Pathologizing behavior: Meanings of behaviors in dementia care

Deficit and problem-based approaches to behavior stigmatize persons with dementia and cause great unnecessary suffering. In order to reduce the harm caused to persons misunderstood, it is important to understand the process by which staff attach meaning to behaviors and how those meanings ultimately influence how staff respond to behaviors. To this end, this research sought to examine the perceptions and meanings that staff attach to behaviors, how staff experience these behaviors, and the role that meanings and experiences have in staff actions and responses to specific behaviors. This paper focuses on one sensitizing concept that emerged from our study — pathologizing behavior — that reflects how behaviors become pathologized and problematized in the long-term care context. Conducted as part of a larger interpretive grounded theory study, active interviews were conducted with 48 staff members working in a range of positions in long-term care homes in Ontario, Canada. All staff interpreted and placed residents' behaviors in context through a complex process that started with the process of filtering behavior through the lens of pathology, and guided how staff then assigned meaning to the behaviors, how they characterized behaviors as “challenging”, and ultimately reacted through crisis management. The findings demonstrate the impact biomedical discourses have on meanings attached to behaviors and responses to behaviors and point to the need for alternative discourses that emphasize understanding meanings of actions using multidimensional lenses.

► Biomedical discourses prevalent in long-term care shape the meanings of behaviors.
► Behaviors are interpreted by filtering behavior through the lens of pathology.
► Characteristics of behaviors are used in defining behaviors as challenging.
► Pathologizing behavior results in reacting through crisis management.
► Alternative discourses are needed that emphasize understanding meanings in actions.