"Who am I" Using Fairbairn's object relational theory to reconceptualise experiences of dementia

The purpose of my PhD is to try to answer the question, ‘Who am I?’ from the perspective of those with a dementing illness, using Fairbairn’s endopsychic model of the self. Dementia is often described as an illness causing progressive loss of self. It is this loss of self and its consequences that will be the focus of my study. I have chosen a psychoanalytic model, called Fairbairn’s endopsychic model of self, because it is supported by a lot of recent research outside of psychoanalysis, such as attachment theory, developmental psychology and neuroscience, as well as reflecting current trends within psychoanalysis which focus on the regulation of affect within relationships. As well as finding support both inside and outside the discipline of psychoanalysis, it is also congruent with the interpersonal view of self, which is widely used in the person-centred literature and is used to define best practice in dementia care. However, there are differences, because these non-psychoanalytic theories do not have a concept of the unconscious within which to understand relationships, nor do they have a developmental view of self. This limits their understanding of people’s experience of dementia, because their view of the self is a simple unitary one, meaning they are unable to consider unconscious motivations for people’s behaviour. I work on a ward for male patients with dementia and to investigate the meaning of the question “Who am I?” from the perspective of this cohort of patients, I kept a reflective diary of my experiences on the ward. Using these diaries, I hoped to better understand the experiences of patients, as inferred from their behaviour. I started my data analysis by grouping together behaviours that were similar, and then I reduced and organised all these behaviours into six categories, some of which were then divided into subcategories, if there were significant differences in the way a particular behaviour manifested itself. I then arranged these six categories hierarchically. Thus, category one, for instance, represented the behaviours of people with no discernible cognitive impairment (although two people did become confused during the study), while category six represented the behaviour of those with the severest cognitive impairment. I believe that it is important to see how the behaviour of people changed, relative to the severity of their illness. The next stage was to apply Fairbairn’s theory to the different behaviours within each category, to try and understand these in terms of a person’s sense of self, as defined by Fairbairn. This allowed me to infer from people’s behaviour, how the illness has affected their sense of self. It is also important to locate my findings relative to the work of other researchers, to see if I could find any support for my findings. I did this by carrying out a mini literature review for each of my six categories, to see if others had found similar results, and, just as importantly, how they had understood their results. This allowed me to compare my understanding of my findings using Fairbairn, with the work of other researchers, to see where there was support for or differences between our results, which I then tried to understand. In the conclusion, I summarised my findings and how I understood these using Fairbairn’s model of the self, which enabled me to answer my research question. I then compared the answer to alternative perspectives on how dementia affects a person’s sense of self and the possible consequences for nursing treatment and the ward routine. From this comparison, I developed further ideas on how to use Fairbairn’s theory to enhance our understanding of the experiences of those with dementia and find improved ways of treating these patients.