September 09, 2014

Books -Medical model vs social model

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The Alzheimer conundrum : entanglements of dementia and aging
This delicate crossing of hope, uncertainty, and high-tech bioscience is precisely what is at stake in Margaret Lock’s The Alzheimer Conundrum. Lock, a distinguished medical anthropologist, is well known for her work on the intersections of bodies, cultures, and environments, analysed through attention to aging, organ transplantation, and genomics, among other topics.   She locates this uncertainty in a wider series of tensions between: a ‘localization’ theory of Alzheimer’s focused on neuropathology and an ‘entanglement’ theory of minds and environments; the ambiguous disconnect between pathology and ‘normal aging’; and questions over how in a ‘post genomic’ era, researchers should interpret ‘the numerous extrasomatic factors’ that affect dementia (p.5, p.232, p.240). Lock’s own commitments are admirably clear: against a reductionist bioscience ‘oriented primarily to the development of effective drugs,’ she argues for attention to ‘social, political and environmental factors, including poverty, inequality, discrimination and racism’ (p.229, p.15).
 Most compelling is Lock’s account of the shift to Alzheimer’s ‘prevention.’ She shows how a new diagnosis, Mild Cognitive Impairment, enrolled a novel cohort of patients, helping to create a larger ‘at-risk’ population (p.79). Drawing on interview data with at-risk patients, she shows how little attention has been paid to ‘the uncertainties associated with predicting the future by means of biomarker testing,’ as well as the risk of generating unresolved ‘chronic anxiety’ through new forms of ‘embodied risk’ (p.98, p.93, p.77).
By a distance, the most powerful chapter and, not coincidentally, the chapter most reliant of Lock’s own interview material, investigates how people actually live with ‘embodied omens’ of Alzheimer’s Disease (p.174). Here, Lock shows how many people she spoke to were simply ‘unclear about what exactly they should do with the information’ about their risk (p.192) – and how many actually, and in the face of biomedical insistence, re-interpreted their risk through personal, familial narratives of inheritance and resemblance: ‘I look like my mother,’ one participant tells here: ‘so…I would not be surprised that I carried the risk’ (p.195). Lock shows how individual senses of subjectivity and selfhood remain remarkably resilient in the face of biomedical narratives – that stories about families, solidarity, and care, are what continue to dominate patients’ concerns (p.201, p.206).
The forgetting : Alzheimer's: portrait of an epidemic
 David Shenk ultimately finds reasons to accept Alzheimer's disease--and almost forgive it--in The Forgetting. Shenk describes his work as a biography, the life story of a biological outlaw that sends victims "on a slow but certain trajectory toward forgetting and death." But his illuminating portrait of this growing epidemic offers more than a basic chronology. 
 It includes impossible twists: longer life expectancies and successful treatments for other diseases mean more cases of Alzheimer's will inevitably occur. Shenk's graceful synthesis of personal accounts (from Plato to Reagan) with a century-long search for answers and cures leads him to an impressive conclusion. Perhaps Alzheimer's disease is much like winter: "Once it is gone, we'll face less hardship, but we'll also have lost an important lens on life."

Forget memory : creating better lives for people with dementia
Memory loss can be one of the most terrifying aspects of a diagnosis of dementia. Yet the fear and dread of losing our memory make the experience of the disease worse than it needs to be, according to cultural critic and playwright Anne Davis Basting. She says, Forget memory. Basting emphasizes the importance of activities that focus on the present to improve the lives of persons with Alzheimer's disease and other dementias.
Based on ten years of practice and research in the field, Basting's study includes specific examples of innovative programs that stimulate growth, humor, and emotional connection; translates into accessible language a wide range of provocative academic works on memory; and addresses how advances in medical research and clinical practice are already pushing radical changes in care for persons with dementia.
Bold, optimistic, and innovative, Basting's cultural critique of dementia care offers a vision for how we can change the way we think about and care for people with memory loss.
Understanding Dementia - the man with the worried eyes
Over the last ten years a number of new concepts have emerged within social psychology, gerontology, socio-linguistics and psychotherapy which present a challenge to the view of dementia as simply an organic illness. These ideas have led to service innovations including the development of support groups for people with dementia; the adaptation of psychotherapeutic approaches to this client group; and the development of methods of care evaluation from the perspective of the dementia sufferer. This book seeks to summarize these 'new' ideas thereby bringing together, for the first time, a wide range of critical thinking relating to old age and dementia.
The authors aim to advance a psychological framework from which to understand the experience of dementia from the perspective of the dementia sufferer, so making intelligible the symptoms of dementia and setting out new avenues of care such as the need to adopt psychotherapeutic/counselling approaches as an integral part of care. Including background, clear argument and practical guidelines, this insightful and comprehensive study makes an important contribution to the currently emerging trend in dementia care towards person-centred work.

The social construction of dementia : confused professionals?
Confused Professionals outlines the limited knowledge base about dementia and the effects which that has on the design of services for people with dementia. The authors have researched designs and methods for assessing the impact of services upon service receivers, including family carers and the implications for resources.

The authors have been involved in an intensive three year long evaluation of a community care service for older people with dementia. In writing this book, they call on this experience and previous experience as analysts of community care and health services, looking at the experience of users and providers alike.

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