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No potential conflict of interest was reported by the author(s).
Correction Statement
This article was originally published with errors, which have now been corrected in the online version. Please see Correction: http://dx.doi.org/10.1080/24720038.2024.2339172.
Notes
1 What is now called Lifestyle Medicine appears to hold much promise. Lifestyle Medicine is generally understood to consist of six pillars: diet/nutrition, sleep, exercise, healthy relationships, stress management, and avoidance of harmful substances.
2 I first heard this phraseology in personal communication with psychiatrist Keri Oxley Brenner, a palliative care physician at Stanford University Medical Center. Similar concepts or phrasing (regarding physical health and organ failure) can be found in surgeon Atul Gawande’s (Citation2014) book Being Mortal and in Lunney et al. (Citation2002) and Lunney et al. (Citation2003).
3 Tondi et al. (Citation2007): “Among the patients who underwent VT [Validation Therapy], agitation/aggression, apathy/indifference, irritability/lability and nighttime behavioral disturbances were found to be the most improved NPI symptom domains. Also a decrease of average NPI [neuropsychiatric inventory] caregiver distress score occurred in the case group from T0 to T1 (8.6 versus 3.5), whereas the change turned out to be negligible in the control group.” Additionally: “In agreement with other studies about a similar subject (Robb et al., Citation1986; Toseland et al., Citation1997), our results suggest that VT is able to reduce the severity and the frequency of BPSD [behavioral and psychological symptoms of dementia] without using pharmacological or physical instruments.”
4 Feil and de Klerk-Rubin (Citation2012) describe four phases of Resolution: (1) Malorientation, in which the person is oriented to present time and place, but not happily oriented. They struggle with emotional scars from the past, and they express “past conflicts in disguised form” (p. 24); (2) Time confusion, in which the person retreats inward and loses firm contact with chronological time. “Instead of keeping track of time, they keep track of memories” (p. 69); (3) Repetitive motion, in which “movements replace words and are used to express needs and feelings” (p. 25); and (4) Vegetation, in which there is total inward withdrawal.
5 See also Adrian Burton (Citation2009), writing in The Lancet Neurology: “The observational and anecdotal evidence that different types of arts-based therapy can improve the quality of life for, and even cognitive function of, patients with dementia is huge.” Also Teppo Särkämö et al. (Citation2012), writing about dementia in Music and Medicine: “music is a multifaceted and powerful stimulus for the brain that engages not just auditory brain areas but a vast network of temporal, frontal, parietal, cerebellar, and limbic areas that govern auditory perception, syntactic and semantic processing, attention and memory, emotion and mood control, and motor skills … . Music has the capacity to induce long-term plasticity in the brain, as indicated by changes in neurotransmitter and neurotrophin levels, synaptic plasticity, neurogenesis, and gray and white matter volumes in many cortical and subcortical areas.” Music therapy could now be considered part of “Cognitive Stimulation,” an approach to working with those with dementia that fortunately has replaced “Reality Orientation” in recent decades. See, for example, Woods et al. (Citation2012).
6 See also McGilchrist (Citation2010), Reciprocal organization of the cerebral hemispheres, Dialogues in Clinical Neuroscience: “The right hemisphere is more concerned with living individuals than manmade objects. The left hemisphere alone codes for nonliving things, while both hemispheres code for living things. However, at least one study has found a clean divide between the hemispheres, the left coding for the nonliving, and the right for the living, regardless of task. The body image as a whole is a right-hemisphere entity, whereas body parts are the province of the left hemisphere. The left hemisphere codes for tools and machines. Right-hemisphere damage leaves the ability to use simple tools unaltered, whereas left hemisphere damage renders the sufferer incapable of using a hammer and nail, or a key and a padlock” (p. 508).
7 For example, in his Citation2003 book Affect Regulation and the Repair of the Self, Allan Schore adds: “The structural development of the right hemisphere mediates the functional development of the unconscious mind … . The right hemisphere is the repository of Bowlby’s unconscious internal working models of the attachment relationship … . The interactive regulation of right brain attachment biology is thus the substrate of empathy.”
8 As one example: “A 53-year-old right-handed man was an honest, dynamic leader who ran a successful advertising agency from the ages of 29 to 35. He then decided to write a political novel and spent several years in Guatemala but wrote nothing. Instead, he became passionately interested in photography and completed a series of meticulous photographic studies. He also carved wax miniatures. During this time, he disregarded his wife and children and did not communicate with them for months at a time. At age 41, he returned home and made unsuccessful attempts to real estate development. By age 48, a frank dementia syndrome had developed … . Although he had always been a conscientious driver, at age 51 he began running red lights, cheating at family board games, lying compulsively, and criticizing unsuspecting guests and family members. His table manners worsened and he ate excess chocolate. Sexual relations with his wife ceased and he began to masturbate, at times in view of others. He also stared inappropriately at women, bought phone order products without restraint, and wet himself publicly without embarrassment. His MMSE score was 26, he named 58 of 60 items on the Boston Naming test, and generated 7 D words and 0 novel designs. Basic neurologic examination results were normal. SPECT showed bifrontal right-worse-than-left hypoperfusion.” The authors conclude: “The intellectual concept of self requires language, yet the patients in this study retained their linguistic skills despite losing self-schemas. Conversely, FTD patients with selective left anterior temporal degeneration reliably lose the abstract and semantic concepts that constitute self-schemas so that words lose their meaning. Yet, our cohort of patients with semantic dementia were not subject to this shift in the self, suggesting that the linguistic concept of who we are is not the only factor required for maintenance of self. Although patients with semantic dementia lose their comprehension of words like Catholic and Republican, their behavior remains consistent with their premorbid identity and they continue to attend the same churches and vote for the same political candidates. It appears that a nondominant frontal lobe process, one that connects the individual to emotionally salient experiences and memories underlying self-schemas, is the glue holding together a sense of self.”
9 See also https://diceapproach.com/.
11 Mittelman and Papayannopoulou (Citation2018) writing in International Psychogeriatrics: “In the past six years, they have sung approximately 300 songs, including familiar songs, new repertoire, and canons from a variety of backgrounds and styles, including patriotic, folk, popular, Broadway, Latin, religious, American Songbook, and opera” (p. 781). “Participating in a chorus is a multi-faceted experience that includes activating parts of the brain that may be relatively undamaged by AD until the latest stages, remembering songs from earlier years and learning new ones, socializing, and giving pleasure to others through performance” (p. 785).
Additional information
Notes on contributors
Greg Kolodziejczak
Greg Kolodziejczak is a clinical psychologist in private practice in Cambridge, Massachusetts, specializing in the treatment of borderline personality disorder, as well as the integration of psychology and the spiritual life. He received his PsyD from Divine Mercy University in 2006, having previously received an MA in theology from Catholic University of America and a PhD in ocean engineering from MIT. His perspective on this topic is informed not only by Self Psychology and several other clinical approaches, but also by his own mother’s struggles with dementia prior to her passing in 2021.