A psychotherapeutic exploration of self and subjectivity in dementia

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Coonan, Emma
Issue Date
MA in Psychotherapy
Dublin Business School
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This thesis will present a psychotherapeutic exploration into the subjective experience of dementia. Dementia impacts the person in many ways. It is not simply a condition which impairs memory function. It impacts to varying degrees a person’s fundamental sense of self. It can distort the individual’s experience of themselves and others. Perceptions can come undone, relationships can become rattled, and the connection to who one is becomes less reliable, and therefore more threatening and untrustworthy. So much of the self and how it has developed is attached to unconscious processes. Becoming a person, from infancy through to old age, can be considered to a large extent with unconscious frameworks of evaluation and integration in mind. These processes are a necessary part of the maturation process. These frameworks are not rigid predictors of who one will become - nobody develops in the same way at the same time - however these variations are still understood within the context of psychical developmental frameworks. The self is constructed through navigating these unconscious and instinctual pathways. One’s sense of self is therefore not only connected to the brain, but to the mind, the body, and the very many unconscious internal processes and experiences which a person has integrated from the moment of conception. Psychotherapeutic and Psychanalytic theories have much to say about the construction of self and the unconscious. In this way they are well positioned to present a perspective on the unconscious processes which affect dementia. Dementia can be perceived through the lens of interruption and fragmentation. The self as it was before dementia is now faced with memory loss, breakdown of an internal scaffolding of experience, disturbance of perception, and of biological function. It is not however so simple as to say that dementia takes the person over, and that the experience is one of total annihilation. There is an argument to be made that as long as one is living, one has identity. It is becoming ever more important in a society where people are living longer and many are living with dementia that more room is allowed for the whole experience of dementia to be explored. In so doing, concepts of wholeness of experience and value are retained, and traditional assumptions about the experience of dementia are challenged. Part of that challenge however is to first challenge notions of selfhood and identity, and as subjects and selves, to challenge notions of subjectivity.