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Psychological therapies can be effective in reducing symptoms of depression and anxiety in people living with dementia (PLWD). However, factors associated with better therapy outcomes in PLWD are currently unknown.
Aims
To investigate whether dementia-specific and non-dementia-specific factors are associated with therapy outcomes in PLWD.
Method
National linked healthcare records were used to identify 1522 PLWD who attended psychological therapy services across England. Associations between various factors and therapy outcomes were explored.
Results
People with frontotemporal dementia were more likely to experience reliable deterioration in depression/anxiety symptoms compared with people with vascular dementia (odds ratio 2.98, 95% CI 1.08–8.22; P = 0.03) or Alzheimer's disease (odds ratio 2.95, 95% CI 1.15–7.55; P = 0.03). Greater depression severity (reliable recovery: odds ratio 0.95, 95% CI 0.92–0.98, P < 0.001; reliable deterioration: odds ratio 1.73, 95% CI 1.04–2.90, P = 0.04), lower work and social functioning (recovery: odds ratio 0.98, 95% CI 0.96–0.99, P = 0.002), psychotropic medication use (recovery: odds ratio 0.67, 95% CI 0.51–0.90, P = 0.01), being of working age (recovery: odds ratio 2.03, 95% CI 1.10–3.73, P = 0.02) and fewer therapy sessions (recovery: odds ratio 1.12, 95% CI 1.09–1.16, P < 0.001) were associated with worse therapy outcomes in PLWD.
Conclusions
Dementia type was generally not associated with outcomes, whereas clinical factors were consistent with those identified for the general population. Additional support and adaptations may be required to improve therapy outcomes in PLWD, particularly in those who are younger and have more severe depression.
With contributions from an international team of experts, this collection provides a much-needed international, comparative approach to mental capacity law.
In her lifetime, African American composer Margaret Bonds was classical music's most intrepid social-justice activist. Furthermore, her Montgomery Variations (1964) and setting of W.E.B. Du Bois's iconic Civil Rights Credo (1965-67) were the musical summits of her activism. These works fell into obscurity after Bonds's death, but were recovered and published in 2020. Since widely performed, they are finally gaining a recognition long denied. This incisive book situates The Montgomery Variations and Credo in their political and biographical contexts, providing an interdisciplinary exploration that brings notables including Harry Burleigh, W.E.B. and Shirley Graham Du Bois, Martin Luther King, Jr., Abbie Mitchell, Ned Rorem, and – especially – Langston Hughes into the works' collective ambit. The resulting brief, but instructive, appraisal introduces readers to two masterworks whose recovery is a modern musical milestone – and reveals their message to be one that, though born in the mid-twentieth century, speaks directly to our own time.
Margaret Bonds’s upbringing and education inculcated in her a profound sense of pride in her racial and familial heritage and an equally profound sense of obligation to “go farther” than those who came before her in using her art for the betterment of the lives of others. Moving from her youth through her years as a struggling musician in New York and Los Angeles during the Depression and World War II, through her ascendance to national and international fame, this chapter traces the development of these themes in her personal philosophy and compositional work over the period ca. 1939–63 in works including the incidental music to Shakespeare in Harlem, The Ballad of the Brown King, and Simon Bore the Cross, leading to their coalescence in The Montgomery Variations (1963–64). The Variations thus emerges as the summit of Bonds’s works centered on the theme of racial justice up to that point.
Bonds’s setting of the Du Bois Credo continues and extends the series of musical appeals for racial justice that had led to The Montgomery Variations, just as the revised version of Credo published at the head of his first autobiography, Darkwater: Voices from within the Veil, in 1920 extends the ideas that had led to the original 1904 version of Du Bois’s text. This chapter frames both the Du Bois Credo and Bonds’s musical setting thereof as articulations of the themes and issues of the works’ respective biographical contexts and, taken together, a dyadic lens into their creators’ perspectives on the societal upheavals of the most turbulent years of the twentieth century. Then, after demonstrating why, and how, the Credo was effectively silenced during Margaret Bonds’s lifetime despite its obvious importance, timeliness, and musical genius – including conversation with the publisher who insisted that the work could not be published unless its text were altered – the chapter closes by exploring the work’s first posthumous performances and documenting the ringing endorsement of Shirley Graham Du Bois, widow of the poet, for this “work of art that is eternal.”
The Great Migration, which began in the late nineteenth century and witnessed the movement of more than six million Black folk from the agrarian US South to the urban North between 1919 and 1970, and the flourishing of “Black Renaissances” in Harlem, Chicago, Pittsburgh, and other Northern urban centers were the essential soil in which are rooted not only the two works that are the subject of this book, but also the lives and careers of Margaret Bonds, W. E. B. Du Bois, and Langston Hughes. This chapter explores the roles of those two large societal seizings of freedom for the poor and oppressed as the context for Margaret Bonds’s career and the source of her career-long commitment to using her art to uplift what she in 1942 called “our oppressed Race” and work for global equality.
Margaret Bonds conceived The Montgomery Variations during a thirteen-state Southern tour in the spring of 1963 – a tour that took her not only to Montgomery, Alabama (a fiercely contested battleground in the ongoing Civil Rights Movement), but also to Birmingham in the same state – the latter at the beginning of Dr. Martin Luther King’s difficult Birmingham campaign. Of her experiences there was born a programmatic composition that used the spiritual “I Want Jesus to Walk with Me” as the basis of a symphonic variation set that drew on models including J. S. Bach’s Goldberg Variations and Richard Strauss’s Don Quixote and Death and Transfiguration to trace the history of the Civil Rights Movement from the Montgomery bus boycott (1955–56) through the Sixteenth-Street Baptist Church bombing (Birmingham, 1963), with a radiant “Benediction” evidently born in the wake of the passage of the landmark Civil Rights Act of 1964. This chapter situates The Montgomery Variations in the personal, professional, and societal developments traced in Chapter 1 and analyzes the music and program to explore how Bonds used it to advance her activist agenda.
Margaret Bonds’s Credo sets the nine articles of W. E. B. Du Bois’s iconic manifesto for global equality – first penned in 1904, revised in 1920, and modeled on the sacred symbol of the arch – as a symmetrical set of seven movements for soloists, chorus, and piano (1965) or orchestra (1965–67). This chapter offers a close reading of Du Bois’s anti-racist, anti-sexist, anti-colonialist, anti-imperialist, pacifist text and examines the means by which Bonds translated it into a musical structure all her own that reflects diverse influences ranging from gospel song through the cantatas of J. S. Bach (whom she called “the father of all good music”), also emphasizing womanist themes that are at best minimally present in Du Bois’s text.
The Montgomery Variations and Credo were not just timely musical masterpieces; they were also large-scale compositions dealing with racial justice and global equality that were penned by an African American woman, an individual to whom the doors of the classical music performance and publishing establishments were closed because of race and sex. Both works may thus be understood as compositions tendered from within a double application of the “veil” or “double-consciousness” that Du Bois had seminally discussed in his 1903 book The Souls of Black Folk – one application is that of race; the other, that of sex. Keenly aware of both of her doubly veiled existence and of the near-total absence of Black folk and women in orchestras, as well as their disproportionately small presence in choruses and audiences, Margaret Bonds undertook a gambit of dual perspective. She used the rhetoric of White Euro-American classical music to valorize contemporary African Americans and others who bravely fought against the system with which most performers and audiences of that music normally identified. The chapter closes with a reflection on the crucial role played by Bonds’s personal and professional affinities with Langston Hughes in inspiring her to this gambit.
Since the start of the 21st century, policy developments and legal practice have increasingly sought to express and implement changes that recognise the equality and rights of persons with mental impairments, including persons with learning disabilities and mental disorders. A great deal of academic scholarship, legal commentary and policy recommendations have focused attention on internal analyses of specific jurisdictions – for example, academic and practice-based discussions of mental capacity law in England and Wales have flourished in the time leading up to and since the instantiation of the Mental Capacity Act 2005 (MCA). Equally, much scholarship has focused on the changing human rights landscape since the advent of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), with particular attention on the meaning of its requirements and jurisdiction-specific adherence to human rights aspirations. Dialogue between these jurisdiction-specific and human rights analyses has become increasingly common. Less common – but no less important – is an international comparative perspective across different legal approaches to mental capacity law, to encourage learning and critical reflection based on a closer analysis of how different jurisdictions grapple with common issues and imperatives around assuring the empowerment and participation in decision-making by, with and for individuals with impairments.
The purpose of this edited collection is to advance this much-needed international comparative contribution to mental capacity law. Our particular focus in the volume is to spur on a comparative-oriented conversation around substantive commonalities and divergences in normative orientation and practical application embedded in different legal frameworks. Regarding normative orientation, we are particularly keen to critically identify how values and assumptions are built into laws (formally or by convention) about persons and personal decision-making, and what this is taken to mean for the roles of law, institutions, and legal and other professionals. Crucially, we are interested against that to understand what those laws mean for the place and voice of persons whose decisions are governed by such laws. Therefore, in practical application we are not only interested in the letter of different laws, but also how they function; including what they miss, or whether and how they may be inequitable in their application or generate outcomes that are opposed to their (apparent) rationales.
This volume has taken an international approach to learning about, and critically exploring, how legal systems may, or may fail to, assure the (meaningful) participation in decision-making by, with and for individuals who are subject to mental capacity laws (P). Equally, the contributors have explained how laws bring individuals’ values into personal decisionmaking, or present barriers to this, and how values beyond the person's may also feature in such decisions. We invited contributions based on a single template of contextual and law-focused questions across the book's authors, and yet we see significant distinctions in both the practical and the socioethical situations among the respective jurisdictions that the book examines. These are, unsurprisingly, in part explicable by reference to sociocultural, demographic, historical and institutional (including professional hegemonic) distinctions between the different places that the book looks at. They are also a consequence of the distinct critical perspectives and orientations across the book's authorship. And they are explicable given distinct legal framings and assumptions, which prove significant even among the common law systems and their shared traditions that form the focus of the majority of the contributions.
We may begin to collect our own reflections in this concluding chapter by noting that the book's inquiry is pitched as being about mental capacity law. Even among those jurisdictions who share their legal heritage with systems that have expressly enacted ‘mental (in)capacity’ laws, this already presents its own distinct vocabulary, as we see in Stavert's chapter (Chapter 3) on the AWIA in Scotland; likewise the language of guardianship, as discussions of Australia (Chapter 8), the US (Chapter 6) and Hong Kong (Chapter 10) indicate. Accordingly, part of the comparative exercise is in understanding the substance and practical import of technical language when making observations and evaluations. ‘P’ will have been a designation that is alien to readers in many legal systems, and even within legal systems that use the term this designation is not well known outside the realms of mental capacity law. The lack of explicit reference to guardianship laws in the book's title may seem surprising.