This paper examines narrative approaches to care within the context of dementia. It reviews the function of stories and explores some of the narrative genres that shape the cultural perceptions of dementia. We argue that narrative intelligence within healthcare is an important element in nurturing communal self‐identity for people living with dementia. Listening and responding to stories and the cultural framework that this encompasses is an embodied action that is not just related to cognitive recall but situates us within a (...) cultural community. People with dementia may have challenges in maintaining narrative legitimacy in the face of fractured stories and incoherent narratives. Health professionals can offer support in reframing and presenting counterstories that maintain identities that can potentially be marginalised, silenced and open to narrative foreclosure. This process requires health professionals to be attentive and responsive to how patients with dementia and their supporters construct and position the stories they tell and the meaning(s) they attach to them. (shrink)

This paper explores the question concerning the relationship between basic and higher layers of experience and self-experience. The latter distinction implicitly presupposes the idea of a univocal foundation. After explaining the formal ontological law of foundation, an attempt is made to clarify how the idea of foundation may be suitable to understand the relationship among moments, or layers, of self-experience. To this aim, the phenomenological descriptions of self- and world-experience in dementia and schizophrenia are compared. The comparison between these two, (...) in many ways radically different, pathologies allows us to highlight both the potentialities and the limits of resorting to the foundational relationship for the description of lived experience. Taking the challenges coming from the description of dementia and schizophrenia into serious consideration, the meaning of the “stratified” account of self-experience will be eventually reassessed, and a way to complement the idea of foundation among layers will be proposed. (shrink)

Attempts to investigate and describe the distinctive spirituality of people with dementia suffer from a serious methodological difficulty in that, by the stage that dementia becomes the determining existential reality, communication is likely to be difficult or impossible. In this paper, the author uses a three stage process to elucidate this problem, its implications and constructive possibilities. First, a critical literature review is undertaken to evaluate the present state of research and explore its assumptions and methodologies. This is followed by (...) a concept analysis to identify possible suggestions in the speculative literature. Finally, each of these solutions is examined in turn for its implications for the definitions and of and discourse on spirituality in dementia care. (shrink)

Verbunden mit dem drohenden Verlust von kognitiven Kapazitäten und der Veränderung der eigenen Persönlichkeit, ist zu vermuten, dass bei Demenzerkrankungen ein Sinnverlust vom Erkrankten befürchtet wird. Es ist Aufgabe dieses Papers aufzuklären, was es mit einer solch meist diffus empfundenen Angst auf sich hat. Dazu wird ein Deutungsangebot gemacht, das auf die Sinnkonzeption Susan Wolfs zurückgreift. Es wird gezeigt, dass es möglich ist, bis zu einem gewissen Grad der Demenz ein sinnvolles Leben zu führen – ein Leben, bei dem subjektiv (...) Anziehendes und rational Wertvolles zusammengreifen müssen. Dies ist möglich, weil ein Mensch mit Demenz noch über entsprechende Fähigkeiten der Wertschätzung verfügt und eine Hilfsbedürftigkeit der Befähigung zu einem sinnvollen Leben nicht widerspricht. Bei einer sehr schweren Beeinträchtigung der kognitiven Kapazitäten wird es hingegen nicht mehr möglich sein, ein solches Leben zu leben; die solcherart erkrankte Person wird dies aber auch nicht mehr vermissen. Wenn das, was man mit der Demenzerkrankung zu verlieren befürchtet, durch das Sinnverständnis Wolfs getroffen ist, dann sollte man diese Überlegungen bei der Beurteilung einer empfundenen Angst berücksichtigen. (shrink)

Theories of personal identity in the tradition of John Locke and Derek Parfit emphasize the importance of psychological continuity and the abilities to think, to remember and to make rational choices as a basic criterion for personhood. As a consequence, persons with severe dementia are threatened to lose the status of persons. Such concepts, however, are situated within a dualistic framework, in which the body is regarded as a mere vehicle of the person, or a carrier of the brain as (...) the organ of mental faculties. Based on the phenomenology of embodiment, this paper elaborates a different approach to personal identity in dementia. In this perspective, selfhood is primarily constituted by pre-reflective self-awareness and the body memory of an individual, which consists in the embodiment and enactment of familiar habits, practices and preferences. After describing the different types of body memory, the paper develops a phenomenology of dementia as a loss of reflexivity and meta-perspective. This is contrasted with the preservation of individual forms of body memory even in the later stages of the illness. The ethical consequences of an embodied approach to dementia are outlined. A final look is given to narrativistic and constructionist concepts of the self in dementia. (shrink)