Chapter

Meaning-making in dementia: a hermeneutic perspective

Guy A. M. Widdershoven and Ron L. P. Berghmans

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/9780198566151.003.0011

Series: International Perspectives in Philosophy & Psychiatry

Meaning-making in dementia: a hermeneutic perspective

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People are continuously involved in processes of meaning-making. They interpret and try to make sense of what happens around them, so that they understand the world and know what to do. Processes of meaning-making are not the result of conscious calculations or decisions by the individual; they precede such activities and serve as their foundation. In dementia, meaning-making becomes problematic. Common ways of understanding often tend to break down. Perspectives, which used to be shared, may drift apart. From a hermeneutic perspective, the challenge is to find ways to reintegrate these perspectives once again. This requires a dialogical attitude, exemplifying both openness and preparedness to change. A fusion of horizons is not a conscious achievement brought about through the exchange of information. It is a realignment that occurs when people take part in joint movements and rituals and find themselves changing into a community. Such processes can be developed in dementia care by sharing everyday activities, such as eating or singing. They can be sustained by tools, which may help people to orient themselves in a common world. From a hermeneutic perspective, advance directives should not be seen as objective statements about prior wishes, to be executed when the moment has come, but as vehicles for joint meaning-making, before and during the experience of dementia. As tools, such documents can orient behaviour and symbolize shared practices of care.

Chapter.  6520 words. 

Subjects: Psychiatry

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