D'Arcy Little, MD, CCFP, Lecturer and Academic Fellow, Department of Family and Community Medicine, University of Toronto; Director of Medical Education, York Community Services; 2002 Royal Canadian Legion Fellow in Care of the Elderly at Baycrest Centre, Toronto, ON.
Introduction
I was recently given the difficult task of creating a paper on the application of developmental theory to the human condition of dementia. Given the complexity of that endeavor, this article will address both content and process issues involved. I will start with a consideration of the relevant developmental stage as conceptualized by Erikson, and then demonstrate that the biomedical model of dementia is actually insufficient to allow a discussion of dementia in a developmental context. This will be followed by an introduction to a paradigm shift from the biomedical model to the social-environmental model whereby developmental issues in dementia can be more fully explored. The prominence of spirituality as a means to resolve Erikson's final crisis of integrity versus despair will be discussed with reference to both personal reflection as well as recent arguments by clinical ethicists and psychologists working in this field and a prominent patient with dementia. Finally, connections to a different developmental model will serve to confirm the views put forth here.
Erikson's Life Cycle: Application to Dementia
According to Erikson, the dominant antithesis in old age is "integrity versus despair".
