Health and Social Care Chaplaincy, Vol 2, No 2 (2014)

10.1558/hscc.v2i2.26929

doi:10.1558/hscc.v2i2.26929

Review

Elizabeth MacKinlay and Corinne Trevitt, Finding Meaning in the Experience of Dementia: The Place of Spiritual Reminiscence Work. London: Jessica Kingsley, 2012, 302 pp. (Pbk). ISBN: 9-781-84905-248-1, £22.99.

Reviewed by: Revd Dr Margaret Whipp, Chaplain, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK

Email: margaret.whipp@ouh.nhs.uk

Professor Elizabeth MacKinlay, an Australian nurse and Anglican priest, brings a heartening voice to the field of ageing and spiritual care. In the current volume, co-authored with her research associate Corinne Trevitt, she shares the findings of a major study of spiritual care in people with dementia.

Chaplains working with older people will be familiar with practices of life review and reminiscence therapy which can be well-suited to spiritual and pastoral care in cognitively able subjects. But what about patients with dementia? To what extent might they also benefit from interventions which build meaning, identity and a sense of coherence through working with life narrative and reminiscence groups? MacKinlay’s latest book reports in detail the methodology and findings of her decade-long research programme based in aged care facilities in Canberra, Merimbula and Sydney.

Written with clarity and real compassion, it is an uplifting account. Negative stereotypes of dementia are challenged on every page, the authors’ emphatically person-centred approach to spiritual care shining through both the design and interpretation of a profound and patiently enacted programme of qualitative research. “Part of the stigma associated with dementia”, they write (p. 205), “is the commonly held view that meaningful conversation cannot occur – so it is not tried”. Page after page of remarkably meaningful transcript material from patients with MMSE scores reaching as low as 3 and 4 give the lie to this defeatist stereotype, as skilled facilitators elicit themes of real depth and significance from painstaking group work.

At one level there is nothing new here. Anyone devoting the calm respect which this book so beautifully embodies can be surprised by the potential for spiritual growth and insight which, despite challenges of communication, individuals with dementia still manage to express. Their virtues of resilience and transcendence, and the flashes of real wisdom and humour persisting through quite broken tracts of conversation, witness to a lively ongoing spiritual narrative which is not totally disrupted by the ravages of cognitive decline. What is striking in this project is the extent to which this hope-full engagement with spiritual reminiscence work has been sustained in groups of deeply disabled participants over a period of many weeks.

The book might have been shorter. Few readers will be excited by the exhaustive methodological sections and repetitive descriptions of group process. And, although the transcript material is riveting in parts, the inclusion of almost 100 pages of inevitably slow-paced verbatim provides far more than is needed to exemplify the major themes.

There are some useful summaries of the kind of topics which would be as useful in reminiscence work with individuals as with groups – life-meaning; relationships; hopes, worries and fears; growing older and transcendence; spiritual and religious beliefs and practices. And there are many hints and, better still, fine instances of the arts and skills of compassionate communication with elderly and/or demented patients. I learned a great deal from reflecting on these examples of thoroughly good practice.

Although this is an encouraging book about a very stimulating piece of research, I was troubled by the omission of any serious consideration of the social, economic and political context which constrains the quality of more typical dementia care in acute and community settings. MacKinlay’s prophetic voice may be heartening in its selective context. But there remains a terrible wilderness out there.

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