An article published in April 2019 Language paradigms when behaviour changes with dementia: #BanBPSD, rather ironically helps explain to me why we need to ban the contruct known as the Behavioural and Psychological Symptoms of Dementia (BPSD), and not just change the name. I’m doubtful that was the intention of the authors…
Over the last few years, many people in academia and in clinical practice have been actively ‘reviewing’ BPSD, but usually without the voices of the growing numbers of academics, clinicians and advocates who want it banned, and believe it has been doing significant harm.
Many seem resistant to discussing it in depth with those of us who are deeply concerned about it, and believe in the need to ban it entirely. Instead they are busy justifying it, or worse, modifying it, as if to keep it alive. Perhaps they hope if they ignore ‘us’ don’t engage with us as equals on this topic – that the #BanBPSD campaigners will go away?
Is it egos, or is it many have spent decades of their careers on the topic, or is it because they have been seen as the experts about dementia and BPSD, and hence may be feeling threatened so many of us are questioning it?
Some are even trying to rewrite history by laying claim to wanting to change the terms BPSD or Behaviours of concern, and also to the need for a human rights based approach to dementia and aged care. Even though these people have not been the campaigners for our human rights, disability rights or legal rights…
But back to the article, as I am rambling on! If you read Language paradigms when behaviour changes with dementia: #BanBPSD, which was published in April 2019 (Cunningham, Macfarlane & Brodaty), you may think, as I do, that this article reinforces the need to Ban BPSD, rather than offering us a rational as justification for keeping it, or simply reworking the name.
By claiming that ‘behaviours’ are a direct result of the pathology of dementia, but that they can be modified by non pharmacological interventions, I think the authors prove the case for banning BPSD.
An environmental issue, an unmet need such as untreated pain, or a response to having had rights taken away, eg confined and segregated in a secure dementia unit, are nothing to do with the pathology of dementia.
The authors ask, why is the term ‘Challenging bahaviours’ any different to BPSD?
It also says: Today, guidelines authored by medical organisations and expert groups recommend psychosocial approaches as the first line of “treatment” for BPSD. This growing emphasis upon non‐pharmacological responses to BPSD is particularly important, given the side effects linked to many psychotropic medications, including an increased risk of falls, stroke and death, and their small effect sizes.
If we can ‘treat or manage BPSD’ with non pharmacological interventions such as for example, music, or improving the environment, then MOST ‘behaviours’ which are actually normal human responses have VERY LITTLE to do with the pathology of dementia.
Nor can it have anything to do with any of the REAL neuropshchiatric symptoms such as hallucinations that are caused by the pathology of dementia…
Yes, it is important we reduce antispychotics, as they do harm. A great many of us have been advocating for that many years; yet still they get dished out like lollies.
This is not the argument, nor is it what the BanBPSD campaign is about. The reduction of antipshchotics and other forms of restraint is merely a very positive side effect of banning BPSD.