Though much is taken, much abides

When she was confused and incoherent and aggressive, it was consoling to think that this was not really Elaine. This was a disease having its way with her. She was still there, in there somewhere, but this was not her. This was not real. I still think that was true, and tonic for our distress, but at the same time she demanded and deserved care because she was still herself. Though ravaged and fouled, her personhood was undiminished. 

This is the thinking behind a reconsideration of dementia care in the US, based on the work of British social psychologist Thomas Kitwood, a pioneer of what it seems strange anyone should have had to pioneer: person-centric care. It's a view that critiques our prizing of cognition over other aspects of human being, like sensuality, intimacy, pleasure, which survive the dereliction of the mind. A view that returns us to the mystery of human life, the more mysterious at the moment of its unravelling.

A recent New Yorker piece describes what Kitwood saw as the problem. “In advanced Western societies, where a sense of community is often weak, the evident frailty of people with dementia generates fear; this unease is socially managed by turning the demented into nonpersons, who are warehoused in nursing homes and pathologized with terms like 'resisting care.' The problem, Kitwood concluded, 'is not that of changing people with dementia, or of “managing” their behavior; it is that of moving beyond our own anxieties and defences, so that true meeting can occur, and life-giving relationships can grow.' Only in this way could the personhood of people with dementia be conserved, even as their intellection declined." This is about seeing people for what they keep, not what they lose. Though much is taken, much abides.

None of this does away with the indignities of showering and feeding and changing nappies, but perhaps it transforms them from mechanised processes into acts of grace. Acceptance instead of anxiety. Love instead of fear.

Bloom, waterlover

Here's a man who knew what water was, and what words were. Happy Bloomsday!

“What in water did Bloom, waterlover, drawer of water, watercarrier, returning to the range, admire?

Its universality: its democratic equality and constancy to its nature in seeking its own level: its vastness in the ocean of Mercator's projection: its unplumbed profundity in the Sundam trench of the Pacific exceeding 8000 fathoms: the restlessness of its waves and surface particles visiting in turn all points of its seaboard: the independence of its units: the variability of states of sea: its hydrostatic quiescence in calm: its hydrokinetic turgidity in neap and spring tides: its subsidence after devastation: its sterility in the circumpolar icecaps, arctic and antarctic: its climatic and commercial significance: its preponderance of 3 to 1 over the dry land of the globe: its indisputable hegemony extending in square leagues over all the region below the subequatorial tropic of Capricorn: the multisecular stability of its primeval basin: its luteofulvous bed: its capacity to dissolve and hold in solution all soluble substances including millions of tons of the most precious metals: its slow erosions of peninsulas and islands, its persistent formation of homothetic islands, peninsulas and downwardtending promontories: its alluvial deposits: its weight and volume and density: its imperturbability in lagoons and highland tarns: its gradation of colours in the torrid and temperate and frigid zones: its vehicular ramifications in continental lakecontained streams and confluent oceanflowing rivers with their tributaries and transoceanic currents, gulfstream, north and south equatorial courses: its violence in seaquakes, waterspouts, Artesian wells, eruptions, torrents, eddies, freshets, spates, groundswells, watersheds, waterpartings, geysers, cataracts, whirlpools, maelstroms, inundations, deluges, cloudbursts: its vast circumterrestrial ahorizontal curve: its secrecy in springs and latent humidity, revealed by rhabdomantic or hygrometric instruments and exemplified by the well by the hole in the wall at Ashtown gate, saturation of air, distillation of dew: the simplicity of its composition, two constituent parts of hydrogen with one constituent part of oxygen: its healing virtues: its buoyancy in the waters of the Dead Sea: its persevering penetrativeness in runnels, gullies, inadequate dams, leaks on shipboard: its properties for cleansing, quenching thirst and fire, nourishing vegetation: its infallibility as paradigm and paragon: its metamorphoses as vapour, mist, cloud, rain, sleet, snow, hail: its strength in rigid hydrants: its variety of forms in loughs and bays and gulfs and bights and guts and lagoons and atolls and archipelagos and sounds and fjords and minches and tidal estuaries and arms of sea: its solidity in glaciers, icebergs, icefloes: its docility in working hydraulic millwheels, turbines, dynamos, electric power stations, bleachworks, tanneries, scutchmills: its utility in canals, rivers, if navigable, floating and graving docks: its potentiality derivable from harnessed tides or watercourses falling from level to level: its submarine fauna and flora (anacoustic, photophobe), numerically, if not literally, the inhabitants of the globe: its ubiquity as constituting 90 percent of the human body: the noxiousness of its effluvia in lacustrine marshes, pestilential fens, faded flowerwater, stagnant pools in the waning moon.”

From Ulysses, by James Joyce