Performing Art Therapy in Geriatric Care

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Performing Art Therapy in Geriatric Care

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Dr. D. Dutta Roy, Ph.D.
Psychology Research Unit
Indian Statistical Institute, Kolkata – 700108
Web:http://www.isical.ac.in/~ddroy
E-mail: ddroy@isical.ac.in

Other site: Geriatric Assessment,Counselling,Psychotherapy

DEFINITIONS
Geriatrics is the branch of medicine that focuses on health promotion and the prevention and treatment of disease and disability in later life. The term itself can be distinguished from gerontology, which is the study of the ageing process itself. The term comes from the Greek "geros" meaning "old man" and "iatros" meaning "healer.“

Psychology is the study of science to understand, control and predict behaviour.

Geriatric Psychology is the study of science to understand, control and predict health related behaviour of human being in the later life.

Health is physical, mental, social and spiritual well-being of the individual and not merely the absence of disease or infirmity.

What is Mental health ?

It is a state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life.“ It is not the absence of a recognized mental disorder.
Mental health Studies:

• how effectively and successfully a person functions.
• Feeling capable and competent;
• being able to handle normal levels of stress,
• maintain satisfying relationships,
• lead an independent life;
• being able to recover from difficult situations

Principles of Mental Health

Restoration
Prevention
Promotion

Strategies:
1 Individual - encouragement of individual resources by promotion of interventions for self-esteem, coping, assertiveness.

2.Communities - increasing social inclusion and cohesion, developing support structures that promote mental health in workplaces, schools and neighbourhoods.

3.Government reduce socioeconomic barriers to mental health at governmental level by promoting equal access for all and support for vulnerable citizens.

Ageing of the population is a highly desirable and natural aim of any society. By 2025 there will be 1.2 billion older people in the world, close to three-quarters of them in the developing world. But if ageing is to be a positive experience it must be accompanied by improvements in the quality of life of those who have reached - or are reaching - old age.

Classification

Organic Disorders :
Dementia, Delirium

Psychological Disorders :

Neurotic (Anxiety disorder, Phobic disorder, Conversion reaction, Dissociative Reaction,

Obsessive Compulsive disorder, Depression, Hypochondriasis)
Psychotic (Schizophrernia, Manic-Depressive Disorder, Paranoia)

Substance abuse
Sexual disorder

History

Modern geriatrics in the United Kingdom really began with the "Mother" of Geriatrics, Dr. Marjorie Warren. Warren emphasized that rehabilitation was essential to the care of older people. She developed the concept that merely keeping older people fed until they died was not enough- they needed diagnosis, treatment, care and support. She found that patients, some of whom had previously been bedridden, were able to gain some degree of independence with the correct assessment and treatment.

Another "hero" of British Geriatrics is Bernard Isaacs, who described the "giants" of geriatrics: incontinence, immobility, impaired intellect and instability. Isaacs asserted that if you look closely enough, all common problems with older people relate back to one of these giants

Geriatric Psychology for the Care givers

To understand different principles leading to formation of different symptoms of geriatric disorders.Biological Paradigms : Brain mapping, Loss or injury
Psychological Paradigms : Psychodynamic, Learning, Cognitive

To understand principles of Psychology in order to improve quality of life of the elderlylyly people.
Counseling, Psychotherapy, Individual and community care.

Biological Paradigm

BRAIN MAPPING



Frontal Lobe
How we know what we are doing within our environment (Consciousness). How we initiate activity in response to our environment. Judgments we make about what occurs in our daily activities. Controls our emotional response. Controls our expressive language. Assigns meaning to the words we choose. Involves word associations. Memory for habits and motor activities.

Parietal Lobe
Location for visual attention. Location for touch perception. Goal directed voluntary movements. Manipulation of objects. Integration of different senses that allows for understanding a single concept.

Occipital Lobe
Vision

Temporal Lobe
Hearing ability Memory acquisition Some visual perceptions Categorization of objects.

Brain Stem
Breathing Heart Rate Swallowing Reflexes to seeing and hearing (Startle Response). Controls sweating, blood pressure, digestion, temperature (Autonomic Nervous System). Affects level of alertness. Ability to sleep. Sense of balance (Vestibular Function).

Cerebellum
Coordination of voluntary movement Balance and equilibrium Some memory for reflex motor acts.

LOSS OF BRAIN FUNCTIONS
1. Frontal Lobe
Loss of simple movement of various body parts (Paralysis). Inability to plan a sequence of complex movements needed to complete multi-stepped tasks, such as making coffee (Sequencing). Loss of spontaneity in interacting with others. Loss of flexibility in thinking. Persistence of a single thought (Perseveration). Inability to focus on task (Attending). Mood changes (Emotionally Labile). Changes in social behavior. Changes in personality. Difficulty with problem solving. Inablility to express language (Broca's Aphasia).

2. Parietal Lobe
nInability to attend to more than one object at a time. Inability to name an object (Anomia). Inability to locate the words for writing (Agraphia). Problems with reading (Alexia). Difficulty with drawing objects. Difficulty in distinguishing left from right. Difficulty with doing mathematics (Dyscalculia). Lack of awareness of certain body parts and/or surrounding space (Apraxia) that leads to difficulties in self-care. Inability to focus visual attention. Difficulties with eye and hand coordination.

3. Occipital Lobe
Inability to attend to more than one object at a time. Inability to name an object (Anomia). Inability to locate the words for writing (Agraphia). Problems with reading (Alexia). Difficulty with drawing objects. Difficulty in distinguishing left from right. Difficulty with doing mathematics (Dyscalculia). Lack of awareness of certain body parts and/or surrounding space (Apraxia) that leads to difficulties in self-care. Inability to focus visual attention. Difficulties with eye and hand coordination.

4. Temporal Lobe
nDifficulty in recognizing faces (Prosopagnosia). Difficulty in understanding spoken words (Wernicke's Aphasia). Disturbance with selective attention to what we see and hear. Difficulty with identification of, and verbalization about objects. Short-term memory loss. Interference with long-term memory Increased or decreased interest in sexual behavior. Inability to catagorize objects (Catagorization). Right lobe damage can cause persistant talking. Increased aggressive behavior.

Paradigms

Psychodynamic

Sigmund Freud


1. Pathology of elderly people is due to conflict between structures of mind - Id, Ego and Super Ego.
2. Study the pathology in terms of energy processing from Unconscious to conscious through Pre-conscious.

Psychosexual stages
Oral, Anal, Phallic,Genital and Latency

3. Study it in terms of Ego-defense mechanisms – Regression, Repression, projection, rationalization, displacement, reaction formation etc.


NEO-FREUDIANS
Alfred Adler


Study abnormal behavior in terms of one’s failure in striving for perfection,
Organ Inferiority, Psychological inferiority.
Defenses
Compensation;
Superiority Complex


Erikson





Abnormality is due to one’s failure in handling crisis of earlier stage.
1. Stage One Oral-Sensory: from birth to one, trust vs. mistrust, feeding;
2. Stage Two Muscular-Anal: 1-3 years, autonomy vs.doubt, toilet training;
3. Stage Three Locomotor: 3-6 years, initiative vs.inadequacy, independence;
4. Stage Four Latency: 6-12 years, industry vs.inferiority, school;
5. Stage Five Adolescence: 12-18 years, identity vs.confusion, peer relationships;
6. Stage Six Young Adulthood: 18-40 years, intimacy vs.isolation, love relationships;
7. Stage Seven Middle Adulthood: 40-65 years, generativity vs.stagnation, parenting;
Stage Eight Maturity: 65 years until death, integrity vs.despair, acceptance of


Classical Conditioning


Abnormality is due to faulty conditioning. It can be created experimentally




Operant Conditioning (B.F.Skinner)


Abnormality is shaped by positive and negative reinforcement.

1.Positive reinforcement : Strengthening of a tendency to respond by virtue of the presentation of an event
2.Negative reinforcement : Strengthening of a tendency to respond by virtue of the removal of an event

Cognitive Psychology


Aaron Beck and Allbert Ellis

Aaron Beck
Dysfunctional behavior is dysfunctional thinking, and that thinking processes are shaped by underlying *beliefs*. Situations are interpreted according to basic beliefs and acted on accordingly. "If beliefs do not change," he said, "there is no improvement. If beliefs change, symptoms change. Beliefs function as little operational units".


Principles
1. Arbitrary Inference: Conclusions drawn without the absence of sufficient evidence.
nSelective Abstraction: Conclusion drawn on the basis of but one of many elements in a situation.
2. Overgeneralization: Overall sweeping conclusion drawn on the basis of a single, perhaps trivial, event.
3. Magnification and Minimization: Exaggerations or feeling of self worthless

Allbert Ellis
"I would like x, but I hate y... versus, I would *like* x, and if y happens, Sh--! But I'll live with it!". He described his active technique of confronting irrational beliefs by explaining that "Whenever we get people to change their Musts, Shoulds, and Have-to's... they're cooked!" (ie., irrational beliefs will yield to better functioning after being argued out of existence).

Social Learning



Abnormality is due to faulty modelling and self regulation.

Assumptions:
1.Reciprocal Determination: Environment causes behavior, true; but behavior causes environment as well.
Regarding self-observation -- know thyself! Make sure you have an accurate picture of your behavior.
2. Regarding standards -- make sure your standards aren’t set too high. Don’t set yourself up for failure! Standards that are too low, on the other hand, are meaningless.
3. Regarding self-response -- use self-rewards, not self-punishments. Celebrate your victories, don’t dwell on your failures.

Integral Psychology

Abnormality is due to arrested and bewildered inner evolution in consciousness. It is the lack of harmonisation of physical, vital, mental and psychic energies

References:
* Theories of Personality
* Personality Theories with Biography
*Lectures of Freud on Psychoanalysis
* Psychoanalysis Links
* Personality theories of Alfred Adler
* Personality theories of Erik Erikson
* Classical Conditioning
* Operant Conditioning
* Integral Psychology

The above lecture was given at the
Calcutta Metropolitan Institute of Gerontology
-1 Sopan Kutir : 53B, Dr.S.C.Banerjee Road : Calcutta - 700 010 Phone - (033) 350-1437, E-mail cmig@rediffmail.com INDIA

Activities