When the problem is not the person but their day

Many years ago I was called by the management of a home where people with a cognitive impairment are cared for around the clock. It was about one of the residents.

Her behaviour had been escalating for months. She could no longer bear being in her room, she became restless, then loud, and in the end the situation was no longer safe for the carers or for her. The home had its own psychologists and sociologists, it had spoken to every carer, it had tried everything anyone could think of. They were at the end of their wits.

Because the management knew what I work with, they asked whether I could take a look at her.

Ninety seconds

A conversation with her was not possible. For me that was not an obstacle but the point itself: because she could not steer her impulses cognitively, she acted straight out of them — without control, without inhibition, without the layer of upbringing and adaptation that lies over the rest of us.

I asked for ninety seconds. That is all it takes to see which basic impulses a person carries.

What I saw was unmistakable: a very strong impulse towards movement. A great deal of drive, a clear surplus of energy, a marked ability to recover quickly. A nature that does not like movement but needs it.

What the daily schedule did to her

After that I stopped talking about her and talked about her day instead. I brought the early shift and the late shift together and asked what actually happens with her on an ordinary day.

The answer was orderly and well meant. Breakfast, then back to her room. Half an hour outside. Lunch, then back to her room. In the afternoon the craft workshop or sport. Dinner, then back to her room, then sleep.

For a lot of people that is a good day. For her it was the opposite.

A person of that nature, sent back to a room again and again, builds up energy that has nowhere to go. If they also sleep too much, the surplus grows rather than shrinks. In the end the impulse finds itself a way out — any way at all. What looked from the outside like a problem with her behaviour was a problem with her timetable.

The suggestion

It came down to two sentences.

First: do not send her to her room after breakfast. Give her a workbench where she can work on something with her hands.

Second: do not send her to her room after lunch. Do sport with her. Table tennis.

At that point something occurred to the carers. Six months earlier they had seen her once at the table tennis table, and she had visibly enjoyed it. Nobody had made anything of it, because it had looked like a whim. It was not a whim. It was her nature, getting its way for one afternoon.

The carers asked me how I knew it would work. The only question I had in return was this: have you got anything left to lose?

Two weeks later

The word came back after two weeks. The incidents had not become fewer. They were gone.

I do not tell this story because it is spectacular. I tell it because the pattern in it turns up everywhere, only usually more quietly.

A child who cannot sit still in class. An employee who becomes restless in a role that asks them to work quietly. Someone who grows edgy in their own flat and does not know why. In every one of these cases the talk is about the person first. Almost never about the shape of their day.

One more point that matters to me: what we suggested was cut to fit this one person. There is no approach you pour out over everybody, and certainly not over everybody with an impairment. The features are the same in all of us. How they are put together is different in every single person.

What counted in the end was not that anyone had been proved right. It was that both sides could manage with each other again — the woman and the people who look after her.

The whole thing as a video

Klaus tells this story himself as well. In the video he speaks more openly about how serious the situation had become for the resident — which is why it carries a blunter title than this text does.

If you are in a difficult place yourself right now: in Germany, TelefonSeelsorge can be reached around the clock, free of charge and anonymously, on 0800 111 0 111, 0800 111 0 222 or 116 123. Elsewhere, findahelpline.com lists free and confidential services in most countries.