Until recently, my awareness of Dr. Maria Montessori was limited to signage on the educational centers bearing her name. With my focus on cognitive decline (in partnership with Nightingale Dementia Consultants) I was finally compelled to understand her contribution to society.
That may seem paradoxical, but Dr. Montessori was a habilitator of children with mental challenges, and as I have learned through the writings of Stephen and Bernadette Phillips (Montessori Works for Dementia: Everyday Activities for People Living with Dementia), her goals and strategies apply whenever we find ourselves challenged by behavioral limitations.
Dr. Montessori started her career working with “retarded” children trapped in institutions. Her work celebrated the plasticity of the human brain – that skills, character, and engagement can be nurtured even in those rejected by society. Today we find ourselves in need of those insights on both ends of life: with autistic children and with adults experiencing cognitive decline.
While the application of Montessori methods to cognitive decline was pioneered by Cameron Camp, his works are not widely available (though see here). The Phillipses reference his contributions, but their book is my introduction to his work, and I find the treatment delightful.
They begin with a survey of the different types of cognitive decline, and then step into vignettes illustrating the confusion that it creates for caregivers. Those vignettes are the scaffolding for their exploration of the difference between declarative and procedural memory. Declarative memory is the foundation of our capacity to make decisions from moment-to-moment. Procedural memory is the foundation of our ability to do something – it coordinates our muscle movements in rote performance. The distinction is essential in managing cognitive decline because procedural memory is far more durable.
For caregivers, the distinction is not obvious. We find ourselves combing Nana’s hair every morning. How does it help to know why she cannot do it herself? This is where this book shines, taking us step-by-step through each of the Activities of Daily Living (ADLs) gradually assumed by care givers. The Phillipses illustrate how our normal environment presents too many choices, forcing us to invoke declarative memory to get anything done – even if just to realize that we should ignore the comb when we need to use the toilet. In creating conditions that limit the activity to rote performance, we can restore independence.
The book also shines in conforming to Dr. Montessori’s full definition of essential humanity, encompassing independence, work, dignity, self-esteem, contribution, and intergenerational living. They offer specific activities for each dimension, ensuring that we in caregiving we engage the whole individual, thereby stimulating and preserving all her mental faculties.
This book is terribly British in its tone and terminology, which may discourage Americans, but it is well worth fighting through to the end. After reading it, I was able to apply the insights to novel situations. And in addressing the full spectrum of cognitive ADLs, the reading brings hope.