Brains, minds and selves: changing conceptions of the losses involved in dementia

Until the last 10 years or so, dementia research had been dominated by the psychiatric or medical approach to dementia. However, increasing numbers of new psychological and social psychological approaches to dementia have begun to emerge. Consequently, there has been a significant change in the descriptions of the losses involved in the dementing process: from being represented in terms of brain functioning, they have become repositioned as occurring within both personal and social contexts. We elaborate these frameworks and apply them to three phenomena associated with dementia--depressions, delusions and denial. While these conceptualizations are limited by a number of difficulties, they nevertheless represent a significant change in approaches to dementia care and allow the potential for positive change through psychological as well as chemical means. The emergence of these new accounts of the losses involved in dementia needs to be matched by the equivalent development of effective psychosocial interventions to maintain individuals within their own homes.