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Is the self lost in dementia?

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If personhood is primarily bodily selfhood and implicit memory, dementia disturbs reflective meta-perspective without erasing the self-as-subject.

Source

Embodiment and personal identity in dementia

Fuchs T · Medicine, health care, and philosophy · 2020

doi.org/10.1007/s11019-020-09973-0Read the full paper ↗26 citationscc by

Study at a glance

Design
Other — Phenomenological argument that basal bodily selfhood persists despite reflective losses in dementia
N
Philosophical phenomenology; not an empirical sample
Population
Personhood and selfhood accounts applied to people living with dementia
Outcome
Dementia disturbs reflective meta-perspective without erasing the self-as-subject

Structured fields used in claim comparison tables when every cited study has a complete layer.

What they did

The author opposes a cognitivist picture of dementia (loss of self as loss of memory and reflection) to a phenomenology of the body. Drawing on body-memory traditions (Maine de Biran, Bergson), they distinguish self-as-object from self-as-subject and criticise purely externalist or discursive accounts of remaining personhood.

What they found

Dementia disturbs decentering and meta-perspective, but large ranges of implicit/body memory can remain even late. Continuity of a basal feeling of self should block talk of a total loss of self. Founding the self only in others’ discourse misses first-person awareness. A purely rational concept of person stigmatises people with severe cognitive deficits.

The limits

What it doesn't show

This is a philosophical reconstruction, not a new clinical cohort. It does not measure residual body memory in a sample, and it does not deny that dementia is devastating for reflective capacities.

Key terms

Self-as-subject
Pre-reflective experience of self that need not be put into words.
Self-as-object
Knowledge about oneself that can be lost as explicit memory fails.
Body memory
The past sedimented in the body as implicit, accumulated experience rather than recollection.
Meta-perspective
Reflective decentering; its disturbance is central to this account of dementia.

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Alternative to cognitivist dementia?

Common questions

Does the author say nothing is lost?

No. Reflective self-as-object and meta-perspective are disturbed; the claim is that basal bodily selfhood remains.

Why not just say personhood is social?

A purely externalist story misses the patient’s first-person perspective.

Why does the cognitivist view matter ethically?

Tying personhood only to rationality stigmatises people with severe cognitive deficits.

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