Patterning dementia

In Chapter 5 we started a process of thinking through divergent practices, those of families and formal care providers, as well as some of the kinds of relations family practices must make with ‘other’ practices. In thinking through this question of relations between practices, it is impossible not to see, and discuss, the effects of the ‘patterning’ of dementia in family practices. In this chapter we focus more specifically on this idea of patterning, exploring how each family needed to make relations with the dominant dementia discourse – specifically, the changes each needed to make to remain ‘in sync’ with the idea of the ‘dementia trajectory’. As has been well established in multiple disciplines, medicine serves a powerful organizing function in people's experiences of health and illness (see, for example, Armstrong, 1982; Gubrium, 1986; Cohen, 1998; Dillman, 2000; Beard, 2016), with the biomedical gaze an exemplar of a way of seeing that looks for patterns, that systematizes in order to know and to intervene (Foucault, 2003). Identifying and ordering ‘disorder’ through the concept of disease, biomedical discourses and practices also direct how such disorder should be perceived and acted on (Dillman, 2000; Holstein, 2000). An important element of this influence is, as Foucault points out, the anteriority of the medical gaze: ‘one now sees the visible only because one knows the language’ (2003, p 140). The analytical structure, he suggests, precedes the picture, providing knowledge ‘not of what “is” but of the anteriority of ordering’ (2003, p 140). Thus the perceived ‘ “givenness” of the disease model’ itself (Holstein, 2000, p 171), its easy recognition and mostly smooth application, becomes important in our current context where Alzheimer's disease and other dementias have become the dominant medicalization of old age (Cohen, 1998; Lock, 2013; Latimer, 2018), and where the phenomenon of ageing itself has become deeply associated with a ‘crisis rhetoric’ (Beard, 2016, p 5). As discussed in previous chapters, fears of demographic ageing, connected explicitly to predictions of an increasing incidence of dementia and the grave threats this is thought to pose to the future sustainability of health and social care systems, mobilize research and policy and shape public attitudes and knowledge (Holstein, 2000; Lock, 2013; Latimer, 2018).

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