Dementia and the Double Empathy Problem

In this chapter I will make the argument that it can be beneficial to view dementia through a neurodiversity lens. If neurodivergence is viewed as differences in cognitive, affectual, and/or sensory functioning compared to the neurotypical majority, it is possible to see how it might apply to dementia. Under the Diagnostic and Statistical Manual, (DSM5), dementia is classified as a neurocognitive disorder (major or minor), in which there is a significant cognitive decline in one or more domains - complex attention; executive functioning; learning and memory; language; perception; and social cognition. Understood as neurodivergence, although still acknowledging dementia as pathology, it becomes possible to see how people with dementia experience the double empathy problem whereby ‘difficulties’ in communication are attributable to their cognitive decline, rather than an interactional failure. In conceptualising the double empathy problem, Milton also drew on the work of philosopher and feminist theorist, Iris Marion Young and her concept of asymmetrical reciprocity which posits that '[I]t is neither possible nor morally desirable for persons engaged in moral interaction to adopt one another’s standpoint' (1997: 340). Young argues that the best we can do is to engage in a process of enquiry, and she proposes asymmetrical reciprocity as “a communicative ethics that recognizes difference and particularity” (Young, 1997:340). Based on moral respect and recognition, Young suggests the adoption of a sense of wonder when listening to the perspectives of others. This sense of wonder challenges a wholly deficit model of dementia that assumes a lack of capacity and instead invokes enquiry into better understanding the unique ways that people with dementia see, feel, hear and communicate with the world around them.