ABSTRACT
The notion of ‘person-centred care’, popularised by Tom Kitwood in the latter part of his career, has become an influential moral and therapeutic ideal in the dementia care of older people. It has also nurtured a humanistic and de-medicalising turn to a cluster of affiliated philosophical, artistic, relational, spiritual and ethical approaches to dementia as a shared human condition rather than an isolating disease. However, critical dementia researchers argue that better treatment of people with dementia requires a broader understanding of what it means to be a person; an understanding that advances beyond static and individualising models of mind, memory and identity towards more inclusive models of difference, imagination, embodiment and community. Thus, intervention becomes a series of positive acts based on the recognition of personhood and restoration of capacity that challenge the traditional management of disability and functional loss.
This chapter provides an overview of these developments through three thematic stages: ‘Disease, Loss and the Medicalisation of Dementia’, ‘Person-Centred Care and Its Critics’ and ‘De-Centring Humanism’. The discussion is structured by the strengths and limitations of each while questioning how the humanist movement in general is important to reflect upon because of the moral divisions by which people with dementia are located, the affective ‘fallacies of care’ that undergird certain humanistic care practices, the sidelining of structural and historical constraints and person-centred dementia care costs, training and labour, and assumptions about universalised concepts of selfhood and personhood often embedded in humanistic models. The chapter draws upon approaches in medical anthropology, post-humanist and postcolonial literature, and recent research on the materialities and ecologies of dementia care, with Brazil as an example. Conclusions suggest that critical dementia studies, as a radical and adventurous sub-field, benefits from its growing ensemble of interdisciplinary conversations and the gravity and values it accords them.
