The Pioneer: Tom Kitwood and the Biopsychosocial Model
Tom Kitwood's work emerged in response to the prevailing biomedical model, which reduced a person with dementia to a diagnosis and focused solely on the neurological damage. Kitwood saw this approach as dehumanizing and believed it neglected the individual's personal experiences, well-being, and dignity. His perspective, formalized in his 1997 book Dementia Reconsidered: The Person Comes First, proposed a new way of understanding the condition, integrating biological, psychological, and social factors.
Kitwood's central argument was that many of the challenging behaviors associated with dementia were not simply a direct result of brain damage. Instead, they were often a reaction to a toxic social environment, a concept he termed "malignant social psychology". This perspective was revolutionary, shifting the focus from managing "problem behaviours" to creating a supportive and affirming social context. His work advocated for building respectful, trusting, and mutually beneficial relationships between carers and individuals with dementia.
Malignant Social Psychology and its Effects
Kitwood identified several ways that caregivers and institutional systems could unintentionally diminish a person's sense of self, leading to the behaviors and negative outcomes often attributed solely to dementia. These acts, categorized as malignant social psychology, can lead to the erosion of a person's identity and well-being. Examples include:
- Disempowerment: Stripping away the person's right to make choices, no matter how small.
- Infantilisation: Treating an adult as if they were a child, using condescending language or gestures.
- Labelling: Viewing and defining the person primarily by their diagnosis rather than their unique history and personality.
- Objectification: Treating the person as an inanimate object or a body to be managed, rather than a feeling individual.
- Bypassing: Talking about the person as if they are not present or cannot understand.
Kitwood argued that by recognizing and eliminating these harmful dynamics, caregivers could significantly improve a person's quality of life and potentially slow the progression of some symptoms exacerbated by emotional distress.
Kitwood's Flower of Psychological Needs
To counter the effects of malignant social psychology, Kitwood developed a model emphasizing the universal psychological needs of all human beings, including those with dementia. His famous "Flower of Psychological Needs" illustrated that at the core of all these needs is Love. The five petals of the flower represent other crucial needs:
- Comfort: The need for security, warmth, and physical closeness.
- Attachment: The need to have bonds and feel safe in relationships with others.
- Inclusion: The need to be part of a group and have social interactions.
- Occupation: The need to be involved in meaningful activities that use their skills and experience.
- Identity: The need to maintain a sense of self and feel connected to one's past.
Meeting these needs through what Kitwood called "Positive Person Work" helps to maintain a person's sense of identity and self-worth.
The Shift to Person-Centred Care
The move away from the biomedical model has fundamentally reshaped dementia care practice. Below is a comparison contrasting the traditional approach with Kitwood's person-centred model.
| Feature | Traditional Biomedical Model | Kitwood's Person-Centred Model |
|---|---|---|
| Focus | The disease and its neurological symptoms. | The whole person, including their history, personality, and emotions. |
| Problem Behaviours | Seen as a direct result of brain damage and needing to be managed or suppressed. | Viewed as communication stemming from unmet psychological needs or a negative social environment. |
| Role of the Carer | Primarily focused on tasks, schedules, and medical interventions. | Focused on building authentic, caring relationships and seeing the world from the person's perspective. |
| The Individual | Defined by their cognitive deficits and loss of capacity. | Recognized as having an intrinsic and preserved personhood, worthy of dignity and respect. |
| Environment | The setting is organized for staff efficiency and institutional needs. | The environment is designed to be supportive and enabling, fostering a sense of belonging and normalcy. |
Kitwood's Lasting Influence and Legacy
Kitwood's work, including the development of Dementia Care Mapping (DCM), had a profound and lasting influence on dementia care globally. DCM is an observational tool used to evaluate the quality of care and identify opportunities for improvement by focusing on the individual's well-being and social engagement. Despite facing some challenges in implementation, the core principles of Kitwood's model have been widely adopted and continue to be considered a gold standard in dementia care.
His legacy lives on through the work of the Bradford Dementia Group, which he founded, and in the numerous person-centred care interventions and training programmes that have been developed since. Kitwood's insistence on seeing the person behind the diagnosis has helped countless individuals with dementia to live with greater dignity, meaning, and respect.
Conclusion
In conclusion, Tom Kitwood was the first to successfully apply the framework of person-centred care to dementia, transitioning the focus from a purely medical perspective to one that prioritizes the individual's personhood and psychological needs. His theories on malignant social psychology and the Flower of Psychological Needs have provided a powerful lens for understanding and improving the experience of living with dementia. By emphasizing relationships, meaningful occupation, and a supportive environment, Kitwood's work continues to inspire a more compassionate and humane approach to care that honors the unique identity and value of each person.
Further Reading: The Social Care Institute for Excellence (SCIE) provides further resources and information on person-centred care and its application in practice. https://www.scie.org.uk/
