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Understandings of dementia: Explanatory models and their implications for the person with dementia and therapeutic effort

Murna Downs, Linda Clare and Jenny Mackenzie

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/9780198566151.003.0015

Series: International Perspectives in Philosophy & Psychiatry

Understandings of dementia: Explanatory models and their implications for the person with dementia and therapeutic effort

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There are many different ways of understanding the experience of living with dementia. These understandings can be thought of as explanatory models. None of them reflects, or indeed is capable of reflecting, the one and only truth. Rather, they represent the attributions we make for why people behave as they do. By inference, they provide us with guidance as to the most appropriate and helpful response.

Individuals, families, professionals, and communities all have belief systems about what causes dementia. The explanatory models of dementia, which we as individuals and societies adopt, will affect both the experience of living with dementia and how we support people and their families living with these conditions (Cassell 1976). Explanatory models are ways of conceptualizing how illness is recognized, understood, and interpreted, from popular, folk, and professional perspectives (Kleinman 1981).

The purpose of this chapter is to describe four explanatory models of dementia and to examine their implications for a person with dementia and the nature of the therapeutic effort required to provide support. The models are not intended to be exhaustive. For example, psychoanalytic explanatory models are omitted. The models included are dementia as normal ageing; dementia as a spiritual experience; dementia as a neuropsychiatric condition; and dementia as a dialectical process involving an interplay between biological, psychological, and social components. While these are presented as discrete models, we recognize that in real life they rarely appear in a pure form. Rather, as individuals and societies, we adopt an eclectic approach to explaining dementia. Our separation of the models into discrete categories is only for purposes of discussion.

We shall demonstrate that, in general terms, different explanatory models dominate at different time periods, and, within the same time period, between and within ethnic groups. We shall describe how some explanatory models place more or less emphasis on the therapeutic effort required to ensure quality of life and on the form such therapeutic effort may take. We shall conclude by stressing the ethical imperative to promote understandings that both emphasize the essential humanity of the person with dementia and maximize quality of life for people with dementia and their families.

Chapter.  8647 words.  Illustrated.

Subjects: Psychiatry

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