Seeing whole

Julian C. Hughes, Stephen J. Louw and Steven R. Sabat

in Dementia

Published on behalf of Oxford University Press

Published in print December 2005 | ISBN: 9780198566151
Published online February 2013 | e-ISBN: 9780191754418 | DOI:

Series: International Perspectives in Philosophy & Psychiatry

Seeing whole

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We started this chapter by considering the idea, which is not immediately apparent because of the ‘organic’ nature of dementia, that the diagnosis of dementia was evaluative. Recognition of values brings into play a greater consideration of meanings. This becomes important when we consider the scale of the problems raised by dementia, both globally and individually. How we think of people with dementia will be crucially important in determining how we care for them.

We saw that our minds and our subjectivity seem to involve other people, although later we became more inclined to add the caveat that this involvement with others had to be at least potential if not actual. The notion of the externality of the mind pushed us further into the world and, in connection with meaning (and therefore meaning-making), we saw that it was in the public spaces formed by communication that this occurred. Again, despite the need to be cautious about the extent to which others construct meaning, there seems little doubt that our (at least potential) engagements with others are crucial to our standing as people who can convey meaning and use language. At the level of the person, the emphasis on the world is a corrective to the hyper cognitivism that tends to reduce the notion of personhood to inner goings-on. Instead, we need to see the person as a situated human being, who engages with the world in a mental and bodily way in agent-like activities, showing (amongst other things) desires, choices, drives, emotions, needs, and attachments.

Our recurring theme has been the need to broaden the view, to move outwards to the world. We have seen how clinical practice takes us in this direction, by the emphasis from the practitioners on the importance of relationships. We have seen how philosophers also talk of public space (the space of meaning) and of the way in which the mind must (constitutively) engage with the world. Meaning-making takes place in the world between people, including people with dementia. So the emphasis is on seeing things whole. Perhaps this is best put by the philosopher Midgley: People sometimes say that the human brain is the most complex item in the universe. But the whole person of whom that brain is part is necessarily a much more complex item than the brain alone. And whole people can't be understood without knowing a good deal both about their inner lives and about the other people around them. Indeed, they can't be understood without a fair grasp of the whole society that they belong to, which is presumably more complex still. (Midgley 2001, p. 120)

Our substantive conclusion is that people with dementia have to be understood in terms of relationships, not because this is all that is left to them, but because this is characteristic of all of our lives. How this is so, as we shall see in the rest of the book, is a matter for fine debate. The philosophical disputes that may be unearthed will not be solved without further exploration. But Midgley is surely right to draw our attention to the bigger picture, towards which we have been heading all along. Without this form of whole sight—the broader view of people with dementia that comes from the connection of practice and philosophy—our futures might indeed seem desolate.

Chapter.  19816 words. 

Subjects: Psychiatry

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