Introduction

This chapter reviews links between the ways we conceptualise and construct dementia and treat people living with dementia, and explores the extent to which existing frameworks and models take account of life course issues and social and structural inequalities. The implications of adopting a broader lens for the mental health and well-being of people living with dementia, and for understanding and responding to their needs, is also explored. The intersection of relevant policy with this discourse is discussed too.

Understanding and conceptualising dementia

The chapter begins with an overview of the different approaches taken to conceptualising dementia and how these inform the way that people living with dementia are viewed and supported. Figure 9.1 is a pictorial representation and timeline of the key models.

Biomedical model

The dominant approach to understanding dementia is located in the biomedical paradigm. The 1970s and 1980s heralded a shift away from regarding ‘deteriorating cognitive function’ as a normal part of the ageing process and relabelled it a ‘pathological condition’, most notably Alzheimer's disease. This lens assumes irrevocable decline related to neuropathological changes and predicts that over time the person with dementia will become progressively more dependent and in need of care (for example Mitchell and Shiri-Feshki, 2009). Although the medicalisation of dementia has some benefits, including investment in pharmacological treatments and the development of (some) health services, it encourages a focus on disease and fatalism (Bond, 1992). It also positions the person living with dementia as a victim of chronic illness with a particular set of symptoms and a distinctive trajectory. Further, it tends to be accompanied by clinical and service-oriented language and an ageist nihilistic set of assumptions about lack of potential and ability.

That this approach eclipses all other facets of the person's biography, life and personality is a long-standing criticism (Killick and Allan, 2001; Milne, 2010a). Understanding of the individual's subjective experiences, life course, relationships and nature is lost beneath, or at least marginalised by, a primary focus on dementia as a medical condition and a ‘master status’ (Goffman, 1963; Milne 2010b).