Where lies the expert?
This chapter looks at expertise in dementia. Does it lie with the patient, the family, the staff employed to care, the institutions or politicians? Is it possible to alter/manipulate the level of expertise wherever it lies? The notion of the expert patient, expert by experience is discussed in relation to dementia in terms of ongoing identity, particularly that affective memory outlives cognitive memory.
Not everything about the patient can be attributed to organically determined impairment. Expertise from the family will be primarily about the person due to shared experience over the years, also before dementia. It may be tempered by their psychological reaction to the patient, the illness and the staff. Researchers and health professionals know much of the facts of dementia but the felt experience of neuropsychiatric conditions is particularly difficult for others to understand. Those working closely with patients also need personal, psychological capacities and warmth. Health leaders and politicians rarely set an empathic tone when discussing old age and its exigencies although this is needed. Well founded ideas in the National Health Service fail without psychological understanding, moral strength and commitment.