Dementia as an Existential Threat: The Importance of Self-Esteem, Social Connectedness and Meaning in Life

Dementia is an umbrella term for a large number of illnesses, all of which involve neurodegenerative changes in the brain. The most common forms of dementia are Alzheimer's disease and vascular dementia, but there are over 100 other, rarer conditions. All of these different illnesses involve a progressive decline of cognitive functions in which symptoms gradually spread, so that eventually almost all areas of cognitive functioning are affected. Over time, these cognitive changes compromise the person's practical ability to manage everyday activities, leading to increasing levels of dependency on those around them. At present there is no cure for any form of dementia. If we are to achieve an understanding of the psychological impact of dementia, then we also need to understand the way in which dementia acts as an existential threat. Dementia can compromise identity, challenge independence, prompt social isolation and threaten our ability to find meaning and purpose in life. Thus, a 2014 YouGov poll commissioned by Channel Five news in the UK found that fear of dementia was greater than fear of cancer, particularly amongst older people (1). Managing existential threat Over the last 20 years, an established body of literature has emerged that has detailed the way in which people respond to threats. To date, this body of work has been largely conducted from a social psychology perspective. However, we believe that the insights that have steadily accumulated may help us to develop a much better understanding of how people respond to dementia. This, in turn, may help us to improve a number of different areas of dementia care. This work clearly points to three, linked factors that play a crucial role in helping to prevent anxiety when people are confronted by threats including reminders of their own mortality: self-esteem, social connectedness and meaning in life. People who score highly on all three of these factors seem to be more able to think about the nature of the threat that they face without becoming overwhelmed with anxiety. In other words people who feel good about themselves and who feel more connected to the world around them are also better able to find meaning and purpose in life even when they are reminded that life can be short, brutal and nasty. Given the importance of self-esteem, social connectedness and meaning in life in enabling people to tolerate threats to their identity, it follows that it is important within dementia care both to understand the consequences of low self-esteem and to identify methods of increasing this. Forgetting is a psychological defence as well as a neurological symptom As humans we are good at putting up mental barriers that help to prevent us from being disturbed by threats to our self-esteem. Research suggests that there is a pattern of selective forgetting in which memories that enhance our self-esteem are better recalled--a phenomena that has been termed mnemic neglect. For instance, if we are asked to remember two types of feedback, some of which is positive and enhances self-esteem and some of which is negative, then we are more likely to remember the negative information if it relates to another person than to ourselves. Memory, then, seems to act in a self-protective fashion. If mnemic neglect occurs in the same way for people affected by dementia as it does amongst the general population, then this may help to explain why some people who are affected by dementia struggle to recall information about their illness. In addition, research also indicates that under certain circumstances mnemic neglect disappears. This is the case, for instance, when information is provided by a close friend (2), when the information is about traits that are changeable (3), or which are not highly negative (4). Understanding more about how mnemic neglect operates with people affected by dementia may help us to go on to develop more effective ways of talking to people with dementia about their illness. …