Chapter

Dementia and the identity of the person

Eric Matthews

in Dementia

Published on behalf of Oxford University Press

Published in print December 2005 | ISBN: 9780198566151
Published online February 2013 | e-ISBN: 9780191754418 | DOI: http://dx.doi.org/10.1093/med/9780198566151.003.0010

Series: International Perspectives in Philosophy & Psychiatry

Dementia and the identity of the person

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When we care for someone with dementia, or when we fear the possibility of becoming demented ourselves, it is easy to fall into thinking of dementia as a kind of ‘living death’. We say things like ‘She's not the mum I used to know as a child’ or ‘He's not the man I married’: it is as if the person is no longer there with us, even though their body is still living and breathing. The person's body, as we might put it, is seen as still alive, but the person ‘inside’ the body is experienced as dead, or as good as dead. There is an obvious contradiction in saying that a person is both alive and dead at the same time, but it expresses as well as anything could the confusion in our feelings about the dementing person. They are not really dead, so that we cannot even grieve properly for them; but at the same time we feel we ought to grieve their loss, because it is as if they were dead. These feelings are not entirely irrational: there is an element, but only an element, of truth in this view, because awareness of oneself as a self, as the individual one is and memories of one's own past life as a person are crucial to our view of what it is to be a self, more crucial than physically looking the same. People do change physically as they get older and sometimes so radically that they are hardly recognizable as the person they once were; but even so we can soon identify them if they can recall past experiences that we have shared with them. But to say that continued self-awareness is ‘crucial’ in this sense is not the same as saying that it is all there is to being the self one is.

What we are expressing when we say such things is a particular view of personal identity. A view of personal identity is an account of what it is to be the individual person one is, what makes one the same person at different times, and so at what points one begins and ceases to be the individual one is—the points at which a person is born and dies. These are philosophical questions, with a long history of being discussed among philosophers; but they are also questions that go to the heart of human life and the way in which we relate to ourselves and to others. The view expressed has much in common with certain classical philosophical accounts of the self and self-identity and it is my contention in this chapter that a consideration of these classical accounts may help us to arrive at a clearer and perhaps even a more humane view of people with dementia. If we can see what is true and what is confused about them, we can perhaps develop a more adequate view of personal identity, which will make possible a better explanation of our tangled feelings about people with this condition and so help us to deal with them in a more sensitive way. As I hope will become clear by the end of this chapter, this is one case in which the apparently purely cerebral abstractions of philosophy can make a real difference to human relationships.

Chapter.  8007 words. 

Subjects: Psychiatry

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