Making Sense of Things in Dementia

The paper offers a phenomenological approach to dementia, and consideres certain ethical issues related to epistemic injustice in healthcare settings. The phenomenological analysis indicates that there are fundamental layers of sense making which are preserved in dementia. By shifting the focus away from deficits to basic sense-making capabilities maintained in this condition it is possible to understand how certain new practices of sense-making can be developed in social, collaborative ways which involve both caregivers and patients, and can overcome epistemic injustices in healthcare settings and institutions. The focus on deficits and incapacities can lead to the devaluation, marginalisation and disempowering of individuals affected by dementia, and can also cover up valuable resources for potential restructuring of experiences and modes of being in the world. Considering mental illness in terms of such resources for meaning reconstitution through resilient strategies of life-coping can be empowering for both individuals affected by dementia and caregivers, and can improve the well-being of both groups. This paper contributes in this way to person-based and value-based practices which can be pursued in partnership with evidence-based healthcare.