Using Terror Management Theory to understand the existential threat of dementia

This paper sets out an argument for understanding the subjective experience of people with dementia in terms of Terror Management Theory (TMT). This theory is a broad and detailed account derived from experimental psychological research of the way in which material that represents an existential threat to psychological equanimity triggers a range of social and personal defences. These responses are mediated by levels of self-esteem and include the process of mnemic neglect in which threatening material is processed less efficiently and recalled less thoroughly. Using TMT to understand the responses of people with dementia has a range of clinical implications.Judith:I just wonder where it’s all going to end, that’s my fear …Janet:Whenit’s going to end?Judith:Whereit’s going to end, where am I going to end up, just before the end, you know.Janet:Oh, I see you mean, I talk about death…Judith:YeahJanet: …to my family and I think the only thing that I’m frightened of is the unknown and that is death to me.Judith:and after that. Oh, no I’m worried about what comes just before [laughs] it could be years before, couldn’t it?Janet:It could be tomorrowRobert:Is it the dying that?Judith:I don’t feel that at all, no, because we all go through that, no I’m not frightened about that, no. It’s not really my religion to say it at all, but I don’t know if there’s anything else and I’m not going to worry about that right now, you know.Facilitator:So what is the frightening, when you say about the future?Judith:Being, being useless, you know.Janet:Yes.Judith:Not having all my faculties, I dread that, I dread that, its as if I’m going to come to it one morning, perhaps, you know and think ‘Oh my godfathers, what’s left?’, I really worry about that … so I’m quite happy in a situation unless I chose to sort of sit there and think. And it’s when I think about that, that the curtain comes down.From Cheston (2004).