The problem: models of dementia and normativity

Julian C. Hughes

in Thinking Through Dementia

Published on behalf of Oxford University Press

Published in print February 2011 | ISBN: 9780199570669
Published online February 2013 | e-ISBN: 9780191754654 | DOI:

Series: International Perspectives in Philosophy & Psychiatry

The problem: models of dementia and normativity

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In this chapter, I have considered the disease model, the cognitive neuropsychology model, and the social constructionist model. I have interrogated these models of dementia in the light of the Wittgensteinian analysis of intentional mental states and asked, in particular, how they conceptualize remembering. In each case, although I have been able to acknowledge good points, I have found the models wanting. The disease model of dementia presents a perfectly reasonable causal account of what it is to remember (or forget) Adlestrop. But it does not speak of the constitutive account, of what remembering and forgetting actually mean. This model needs to be broadened. The cognitive neuropsychology model, with its reliance on inner representations and sub-personal processing, again gives us a form of causal explanation, but one that is metaphorical. It will need to be understood in a broader surround. The social constructionist model presents us with an ambiguity between a causal and a constitutive account. In the next two chapters I shall broaden the view of these models and confront the ambiguity of social constructionism.

There is then a hint that what it is to remember something, Adlestrop say, is difficult to pin down. Of course, there will be criteria of correctness—this is what normativity is all about. Remembering Slough is not the same as remembering Adlestrop. The transcendental account of normativity points to the conditions for the possibility of remembering, which are that the normativity is constitutive of the practice of remembering, immanent in it, and irreducible. Remembering Adlestrop is like nothing else. The poem captures for us a moment and an emotion. And for that minute a blackbird sang Close by, and around him, mistier, Farther and farther, all the birds Of Oxfordshire and Gloucestershire. (From Adlestrop by Edward Thomas; vide supra)

What it is to remember, therefore, is clouded in some sort of mystery. In the end there are some things that cannot be said about it: our conception of our mental states points towards something other (the confusing impetus to dualism maybe), even though we are aware, darkly, that we cannot lay that conception bare. But it is also mundane: it is just what it is in the everyday world.

So, too, with Miss Breen: her forgetting is ordinary, with straightforward causal explanations; but is also extraordinary. It is a mundane fact of the world; but what we make of it shows our evaluative judgements. To forget the face of a loved one is to have lost a part of one's world; but it is not the whole of the human world. Our mental states reach out to the world and are constituted in part by it. Our embeddedness in the human world of practices is, therefore, part of what we are: these practices are constitutive; what is normative is immanent in them and cannot be reduced. Our understanding of what it is to remember Adlestrop—with all that normativity entails—means that our understanding of Miss Breen cannot be circumscribed. The text is always open to further interpretation.

Chapter.  17286 words.  Illustrated.

Subjects: Psychiatry

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