Update on “Contented Dementia”
[I wrote this update in 2013 and have revisited for a very light tickle in April, 2017.] Rather gallingly, my sceptical review of Oliver James’s 2009 book, Contented Dementia, produces far more comment than most of my posts do. I more or less stick by it, though I wish I had found a way of noting my criticisms in a way which didn’t seem such a red rag to fans of the care methods it promotes. Looking at the brouhaha now, there are some interesting things to note….
My limited apologia….
Looking at the comments people have written on my blog reminds me to remind readers that I have a lot of respect for soft versions of the Contented Dementia/SPECAL idea. In non-PC, RDN-speak, these might be expressed thus. Firstly, plenty of batty old people respond very badly to direct or hypothetical questions or challenges about their present, their recent past, or their immediate wishes. (The trick is to find ways of dealing with them without expecting ordinary reasonableness.) Secondly, old people can often benefit from being allowed or even encouraged to enjoy and even work with their fond and quite sharp memories of the past. (The trick is to affect to be interested in their interminable and repetitive ramblings.)
The big message here is that people new to dealing with old people will do themselves a huge favour if they abandon the idea that they are dealing with the same old, highly-rational, ordinarily cognitive person they once knew – and quite posissibly rather disliked, or argued with, or admired, or whatever. Instead they need to relax into the understanding that they are managing their relations with an old person who is a version of the person he or she used to be. Don’t stick with your old way of dealing with them; don’t fight the new person you find before you.
Anyway, I accept (from a position of some ignorance) that SPECAL techniques may have great relevance to old people with far more advanced dementia, or with certain sorts of dementia. My criticism was of the uniqueness and universality claimed by the book whose general message may nonetheless come as a huge relief to some readers marooned in useless rationality and unnecessary irritation.
By way of an update:
(1) I was pleased that the Alzheimer’s Society in 2012 endorsed an earlier criticism of the book which it had posted from a source it presumably respected, and which was pretty much in line with mine. I can’t find those URLs now (April, 2017), but have found a later, undated, general statement from the AS which is in line with their earlier strictures. I don’t have any special brief for the society, but I suppose it not to be stupid or nasty.
(2) I am surprised that the SPECAL technique has produced so little academic or professional comment. Its promoters certainly used to say that SPECAL was endorsed by the Royal College of Nursing in 1999 and 2001 (see also Oliver James in the Guardian, here) and at one point (though not now, I think) the RCN website seemed cursorily to confirm this. The Contented Dementia Foundation/SPECAL [as checked in April 2017] cite a few apparently independent- and quite elderly – supportive research papers but give little indication of the lively debate which one would expect of a major therapy.
My point here is not that anything good would have been widely endorsed. Plenty of excellent insights labour in the shade of ignoral. Still, the mental health of the old is a very big deal now, and SPECAL is touted by its fans as a get-out-of-gaol card. Surely, if it were so wonderful or significant we would be hearing more of its benefits as discovered, tweaked, refined, admired – or even challenged – by the armies of committed people in this line of work?