Contented Dementia? I don’t think so
Posted by RDN under Mind and body / Politics and campaigns on 19 October 2009
Oliver James has written some silly and poorly-argued books and it would have been nice if Contented Dementia, his new offering, was an exception. It isn’t.
Dr Jame’s new thesis is, as he proudly acknowledges, someone else’s. His mother-in-law, Penelope Garner, is the inventor of the methods it describes. The thesis is that all patients with dementia can be made pretty happy provided they are not challenged about anything very much and especially about the recent past and their view of it. The trick is never to ask them questions but instead to find trigger themes from their past about which they can be confident, and thus indulged and comforted.
I happen to spend an inordinate amount of time with two individuals over 90 and niether of them has Alzheimer’s (so far as I know). They may have a touch of dementia. Frankly, I wouldn’t know. They are both in different and varying ways not altogether with-it, though both are capable of being very sharp, and very seldom politically-correct. Still, I recognise the soundness of some of Dr James’s case in that there is not always much point in asking very old people questions. “What would you like for supper?” is quite likely to be met with a blank stare and a vaguely anxious look, as though one was Bruce Forsyth asking a quiz question about the conveyor belt on The Generation Game. But I find asking questions often seems to stir up batty old people and helps them wake up and get with the programme and rediscover the means of enjoying their present. Without lively interrogation and challenge, they seem to sink into gloom.
OK, you say, but those old people haven’t got Alzheimer’s and maybe not dementia – they’re just a bit do-lally - so what would you know?
I know enough to be suspicious of James. It seems dubious to lump dementias and Alzheimers together as though they were like each other. I think he is wrong to reach for a simple mechanism and insist that it works for all patients with whatever degree of illness. I know he is horribly and probably incurably immodest, though his own accounts of the lessons Penny Garner has learned from other practitioners (page 14, page 20) suggest that their technique is not a fresh discovery, but rather a radical version of what plenty of other carers have found out for themselves. I doubt all questions are toxic, as he asserts. I doubt all patients need to be indulged in lies as much as he supposes.
Oliver James fails one crucial test of my own devising: the Cuckoo Metre. It comes from my irritation at the Laingian nonsense popularised by One Flew Over the Cuckoo’s Nest. Here I am in full flow:
“These sins include saying the well have much to learn from the unwell; that it’s the unwell who are sane, really; and that institutions never really understand their inmates.”
Contented Dementia is full of statements such as:
“With Dorothy’s [a sufferer's] help, Penny was beginning to get the hang of what dementia was like.”
What he might reasonable say, in this and several other cases like it, is that Penny was working out what her patients needed, and doing it by working with them. But they weren’t teaching her, and weren’t the experts in their condition, and it is specious to say otherwise. And of course the USP of his book is that he and Penny are super-right and everyone else has got it pretty wrong.
So this is a poor book because it wildly over-reaches itself. When I wondered whether I had anything like the expertise to opine on it, I at first comforted myself that its failing were open to logical as opposed to merely medical challenge. And then I googled the title and found that the Alzheimer Society dislikes the book in much the same terms as I do. What I merely suspect or can deduce, they assert from experience.
Written by L White on 09/09/11 at 12:44 pm:
Whilst I appreciate your argument, I feel you are missing the point. Anyone who reads the book thinking that the activities sound easy or that the results will be easily applied are rather misguided. Nowhere in the book does James state that dealing with dementia is an easy task, moreover, it highlights the fact that managing someone with dementia is time consuming and wearisome. I read the book and the anecdotal nature allowed me to better understand what it would be like to have short term memory loss and appreciate why individuals with dementia act the way they do. He has turned what may be described as a dry medical subject into something with an actual application.
Written by Dr. Margo Karsten on 01/01/12 at 8:46 pm:
Mr. North, I strongly disagee with your statements. I have researched “SPECAL” care and found empirical studies which demonstrate the effectiveness of this approach. I have also implemented the concepts into my own mother’s care, and it has had a significantly positive impact on her overall wellbeing. I commend both Oliver and Penny for spending over 20 years evalutating the effectiveness of SPECAL and now publishing their insights for all of us to benefit from! It is one of the most positive books written about dementia, and I recommend it to everyone I meet!
Written by paul filsell on 09/01/12 at 2:34 pm:
I have had over thirty years of looking after people with dementia and this book highlights what I have known and practised for many years.
It should be compulsory learning for everyone involved in this type of care.
Written by Sylvie Clayden on 01/02/12 at 12:28 pm:
Hello. I am an Occupational Therapist whose community work in ” Health ” has driven me to want to specialise in Dementia, find a platform and a voice for these people. I am another advocate of Penny Garner`s approach and am disappointed that the Alzheimers` Society reject it. I feel they hold too much power and would like them to change their name to The Dementia Society as they support all forms of dementia. Anything positive and proactive for this group of people gets my support – we must stop patronising them and medicalising them – acceptance is all and engaging in the SPECAL sense way is positive.
The tone of your article is angry, why is this ?
Best Wishes
Sylvie Clayden
Written by RDN on 01/02/12 at 1:37 pm:
Dear S,
Thanks for that.
To deal with the “angry” point first. I hope it isn’t true, but if I was sparky then that is because I have for many years been at loggerheads with much of Oliver James’s “Britain on the Couch” and “Affluenza” material. In particular, I haven’t liked his handling of evidence nor his egotistical tirumphalism (if I may be so sparky as to call it that).
Coming to the “Contented Dementia” material, I wanted to point out that many elements of his case are sound and have been known to be so for several or many years (as I know not least from his book). So I think the risk of the OJ writing is that it renders universally applicable what needs to be selectively considered and it suggests an embattled, visionary status for his campaign which would be better framed as a candidate for being useful rather than as a unique bastion of truth in a bad world.
Written by Sylvie Clayden on 18/02/12 at 3:33 pm:
Dear Richard
My reply is very simple – it is not a bad world.I feel there is something in your way and it is not Oliver James – only you know the answer to that – let`s say you are passionate as opposed to angry – I am sure you can turn that into something positive.Being negative is rarely productive and it doesn`t feel good!
Heaps
Sylvie
Written by Jonathan on 27/03/12 at 2:30 pm:
Richard, just found your site after researching Contented Dementia for a relative. Out of interest what informs your judgements of mental health issues and the work of Oliver James – is your background in this area?
Regards,
Jonathan
Guidance Counsellor
Written by RDN on 27/03/12 at 5:13 pm:
Jonathan,
My experience of mental health issues is slight. A long time ago I read Bettelheim and Laing and Foucault. I saw “One Flew Over the Cuckoo’s Nest”. Much more recently, I have looked quite carefully at the Seligman and positive psychology work – and find it fascinating and wanting. Like everyone, I have been close to people with depression. I have several man years’ experience of caring for and catering to very old people.
On OJ’s dementia work, it may be worth reminding you that my beef with his book was not based on huge experience: rather it was a matter of suggesting that his large conclusions did not flow well from the evidence he quoted. (One got the impression that lots of people have pioneered this territory whilst knowing that it is wise not to be overly proscriptive.) This is a matter of textual analysis as much as my experience. However, I did point out that the book seemed to conflate the business of dealing with ageing or failing mental faculties with the business of dealing with Alzheimer’s. I know something about the former and can say that very old people do indeed have difficulty with dealing with some sorts of questions; but they seem positively to respond well to some sorts of challenge. It seems tricky to base a strategy on never asking questions or posing challenges. It’s a matter of horses for courses.
My point was that one needs to go rather modestly into this territory and that doing so seems supported by the evidence in OJ’s book (and by the AS view of it), but not by OJ’s typically grandiose and sweeping generalisations.
So: never mind my experience of mental health. My long experience of book-reviewing may help you to unpick OJ’s book a bit. Or you may think OJ’s book easily survives what you think are my ill-considered (and what you may freely call uninformed) remarks.
On my experience of OJ’s other work Britain On the Couch sort of work, I think I understand the “happiness” and “well-being” data rather better than OJ (or, come to that, the authors of “The Spirit Level”). That again is a matter of looking at the data and talking clearly about what it says, as a matter of text and logic, more than mental health experience.
Written by B. Malone on 29/03/12 at 6:16 pm:
Richard, it is very hard to see, when your head is up your ass! I’m not a caregiver or Doctor, but I do know a naysayer when I hear one.
Written by Carol Lintern on 03/04/12 at 8:51 am:
Interesting reading Richard. Penny is labelling what many carers supporting people with dementia strive towards. You have to really ‘be’ with that person to learn and promote wellbeing- a very selfless request and we are all different.
Written by Deborah on 06/04/12 at 11:59 am:
Whether you like Oliver James style or not he is writing up a practitioner based method from a small charity offering techniques to help desperate carers. These techniques have been a life line to many of us because they work. Nobody is yet able to cure dementia but you can make it more tolerable.
Anyone interested in cost-benefit analysis would do well to add up the long line of professionals involved with my relative and compare this to a method to ease anxiety and help the carer empathise which gives results and relief.
The thesis about feelings remaining even when facts have gone links to a Univeristy of Iowa study where two groups of dementia patients watched a sad or happy film. They could not remember the film but their mood reflected what they had seen.
There is now a film with case studies of how people used this approach.
Do re-consider, Richard. There really is something here worthy of further investigation.
I
Written by RDN on 06/04/12 at 2:30 pm:
Dear Deborah,
I am thrilled OJ’s book has helped you with the your caring issues. I don’t know what I have to say to make it clear that I comepletely see how such a book and such a campaign may help people. I only said that the OJ approach was too simplistically triumphalist and universalist.
Written by Glenda Shaw on 26/04/12 at 9:58 pm:
Don’t make such stupid comments until you’ve spent some time at Burford and see for yourself, “It Works”. I’ve spent many hours there and use the methods every dayin my job.
Senior Support Officer 55+ Team Oxford City