic and genuine with the attitude of what can we do better.

The simple fact is, behaviours do not define people – feelings and emotions do.  An expression of illbeing which is commonly considered to be a ‘challenging behaviour’ is simply an expression of need being communicated which we as health professionals are yet to figure out. 

So what in fact is ‘Behaviour’

1. The way in which one acts or conducts oneself, especially towards others.
2. The way in which an animal or person behaves in response to a particular situation or stimulus.
3. The way in which a machine or natural phenomenon works or functions

(Google United Kingdom, 2022).

Behaviour simply put is our outward expression to the world in which we live, based on our internal feelings and emotions.  People living with dementia cannot regulate their response in the language construct which people who are able to communicate and comprehend can.  The outward response is an expression of an internal feeling and emotion.  We need to learn to speak in the language of feelings to recognise our own response and actions to support the person to feel safe, comfort and secure… aka – restore their internal equilibrium through sensing and feelings-based responses.

Behaviour does not have to be a dirty word, it is a natural human phenomenon, and we need to change the narrative to understanding that our behavioural expressions are unique, individualized and completely normal. (Lanzer, 1950)

References

Dean., R. P. (1993). The Quality of Interactions Schedule (QuIS): Development, reliability and use in the evaluation. International Journal of Geriatric Psychiatry, 819 – 826.

Google United Kingdom. (2022, February 02). https://www.google.com/search?q=behaviour. Retrieved from Google: https://www.google.com/search?q=behaviour&rlz=1C1CHBF_en-GBGB877GB877&oq=Behaviour&aqs=chrome.0.0i433i512j0i512j0i433i512l4j46i131i199i433i465i512j0i433i512j0i10i512j0i512.1530j0j15&sourceid=chrome&ie=UTF-8

Lanzer, I. A. (1950). A Critique of the concept of normality in behaviour. The Journal of Educational Sociology, 86 – 92.

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[1] (Dean., 1993)