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Open Access 01-08-2011 | Scientific Contribution

Dwelling, house and home: towards a home-led perspective on dementia care

Author: Wim Dekkers

Published in: Medicine, Health Care and Philosophy | Issue 3/2011

Abstract

“Home” is well known from everyday experience, plays a crucial role in all kinds of narratives about human life, but is hardly ever systematically dealt with in the philosophy of medicine and health care. The notion of home is ambiguous, is often used in a metaphorical way, and is closely related to concepts such as house and dwelling. In this paper the phenomenon of home is explored by means of some phenomenological writings of Heidegger, Bollnow, Bachelard and Levinas. Common in their views is that being at home and dwelling mean something more fundamental than an activity we do along with other activities, such as working and travelling. Dwelling, building a house and being at home are fundamental aspects of human existence. Being human is dwelling. While exploring the relevance of this phenomenological perspective for medical theory and practice, the focus is on the care of people suffering from dementia.

Also the Flemish philosopher Jacques de Visscher must be mentioned. In his many writings on architecture, house, home, and dwelling, the writings of the four philosophers mentioned here play an important role. See, for example: de Visscher (1991, 1998, 1999, esp. Chap 4 and 5). A fine example of a phenomenological exploration of home is the research project on the notion of home under the leadership of Max van Manen of the University of Alberta (Edmonton, Canada), who is also the founder of the web based project Phenomenology Online: http://www.phenomenologyonline.com/home.html (acccessed July 16 2010).

Bachelard’s position is interesting for another reason, because he insists upon a radical difference between metaphor and image. He acknowledges that a metaphor might give concrete substance to an experience that is difficult to put in other words, and that this experience is related to another thing from which it differs. He argues, however, that a metaphor is completely different from an image. In his view, an image owes its entire being to the imagination. He calls an image “the pure product of absolute imagination” (Bachelard 1964, p. 75). According to Bachelard, a metaphor cannot be studied phenomenologically. At most it is a “fabricated image” (ibid., p. 75). He goes on to say: “A metaphor is a false image, since it does not possess the direct virtue of an image formed in spoken revery” (ibid., p. 77).

As Svenaeus (2000, 2001, 2002) explains, in Sein und Zeit the notions of “homelikeness” (“Heimischkeit”) and “unhomelikeness” (“Unheimlichkeit”) play a crucial role. According to Heidegger, unhomelikeness is, even in our everyday modes of being-in-the-world, a basic aspect of our existence, but in our everyday life it is hidden by the dominant being-at-home in the world. Consequently, the being-at-home of the human being is also a being not quite at home in this world: this is my world but it is also not entirely mine. Therefore, health can be understood as a being-at-home that keeps the fundamental homelessness of human existence—the not being at home in the world—from becoming apparent.

To explain this, Heidegger refers to the original meaning of the German verb “bauen” (to build), that is, to dwell, to remain, to stay in a place. The old German word “bauen” says that man is insofar as he dwells, but it also means at the same time to cherish and protect, to preserve and care for, specifically to till the soil and to cultivate the vine.

This weak interpretation comes close to the metaphorical meaning of being at home as “easy motion through a landscape” (Krasner 2006, p. 211). A person who is at home can move “fluidly through the dwelling because body-subject knows that space intimately” (Seamon, citation in Krasner 2006).

Also in Neue Geborgenheit [New Security] Bollnow (1955) devotes one chapter to ‘The Meaning of the House’. The broader context of this book is a critique of an existentialist view of the human being in which the focus is on notions such as despair (Kierkegaard), anxiety (Heidegger) and nausea (Sartre) and the image of a human being as a traveller (homo viator) and as a refugee ever under way. According to Bollnow, a human being fulfils his existence by dwelling. Dwelling and finding a (new) security is the very “essence” of his existence. Being home or homelike being in the world is an existential aspect of human beings not reducible to an underlying negative experience as it is in Heidegger’s analysis.

Bollnow (1961) adds that the boundary between the security of the inner space and the insecurity of the outer space in fact is a gradual one. Around the individual house is a broader area that can also be called a home (in German “Heimat”).

Levinas writes: “To exist […] means to dwell” (Levinas 1971, p. 156) and “With the dwelling the latent birth of the world is produced” (ibid., p. 157).

Of the four authors presented here, only Heidegger refers to a specific disease, namely depression. He argues that in states of depression there is a loss of rapport with things and a change in the “staying with things” (Heidegger 1971, p. 157). This change in relationship with the things in the outside world occurs in many more diseases, especially in psychiatric disorders.

Tronto explicitly refers to Heidegger’s description of care (“Sorge”) as a fundamental aspect of “Dasein” (Tronto 1993, p. 3, 118, 125).

Bachelard, G. 1964. The poetics of space. Boston: Beacon Press.

Bermann, K. 2003. Love and space in the nursing home. Theoretical Medicine 24: 511–523.CrossRef

Bollnow, O. 1955. Neue Geborgenheit. Stuttgart: Kohlhammer.

Bollnow, O. 1961. Lived-space. Philosophy Today 5: 31–39.

Dahlberg, K., L. Todres, and K. Galvin. 2009. Lifeworld-led healthcare is more than patient-led care: an existential view of well-being. Medicine, Health Care and Philosophy 12: 265–271.CrossRef

Davis, S., S. Byers, R. Nay, and S. Koch. 2009. Guiding design of dementia friendly environments in residential care settings. Dementia 8(2): 185–203.CrossRef

Dekkers, W. 2009. On the notion of home and the goals of palliative care. Theoretical Medicine & Bioethics 30(5): 335–349.CrossRef

Dekkers, W. 2010. Persons with severe dementia and the notion of bodily autonomy. In Supportive Care for the Person with Dementia, ed. J.C. Hughes, M. Lloyd-Williams, and G.A. Sachs, 253–261. Oxford: Oxford University Press.

de Visscher, J. 1991. Wonen: de nabijheid van de ander in de bezieling van de dingen. In Wonen: architectuur in het denken van Heidegger, ed. J. de Visscher, and R. de Saeger, 117–146. Nijmegen: SUN.

de Visscher, J. (ed.). 1998. Over de drempel. Van architectonisch minimum tot symbolisch maximum. Best: Damon/Kritak.

de Visscher, J. 1999. Naakt geboren. Over herbergzaamheid, lijfelijkheid, subjectiviteit en wereldlijkheid. Leende: Damon.

de Witt, L., J. Ploeg, and M. Black. 2009. Living on the threshold. The spatial experience of living alone with dementia. Dementia 8(2): 263–291.CrossRef

de Witt, L., J. Ploeg, and M. Black. 2010. Living alone with dementia: an interpretive phenomenological study. Journal of Advanced Nursing 66(8): 1698–1707.PubMedCrossRef

Heidegger, M. 1927. Sein und Zeit. Tübingen: Niemeyer.

Heidegger, M. 1971. Building dwelling thinking. In Poetry, language, thought, ed. Heidegger, M, 145–161. (Translation and introduction: Albert Hofstadter). New York: Harper & Row.

Hertogh, C.M.P.M., and B.A.M. The. 2008. The loss of a common shared world. Ethical problems in palliative care for people with advanced dementia [Ethische vragen in de palliatieve zorg voor mensen met dementia]. Tijdschrift voor Gerontologie en Geriatrie 39(6): 265–272.PubMedCrossRef

Hughes, J.C. 2001. Views of the person with dementia. Journal of Medical Ethics 27: 86–91.PubMedCrossRef

Hughes, J.C., S.J. Louw, and S.R. Sabat (eds.). 2006. Dementia. Mind, meaning, and the person. Oxford: Oxford University Press.

Jacobson, K. 2009. A developed nature: a phenomenological account of the experience of home. Continental Philosophical Review 42: 355–373.CrossRef

Kalis, A., M.H.N. Schermer, and J.J.M. van Delden. 2005. Ideals regarding a good life for nursing home residents with dementia: views of professional caregivers. Nursing Ethics 12(1): 30–42.PubMedCrossRef

Kitwood, T. 1997. Dementia Reconsidered. The Person Comes First. Buckingham, Philadelphia: Open University Press.

Kontos, P.C. 1998. Resisting institutionalization: Constructing old age and negotiating home. Journal of Aging Studies 12: 167–184.CrossRef

Kontos, P.C. 2005. Embodied selfhood in Alzheimer’s disease. Dementia 4(4): 553–570.CrossRef

Krasner, J. 2006. Accumulated lives: Metaphor, materiality, and the homes of the elderly. Literature and Medicine 24: 209–230.CrossRef

Lakoff, G., and M. Johnson. 1980. Metaphors we live by. Chicago and London: The University of Chicago Press.

Leder, D. 1990. The absent body. Chicago: University of Chicago Press.

Levinas, E. 1971. Totality and infinity. An essay on exteriority. The Hague/Boston/London: Martinus Nijhoff Publishers.

Meijer, M. 1992. ‘Thuis’ is het sleutelwoord. De Bazuin 18: 24–26.

Meijer, M. 1993. Alleen God weet nog waar ik woon. Pastorale zorg in het verpleeghuis. Speling: 62–66.

Moore, J. 2000. Placing home in context. Journal of Environmental Psychology 20: 207–217.CrossRef

O’Sullivan, M. 2000. At home with dementia (http://www.dadhc.nsw.gov.au/NR/rdonlyres/D87FA83D-4E00-446B-A6B9-7CCE54143820/4024/AtHomeDementia_manual.pdf).

Perkins, H., D. Thorns, A. Winstanley, and B. Newton. 2002. The study of ‘home’ from a social scientific perspective: An annotated bibliography, 2nd ed. New Zealand: Canterbury.

Phinney, A., and C.A. Chesla. 2003. The lived body in dementia. Journal of Aging Studies 17: 283–299.CrossRef

Sabat, S.R. 2001. The Experience of Alzheimer’s Disease. Life Through a Tangled Veil. Oxford, UK: Blackwell Publishers.

Spiegelberg, H. 1982. The phenomenological movement. A historical introduction, Third and enlarged edition ed. The Hague/Boston/London: Martinus Nijhoff Publishers.

Svenaeus, F. 2000. Das unheimliche—towards a phenomenology of illness. Medicine, Health Care and Philosophy 3: 3–16.CrossRef

Svenaeus, F. 2001. The Hermeneutics of medicine and the phenomenology of health. Dordrecht: Kluwer Academic Publishers.

Svenaeus, F. 2002. The phenomenology of health and illness. In Handbook of Phenomenology and Medicine, ed. S.K. Toombs, 87–108. Dordrecht: Kluwer Academic Publishers.

Todres, L., K. Galvin, and K. Dahlberg. 2007. Lifeworld-led healthcare: revisiting a humanising philosophy that integrates emerging trends. Medicine, Health Care and Philosophy 10: 53–63.CrossRef

Toombs, S.K. (ed.). 2001. Handbook of Phenomenology and Medicine. Dordrecht: Kluwer Academic Publishers.

Tronto, J.C. 1993. Moral Boundaries. A Political Argument for an Ethic of Care. New York/London: Routledge.

van Hoof, J., and H.S.M. Kort. 2009. Supportive living environments. A first concept of a dwelling designed for older adults with dementia. Dementia 8(2): 293–316.CrossRef

Title: Dwelling, house and home: towards a home-led perspective on dementia care
Author: Wim Dekkers
Publication date: 01-08-2011
Publisher: Springer Netherlands
Published in: Medicine, Health Care and Philosophy / Issue 3/2011
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI: https://doi.org/10.1007/s11019-011-9307-2

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