The Discontinuous Self: A Christian Ontology of Personhood for Dementia Care
Adam Bedford, University of Calgary, Calgary, Canada
There has been extensive philosophical inquiry into medical models of the self/person. Most of this engagement aims to critique medicine’s classically ‘mechanistic’ approach, which reduces the patient to a diagnosable ailment. Yet these critiques often overlook more fundamental problems in medicine’s conceptualization of personhood, particularly the tendency to over-equate the ‘self’ with the interior, psychological locus of the individual. In this framework, sickness is interpreted as an alien presence that accretes on the inner self, leading treatment to focus primarily on restoring functioning and individual agency. My paper highlights key issues that arise in clinical thought and practice from this “psychologized” understanding of personhood (Carrette and King, 2006). Examining medicine through a Christian theological lens, I argue that a psychological notion of the self struggles to address the experience of discontinuity in self-identity brought on by serious illness. I propose a theological resource for an ontology of the person that emphasizes relationality rather than psychological coherence, which can lead to more humane and effective medical practice.
I use dementia care as a case study. For many patients and their families, the experience of dementia constitutes a radical rupture and discontinuity in the identity of the person. Families of individuals living with dementia often express a struggle to recognize the individual as their loved one. They may grieve that “this person is not my mother,” or “I didn’t know her at the end.” The psychological model of the self that is dominant in medicine is ill-equipped to respond to the impact of dementia on identity, relationship, and social belonging. My paper explores what dementia care can teach us about medicine’s model of the self, how it addresses illness-induced changes in identity, and whether this model serves practitioners and patients well.
Drawing on Orthodox theology, I propose that a relational ontology of the self provided by Christian traditions of thought and practice can address the inadequacies in medicine’s current model. I use the work of theologian John D. Zizioulas, who critiques the overly psychological notion of the self in late modernity. Zizioulas argues that the “emergence of consciousness and subjectivity as fundamental anthropological categories has led to a confusion between ontology and psychology in our ordinary way of thinking” (Zizioulas, 2006, p. 46). By contrast, Christian theology offers a richer ontology of the person, in which the primary locus of the self is not psychological but relational. In other words, this account takes seriously that there is no ‘self’ without other ‘selves,’ and the individual freedom and agency that constitutes personhood ought to be oriented not in the service of self, but in the service of the Other.
A relational ontology of the person has significant implications for clinical practice in dementia, reframing the task of care from restoring lost autonomy to restoring the relational networks that sustain identity. Here the goal of treatment is to maintain meaningful relationships even within the limitations of illness, shifting focus from the restoring of functioning to the restoring of relationship that constitutes what is most fundamental in self-identity.
CITATIONS
Carrette, J,. & King, R. (2005). Selling spirituality: The silent takeover of religion. Routledge.
Zizioulas, J. D. (2006). Communion and otherness: Further studies in personhood and the Church. T & T Clark.
I use dementia care as a case study. For many patients and their families, the experience of dementia constitutes a radical rupture and discontinuity in the identity of the person. Families of individuals living with dementia often express a struggle to recognize the individual as their loved one. They may grieve that “this person is not my mother,” or “I didn’t know her at the end.” The psychological model of the self that is dominant in medicine is ill-equipped to respond to the impact of dementia on identity, relationship, and social belonging. My paper explores what dementia care can teach us about medicine’s model of the self, how it addresses illness-induced changes in identity, and whether this model serves practitioners and patients well.
Drawing on Orthodox theology, I propose that a relational ontology of the self provided by Christian traditions of thought and practice can address the inadequacies in medicine’s current model. I use the work of theologian John D. Zizioulas, who critiques the overly psychological notion of the self in late modernity. Zizioulas argues that the “emergence of consciousness and subjectivity as fundamental anthropological categories has led to a confusion between ontology and psychology in our ordinary way of thinking” (Zizioulas, 2006, p. 46). By contrast, Christian theology offers a richer ontology of the person, in which the primary locus of the self is not psychological but relational. In other words, this account takes seriously that there is no ‘self’ without other ‘selves,’ and the individual freedom and agency that constitutes personhood ought to be oriented not in the service of self, but in the service of the Other.
A relational ontology of the person has significant implications for clinical practice in dementia, reframing the task of care from restoring lost autonomy to restoring the relational networks that sustain identity. Here the goal of treatment is to maintain meaningful relationships even within the limitations of illness, shifting focus from the restoring of functioning to the restoring of relationship that constitutes what is most fundamental in self-identity.
CITATIONS
Carrette, J,. & King, R. (2005). Selling spirituality: The silent takeover of religion. Routledge.
Zizioulas, J. D. (2006). Communion and otherness: Further studies in personhood and the Church. T & T Clark.