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Research project of Dr. Erik Norman Dzwiza-Ohlsen

"Philosophy of Dementia. Phenomenological-psychopathological Contributions"

Current research in medicine and psychology is all too often one-sided, because it follows a naturalistic paradigm: complex phenomena, such as mental illnesses in particular, are made measurable and their causes are explained in terms of biological, chemical or physical variables. Based on cognitivist and cerebrocentrist models, summative definitions of what the respective illnesses are tend to emerge. In this way, research loses sight of what should be the focus of every successful therapy: the life-world experience of concrete persons.

The essential goal of the research project is to develop a general theory of Alzheimer's dementia (AD) that avoids such reductionisms. Its aim is not to deny the major medical advances in diagnosis and therapy, but to offer a research design that bridges the gap between diagnostics and therapeutics. At the center of this approach is the lifeworld experience of individuals with AD, which is to be captured using phenomenological and psychopathological approaches.

The correlation of language and orientation serves as an analytical access: Thus, in the lifeworld we are oriented three-dimensionally, namely not only spatially (1), but also temporally (2) and personally (3) and can express this linguistically with the help of indexical expressions (e.g. 'I', 'here' or 'now'). The crucial observations are that on the one hand, both orientation and language disorders are among the central symptoms of AD; and on the other hand, that affected persons understand indexical expressions more poorly, but nevertheless use them more frequently.

Indexical expressions can be made fruitful for AD from a diagnostic and therapeutic point of view, according to the thesis that follows from these observations: In the sense of deficit indicators, they are suitable for analyze the lifeworld experience of persons with AD; in the sense of resource indicators, however, they are also suitable for therapeutically shaping the lifeworld experience of persons with AD. Finally, their deictic (= pointing) character allows us to refer back to our rudimentary, bodily orientation and expressivity - these are sources of interaction and communication that become more and more important in the course of the disease, as purely verbal expressiveness continuously decreases.

While it is by no means intended to deny that memory plays a central role in the symptomatology of the disease, it is rather intended to integrate it in its manifold varieties into a theoretical model that captures the dynamics of language, orientation, and memory. In this way, an integrative theory of AD will be developed in dialogue with empirical findings, which will also be useful for therapy.

For example, numerous opportunities for therapeutic approaches can be identified in the concrete interaction of individuals in their environment if basic conceptual understandings are expanded: (1) An expanded concept of language and expression - which also takes into account bodily and creative expression, such as gestures, facial expressions, or touch on the one hand, and music, dance, or architecture on the other hand - leads to the fact that important resources for interpersonal interaction can be considered in a more targeted way than before. (2) An expanded concept of orientation leads to the specific design of the living environment of the persons concerned, for example by embedding personal objects (temporal and social orientation) in a clear and bright living environment (spatial orientation). (3) Finally, an expanded concept of memory leads to the fact that, for example, habitual practices, which regulate our lives as a self-evident basis and are often preserved until late phases of dementia (such as skills and beliefs), can be activated in a focused manner, taking into account the respective concrete biographies.

With this interweaving of analytical and therapeutic perspectives in the targeted integration of medical, psychological, linguistical and sociological insights into a philosophical framework theory, research and therapy are to be brought closer together again in order to meet one of the greatest social challenges of the future in a more humane way.

Such an approach has an important, emancipatory effect in this regard: it is intended to counteract the one-sided tendency to perhorresce life with dementia. Instead of making it even more difficult for persons with AD by isolating them socially as deficient people, all actors in concrete life practice should work towards ensuring that the focus is not on deficits but on resources - so that persons with AD can also lead a dignified life.“