Making sense of dementia using infant observation techniques: a psychoanalytic perspective on a neuropathological disease

Abstract

Dementia is relatively poorly understood from a psychological perspective and current care provisions focus preferentially on pharmacological and social interventions. Although dementia preys on a sufferer's cognitive attributes, this loss does not equate to a loss of emotional attributes in these patients. In dementia, the trajectory of life reverses and a degree of regression occurs. Through observations in an acute dementia ward, this work scrutinizes the potential that infant observation may hold for achieving greater insights into the internal worlds of dementia patients and their external environment. I look at the experience of caring for these challenging patients and examine the psychoanalytical constructs behind it. The findings derived from the platform of infant observation appear to support a more psychological rather than biological stance in approaching the complicated but fragile configuration of care on acute psychiatric units for dementia sufferers.

Understanding and improving experiences of care in hospital for people living with dementia, their carers and staff: three systematic reviews

“…Appendix 5, Table 4, summarises the characteristics of the studies included in review 1. Studies were conducted in 15 countries; 28 42,44,45,[56][57][58]63,64,69,73,76,79,82,87,88,90,99,106,110,[116][117][118][119][120][121][122]131,132 (44%) studies were conducted in the UK, 12 46,[60][61][62]78,93,97,104,105,[126][127][128] (19%) studies were conducted in Australia, and seven 80,81,83,100,107,108,123 (11%) studies were conducted in Sweden. All included papers were published in peer-reviewed journals, except six dissertations 47,…”

“…Studies were conducted in a range of hospital settings, including general acute wards (accident and emergency, acute longer stay, subacute and acute wards) in 29 studies; [44][45][46][56][57][58][60][61][62]90,93,117,118,132 older persons' wards (geriatric, dementia, psychogeriatric, geriatric rehabilitation, geriatric acute, geriatric subacute, geriatric long stay) in 24 studies; 43,65,68,69,73,76,[78][79][80][81][82]87,88,98,101,106,115,116,[121][122][123]126,127,131 general rehabilitation wards in four studies; 79,82,130,131 general wards in two studies; 47,120 admission in one study; 111 palliative care ward in one study; 65 respite care ward in one study; 86 and ambulances in one study.…”

“…[44][45][46][56][57][58][60][61][62]90,93,117,118 Qualitative data were collected most often using semistructured interviews, with 53 studies 42-47,56,57,60-63, 65,67-69,73,76-80,82,83,85,86,88,90-93,98,100,104,105,107,108,110,115-120,122-124,126-128,130-132 drawing on this approach. Seventeen studies 68,69,73,79,81,82,87,91,94,98,106,107,110,121,122,127,132 made use of observation; nine studies 58,64,82,97,101,110,112,118,122 held focus groups; and two studies 98,108 conducted document analysis. Thirteen studies combined methods, using a combination of interviews and observation; 68,69,73,79,91,127,…”

“…The aim of some papers was to explore the experience of care more generally, [71][72][73][74]87,110,111,114,115,117 whereas other papers focused on aspects of the experience of care for specific participant types such as porters and cleaners, 57 health-care assistants, 122 student nurses/paramedics, 58,59,64,131 nurses and/or health-care professionals generally, 43,62,63,65-67,75,76,83,85,88-90,95,97,100,101,104,108,109,112,116,120,123,125,128 carers 42,[44][45][46][47]61,69,70,77,86,93,96,98,99,105,124 and people living with dementia. 78,80,91,106,127 Finally, the aims of some papers involved a focus on particular topics such as admission, 93 communication, 75,76,91,100,121,125 end of life, 56,65,66,…”

“…However, we considered these to be compatible interpretations. One study 106 structured findings around psychoanalysis and infant theory. Although the conclusions of this work were interesting, because the methods were poorly reported, and the findings differed from those of the remaining studies, we did not incorporate these findings into review 1.…”