When we care for people with dementia, failing memory changes how we remember together who we are, and this makes how recognition happens between persons more noticeable. We cannot take for granted that the two of us will be able to recognize each other through going back into memories or telling stories about our lives. So, we have to recognize each other in new ways. And then we can let memories surface, if any do come about, in a slower and more patient way. Sometimes memories will not come to the mind of the person living with dementia, and this is OK too. Recognition is still important as a way to see each other and respond to each other’s needs.
Mutual recognition between two persons, when one has problems remembering, can be very simple. It can mean that each says hello, asks how the other person is, and listens to their reply. What supports two persons recognizing each other is the place in which it happens. Places cue certain moral qualities and our moral imagination. The landscape, which gives us a sense of place, embodies moral cues for us. When a person living with dementia recognizes their surroundings, this cues them in remembering who they are and what they value. It isn’t always possible for people with dementia to remain at home, but the longer that they can or the more their new place in a facility is made like home, the longer that their personhood will remain vital and closer to the surface of their being.
I used to ask Grandpa Dickey every morning how he was. “How are you grandpa? How did you sleep?” And he would say almost always the same thing, “Fair to middling,” Calmly. And then he would say, “I slept well.” And he would look out on the green grass and hardwood trees and pines in his backyard and say, “Isn’t this beautiful?” I would agree.
Sometimes memories of time spent together would cross my mind, and I would remember with him camping with our cousins or building a campfire out in the backyard during the holidays. I would speak these memories out loud. Grandpa would say, “Yeah …” This is what it means to recognize each other in a familiar time and place that cue moral imagination and memory.
My mom would say too, that he would often comment, “your mother [my Grandma Carolyn] did such a good job picking this place out …” When we recognize each other, we affirm that our common humanity cannot be erased or negated by degenerative neurological disease. At worst, disease can disable us. It can never destroy the humanity that we recognize in each other. One’s identity is grounded in a particular time and place, and certain relationships. Kitwood speaks of identity and attachment as important pillars of dementia care, and this is what he means.
This is why recognition is the first and most important step in compassionate person-centered dementia care. The first thing to do is to continue to mutually recognize each other in the context of caring relationships. This prevents dehumanization. Recognition is simple and happens in small gestures of greeting and remembering. It is supported by the morality that lives in our spaces, like our homes and places where we spend time where the land and built environment imprints a moral stamp on our minds and hearts and orients our identities.
