Understanding identity and representations of dementia: a conversation analytic and discursive analysis

Our interactions with others, and with societal and media representations, are key to influencing our identity and perceptions of self. Memory loss is often equated with identity loss through the portrayal of dementia in the media and the way people living with dementia are spoken with, or to, in conversation. Media representations and interactions with others are both central to the experience of dementia and impact upon identity and selfhood. Through a more inclusive approach to communication with, and representations of, people living with a dementia, research and representations can reflect the breadth of what it can mean to be impacted by dementia in a way that supports individual and relational aspects of a person.

To contribute to investigating these areas, the empirical work of this thesis draws on two datasets: recordings of interactions between people with dementia and their conversation partners, focusing on interactions where memories are salient (Chapters 5 and 6); and focus group discussions centred on dominant media representations of dementia involving people with different identities in relation to dementia (Chapter 7). To examine these datasets, this thesis employs two approaches: (1) conversation analysis (CA) to examine practices that can be used to interactionally support individual and relational identities; and (2) thematic discourse analysis (TDA) to explore how participants with differing identities in relation to dementia challenge and interpret dominant societal discourses about dementia in focus group discussions.

The CA studies showcase interactional practices that promote conversational progression and support both individual and shared identities. Chapter 5 identifies specific practices (candidate answers, tag questions, and single-party memory of a shared event) which help conversation partners navigate co-remembering conversations without emphasising any potential interactional difficulties of people with dementia, whilst also highlighting their present interactional competences. These practices prioritise the activity of shared connection over the recall of memories, supporting individual and shared identities. Chapter 6 delves into the structure of reminiscence activities, noting disparities between recommended practices and observed behaviours, such as the scarcity of open questions and prevalence of closed ones. Common practices for initiating, progressing, and closing sequences of reminiscence are identified and discussed, showing how both formal carers and people with dementia contribute to the activity of reminiscence. Initiating utilised closed questions, commenting on photographs or stories, and summons of attention. Progressing practices included those requiring only a minimal response to progress – closed questions and continuers – and practices requiring more than a minimal response to progress – open questions and repeating the talk of another. Observed closing practices were assessments and movements of photographs.

The TDA examines focus group discussions amongst participants with differing identities in relation to dementia, demonstrating both shared and differing interpretations of ageist and healthist discourse surrounding dementia. Three themes were constructed around these discourses: (1) dementia preventability; (2) demonstrating dementia diligence, and (3) dementia as an “old person’s disease”. These themes demonstrate the complex experience of dementia and its representation in the media. The possible impacts of discourses of individual responsibility for dementia on the identity of people impacted by dementia are discussed, and recommendations are made for presenting ‘living as well as we can’ with dementia.

This thesis demonstrates the contribution of using different approaches to examine the interactional support of identity alongside wider societal representations of dementia. By zooming in and out on these interrelated topics, we can start to see the reflexive relationships between interactions and representations and begin to make improvements which support the individual and relational identities of people impacted by dementia.