Tom Kitwood's emergence as a leading figure in the international field of dementia care has continued since his death in 1998. His critique and revision of the theories that underpin dementia-care practice challenged the prevailing understanding of the nature and experience of dementia among researchers and clinicians. In many respects, his eclectic writing reflected the many strands of his own biography: a graduate of the natural sciences at Cambridge, an ordained priest, a chemistry teacher prior to completing a PhD in social psychology at the University of Bradford, where he was subsequently a senior lecturer and professor. Kitwood is probably best known for highlighting the importance of human experience, viewing the person with dementia through the lens of ‘personhood’, developing clinical practice through the tool of Dementia Care Mapping, and establishing the Bradford Dementia Group to develop ‘person-centred care’. His decade of involvement in dementia care generated a breadth of material, theories and perspectives on understanding the lived experience of dementia, the complexities of care and how best to develop services.
A central challenge of this book is set out in the Introduction. This recognises that ‘the overall sweep of Kitwood's work is vast’, and that there are simultaneous ‘dangers of eulogy and criticism’. Nonetheless, this book provides a valuable resource both for those unfamiliar with Kitwood's writing and those wishing to deepen their current understanding. The book has four parts, which enable the reader to navigate through Kitwood's writing. A cohesive view of Kitwood's thought emerges through critical commentaries on five selected writings that are reproduced. The critical commentaries articulate balanced and thoughtful criticisms. The major issues embedded in each strand of work are considered in some detail but there is a unifying thread, that ‘many of the inconsistencies etc. to be found in Kitwood's work are explainable, not as failings inherent in the framework he was developing, but partly as a result of the time and environment in which Kitwood was working, and partly as a function of who Kitwood was and how he worked’ (p. xvii).
Part 1 addresses ‘Kitwood's critique of the standard paradigm’ and is focused on uncovering his theory of dementia. The commentary enables the reader to identify the key elements that emerge from Kitwood's writing, such as the dialectics of dementia and the evolution of his ideas. The editors present an account that situates his emergent theory of dementia within the contemporaneous paradigm of neuropathological and medical research. As an overview, the commentary is concise and informative and identifies areas of ambiguity or inconsistency in Kitwood's writing. Part 2, ‘Ill-being, well-being and psychological need’, examines the balance between pathology, self and society and is central to Kitwood's thesis and carefully maps his conceptual approach to ill-being and well-being. It indicates the importance of these concepts and their contribution to understanding psychological need and the quality of care. The editors present an interesting argument regarding the shift in emphasis by Kitwood and his initial ideas on the influence of macro-social contexts of care and his later focus on the importance of the micro-social. The commentary draws together the key points, providing a platform for the interpretation of the subsequently featured texts, which include Kitwood and Bredin's influential Reference Kitwood and Bredin1992 paper.
Part 3 explicates Kitwood's thesis on person-centred care and ‘personhood’. Baldwin and Capstick provide an authoritative critique that draws out the central components of personhood and the strengths and weaknesses of Kitwood's vision. A section, ‘Moving forward’, argues for the development of this work focused upon reciprocal relations between people with dementia and their carers and the political context of personhood within citizenship. The embodied self and sense of place is also discussed as a strand of Kitwood's work that requires further development in contemporary research and practice in dementia care. Part 4 centres on ‘Organisational culture and its transformation’. This provides a fascinating insight into the range of Kitwood's ideas that extend well beyond the personal psychology of dementia. The balanced account considers the humanism of his approach and its implications for organisational development and change in dementia care. It is argued that this element of Kitwood's work should also be valued but requires further development. Overall the editors argue that Kitwood's significant contribution to dementia care should be valued, critiqued and developed and that it is time ‘to come out from his shadow’ (p. 273). The book will be valuable for undergraduate and postgraduate students, researchers and lecturers involved in the field of dementia care and the health-care sciences. Furthermore, it provides a useful resource for clinicians who wish to explore their understanding of ‘personhood’, person-centred care and the nature of Kitwood's critical appraisal of how ‘care’ should be constructed and delivered.