There are competing discourses and constructions on how dementia should be viewed, the biomedical model being one such view which has led medical staff towards altering the course of disease processes, such as diagnosis, assessment and treatment. Lets look at dementia from a sociological viewpoint and consider symbolic interactionism as a way to begin to understand identity and self.
The experience of living with dementia has been assumed as having been socially constructed insofar as the personal meanings and compensatory coping adjustments will be attributed by the person living with dementia. He or she makes sense of a changing reality and preserves self, drawing attention to the way interactions with others influence the experience of the disease. This can be seen in many ways we shall look at two of such ways – interactions that maintain personhood and those that undermine it. Looking at Tom Kitwoods significant work on personhood, where he defined the construct of personhood as a standing or status bestowed upon one human being by another in the context of a relationship and social being. This characteristic of dementia described it as being in a relationship with society and other people.
A possibility put forward within Kitwood`s 1997 article entitled “The Experience of Dementia” discusses the uniqueness of people living with dementia which in any context is a very complex matter, especially within the framework of dementia and it’s relationship with society and other people. Kitwood called for peoples’ interests, tastes, lifestyle, gender, culture and class to be taken into consideration when incorporating dementia into a social science framework and promotes the consideration of the eclectic use of several bodies of theory traversing psychology and sociology, the key point being made here is that everyone is unique and will have a different approach to self and identity.
From a very early stage, the emphasis on loss of self has been a central theme throughout the discourse of dementia. I have been conscious within my reading and talking with other professionals that considerable attention is concentrated on and assumptions made that self and identity can be seen as being eroded and eventually lost as cognitive impairment increases and functioning decreases. Some other theorists have highlighted in various papers that as dementia progresses and extreme cognitive deterioration has taken place, the person is still physically present in their body, yet the deterioration appears to have had a significant impact on his or her ability to engage with the social world. Interaction with the social world significantly influences how dementia is experienced, the exchanges and interactions can enhance identity or equally damage it. That is to say, the effects of dementia cannot be solved by social manipulation as the person is unable to maintain self and merely manages its presentation. This is a very important issue, however very few researchers have systematically and empirically investigated the loss of self theory to test the reliability of it. Equally, some researchers have accepted that the perspective of the self is difficult to define despite basing their studies on diverse models and concepts. These models have implications on how self can be measured as the self and identity are seen as intertwined and woven together. Equally, dementia challenges the conceptual meaning of self and identity, as people living with dementia in the early stages are still able to maintain their social self and indeed their identity.
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