Moments of Validation.

Abstract

Life as a junior academic can be a lonely path. Especially in the pretenure years, it can seem that one is floating along not knowing whether one's service, scholarship, and teaching are having enough of an effect to justify retention. Moments of validation can be scarce—a fact that has led assistant professor colleagues to joke about having “pretenure depression syndrome (PTDS).” Sometimes we find affirmation in unexpected places. In my case, such a moment occurred this winter as I sat in a coffee shop grading papers. I teach a course for fourth-year students at Penn State College of Medicine called “Narratives of Aging.” Over an intensive month, we examine dementia from a cultural–historical perspective, contrasting disease-oriented approaches with a more-humanistic, person-centered care model. As part of the experience, students visit a locked dementia unit and participate in several sessions of TimeSlips, an improvisational storytelling activity designed to engage the imagination of people with memory loss. TimeSlips is predicated on the care philosophy of validation—the notion that we must respect and affirm the lived experience of cognitively frail individuals rather than orienting them to “our” reality. For students trained in the rational practice of Western medicine, who generally come to view people with dementia as “difficult” types of patients, validation can be an elusive concept to grasp. Thus, throughout the course, I try to give students opportunities to explore and expand their empathy through creative self-expression. One prompt instructs students to write a poem, essay, dramatic dialogue, or story from the perspective of someone with memory loss. This can be based on an actual encounter they have had on the locked unit, in clinical rounds, or in their personal life—or it can be purely fictionalized. The goal is to get inside the mind of someone with memory challenges and view reality on their terms. When I assign this prompt, my PTDS flares up as I worry that students will see it as a “fluff” exercise and thereby scoff at the psychosocial side of dementia I am trying to build an academic career around. As I read through their efforts on this snowy morning, enveloped in the aroma of brewing coffee, I came across a poem a student named Caleb had written about his wife's grandfather: Why am I imprisoned here? These white walls I grow now to fear. They tell me I am safer now, though truly I do not know how. Please let me out of this dark cell, what's happening I cannot tell. My wife, my daughter, where've they gone? They came yesterday? You must be wrong. Why won't I eat? Well, it's my farm; you see my cows will come to harm. It's raining out, you see the mud? My cows will drown if my barn floods. The nurse here says she'll pump the barn, she saved my cows, she saved the farm! Perhaps this place is not so bad. They are so kind, it makes me glad. I'm hungry now, it's time to eat. Time to see who I can meet. As I read Caleb's poem, its rhythmic cadence telling a layered story whose tension was resolved through an act of kindness by a nurse using validation, I was floored. Not only had he grasped the concept of validation, he had rendered it beautifully into a poem that meant something to him. In an accompanying essay, Caleb explained that, before developing dementia and joining the residential facility, his wife's grandfather—Grandpa Berg (Figure 1)—had been a lifelong farmer and milk cow owner. One day, he refused to eat, and nurses were concerned he was backsliding into depression. Finally, a nurse asked him what was wrong and he replied that his barn was flooding and that if nothing were done the cows would drown. When the nurse heard this she used validation technique and told him they were going to remove water from the barn and protect the cows. As she knelt down and pretended to bail water he seemed to relax. Caleb wrote: “He started eating again, and each time he began getting anxious the nurses would validate what he was feeling, and respect him for the man he was.” I certainly did not earn tenure on this cold winter day, and the struggle continues. But the moment of personal validation I felt in reading Caleb's poem that morning—reassurance that my teaching was having some small influence on these doctors-in-training—had arrived at just the right time. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: The authors were responsible for the conceptualization, authorship, and preparation of this manuscript. Sponsor's Role: NA.