Abstract
Theories of personal identity in the tradition of John Locke and Derek Parfit emphasize the importance of psychological continuity and the abilities to think, to remember and to make rational choices as a basic criterion for personhood. As a consequence, persons with severe dementia are threatened to lose the status of persons. Such concepts, however, are situated within a dualistic framework, in which the body is regarded as a mere vehicle of the person, or a carrier of the brain as the organ of mental faculties. Based on the phenomenology of embodiment, this paper elaborates a different approach to personal identity in dementia. In this perspective, selfhood is primarily constituted by pre-reflective self-awareness and the body memory of an individual, which consists in the embodiment and enactment of familiar habits, practices and preferences. After describing the different types of body memory, the paper develops a phenomenology of dementia as a loss of reflexivity and meta-perspective. This is contrasted with the preservation of individual forms of body memory even in the later stages of the illness. The ethical consequences of an embodied approach to dementia are outlined. A final look is given to narrativistic and constructionist concepts of the self in dementia.
Highlights
“I have, so to speak, lost myself”—this was the complaint of Auguste Deter, the first patient who was diagnosed by Alois Alzheimer in 1901 with the illness that was later named after him (Maurer et al 1997)
The shifting between two different frames of reference fails, because the required superordinate perspective or ‘excentric position’ is missing.8. If we summarize these disturbance of reflexivity and metaperspective, we can conceive of dementia as a fundamental disorder of higher-order consciousness, which must lead to a fragmentation of the continuity of the reflective or narrative self
The concept of embodied personhood and history is able to change our image of dementia
Summary
“I have, so to speak, lost myself”—this was the complaint of Auguste Deter, the first patient who was diagnosed by Alois Alzheimer in 1901 with the illness that was later named after him (Maurer et al 1997). An embodied view of dementia emphasizes the implicit relations which the lived body establishes to the environment, and the ecological niche which conveys a sense of familiarity and belonging to the patient It regards body memory, intercorporeality and interaffectivity as the basis of any person-centered approach to dementia, in later phases of the illness. Narrative and constructivist views run the risk to ‘construe’ the patient instead of carefully perceiving his maintained personality in his bodily expressions and behavior They reach their limits when the patient’s capacity of verbal interaction subsides, whereas the embodied self is still attainable and tangible even in the last stages of dementia. This does not mean that the concept of person dissolves into mere relationality: all interpersonal relationships remain bound to the bodily appearance and continuity of the person
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