Hughes’ Thinking Through Dementia contributes to the increasing collection of books concerned with developing theory about and understanding of dementia. Hughes, a consultant in Old Age Psychiatry and an Honorary Professor of Philosophy of Ageing, brings together his clinical experience and philosophising in an interesting and thoughtful way. In the introduction (Part 1) Hughes begins with ‘a lot of what I want to say in this book as a whole is to do with surroundings’. This is a neat way of summarising how Hughes develops his argument throughout the book, that our understanding of dementia will be based on the ‘surroundings’ we have to help us create a picture. Building on his earlier notion of a SEA (Situated Embodied Agent) view of dementia, Hughes takes us through a range of factors that contextualise thinking and understanding about dementia.
After the introduction the book is divided into three further parts: Mental States and Normativity; Models of Dementia; and Personhood and the World. There are case studies of people with dementia presented in the introduction, and the story of Miss Breen is followed up throughout each section of the book and is used to good effect to illustrate the often complex, and sometimes contradictory theoretical concepts and ideas that Hughes discusses. The use of the case study will be particularly helpful to a student audience who might be unfamiliar with the concepts and ideas discussed, and also to practitioners who are less emersed in academic writing styles. In this way the book reminds me of the style of Sabat (Reference Sabat2001), where examples that draw on interactions with people with dementia are used in a highly effective way to demonstrate the complexity of impact on the ‘selves’ of those with dementia. Part 2 of the book, ‘Mental States and Normativity’, provides an overview and critique of theories of the mind. I found this quite thought provoking, although not quite so thought provoking as Whitehouse's (Reference Whitehouse2008) The Myth of Alzheimer's, which presented a true challenge to conventional wisdom about Alzheimer's disease.
The penultimate part of Hughes’ book, ‘Models of Dementia’, presents an overview of different theoretical approaches to dementia that I would broadly describe as biomedical, psychological and social-gerontological. This section would be useful to those new to theoretical ideas about dementia, and acts as a refresher for those who are already well versed in different theoretical models. He concludes this section by posing the challenge of imaging dementia without models. In this way he removes the need to select a model and considers an alternative way of approaching understandings of dementia.
The final section of the book, ‘Personhood and the World’, is the section I found most useful. Kitwood (Reference Kitwood1997) is known for his concept of personhood, but his theorising was primarily at a micro level and concerned with the relationships between the person with dementia and carers, be they family or professionals. Hughes develops and applies the concept of personhood in a way that takes on board different models and contextualises dementia within wider society, while acknowledging and recognising the importance of individual accounts: nonetheless his approach takes us beyond the micro level.
Overall, the book is a valuable addition to theorising about dementia and is a welcome addition to the bookshelves of academics, students and practitioners who wish to challenge their knowledge base about understanding dementia.
