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Professor Steven Sabat: Understanding Alzheimer's Disease

Professor Sabat knows that by introducing the concepts of AD to students, he will help them interact with people dealing with the disease. (Photo: Roland Dimaya)



By Kara Burritt
Professor Steven Sabat's research and teaching are marked by an attitude that distinguishes his work: treat other people as people, no matter their circumstances. This respectful approach to interpersonal relationships has made Sabat a lauded professor of Psychology at Georgetown University, as well as an innovator in the research of Alzheimer's Disease (AD).

For nearly three decades Sabat has been working to understand AD better by interacting with individuals afflicted by the disease. Challenging generalized and mainly negative notions about people with AD, Sabat’s approach emphasizes the personal attention that medical care often lacks. He builds relationships with each individual through face-to-face conversation in comfortable settings, and he focuses on that person’s subjective experience of the disease rather than the disease at large. This "bio-psycho-social" approach to individuals with AD helps Sabat subvert the negative stereotypes that are often attached to the disease.

"Most of the public press is focused on what's wrong with people with AD," said Sabat. "I focus on what's right with them, what their strengths are, and how to use that knowledge about them to enhance communication, [and to] improve interpersonal interactions between people with AD and their loved ones and professionals."

While Sabat recognizes that AD has very real effects on people's cognitive abilities, his research emphasizes the cognitive and social abilities that remain intact in people afflicted with the disease. He has also found that certain perceived symptoms of AD, such as passivity or anger, are not effects of the disease alone. In fact, they are often very logical reactions to the frustrating effects of the dementia, and even to the stereotype-laden attitudes projected upon the afflicted individual by others.

"For example, a person with a Ph.D. who cannot sign her name any longer might be rather depressed," Sabat explained. "But the depression is not a symptom of AD in the same way that red spots on the skin is a symptom of measles. The depression is a reaction—a very appropriate reaction—to what the person is experiencing."

Sabat claims that it is not malice, but often a lack of knowledge, that allows such instances to be propagated as stereotypes of AD. He authored an upcoming article in "Dementia: The International Journal of Social Research and Practice" that discusses a nearly three-year study involving Sabat's counseling of a primary caregiver as she dealt with her husband’s AD. Over the course of the study, Sabat and the woman exchanged more than twelve hundred emails and met in person every three months. Through this counseling, the woman gained education on AD as well as support, which aided in her transformation from a frustrated to a flourishing caregiver.

Several factors contributed to the woman's evolution in her role as caregiver, but at the core was Sabat’s focus on prioritizing the person over the disease. By better understanding her husband's experience with AD, she came to differentiate her husband's reactions to the dementia from the dementia itself. She grew to appreciate that many aspects of his personality were still very much intact. She also began to recognize society’s sometimes-demeaning attitudes towards individuals with AD as stemming from misunderstanding rather than ill will.

Sabat's article will demonstrate that by the caregiver adopting this approach to her husband’s diagnosis, and by gaining emotional support, her aggravation and anxiety were greatly reduced.

"She became less emotionally reactive, less frustrated, less angry, and she became more able to have positive interactions with her husband and felt more competent and confident in herself," said Sabat.

While Sabat's efforts to understand people's subjective experience with AD, and that of their caregivers, are increasingly applied to AD research, he admits there is much room for development in the field. Individuals diagnosed with AD are still seen as "patients" rather than people. He encourages studies that allow people with AD to be active contributors to, not subjects of, the research.

Sabat both teaches this attitude, and applies it to his teaching, in the classroom. Specifically in his Ignatius Seminar in the fall of 2008, "Brains, Persons, 'Otherness,'" Sabat was able to demonstrate to his students the idea that many people are marginalized in society through unwarranted stereotypes.

Drawing from specific experiences that impressed him as a child, Sabat covered many types of discrimination by examining specific examples with the class. These included racial prejudice, as exercised against Jackie Robinson in the baseball industry, and social prejudice, as seen through the experience of migrant workers in Edward R. Murrow's documentary, "Harvest of Shame." Yet, understanding the unique focus of the Ignatius Seminar to be something the professor is deeply interested in researching, Sabat directed much of the course towards the stereotypes affecting the lives of elderly people and individuals suffering from cognitive problems due to brain damage.

"For me, here was a chance to have a small class learn about the remaining abilities of people with Alzheimer's disease… and see if there might be some positive outcomes as a result—perhaps the relationships that people in the class had with their diagnosed relatives might improve significantly," said Sabat, noting that many of the seminar students knew someone who had been diagnosed with AD.

The students' reflections at the end of the semester confirmed that Sabat's course had, in many cases, helped them in relating to a relative or friend with dementia. It was in seeking the person behind the disease, acknowledging his or her personality and functional abilities, that students experienced a shift. Other students not personally affected by AD became aware of how many people who are considered "different" in some way are marginalized by society for no substantive reason.

However, it was getting to know each individual within the class that made teaching the Ignatius Seminar so gratifying for Sabat. He credits the students' discoveries and perspectives with informing his research, and the students reciprocated the respect he showed them. This personal approach toward teaching mirrors that of his research, and he acknowledges passing on this attitude to his students.

"People in the seminar learned about the inner lives of people with AD and thereby were able to connect with such people as people, not merely as 'patients,'" he said, "There is a huge difference."
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