Preserving Selves

Abstract

This participant-observation study examines communication and the construction of identities as they contribute to or impede the preservation of self in an Alzheimer's special care unit (SCU). A social-psychological alternative to a medical model of dementia care was uncovered: what I refer to conceptually as communicative care, the central animating force of the SCU. Communicative care arises out of the world of the unit and is a totality of care where selves are evoked and preserved, and identities are constructed and respected. Classic studies characterize the relationship between staff and residents as adversarial within the hierarchical "total institution," with a devaluing of self. In contrast, I analyze and demonstrate that through the staff's process of communicative care, the SCU works as a self-preserve to shield residents from devaluation and a loss of identity. The staff and residents have a reciprocal relationship and help each other to survive.