By Habib Chaudhury Johns Hopkins University Press, 2009 Review by Jacqui Poltera, Ph.D. on Oct 27th 2009
Habib Chaudhury's book focuses on the ways in which triggering early memories of home can help to restore a sense of self in individuals with dementia, and simultaneously, better equip caregivers to care for them. Dementia typically diminishes some of the primary qualities attributed to selves, namely autobiographical memories, and certain cognitive, affective and interpersonal skills. This makes it challenging for a sufferer of dementia to maintain a sense of self, and for her carers, family members, and health care professionals to relate to and empathize with her.
The book is divided into five chapters. Chapter one outlines Chaudhury's conception of selfhood vis-à-vis sufferers of dementia, which serves as the foundation for the rest of his argument in the book. Chaudhury argues that we need to widen our conception of selfhood and understand the self as a multifarious being with qualities above and beyond those diminished by Alzheimer's disease. According to Chaudhury, individuals suffering from dementia are selves in the broader, spiritual or "sacred" sense, and thus it is a mistake to assume that an individual is only a self if she has the requisite self-reflective, memorial, embodied, and interpersonal skills. Rather, he suggests that we ought to think of the self as having qualities above and beyond those we can know and see.
Chapter two focuses on the role of place in recollecting the past and in anchoring the dementia sufferer's lived experiences in the past. Specifically, Chaudhury discusses the ways in which reminiscing about home has potentially therapeutic benefits for individuals with dementia. In Chapter three, Chaudhury draws on case-studies based on residents in dementfia care facilities and senior housing to illustrate the ways in which memories of childhood homes can be extremely powerful in reconnecting the patient to her to past self-defining memories.
He argues for a dramatic culture change in the approach to dementia care, and recommends that with the help of friends, colleagues, and family members, health care professionals can compile a fairly detailed biography of the dementia patient's life and character, complete with photographs and artifacts to help trigger specific memories of the patient's past. Doing so, he argues, enables health care professionals and carers to empathize with the patient and to view her as a "whole" person, with a life, character and set of interests that predate the onset of dementia. This approach stems from Chaudhury's motivation to equip caregivers with the skills to avoid depersonalizing the patient and failing to treat her with dignity and respect, a concern which underpins much of his discussion in the book.
Chapters four and five develop and defend the centrality of recollections about home in treating dementia sufferers. Chapter four focuses on actual biographies by residents, family members, friends and caregivers, under Chaudhury's guidance. Chaudhury argues that compiling a biography of home stories may help to understand the patient's behavior, to enable caregivers to know how to make the residents feel more comfortable and less distressed, and to promote conversation and a better rapport between staff and residents. Further, it can be used to find specific prompts in guided conversations that may trigger more memories in the resident, which can in turn make it easier for caregivers to relate to her and care for her in innovative ways. Chapter five ends with some comprehensive practical advice and tips for caregivers who want to (re)connect with and care for sufferers of dementia via this method of home stories and biographies.
The primary shortfall of this book it is that Chaudhury's appeal to the spiritual self needs more clarification. The selfhood literature is, as he acknowledges, rich, complex and diverse, and cuts across a range of disciplines in the humanities and the social sciences. Although his conception of the spiritual self prompts us to rethink how we treat individuals with dementia (and thus has interesting ethical and social implications), it does not explicitly get fleshed out in later chapters. Further, Chaudhury's account of selfhood and self-affirmation requires more detailed discussion and defense and. There remain pressing questions concerning the sense in which we ought to understand his notion of self-affirmation, and our obligations as caregivers to the dementia patient qua sacred self.
Nonetheless, Chaudhury's writing is accessible, and engaging, and draws extensively on testimonies. Although this style in part disrupts the flow of his discussion, and does not so much defend, as illustrate the nature of his claims, it illuminates the relational and intergenerational nature of recollection. Further, it enables the reader to get a sense of what it is like for a health care professional to piece together an autobiographical narrative fragmented by the symptoms of Alzheimer's disease. As such, this book provides insight into some of the unique challenges involved in caring for sufferers of dementia.
Remembering Home is predominantly geared towards providing advice for health care professionals and those engaged in caring for memory-challenged adults in health care facilities. The book is of particular interest to those researching gerontology. However, it is also useful for those family members and friends with loved-ones suffering from dementia. Further, it may provide food for thought for cognitive scientists, philosophers, psychiatrists or psychologists interested in selfhood, subjectivity, memory, and practical identity.
Dr Jacqui Poltera is a research fellow in applied philosophy in the Centre for Citizenship and Public Policy at the University of Western Sydney. http://www.uws.edu.au/ccpp Dr Poltera is currently doing research on narrative identity and agency; fragmented narratives and disordered thinking; and, violence and silencing. firstname.lastname@example.org