Dementia in a socio-cultural context: an idea whose time has come

Dementia studies are currently dominated by biomedical and psychological models that focus on the individual without regard to their socio-cultural context (Bond 1992, 1999; Lyman 1989; Harding and Palfry 1997; Whitehouse et al . 2000). There is now a growing interest in how socio-cultural factors may mediate the experience of, and response to, dementia (Holstein 1998). The purpose of this review is to examine this growing interest in the socio-cultural context of dementia with reference to earlier developments in disability studies (Oliver 1990; Thomas 1999) and ageing research in general (Estes et al . 1984). The implications of placing dementia in a socio-cultural context for research, policy and practice will be discussed. Most of the theoretical work on dementia has been devoted to pointing out the inadequacies of biomedical and psychological models in which problems are attributed solely to an individual's neuropathology with a simultaneous neglect of socio-cultural factors (Binney and Swan 1991; Lyman 1989; Harding and Palfry 1998; Kitwood 1998). The study of dementia, it is argued, has been limited by the broader ‘biomedicalisation of ageing’ whereby problems of ageing have been attributed to the ‘tragedy’ of the individual's pathology rather than as a function of an inadequate societal response. Robertson (1991) describes how people so labelled are referred to as ‘victims’ or ‘sufferers’. All difficulties in the person's life are attributed to their underlying disease with a consequent neglect of social and environmental factors that may ameliorate or prevent such ‘symptoms’.