Contented Dementia? I don’t think so

[The following blog – written in 2009 – still represents my views, but please also see a later blog of mine and its useful link to an Alzheimer’s Society position paper on Contented Dementia, which I think states a very similar opinion but with far more authority. RDN, 30 July 2013]

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 James’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 neither 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 Alzheimer’s 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 Metric. 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.