Inhabitants of a lost kingdom: A model of the subjective experiences of dementia

Current concepts of dementia often act to exclude the internal world of the dementia sufferer from consideration as a valid object of study. This paper presents a three stage model of the subjective world of dementia sufferers, drawing on ideas from both clinical and social psychology. The first stage involves the feelings engendered by the process of dementia and includes at least four discrete states: anxiety; depression; grief; and despair/terror. The second stage of the model concerns the behaviour provoked in response to the process of decline. Finally, we consider the social nature of emotional behaviour, with emotional actions falling along a continuum. The ability of an individual with dementia to engage in emotional behaviour depends upon the extent of their cognitive impairment and the social context in which they are located. This model has implications for the delivery of services, including psychotherapy, to people with dementia.