Malignant Social Psychology Research Articles

Exploring why "memory loss" is a misleading descriptor of people living with dementia and can lead to dysfunctional care.

Amidst goals for prevention and improved treatment for people living with dementia, much remains needed to enhance the quality of life of those currently diagnosed, especially the transfer of accurate information from professionals to the public. Although many healthcare professionals understand the various types of memory and which are likely to be more affected than others during the progression of dementia, lay persons are more frequently unaware of that important information. The terms used to describe the symptoms of dementia can have a great impact on perceptions of faculties that are absent, compromised, or preserved. Understanding the nuances of preserved memory faculties and other cognitive abilities retained by persons with dementia is important in this regard. The term "memory loss" as a descriptor of the syndrome of dementia and ascribing it to persons with dementia connotes an inability to form new memories and participate in meaningful social interactions, which is detrimental to their personhood. From a multidisciplinary approach drawn from neurology, neurobiology, psychology, and case vignettes, we aim herein to highlight the ways in which the term "memory loss" can be inaccurate, counterproductive and potentially promote dementia-related misperceptions, malignant positioning and malignant social psychology. Persons with dementia unequivocally struggle with explicit memory, or recalling on demand, but retain implicit memory, as evidenced by research and everyday actions. Therefore, we propose the use of alternative medical language to reflect accurately memory impairment and preservation of some important memory capabilities.

The Other Within Oneself: Understanding Care for a Family Member with Early‐Onset Dementia Through the Lens of Dividuality

AbstractIn this article, I use the concept of the dividual to analyze the dynamics at stake in a family caring for a member with early‐onset dementia. Drawing on anthropological fieldwork in the Netherlands, I argue that using a dividual framework reveals family dynamics that are overlooked when using an individual framework, and it allows one to better understand the emotional pain that family members experience during the care process. Approaching family members as fractal persons shows how their identity is composed of other family members and how this can lead to dilemmas and conflicts in the care situation. The majority of articles on dementia focus on dyadic relationships. This article advocates a systemic approach encompassing the whole family. Moreover, it underlines the importance of taking the historicity of family relations into account and not limiting the analysis to situational dynamics.

Person-centred care for people with learning disabilities: the application of Kitwood’s theory

Tom Kitwood’s conceptual approach has been widely used to provide person-centred care for people living with dementia, but has not previously been explored in relation to people with learning disabilities. This article discusses how Kitwood’s ideas about the common behaviours by healthcare staff that undermine a person’s well-being – malignant social psychology – are also found when working and interacting with people who have learning disabilities. The authors outline how adapting malignant behaviours and interactions to be more person-centred can improve relationships, self-value and worth for people with learning disabilities.

Diabetes and dementia: managing these comorbidities

Diabetes and dementia: managing these comorbidities

The perspectives of people with dementia on day and respite services: a qualitative interview study

AbstractRespite services have traditionally been viewed as services for carers mainly. Perhaps as a result, the perspectives of people with dementia have been largely ignored. In this study, we consider these perspectives in relation to day and respite services, and contextualise them in light of Kitwood's prediction that person-centred care would be adopted only superficially by such services. Convenience sampling was employed and semi-structured interviews were conducted with six community-dwelling people with dementia. A thematic analysis was conducted and four themes were identified: ‘acceptability of service characteristics’, ‘meaningful engagement’, ‘personhood’ and ‘narrative citizenship’. The findings suggest that day services were more acceptable than residential respite, though some people would prefer home-based models, if available. ‘Meaningful’ engagement must be individually defined; however purposeful and reciprocal activity was commonly invoked as meaningful. ‘Personhood’ and ‘narrative citizenship’ were quintessential markers of quality care; while some people experienced personhood being bestowed upon them, others reported distinct instances of malignant social psychology, discrimination and stigma. In conclusion, an implementation gap may still persist regarding person-centred care in some respite services, based on the perspectives of people with dementia. Delivering the vision for care outlined here would require greater flexibility in service provision, more resources and more one-on-one staff–client time. The fundamental shift in thinking required by some staff relies on us supporting them to develop a greater self- and shared cultural-awareness around dementia.

Person-centred care for people with dementia: Kitwood reconsidered.

There is a plethora of literature on person-centred care and its importance in health care. The principles of person-centred care are especially important for people living with dementia because of the clinical manifestations of the disease. This article intends to provide nurses with an overview of the work of Tom Kitwood and how it pertains to providing best practice in dementia care. Various person-centred theories have been developed. However, Kitwood's work is by far the most widely referred to in dementia care. An understanding of Kitwood's ideas, in particular those of malignant social psychology and positive person work, enables nurses to develop competence in delivering optimum person-centred care to people with dementia in clinical practice.

Kitwood's thought and relational social work

Tom Kitwood is a key figure in the development of thought about dementia, but generally no references are made to his work outside of elderly care. This article argues that Kitwood's thought has much to offer to all the professional caregivers, regardless of the users’ category they are caring for, and to the broader field of professional social work. Some key themes from the writings of Kitwood are examined, namely the critique of the ‘standard paradigm’; the conception of malignant social psychology; the respect for otherness in the positive person work; the person with dementia as a resource for reciprocity processes; the new culture of dementia. For each of these issues similarities between Kitwood's approach and relational social work are identified. Relational social work considers the helping process and the well-being development as co-constructions, in which the contributions not only by the helper (or the caregiver, or the social worker), but also by the helpee (or by the care recipient, or by the user) are essential: both at the same time are helped and helpers, and both are empowered by this. This idea—of great value to all social work fields—is remarkably close to the Kitwood's thought about the dementia care.

Ethical considerations of doll therapy for people with dementia

The use of doll therapy for people with dementia has been emerging in recent years. Providing a doll to someone with dementia has been associated with a number of benefits which include a reduction in episodes of distress, an increase in general well-being, improved dietary intake and higher levels of engagement with others. It could be argued that doll therapy fulfils the concepts of beneficence (facilitates the promotion of well-being) and respect for autonomy (the person with dementia can exercise their right to engage with dolls if they wish). However, some may believe that doll therapy is inappropriate when applied to the concepts of dignity (people with dementia are encouraged to interact with dolls) and non-maleficence (potential distress this therapy could cause for family members). The absence of rigorous empirical evidence and legislative guidelines render this a therapy that must be approached cautiously owing to the varied subjective interpretations of Kitwood's 'malignant social psychology' and bioethics. This article suggests that by applying a 'rights-based approach', healthcare professionals might be better empowered to resolve any ethical tensions they may have when using doll therapy for people with dementia. In this perspective, the internationally agreed upon principles of the United Nations Convention on the Rights of Persons with Disabilities provide a legal framework that considers the person with dementia as a 'rights holder' and places them at the centre of any ethical dilemma. In addition, those with responsibility towards caring for people with dementia have their capacity built to respect, protect and fulfil dementia patient's rights and needs.

Het verlies van een gedeelde wereld

Person-centred (nursing home) care for people with dementia is a specific form of ('non cancer') palliative care. In order to elucidate how caregivers in nursing homes give shape to the nurse-patient relationship in people with advanced dementia and how they deal with the ethical questions that pose themselves in this realm of care ethnographial field research was conducted by two researchers in two Dutch nursing homes. It was found that in both facilities--despite differences in organization and quality of care--many forms of what Kitwood has termed 'malignant social psychology' were prevalent. A more detailed analysis of our research data revealed a relation--not only with staffshortages and a lack of professionalism--but also and primarily with the 'intrinsic complexity' of care giving in this field of palliative care. This complexity has its origin in the key problem of dementia, namely the loss of a common shared world of meaning. We discovered three features of this core problem: the dilemma(s) of truth speaking and truthfulness, the struggle to hold on to reciprocity in care giving and the paradoxes of normality nurses face in their treatment of people with dementia. In order to help caregivers cope with these problems we recommend to invest seriously in diverse forms of supportive care for nurses.

Responsibility and decision making help to minimise effects of AD.

People with Alzheimer's disease (AD) are affected not only by changes in the brain but also by the way they react to the effect of these changes and the way they are treated by others. When treated by 'healthy others' in a way that could be described as 'malignant social psychology', the person with AD can become depressed and angry and lose their sense of self-worth. This article discusses the importance of the sense of self-worth in all older people; they perform better on memory tests after being exposed to positive subliminal messages about older people.

Patients who present with dementia: exploring the knowledge of hospital nurses

With the older population growing, there is likely to be an increase in the numbers of people with dementia on acute hospital wards. This article presents some of the findings from a Masters study (Ballard 2005) that explored the knowledge, understanding and implications for care of adult nurses working with patients who present with dementia in general hospital wards. Kitwood's 'malignant social psychology' and 'person-centred approach' were used as the theoretical framework to develop a questionnaire distributed to nurses. The findings about nurses' knowledge and understanding of person-centred dementia care and gaps in this area are discussed, and implications for future education and training of nurses presented.

Nursing assistants’ behaviour during morning care: effects of the implementation of snoezelen, integrated in 24‐hour dementia care

This paper reports an investigation of the effects of the implementation of snoezelen, or multisensory stimulation, on the quality of nursing assistants' behaviour during morning care. Nursing assistants in long-term dementia care are often unaware of the impact of their behaviour on patient functioning. Snoezelen is a psychosocial intervention that might improve the quality of caregiver behaviour by combining a person-centred approach with the integration of sensory stimuli. A quasi-experimental pre- and post-test design was implemented in 12 wards for older mentally infirm patients at six nursing homes. The experimental group intervention was a 4-day in-house 'snoezelen' training, stimulus preference screening and supervision meetings. The control group received usual nursing home care. The effectiveness of the intervention was studied by analysing 250 video recordings, which were assessed by independent observers using a 4-point measurement scale developed for this study and based on Kitwood's Dialectical Framework. The results showed a statistically significant increase in 'Positive Person Work' and decrease in 'Malignant Social Psychology' (total scores) after the implementation of snoezelen. Nursing assistants in the experimental group also improved by statistically significant amounts on all subitems of 'Positive Person Work'. The mean number of sensory stimuli, offered explicitly, increased. The implementation of snoezelen succeeded in effecting a change to a more person-centred approach during morning care. The results indicate that nursing assistants' behaviour can be positively changed provided that the new care model has been successfully implemented.

When late life brings a diagnosis of Alzheimer's Disease and early life brought trauma. A cognitive‐analytic understanding of loss of mind

AbstractThis paper contrasts the loss of mind from the loss of brain cells in Alzheimer's Disease and other neurodegenerative conditions with the threats to one's mind from the mindlessness of others from a cognitive‐analytic perspective. Case studies are presented that show how the therapeutic framework of Cognitive‐Analytic Therapy (CAT: Ryle 1990, 1995, 1997) can bring containment for both client and therapist for clients facing this dilemma, particularly when past trauma is potentially overwhelming. This is set in a dialogue with the pioneering work of Tom Kitwood (1990, 1995, 1997) in dementia care, in which Kitwood's thesis of the ‘malignant social psychology’ surrounding people with dementia is re‐stated in terms of ‘reciprocal roles’ developed in Cognitive‐Analytic Therapy. Copyright © 2003 John Wiley & Sons, Ltd.

Excess disability and malignant social psychology: A case study of Alzheimer's disease

AbstractAn in‐depth case study was undertaken to assess the effects of what Kitwood has termed ‘malignant social psychology’ on the observed behaviour of an Alzheimer's disease sufferer. Interviews were conducted with the spouse and observations were made in an adult day‐care centre, where staff members were also interviewed. Abilities that the spouse reported to be absent at home were readily observed at the day‐care centre, lending support to Brody's idea of excess disability, i.e. disability not due to disease alone. Furthermore, forms of malignant social psychology existed in the home environment but did not exist in the day‐care centre. Excess disability and its absence coincided with the presence and absence of aspects of malignant social psychology. The sufferer's behaviour was found to be affected not only by the extant neuropathology, but also by social relationships.