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Dementia Care: The Toxic Nature of Malignant Care
You will also remember I suggested we think differently about how we conceive care of those living with a dementia and I used the late professor Kitwood as our starting point. Kitwood (Kitwood, 1997) wrote about a ‘conferred condition’ he described this condition as ‘personhood’ we understand now that this is: ‘A standing or status that is bestowed upon one human being, by others, in the context of relationship and social being. It implies recognition, respect and trust.’
Quite simply put this means that in certain conditions the bestowing of personhood can be withheld or withdrawn. Long term care has been shown repeatedly to provide the conditions for carers to be unaware of their impact and power positions and for the conditions to exist where a person’s sense of self, their dignity and indeed their human rights can be pervaded or abused.
These conditions have often been referred to simply as institutionalisation however Kitwood went much further than this and he coined a term which sent a shiver through practitioners at all level. Malignant social psychology was the term Kitwood used to describe the collective impact of certain behaviours and traits in the care deliverer which led to an overall pervasion and erosion of the care receiver’s personhood.
In the last blog I left you a list of positive personal traits and behaviours that a carer exhibits, which leads to positive outcomes and fosters wellbeing. This week I leave you with a more sinister list.
Kitwood does not just claim that poor care is bad for people, he states that it has at its core a malignancy – that it creates a cancer among the psychology of those providing and maintaining the care and its regime.
In the remit of a normal working day spent caring you may come across the use of one or probably more than one of the behaviours listed below. These types of behaviour are indicative of an abusive social culture that may be intentional or non- intentional but nevertheless exists. Its existence prohibits the provision of any of the positive care factors we have discussed as being so necessary for good dementia care and invariably generates cultural ill-being.
The list may shock you as these behaviours are so common and so pervasive – you may also unintentionally be undertaking these actions and behaviours. I ask you to think hard on the following:
Malignant social psychology
- Treachery: using forms of deception in order to distract or manipulate a person, or force them into compliance.
- Disempowerment: not allowing a person to use the abilities they do have, failing to help them complete actions they have initiated.
- Infantilisation: treating a person very patronisingly, as an insensitive parent might treat a very young child.
- Intimidation: inducing fear in a person through the use of threats or physical power.
- Labelling: using a category such as dementia, or ‘organic mental disorder’ or ‘elderly mentally infirm’ as the main basis for interacting with a person or as an excuse for their behaviour.
- Stigmatisation: treating a person as if they were a diseased object, an alien or an outcast.
- Outpacing: providing information, presenting choices and the like at a rate too fast for the person to understand; putting the person under pressure by expecting them to do things at a rate far exceeding their current capability.
- Invalidation: failing to acknowledge the subjective reality of a person’s experience and especially their feelings attached to it.
- Banishment: sending a person away, or excluding them – physically or psychologically.
- Objectification: treating a person as if they were a piece of dead matter or an item of furniture rather than as the real person they are.
- Ignoring: carrying on in the presence of someone as if they were not there.
- Imposition: forcing a person to do something, overriding a desire or denying any possibility of choice.
- Withholding: refusing to give asked for attention or to meet an evident need.
- Accusation: blaming a person for actions or failures of action that arise from their inabilities or their misunderstanding of the situation.
- Disruption: intruding suddenly or disturbing upon a person’s action or reflection – crudely breaking the frame of reference.
- Mockery: making fun of a person’s ‘strange’ behaviour, action or remarks, teasing or humiliating or making jokes at the person’s expense.
- Disparagement: telling a person that they are incompetent, useless, worthless etc. Giving them messages, verbally or psychologically, that are damaging to their self- esteem.
Till next time
Paul Smith – Dementia Care Expert
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