When someone with dementia gets agitated, angry, or anxious, our instinct is to comfort and reassure. A natural thing to say is “calm down, everything is OK.” We have the best intentions, but might not realize that hearing those words could rub someone the wrong way when they’re already distressed. Dr. Elaine Eshbaugh shares insightful personal stories to explain why someone might react negatively when they hear the words “calm down.”
No one, in the history of the world, ever calmed down because someone else told them to calm down.
Case in point.
A few years ago, I was in the emergency room for kidney stones. As they were admitting me for pain control and eventual surgery, a nurse came in to put an IV in my arm.
Needless to say, it wasn’t one of my best nights. I was rolling around in pain and gripping the sides of the bed. I remember sweating profusely. I had been vomiting and couldn’t stop trembling. I wasn’t sure if they could get the pain under control, so in addition to pain I was dealing with anxiety.
The nurse, wielding a needle, got in my face. With her nose about three inches from mine (at least as my memory serves), she said firmly, “Now just calm down.”
I’m hoping that’s not a line she uses a lot. If it is, I’m surprised a patient in pain hasn’t managed to stick that needle through her forehead yet.
If I hadn’t been such a mess, I would’ve said something like, “Thanks for the tip. I thought I was looking pretty cool by writhing around in pain here, but you’re right. I’m gonna just chill.”
Rather than calming down, as my unhelpful nurse had suggested, I became more anxious.
The more I think about it, the more I realize that this is a natural response to the suggestion of “Just calm down.”
There was the time someone tried to steal $63,000 from our bank account by, in short, stealing my identity. (Like most people, we don’t have $63,000 to steal, and this actually helped the situation be resolved more quickly in the end.) I got on the phone and called our bank. As I was trying to explain what happened, the bank employee on the other end said, “Okay, now just calm down here.”
As if panic was not a valid response to having your identity and more money that you technically had stolen from you?
I’m not sure she could’ve said anything that frustrated me more.
Why does being told to calm down have the opposite effect?
When we are told to calm down, the other person implies that we don’t have reason to be upset or frustrated. It implies that we are overreacting or that our feelings about a situation don’t matter. It implies that we aren’t being listened to or understood.
Unfortunately, we frequently tell people with dementia to calm down. If you have said this to person with dementia (which I have), I’m gonna go out on a limb and guess it wasn’t an effective strategy. My guess is that they felt like you weren’t listening to them. And you probably weren’t. They likely felt disregarded. And, they didn’t calm down. I’d be willing to bet that they got more anxious. They might have even become aggressive.
A woman at a memory care community in my town was once convinced that there was a bomb under the building. She tried to leave, and she encouraged everyone to come with her. When she realized she couldn’t leave, she freaked out. And that’s a logical reaction to her reality. If I thought there was a bomb under the building I was in and realized there was a code on the door that no one would tell me, I’d freak out as well.
She was told to…just calm down. Imagine yourself in her situation. You have information that you and others in the vicinity are in a dangerous situation. And you are being told to….just calm down.
The woman tried to explain the situation to yet another person, who cut her off dismissively yet again. Finally, she shouted, “If one more person tells me to f***ing calm down, I am going to f***ing slap them!”
I like to promote peace rather than physical violence, but if you work in a memory care community and frequently use the phrase calm down, maybe this wouldn’t be the worst way to learn a lesson.
So what works instead?
I’m not sure it matters if someone has dementia or not. When someone is upset, you take the time to listen to what they are upset about. You don’t dismiss their concerns (even if you don’t share them). You try to see their reality (even if it’s not your own).
Think about it. How do you like people to respond when you are frustrated, sad, anxious, or angry? How do you feel when someone tells you that you need to calm down? And how is that feeling any different if the reality you are upset about is a different reality than the one the others around you are experiencing (and I’m not just referring to dementia here – we all live in different realities)?
Recently I was doing a group discussion with ten individuals who have dementia. In about five seconds, a women went from enjoying a chat with the group to being convinced that no one liked her and everyone was “stabbing her in the back.” Of course, in my reality (which is irrelevant in this situation) her perspective made no sense. No one had said anything negative to her. All of the conversation had been pleasant. How could she be okay with everyone…and then not okay?
As she got up (and I worried she might hit someone), my instinct was to say “Now calm down.” But – keeping in mind that I’m quite ineffective when I use this direction with my husband, my college students, or my friends with dementia – I stopped myself.
“Can we step outside for a second?” I asked her.
She followed me outside the room. It took a minute for her to maneuver with her cane, so I had a moment to think about what direction I wanted to go.
I said, “I want to understand why you’re upset.”
She gave me a long explanation of why she felt alienated by the group. To be honest, I couldn’t follow most of it. I listened anyway. Then she told me someone had kicked her under the table. I had no idea if this was true or not, and I didn’t waste effort trying to figure it out. It made no difference.
“I can understand why you’re upset,” I told her. “Do you want to go back in or would you rather go watch TV in your room? I totally get it if you don’t want to hang out with these people.”
There was a long silence before she said, “I want to go back in. It’s okay.”
I’m not giving myself too much credit here. I don’t want to act like I have all the answers because it’s common for me to have situations like this blow up in my face.
But sometimes the best way to get someone to calm down is to deliberately avoid the words “calm down.”
I’m trying to strike those words from my vocabulary.
Recommended for you:
- What Is It Like to Live with Dementia? 8 Insightful Personal Stories
- 5 Tips for Dealing with Caregiver Guilt in Dementia Care
- Habits of Sane Caregivers in Dementialand
Guest contributor: Dr. Elaine Eshbaugh is the author of Welcome to Dementialand. She holds the Davis Professorship of Gerontology and chairs the Division of Family Services and Gerontology at the University of Northern Iowa. She’s on the executive board of the Northeast Iowa Agency on Aging and has collaborated with continuing care communities, adult day services, and hospices. Dr. Eshbaugh is also active in community outreach and does education on dementia for communities, families, and facilities. She often meets with families to provide support after a dementia diagnosis.
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