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In the past, when scholars reflected on the psychological impact of dementia, they often spoke of the loss of the "self" in dramatic and devastating terms, using language such as "self-harm" or "self-harm". disintegration "of the self. . In a new journal published in pre-print at PsyArXiv, an international team of psychologists led by Muireann Irish of the University of Sydney question this dark image they attribute to the common assumption, but erroneous, "that without memory, there can be no self" (as the summarizes Hume's sentence: "Memory alone … should be considered … as the source of personal identity").
In their review, Irish and colleagues, including PhD candidate and lead author Cherie Strikwerda-Brown, present a more optimistic perspective based on their analysis of autobiographical memory loss research literature in people with the disease Alzheimer's, people with semantic dementia, etc. with frontotemporal dementia. "Overall," they write, "… the self is not entirely lost in dementia, with distinct elements of preservation emerging from the contingent linked to the syndrome of the time of life and the dementia".
The central argument of the authors is that our autobiographical memoirs, on which our sense of self is based, are composed of two interdependent elements: episodic (the subjective sense of having lived past events) and semantics (factual knowledge of the past), some aspects of which are partly spared by different types of dementia and different periods of life.
In people with Alzheimer's dementia, they explain that there is often (especially in the early to moderate stages of the disease) an autobiographical saving of the sentence. knowledgeespecially from earlier in life. In particular, the so-called "general events memories" are spared, such as the memory of "I used to go dancing on Fridays" or "I had the 39, habit of teaching in the twenties and thirties "- even if the subjective feeling of having experienced these past experiences are lost. Irish and his colleagues say that this preserved semantic knowledge, including its own traits and preferences, can provide a sense of "narrative continuity" and help explain why social abilities may remain relatively intact many years after the diagnosis of disease. # 39; Alzheimer's.
This does not mean that the sense of self does not pose a problem: "They [people with Alzheimer’s] can display an obsolete auto-schema, in that 'what I was & # 39; becomes "who I am", and this un-updated framework governs their daily behavior, "write the authors, citing anecdotal cases of people with Alzheimer's disease from previous roles in their lives like to believe that they are still nurse (rather than retired) or mother (rather than grandmother).
Conversely, Irish and his colleagues explain how people with semantic dementia lose much of their factual knowledge about themselves, including their past. recent, subjectively experienced episodic memories, especially from the last year or so. These first-hand experiential memories of recent experiences – associated with a general, temporally undetermined knowledge of the type of events they experience frequently – may provide another basis for a consistent sense of self, even if this one is largely rooted in the present and the recent. past. In turn, this time-bound self-esteem can help explain the rigid behaviors and routines often observed in people with semantic dementia – a preference for wearing the same clothes, for example, and d & # 39; always go to the same place at the same time of the week. .
To provide another perspective, Irish and her team highlight the more serious impairments of the individual that are associated with people with frontotemporal dementia, characterized by marked personality change, as well as by varying degrees of lost episodic and semantic autobiographical memory. While the traits, humor, morals, and behavior of people with this dementia are dramatically altered by their illness and perceived as such by close friends and family, the patients themselves have no idea these changes, which are extremely painful. for their loved ones, but at the same time offers the person with this form of dementia emotional protection against their condition. Frontotemporal dementia "equates to a much deeper disturbance of the self" according to Irish and her co-authors.
The authors of the review also point out that there are many things that we still do not know about the impact of different forms of dementia on the sense of self. In particular, little research has been conducted on future thinking (the ability to imagine the self in the future). and wandering in these conditions. The limited research that has been conducted has yielded intriguing results – for example, while people with Alzheimer's disease have a reduced ability to imagine future events, they describe such a vivid imagination as people in Alzheimer's disease. healthy.
Irish and his co-authors believe that mental vagrancy research may be particularly revealing of how dementia affects self-awareness, because in healthy people it often involves reflections on oneself in the past and the future – what the authors call "spontaneous". ego expressions. "" More importantly, "they add," such surveys can provide important information to guide appropriate interventions to improve the overall quality of life of people with dementia. "
The authors repeatedly point out in their report that "despite … serious memory problems, [for many people with dementia] Self-continuity remains present in varying degrees in past and future contexts. "Irish and his team believe that it is an important point, not only philosophical but also clinical." Our approach highlights in particular the dynamic and multi-faceted nature in which the self changes in healthy and pathological aging, with important ramifications for the development of person-centered care, "they write.
The optimistic notion that self-esteem can survive dementia – at least in the early to moderate stages of the disease – may be considered in light of other research not mentioned in the review, such as aesthetic tastes and abilities. People with Alzheimer's Disease Type dementia is often preserved for many years. Recognizing the value in the lives of people with dementia also helps to challenge the offensive "zombie metaphor" that has emerged in some clinical circles (with published book titles such as Alzheimer's disease: coping with a living death to be too common).
Like John Zeisel – author of I'm still here – affirmed, "it is possible to have a decent life with Alzheimer's disease, even though most people do not believe it … In fact, many people over the years the first ten years of this illness fully live their lives – renewing themselves and deepening relationships with those they love and love. "
"All is not lost" – Rethinking the nature of the self in dementia
Christian Jarrett (@Psych_Writer) is editor-in-chief of BPS Research Digest
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This article was originally published on BPS Research Digest. Read the original article.
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