Book Review

Contented Dementia, written by Oliver James is a description of Penelope Garner's approach to dementia care known as SPECAL (Specialized Early Care for Alzheimer's).

Following diagnosis, the caring relative identifies a comfortable theme from the past (the Primary Theme) and from then on systematically supports the re-experience of this long-term memory. Oliver James argues that by supporting these illusions people with dementia can live 'as happily as they ever did'. Not only is this improbable, SPECAL has nothing more to offer. It presents only one solution to the complexity of life being lived by countless thousands of people living with dementia.

I am not dismissing this book, for there is much to be admired. The emphasis on the value of good communication, and the need to evidence-base what works best is to be commended. However, SPECAL is not the approach to dementia care as Oliver James proposes. Rather than recommend that carers do not ask questions that are complex the commandment is never ask questions for these 'are as poisonous to the well-being of people with dementia as radiation is to the health of newborn babies.' Not only does this smack of disempowerment (bearing in mind that SPECAL is to commence as soon as the diagnosis is made) it runs contrary to all that is enshrined within the Mental Capacity Act that supports decision-making as memory and cognition progressively fail.

I advise any reader to respect Penelope Garner's commitment to people with dementia, but not to be seduced by the simplicity of the model into believing that SPECAL is the soundtrack of person-centred care. It is just one psychosocial intervention in the therapeutic toolkit and, as with many interventions that have aspirations to be a 'model', it is flawed.

Graham Stokes, Head of Mental Health, BUPA Care Services