Dementia within the Marital Sphere - Discourse, Power & Knowledge

Introduction: This thesis completed a genealogical enquiry which considered how dementia has been conceptualised historically and contextually, plus the conditions that have allowed for the emergence of certain dementia discourses over others. It explored how dementia has generated biomedical, neuro, psychological, pharmaceutical, technological, charitable and academic forces that in turn, produce and maintain the power of these forces, plus the dominant biomedical model of dementia. It also examined the role of family and marriage in the context of dementia. Method: Drawing upon Foucault’s work and discourse theory, professionally produced leaflets from dementia assessment clinics and NICE (2006) guidelines for dementia were examined. Secondly, participants with diagnoses of Dementia (PWDD) and their spouse were interviewed either jointly or separately (ten participants in total). Ten transcripts were analysed from a discourse theory perspective. Results: The document analysis presented various discursive themes, which corroborated the findings in the transcript analysis. From the transcripts, nine main discourses were identified. For instance, ‘the feared fate’ constructed the inescapability of dementia in old age relating to dementia facts and figures. ‘Pay no mind’ involved paying little attention to dementia and setting dementia talk aside. ‘The biomedical truth of dementia’ depicted professional technologies as ‘truths’ supporting the biomedical origins of dementia. Spouses with and without diagnoses of dementia tended to adopt dissimilar discourses, resulting in spouses monitoring and correcting PWDD and PWDD’s resistance. Marriage discourses constructed the importance of marriage and the need to overcome trials and tribulations. Discussion: Unexpected findings in the data were strongly gendered discourses, plus, where spouses without dementia were positioned in the role of the ‘informal professional’ yet also ‘the confessing patient’. Marriage discourses appeared to be complimentary in making marriage a natural sphere for caring. Biomedical discourse on dementia was effective in self-management of dementia ‘signs’ and electing ‘ethically bound’ spousal support, effective as a modern form of power where there are limited societal resources.