chapter  Chapter 9
15 Pages

Attachment in confusional states and in dementia

Theory into practice
BySandra Evans

Attachment remains a major theme psychoanalytically in dementia and in dementia care. A great deal of modern practice in dementia services has developed from the central importance of continued relatedness with people who are suffering from dementia. The history of this understanding is reflected here and brought up to date with the new research both from ongoing mother-infant observations, dementia observation and the neurobiology of attachment. Psychoanalysis has traditionally drawn its observations from the world of the development of the mind, the person and the relationship between young developing minds and their primary caregiver, usually mother. This is then re-experienced in relationship to and with the therapist. In dementia, we are still drawing observations but through loss rather than development, degenerative processes rather than new learning and from what is no longer functioning that used to be so. We also draw upon what is experienced within us as family members, carers and as treating clinicians. What is distilled from this is a hard-won knowledge and understanding, which is inevitably imperfect.

These losses in no way detract from what remains which, it is asserted, is love.