Memory, language, self and time : personhood and relationship in dementia

Master Thesis


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University of Cape Town

This dissertation contributes to an understanding of how the entanglement of language, memory, self, and time in contemporary Western thought shapes assumptions about the personhood status of elderly persons with dementia and their capacity for meaningful relationship. The ethnographic data that informs the study was drawn from a three-month period of in-depth participant-observation conducted in a dementia ward situated in an exclusive retirement community in the Western Cape, South Africa. By taking the relationship between the elderly 'residents' living in the ward and their professional caregivers as the focus, I show how, in the face of dementia-related language and memory losses, this relationship was established and maintained across time. The focus on relationship allowed me to pay close attention to the face-to-face interactions between caregivers and residents so as to identify and discern the assumptions and practices that shaped the possibilities for personhood and relatedness within the ward. I demonstrate that the relationship between caregivers and residents was established and maintained through myriad and ongoing practices of care. This institutionally structured relation of care must be recognized as both an alternative form of sociality within which 'demented' residents are held in life and relationship, and as an instrument through which old people with dementia are subjected to the routines, norms, and temporal structures on the ward. Invocations and denials of personhood occur at the practical level of intersubjective engagement. I show that despite residents' language impairments, and the consequent importance of embodied gestures for communication and mutual interaction, language was fundamental to the relation of care, and thus to the practical engagements through which personhood was invoked and denied. Caregivers frequently engaged in a practice which involved the recollection and narration of the biographical 'facts' that constituted residents' erstwhile social lives and social identities. Defining this practice as an intersubjective memory practice, I argue that it functions to invoke personhood by establishing continuity between past and present and calling forth residents as socially recognized and situated persons. This intersubjective memory practice can be interpreted both as evidence that personhood is emergent within and through relations of care, and as a normative practice which reinforces the currently taken-for-granted assumption that the self is constructed in and through narrative. I suggest that the widespread acceptance of the notion of the narrative self, in both popular and academic domains, is indicative of the manner in and extent to which language, memory, self, and time are entangled in contemporary Western thought. In order to demonstrate the historical and cultural specificity of this entanglement, I draw attention to the way in which memory, narrative, and temporal continuity became inextricably tied to notions of personhood and relatedness within Western philosophy. I propose that expanding an understanding of the ways in which language, memory, self, and time are entangled in everyday practice provides a means of troubling the widely accepted belief that dementia leads to a loss of personhood and relationship, without resorting to the dichotomous thinking that characterizes much of the scholarly and clinical literature that is influenced by the so-called personhood approach to dementia.