A Brief Look at the Philosophy of Dementia: Presence

Dementia is one of the most common neuro-psychiatric conditions. According to the NHS, around 850,000 people in the UK suffer with dementia. This is number that is fast increasing as people continue to live longer.

The study of dementia has been a primary focus of mine for the last seven years. As a therapist, I have considered at length the ways in which dementia can affect the sufferer. In doing this, I have found that there is a lens through which to study dementia that is largely unused. It is a style of investigation that enriches my study. I am referring to investigating the dementia through philosophy. By thinking philosophically, we can consider the idea of ‘presence’ in dementia in a way that supersedes a purely medical or psychological approach.

Firstly, we can consider whether someone with dementia can be said to have ‘presence’. In Heidegger’s Identity and Difference (1957), it is argued that people are different to animals as they are able to think. He deduces that because of this, humans respond to their state of ‘being’. If the fact that we are self-aware is a qualifying factor for being, then do those that are incapable of sensical thought cease to be? How then can we consider the amnesiac, or the irrational? If someone loses self-awareness, do they cease to be, are they no longer ‘present’?

Another interesting angle is thinking about how someone with dementia changes over the course of their decline. One of Derrida’s theories, likely developed from Heidegger, is the theory of ‘différance’. This is a slippery term, but it is described by Derrida as ‘the sameness that is not identical’. Derrida argues that ‘différance’ subsists in everything. In dementia however, this theory is almost personified. In the case of dementia there is a marked change in the individual, that is more apparent than in someone who does not have it. The individual with dementia is, within themselves as well as to us, ‘the same’ but not ‘identical’, they become, at an increasing rate, incapable of being their ‘old selves’.

This phrase, ‘to us’, is also incredibly important. Philosophical questions of ‘presence’ must also take into account what it is to exist in society. Sartre describes three different types of ‘being’ in his famous essay Being and Nothingness (1943). These are ‘being-in-itself’ (the kind of being we all take for granted), ‘being-for-itself’ (the idea that thinking about being means you’re not really being), and ‘being-for-others’ (when the self exists as an object for others). The final type of being, ‘being-for-others’, or rather être-pour-autrui, is of particular interest when thinking about dementia. Eventually, when dementia is advanced enough, the sufferer ceases to have free-will. By this I mean that they become an object whose fate is decided upon by others, as they become unable to decide for themselves. However, there are other things that render someone with dementia an object. These include lack of accessibility, lack of proper care, disconnected responses from carers etc.

I hope from these examples that you can see how enriching philosophy is when used to consider an illness like dementia. It serves as a springboard for further investigations, and therefore is an indispensable tool in the search for greater personal understanding and social acceptance.