Dr. Steven Sabat * has made an important point about dementia care: just because we do not know the reason a person with dementia is doing something does not mean that person does not have a reason.
That idea sounds simple. But it asks us to reconsider something very important.
When a person without dementia does something unexpected, unusual, emotional or difficult to understand, we usually assume there is some explanation. We may not know what it is yet, but we tend to believe there is a reason behind the behaviour.
Yet when a person living with dementia does something we do not understand, it can be surprisingly easy to jump to a very different conclusion:
- “They’re confused.”
- “They’re just doing things.”
- “It doesn’t make sense.”
- “It’s the dementia.”
- “It’s random.”
But what gives us the confidence to decide that simply because we do not understand the behaviour, there is nothing to understand? That is a very different assumption.
Our Lack of Understanding Is Not Proof
A resident repeatedly moves objects from one place to another.
Another insists on going to a particular door every afternoon.
Someone keeps folding tissues, rearranging table settings, refusing a shower, asking the same question, or becoming distressed at a certain time of day.
Sometimes we can identify the reason fairly quickly.
Other times, we cannot.
But there is an enormous difference between saying:
“I don’t yet understand why this is happening.”
and saying:
“There is no reason for this behaviour.”
The first statement reflects curiosity.
The second closes the door.
And once that door closes, the person’s behaviour can easily become something we simply try to stop, redirect, control or dismiss.
What Makes Us Think We Know Better?
This is where the issue becomes one of respect.
A person living with dementia may no longer be able to explain their reasoning in the way we expect.
They may not have the words.
They may not remember the event that triggered a feeling.
They may be acting from a familiar habit, role or routine that is deeply ingrained.
They may be responding to pain, fear, noise, fatigue, hunger, a confusing environment, a perceived obligation, or something from their life history that we know nothing about.
They may simply be trying to accomplish something that makes complete sense from their perspective.
We may not see it.
That does not automatically make it irrational.
In fact, perhaps the more useful question is not:
“Why are they doing this?” but: “What am I missing?”
Behaviour Makes Sense From Somewhere
Imagine walking into a room and seeing someone repeatedly trying to leave. You might see “exit-seeking.”
The person may see:
- “I need to pick up my children.”
- “I am late for work.”
- “This is not my home.”
- “I need to get back to my husband.”
- “I do not feel safe here.”
- “I always leave at this time of day.”
Those explanations may not reflect present-day reality. But the feeling, intention or need behind them may still be very real. That distinction matters.
Our role is not to prove the person wrong.
It is to understand what the behaviour may be expressing and to look for a way to respond that preserves dignity, reduces distress and supports the person as much as possible.
The Danger of Calling Behaviour “Random”
Once we label behaviour as random, meaningless or simply “part of dementia,” we risk stopping our own thinking.
- We stop looking at the environment.
- We stop considering timing.
- We stop asking about life history.
- We stop examining our own approach.
- We stop wondering whether the person is uncomfortable, frightened, bored, overstimulated, under-stimulated, rushed, lonely or trying to continue a familiar role.
Most importantly, we may stop listening.
And that is where the label becomes dangerous. Not because every behaviour has one simple explanation. It often does not. But because deciding there is no explanation can prevent us from discovering something useful.
Curiosity Is a Form of Respect
We will not always figure it out. Sometimes we will gather information, try several approaches and still not know exactly why a behaviour occurs. That is okay.
The goal is not to solve every person like a puzzle.
The goal is to remain curious enough to keep asking:
- What happened before this?
- What might the person be experiencing?
- What are they trying to communicate?
- Is there something in the environment contributing?
- Does this connect to a familiar routine, role or preference?
- What changes when we approach the situation differently?
That kind of curiosity sends an important message:
Your behaviour is worth understanding. Your experience matters. I am not going to assume that because I cannot immediately make sense of what you are doing, it has no meaning.
Perhaps the Better Starting Point
Instead of asking: “Why is this person behaving this way?”
we might begin with: “There is probably something here I do not yet understand.”
That small shift changes everything. It moves us away from judgment and toward inquiry.
Away from control and toward support.
Away from “What is wrong with this person?” and toward:
“What might make sense from where they are standing?”
And perhaps that is one of the most respectful positions we can take in dementia care:
Just because I don’t know the reason does not mean there isn’t one.
* Dr. Steven R. Sabat is a clinical psychologist and former Georgetown University professor known for his work on the lived experience of Alzheimer’s disease and the preservation of personhood in dementia. His research has emphasized remaining abilities, identity, and the powerful effect that communication and social interactions can have on a person living with dementia.
