The carnival is not over: cultural resistance in dementia care environments

Abstract

Within the still-dominant medical discourse on dementia, disorders of language (such as dysphasia, aphasia, and perseveration) feature prominently among diagnostic criteria. In this view, changes in ability to produce coherent speech or understand the speech of others are considered to be a direct and inevitable result of neuropathology. Whilst an alternative psychosocial account of communicative challenges in dementia exists, emphasis here is placed largely on the need to compensate for deficits in the language or comprehension of the diagnosed individual and on his or her social positioning by ‘healthy others’. Rather less emphasis has been placed to date people with dementia as social actors who create meaning and draw on contextual clues in order to give shape to their interactions. In this article we draw on Mikhail Bakhtin’s concepts of the carnivalesque, heteroglossia, polyphony and dialogism to analyse a series of interactions involving people with dementia in day and residential care environments. Two main findings are foregrounded. The first, consistent with previous studies, is that many of the communicative challenges faced by people with dementia arise from the social environments in which they find themselves. The second is that the utterances of people with dementia in the face of these social challenges show many of the hallmarks of cultural resistance identified by Bakhtin.