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- W2768600790 abstract "Different approaches to person-centred care draw upon various conceptualisations of personhood, in which there is little agreement on how to understand and define it given the heterogeneity of persons receiving care and their needs, expectations, and capabilities. This book is an important and timely contribution for those interested in understanding the intricacies of personhood and care in advanced old age. Higgs and Gilleard are ‘concerned with examining the nature of personhood and the place of care in both resisting and in realising the fourth age's imaginary’ (p. vi, emphasis added). By further elaborating the social imaginary of the fourth age, the authors interrogate (the relevance of) abstractions, such as the ethics of care and personhood, in the practices and social relations of care. The main contribution of the book is to show the enigmatic nature of care which sometimes enables and sometimes hinders agency and personal identity. The book contains nine chapters that are interwoven so as to enable the reader to navigate the equivocality of the notion of personhood (how to define and use the term, especially in the case of severe dementia) and the complexities of care in the fourth age. The first chapter sets out the various ways in which the fourth age can be understood in terms of chronology or disability and frailty in later life, as well as the authors’ model of this stage of life as a ‘social and cultural imaginary’ consisting of four main elements: frailty, abjection, the loss of agency, and care (p. 8). In the second chapter, the authors offer a brief review of the notion of personhood within philosophy and point to Tom Kitwood's confusion of metaphysics with moral philosophy, that is, the standing of persons and the capabilities of persons when outlining a personhood-centred approach to dementia care. Higgs and Gilleard also argue that overemphasising personhood risks obscuring the different capabilities that persons may have or want to deploy, including the capability to participate in relations. In the third chapter, the authors review and argue for sociological and/or anthropological approaches to the person, starting with Durkheim and moving onto recent conceptualisations of reflexive society which frames personhood around ‘self-conscious agency, rationality or self-reflexive narrativity’ (p. 43). In the fourth chapter, Higgs and Gilleard examine the concept of frailty and how it ‘has come to represent the core of unsuccessful ageing’ (p. 45) and personal and social ‘failure’ (p. 46). Frailty has been used as a biomedical construct, yet ‘ambiguity [of the term] only helps a deeper and darker imaginary of the fourth age as a process of othering’ (p. 51). In the next chapter, the authors dig deeper into this process of othering by tracing abjection that marks the experience and subjectivity of both cared for persons in their frailty and carers who assume often messy, dirty, corporeal tasks of care work. The following three chapters explore the practices and social relations of care, and how the moral imperative of care can be understood in its practices and narratives, but also at its limits. By focusing on informal care, the authors argue that even though care can be viewed as a moral duty, it is only socially realised within particular forms of relationship. By reconsidering debates about formal care in chapter seven, they point to the importance of understanding the experience of caring and being cared for in formal care settings. They also underline that ‘the degree of any person's “frailure” [a term merging frailty and failure] can be magnified or minimised by the narratives and practices of care’ (p. 111). In chapter eight, rather than giving clear-cut answers to ethically and practically complex questions [such as decision-making when it comes to the best interests of the cared-for person], the authors investigate the boundaries and limits of personhood, agency, and the relationship between care recipients and carers, especially in dementia care. I found the authors’ suggestion to reconsider care as co-constructed and dynamic to be significantly relevant in order to open up space for resisting the fourth age imaginary. As the authors acknowledge, the conception of the person in recent person-centred care approaches is often confused and confusing. However, it is also important to keep in mind how and why these approaches have been deployed to prevent reducing persons with medical conditions to their diseases. I agree with the authors that these approaches should be clearer in how they define the person and avoid more confusion for both care recipients and carers. Rather than simply ‘avoiding the term’ (p. 132), however, I think that it is equally relevant to elaborate further on the term and its conceptions, as the authors successfully do in this book. For these reasons, I thoroughly recommend this book for anyone interested in the field of ageing, health and care. The book is extremely important for scholars and practitioners who interrogate the ambiguities of person-centred care approaches in their research and practice." @default.
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- W2768600790 date "2017-11-15" @default.
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- W2768600790 title "Higgs, P.and Gilleard, C.Personhood, Identity and Care in Advanced Old Age. Bristol: Policy Press. 2016. 208 pp. ISBN 978-1-4473-1906-1 (pbk)" @default.
- W2768600790 doi "https://doi.org/10.1111/1467-9566.12668" @default.
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