How improv thinking helps Alzheimer’s patients and their families have more good days.
When actor and improviser Karen Stobbe decided to care for her aging mother Virginia in her home, she desperately needed a game plan. Virginia has Alzheimer’s: a degenerative memory disease that affects nearly 6 million Americans, and which turned her sweet mother into a moody stranger who woke up at 2 am to start the day and saw monkeys in the backyard
For Karen, like many of us who crave structure and control, caring for a volatile loved one — who didn’t always understand where there are or why — was terrifying.
But Karen made a joyful discovery about dementia care that’s helped her and her improviser husband Mondy navigate their new world: it turns out, they already knew all the rules.
Forget remembering
The new guidelines for dementia care seem to come straight from the improviser’s handbook.
For many years, nursing home staffs and dementia care experts told families to remind their loved ones who they are, where they’re from — to keep them mentally grounded. “Hang orientation boards everywhere that say today is August 15, the weather is overcast, the president is Barack Obama,” says This American Life reporter Chana Joffe-Walt, recounting Karen’s story.
But these days, rather than correcting dementia patients when they say something absurd, or challenging them to remember something, experts encourage “validation therapy.” The new school of thought urges caretakers to “step into their world” — no matter how fanciful.
“You don’t ever say no, you don’t question their premise. You just say yes and”
For Mondy and Karen — both seasoned performers — this is second nature: It’s a lot like entering an improv scene where you have no idea what your scene partner is going to bring to the table. If you deny their reality, the scene grinds to a halt (or, in Karen’s case, your mother calls you an a*shole). But if you build on the premise they’ve created, magic happens.
Take this exchange between Mondy and Virginia captured in This American Life, when Virginia spotted the family dog, Gus, digging in the backyard:
Virginia:
He’s digging for his life.Mondy:
Oh, yeah, Gus is busy working on his caverns. You’re starting a coal mine. So he’s going to get it started, and you’re going to finish it up, right?Virginia:
I am? I never worked in a coal mine.Mondy:
I know, but I need you to now. I need your help finishing up the mine. Gotta get out there and find some coal, so we can pay out these bills.[Virginia gleefully refuses]
Mondy:
Oh, well, we’ll have to shut down the whole operation then. All right, Gus. No, she doesn’t want to go in, man.Karen:
Stop digging.Mondy:
All right, stop digging.Virginia:
Stop digging!
All aboard the ‘Feelings Express’
Next stop: Happy tears. We know, reading about a family coming together to close down an imaginary pup-run coalmine is absolutely delightful.
And Virginia loves it, too. Mondy’s aptitude for “yes and-ing” her reality has made him one of Virginia’s favorite people — so much so, that’s she’s re-written him into nearly all of her major memories, “like Forest Gump,” Mondy says. “It’s fun for her. She’s definitely having a good time.”
Since cracking the code, Karen has shared her story on This American Life, at TEDMED, and more. She and Mondy have also founded an organization called “In the Moment,” which facilitates training for families caring for loved ones with dementia inspired by “creativity, laughter, and the arts.”
No word yet on the mining operation.
The Point: It’s easier to put on slippers than to carpet the world. When we don’t get the results we want, sometimes it’s our behavior that needs to change.
