Like many others in our field of dementia care, I have found that mindfulness practices like meditation gives me the resilience that is so essential to sustain my work. I was inspired for this month’s blog after a meditation during a podcast I follow: Home | The On Being Project.
Buddha observed and explained many aspects of human nature and suffering 2500 years ago that remain ever relevant today. The Buddhist allegory of The Two Arrows is a lesson related to how we choose to respond to a painful event. The first arrow, or triggering experience, causes the initial pain. The second arrow “is our reaction to the first. This second arrow is optional.”
Looking at the Two Arrow analogy in a bio neurological way, our limbic system automatically kicks when triggered by a painful event, like the impact of an arrow, leaving us with only three options: fight, flight, or fright. The cerebral cortex goes dark and the reptilian brain takes over. Following the initial limbic activity is either a lesson and healing or further suffering from the second arrow — like that of anxiety. An ongoing state of fear.
As a person living with dementia experiences their world with a fully functioning limbic system, yet impaired memory and changed sensory input, we can be faced with some of the most profound testing of our caregiver skills.
The person living with dementia experiences the first arrow of confusion, making their world unpredictable and scary. Their limbic system may react with by trying to leave (flight): I want to go home.” Or with striking out during care (fight). But when fight or flight is no longer possible, the limbic response is fear. With short term memory loss, these cycles can repeat. And there lies the second arrow of emotional pain for all concerned.
What I see in these cycles is sometimes a shared experience triggered in caregivers and family members. And so the fear and anxiety gets passed around. I find myself asking how can we stop dementia’s second arrow of suffering with sadness, grief, self doubt or anger? Putting tremendous energy into thoughts of “I should be able to deal with this better” or “why is this happening to me?” or “if the caregiver would only do XYZ, this wouldn’t happen.” We certainly cannot stop the first arrow of dementia. At least not yet. But we can prevent the second arrow.
Relief is possible and calls on all concerned to ask the question “for the sake of the beloved person living with dementia what can I do to understand their needs and help in this moment?” I notice with this question there is no judgement about the person living with dementia or for the caregivers around them. The second thing I notice is we are brought to the present with a purpose to help. After all, that is our responsibility. To be truly helpful requires that we have a solid understanding of the loved one’s needs. (Or of their unmet needs.)
Dementia creates a puzzling landscape for us as we undergo the detective work to better understand the underlying needs or causes of pain in its many forms. And truly, it can be puzzling and frustrating. All involved in the care and treatment must come together to form an interdisciplinary village; including primary care physicians, geriatricians, hospice nurses, medical social workers, and home health specialists.
And so we find ourselves back to two underlying values that guide us as we care for those living with confusion, uncertainty and fear: Practice compassionate mindfulness in the present moment and continue to support community — the village that you can turn to for kindness, and the fortitude to carry on the care of others in need.
Resources:
Repetitive Behaviors – Alzheimer’s & Dementia Care | UCLA Health
Managing Feelings – The Buddha’s 2 Arrows<br/> — Dr. Laura Ferrer & Associates