Beyond Medication: Meeting People in Their Worlds

I still remember the air on my first day as a volunteer in the dementia ward. It wasn’t the warm, welcoming air I had imagined. It was cold — so cold it felt like walking straight into an arctic storm.

Before stepping inside, I had built my expectations from advertisements, posters, and films. Those glossy images always showed smiling carers, endlessly patient staff, and residents who were gently guided through their day with warmth and kindness. Even workplace diversity trainings and seminars I had attended seemed to carry the same promise: that care environments were filled with resilience, compassion, and unity.

But the reality was something very different. The staff I met didn’t have smiles frozen on their faces; they wore expressions of monotony, exhaustion, and quiet defeat. The atmosphere seemed heavy with gloom, as though sadness clung to the walls. I tried to tell myself this was just my nerves, but I couldn’t shake the feeling that something was missing here.

And then there were the patients. I had prepared for this, or so I thought. Before beginning, I had taken a free online course about dementia. I knew the definitions, the symptoms, the “expected behaviours.” But none of that prepared me for the raw reality of seeing the disease in action — people’s identities blurred, memories fractured, their very selves slipping away in front of me. It felt less like knowledge and more like a nightmare.

That evening, I sat down and wrote a long email in a rush of frustration. In it, I accused the staff of treating residents inhumanely, of handling people like tasks rather than human beings. But I never sent it. Something in me hesitated — maybe uncertainty, maybe humility. Perhaps I sensed I had more to learn before I could judge what I had seen.

As the days went by, I began to look past the cold air and monotone expressions. Slowly, the ward revealed itself to me, and what I saw was not just a place of illness, but a place where the true spirit of London lived.

For years, I had sat in seminars about diversity, read corporate statements, and listened to endless debates about inclusion in the workplace. But here, inside this dementia ward, I didn’t need a policy document to tell me what diversity looked like — it was sitting in front of me.

There was the elderly white gentleman who loved his pigeons, always searching the courtyard sky as though his feathered companions might come swooping in. There was the Indian man whose life carried the weight of three homelands — India, Mauritius, and Britain — a walking reminder of how migration shapes identity. There was the flamboyant African immigrant lady, full of warmth and music, who could light up the room with a laugh one moment and unsettle it the next, as dementia twisted her moods. There was the quiet, devout Bangladeshi gentleman, his religious faith wrapped around him like a final cloak of identity. And there was the British politician, whose career had once been about commanding a room, now reduced to fragments of memory and silence.

Even the staff reflected this mosaic. Nurses and carers came from every corner of the globe, carrying with them accents, languages, and cultural understandings that stitched the ward together in ways that were both practical and fragile.

And yet, for all this richness, the treatment framework seemed oddly narrow. Medication was the backbone. Structured activities and exercises filled the schedule. Volunteers like me were expected to provide the “human touch” — but even that role felt reduced, as though presence itself was only good for hygiene, safety, and distraction. I couldn’t help wondering: if we could really see the worlds each resident carried within them, would we still think medicine was the strongest thing we had to offer?

The more time I spent on the ward, the more I realised that what the residents needed most was not distraction or containment, but a way back into meaning. Dementia had taken away their bearings, but meaning was still there, hidden in fragments, waiting for someone to meet them where they were.

E, the Greek lady, had been written off by many staff as unreachable. She rarely smiled, hardly spoke, and often took other people’s belongings. Her agitation was managed mostly through medication. I learned that dementia patients often revert to their first language, and E spoke only Greek with very little English. Out of curiosity, I used a translation app to speak to her in her own tongue. Her face lit up instantly. She followed me around, tugging at my phone, demanding more Greek words. For the first time, she looked at me with warmth. Staff noticed that her agitation lessened, not after her pills, but after hearing her own language. For E, meaning came not through compliance, but through the simple recognition of her voice and identity.

D, the traveller, was restless. He longed to be outside, to move, to travel. But in the locked ward, wandering was considered a risk. I discovered his love for the Jubilee Line, and together we transformed the corridors into train stations. Each sitting area became “London Bridge” or “Bermondsey.” We walked and travelled together, stopping at stations, laughing at the idea of taking “just one more stop.” The staff saw it as a playful activity, but for D, it was more than that — it gave him back his journey. His world was not a ward but a railway, and meaning returned each time he became a traveller again.

N, the politician, was silent when I first met him. He rarely engaged with activities, and most volunteers assumed he had withdrawn completely. But I noticed how his head turned at the mention of politics. So I began to role-play as his secretary, briefing him on the day’s affairs in the tone of Westminster. Slowly, he started responding: throwing playful boxing jabs, muttering fragments of debate, reliving the spark of his former life. It was not therapy in the medical sense — it was recognition. By treating him as a statesman, not a patient, he found his way back to purpose.

M, the elder from Bangladesh, presented a different kind of puzzle. One afternoon, staff struggled to move him. He resisted fiercely, flailing his frail arms, refusing to sit in his chair. Exhaustion filled the room; everyone was baffled. When I entered, I immediately noticed the problem. His chair was not empty. A copy of a Hadith book — sayings of the Prophet Muhammad — had slipped onto the seat. For M, raised with deep reverence for holy texts, sitting on the book would have been unthinkable, a violation of his earliest and strongest values. I removed it quietly, and in seconds he sat down calmly. The staff looked at me as though I had done something magical. But it wasn’t magic. It was meaning.

Looking back, I realised that what changed E, D, N, and M was not a new pill, nor a carefully scheduled exercise. It was meaning. When their worlds were acknowledged — whether through language, travel, politics, or faith — they responded with life. Their agitation eased, their eyes brightened, and they reached for connection.

And yet, meaning was rarely spoken of on the ward. The framework of care rested on medication, schedules, and risk management. Staff worked hard, often under impossible pressures, but the unspoken assumption seemed to be that “human presence” was there for hygiene, safety, and routine, while real treatment came from prescriptions.

I began to wonder: what if psychiatry is missing its most vital ingredient? Human beings do not survive on compliance, containment, or even safety alone. We survive on meaning. Our lives are stitched together by stories, rituals, identities, relationships, and values. Take those away, and what remains is not a life, but an existence.

Dementia makes this painfully clear. It strips away memory and function, but it does not erase the longing for meaning. If anything, it exposes it more starkly. The Greek woman still longed for her mother tongue. The traveller still longed for his journeys. The politician still longed for his stage. The elder still longed for reverence. These desires did not vanish with diagnosis; they simply became harder to reach.

To rethink psychiatry, perhaps we must start here: by placing meaning-making at the heart of care. Medication may quiet the body, but only meaning can speak to the soul.

On my last days in the ward, I walked in to find N — the former politician — sitting with his wife. His body was frail, his memory fractured, but when his eyes met mine, he lifted his hand and said with sudden clarity: “Here you are, so what’s new?”

It was such an ordinary phrase, but it stopped me in my tracks. To him, I was not just a volunteer. I was his aide, his secretary, the one who brought him briefings from a world that still mattered. In that moment, the distance between who he was and who he had become collapsed. For a second, he was himself again.

I have carried those words with me ever since. “Here you are, so what’s new?” It felt less like a question and more like a passing of responsibility. Almost as though he was briefing me — reminding me that our task, if we are to care for people meaningfully, is always to ask what’s new, what matters, what still gives life its shape.

Dementia had taken much from him, but not his desire to live in a world filled with meaning. That desire remained, just as it remained for every resident in that ward. If psychiatry is to be rethought, perhaps this is where it must begin — not only with safety, not only with medicine, but with the courage to ask each person: What still gives your life meaning, and how can we meet you there?