Frank S. G. Wills
As an approach to thinking about elderly people with mental retardation who have behavioral problems, the disease entity, major depression, will be used as illustration. The first questions I wish that all of us would always ask are, "Is the person suffering?""Is there evidence of internal distress?""Is there physical pain, emotional distress, or both?""What makes you think so?"
The next several questions are subquestions of the last question. "What do you see that makes you think so?""What do you hear that makes you think so?" and "What do you feel that makes you think so?" That may puzzle you for a moment. However, if someone's muscles are very tense you can tell a lot more by feeling them than you can by just looking at the patient.
The next subquestion deserves special attention. "What do your 'innards' tell you?" Many of us are reluctant to pay close attention to those impressions that we cannot really put a finger on, that we cannot objectify, so to speak, but that our heart, our gut, or whatever part of our innards talks to us best, tells us is surely going on. Sometimes we have a sense of what is going on even though we may have a terrible time divining or articulating what it is.
It is crucial, when you get that sort of strong impression, to pay close attention to your intuition, take it seriously, try to listen to your innards, decipher what may be going on, and share your impressions with other people, such as your consulting experts. Some people will tell you that they do not want to hear vague impressions. It obviously does not pay to pursue them with people like that. But I hope you will not give up at that point. Ask the next person. Those intuitive impressions are important.
The next question is, "What is the patient doing that upsets others?" Here we get to the concept of "problem." "Does the person's behavior