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Professional Confusion 
Started by Digger
15 Jun 2014, 3:58 PM

I read the article by Dr. Mike Harlos, What is Confusion? in the Spotlight thread portion of the weekly newsletter.

He talks about delirium and then in a section called Sedation he states:

"If they had the choice, most people would feel that confusion and paranoid behaviour causes an unacceptable loss of dignity, and would prefer to be kept calm and comfortable rather than be restless and agitated."

I agree with the calm and comfortable part but the sedation aspect is worrisome. In my experience, altered states of consciousness have much in common with dream-like states. Both are common in dementia and in dying.

It is challenging to communicate with people in those states. We assume that their experience is somehow not real or devoid of meaning. The professional response: medicate.

Is it possible for us to enter these dream-like states to re-assure the person and validate their inner experience? Yes it is. I have done it and i'm not the only one who has. There are simple techniques to communicate with people who are in mental states (altered states of consciousness) they have little control over.

Professionals are too quick to label conditions they do not understand, have not explored or were missing in training. These states of consciousness are baffling, to us on the outside and more so to those on the inside of the experience. But before we give our consent to medication, let's consider another way to communicate.


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Reply by Tian
16 Jun 2014, 3:25 PM

I am somewhat puzzled by your post, Digger. Dr. Harlos says that palliative sedation may be an option for patients that are confused. But you say "before we give our consent to medication, let's consider another way to communicate." As it is you are suggesting another way to communicate with a person who is confused. But am I correct in assuming that you are really referring to communicating with a patient after they have been palliatively sedated? I am very curious to know how you have communicated with patients in dream-like states and what they have expressed to you.
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Reply by eKIM
17 Jun 2014, 12:42 AM

Dale, I would like to respond to your posting from the perspective of a hospice resident support volunteer.  Having stated this I do not presume to know more than a doctor or other palliative specialist.  I simply basing my opinion based on observing hundreds of hospice residents over the last four years.

When it comes to “end of life” care, I believe that generalizations about what “most people” feel is not helpful.  Why?  Because even if a generalization was true for the majority, a hospice is not run on a consensus basis.  Palliative care in a hospice setting - or any other setting for that matter - is supremely geared to the wishes and the comfort of individuals and families.  I would hope that the amount of medication administered to keep them calm and comfortable would be the choice of the patient, not the medical staff. 

When a person is in a mental state, not of their choosing, I still assume that my attempts to comfort them are appreciated.   Even in the last hours of life, I assume that the person is conscious of my presence, can hear my voice and can feel my hand in theirs.  Depending on the situation I will talk to them, sing to them, pray or meditate beside them, – whatever it takes to bring them comfort.  I have seen changes in people as they become calmer as they are comforted.  I would hope that this approach would not be written off in favour of a prescription.

Dale could you please share with me your experience on how to communicate with people who are in an altered state of consciousness?

-        eKim

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Reply by Digger
19 Jun 2014, 2:34 PM

Hello Tian and eKim,

This is an area worth exploring.

Tian, drugs alter the ability to communicate, internally and with our surroundings. I believe there are options to take before palliative sedation but the client must be willing to explore them. Although sometimes holding a hand is enough, as the experience of Ekim illustrates.

Altered states of consciousness help us in transitions. We experience an altered state any time we dream, watch television, play a video game, take drugs, drink alcohol, smoke tobacco, intense physical exertion, have a near death experience. Coma and dementia are examples of altered states.

Dying is accompanied by altered states of consciousness. Dying has much in common with dreaming, except we don’t wake up, not here at least.

Anecdotal evidence tells us there are things that altered states of consciousness have in common. We know thisfrom our own dream states. Here are two: the absence of time and perceptual/sensory distortion.

How can we use this information?  With dementia, I never make references to clock time. For people with dementia, time is not linear. If they see or hear things I do not perceive then I try to validate their inner experience with words like ‘that must be interesting, can you tell me more’.

People in altered states experience a different ‘normal’ than we do. Care-givers and companions can meet them in that dream-like place. In other words we have the capacity to shift our waking awareness to communicate with them in their inner world.

The technique is called Bridging. I hope to offer it as a workshop in the fall.

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Reply by eKIM
19 Jun 2014, 6:09 PM

Dale I find this subject fascinating.  If you do a workshop, could you provide some of that information to people who cannot attend – somehow via internet?

In the meantime could you provide a link to some place on the web that could enlighten me?  You can obtain my email address through Colleen or Katherine, if you like.

Thank you so much, Dale.  Keep up your fine work.

-       eKim

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