(In)visible materialities in the context of dementia care

Re-thinging Embodied and Enactive Psychiatry: A Material Engagement Approach

Emerging consensus among enactivist philosophers and embodied mind theorists suggests that seeking to understand mental illness we need to look out of our skulls at the ecology of the brain. Still, the complex links between materiality (in broadest sense of material objects, habits, practices and environments) and mental health remain little understood. This paper discusses the benefits of adopting a material engagement approach to embodied and enactive psychiatry. We propose that the material engagement approach can change the geography of the debate over the nature of mental disorders and through that help to develop theoretical and practical insights that could improve management and treatment for various psychiatric conditions. We investigate the potential role of Material Engagement Theory (MET) in psychiatry using examples of aetiologically different mental illnesses (schizophrenia and dementia) in respect of their shared phenomenological manifestations, focusing particularly on issues of memory, self-awareness, embodiment and temporality. The effective study of socio-material relations allows better understanding of the semiotic significance and agency of specific materials, environments and technical mediations. There is unrealised potential here for creating new approaches to treatment that can broaden, challenge or complement existing interventions and practices of care.

Drawing in Ethnography: Seeing and Unseeing Everyday Life with Dementia in Sweden

In this article, I present how drawing offers valuable ethnographic possibilities in care settings where verbal communication is challenging. The empirical examples derive from a study where I drew in situ in dementia care units to explore what residents and staff members found important in their everyday practices. I demonstrate how experimenting with the drawing process as well as the resulting drawings enabled diverse forms of participation to see and unsee matters together with residents and staff members. Treating drawings as steppingstones, meant that inquiries could be shaped together with interlocutors and that questions could be kept open and relevant.

Dispensing care?: The dosette box and the status of low-fi technologies within older people's end-of-life caregiving practices

Technology has been lauded as a solution to range of challenges presented by ageing population internationally. While the lion-share of scholarship has focussed on high-fi, digital technologies, there has been a recent shift to exploring the contributions mundane, low-fi technologies make to older people's daily lives and our understandings of health, illness and care more broadly. Drawing from serial narrative interview data collected with 19 married couples aged 70 and over living in the U.K., this article explores the way one medical technology-the dosette box-was taken-up and deployed in their end-of-life caring process. Informed by actor-network theory and critical feminist scholarship, this article considers how the dosette box played an active role in structuring relationships, scheduling daily care activities and enforcing medical compliance. In doing so, we suggest that the dosette box provided an unexpected companion and 'weapon of the weak' for older partner's attempting to assert their expertise and power while caring. We also explore how the dosette box demanded an even higher level of regular, vital care from older partner's once introduced into the home, thus entrenching the physical and emotional demands of dispensing care.

To Accompany, Always: Psychological Elements of Palliative Care for the Dying Patient

Palliative care clinicians provide psychological support throughout their patients' journeys with illness. Throughout our series exploring the psychological elements of palliative care (PEPC), we suggested that the quality of care is enhanced when clinicians have a deeper understanding of patients' psychological experience of serious illness. Palliative care clinicians are uniquely poised to offer patients a grounded, boundaried, and uplifting relationship to chart their own course through a life-altering or terminal illness. This final installment of our series on PEPC has two aims. First, to integrate PEPC into a comfort-focused or hospice setting and, second, to demonstrate how the core psychological concepts previously explored in the series manifest during the dying process. These aspects include frame/formulation, attachment, attunement, transference/countertransference, the holding environment, and clinician wellness.

Material Citizenship: An ethnographic study exploring object-person relations in the context of people with dementia in care homes

Materiality has become an increasingly important topic in sociological studies of health care. How objects support the identity of people with dementia in care homes is an emerging area. While early research has tended to focus on sentimental or cherished items (such as photographs or keepsakes), the present study focused on functional objects (such as curling tongs or a hairdryer) as a mechanism to actualise citizenship. This article presents findings from an ethnographic study into the everyday experiences of people with dementia living in a residential care home in southern England. Drawing on a framework analysis of observations of daily life, object-elicitation interviews with residents, in-depth interviews with staff and relatives and documentary research, the findings demonstrate that object relations are a critical but overlooked site for citizenship. Residents are rarely involved in decision-making relating to their personal possessions, lack control over objects and are often discouraged from material interactions important to the maintenance and cultivation of identity. We introduce a new concept 'material citizenship' to advance thinking and practice in this area and argue that it is valuable for care practices to combine a material citizenship approach with existing care practices; thus, elevating the importance of object-person relations in dementia care.