Chapter

From childhood to childhood? Autonomy and dependence through the ages of life

Harry Cayton

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/9780198566151.003.0017

Series: International Perspectives in Philosophy & Psychiatry

From childhood to childhood? Autonomy and dependence through the ages of life

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's behaviour does not require us to infantilize the whole person. Indeed the most harmful part of the second childhood metaphor is that it tricks us into responding to adults as though they were children, forcing them to respond in that way, generating powerlessness and dependency. A carer at a support meeting said about her husband, ‘I knew when he was frightened as he came and stood next to me and held my hand like a child.’ But then she concluded, ‘People with dementia are not stupid, or children, or deaf, and shouldn't be treated as such.’ Another carer describes her husband, a musician and music lecturer, as ‘bouncing up and down like a baby’ in time to the music. But his childlike pleasure does not lead her to conclude that he would prefer nursery rhymes to Mozart's Don Giovanni. These carers I think get the balance right.

If people with dementia are playful, respond to that playfulness. If they are fearful like a child, comfort them as you would a child. If they put themselves at risk, protect them. If they are lost, help them to find home. These things seem like empathy and good sense. They do not need to be dressed up as ‘therapy’ or justified by the construct of ‘retrogenesis’.

So the objections to the idea of dementia as a second childhood are both scientific and moral. The science, unconvincingly in my view, tries to squeeze observed behaviours into an artificial construct, whether it is Piaget's theory of child development or Reisberg's retrogenesis. The consequence of such theories is to produce approaches to ‘care’ that reinforce dependence and decline, infantilizing and disabling people with dementia.

Childhood is indeed a compelling metaphor for some of the vulnerabilities and losses of old age. But it is just a metaphor. The sense of self and self-determination we have as adults is hard won through our childhood and adolescence. We should not take that away. We should aim to preserve it, not undermine it.

People with dementia are not going backwards; they are not going round in circles. They are going forwards, on a journey many of us will have to go on but none of us wants to make. They carry their childhood with them, as they do all the ages of their lives. We shall care best, and be cared for best, if we accept the child in all of us but never forget that, however disabled, we have grown into adults.

Chapter.  4515 words. 

Subjects: Psychiatry

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