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I have had more than one grandparent with dementia. This post is a series of personal reflections about the way conversation changes when someone you know well loses the ability to remember, and how linguistics has given me a framework for dealing with this. I don’t know anything about dementia other than these experiences, and there are whole sets of emotional and logistical challenges of living with dementia, or a loved one with dementia that I’m not going to address here. Dementia presents a challenge when you’re having conversations, because the person with dementia loses the ability to track what’s been covered in a conversation - perhaps over the course of 15 minutes, perhaps sometimes in 15 seconds. This creates loops and eddies in conversational topics. It also breaks down one of the fundamental features we require in communication; the belief that our conversational partner is a cooperative one. Cooperation is important because otherwise a well-flowing interaction is, on the surface, a series of non-sequiturs as the person speaking makes a leap and their conversational partner(s) makes the leap with them. Why are we talking about Uncle Desmond? It must be relevant to the conversation about Aunt Muriel we were just having. A person with dementia can feel from their perspective that they’re being cooperative but from your perspective they’re telling you the same story about Uncle Desmond’s first wife for the 3rd time in 15 minutes. I’ve noticed that different family members deal with the destruction of the facade of cooperation in various ways; the helpful one tries to turn the conversation to other topics, the sanguine one lets the story play out a fourth time, the pragmatic one tells my grandmother every time that she’s already told this story and that, in fact, she has dementia. Each is trying to rebalance the illusion of cooperation, and each has varying degrees of success which I’m sure relates to my grandmother’s relationship to them, her personal condition, and everyone’s mood on any given day. Another group we see constantly breaking the sense of cooperation is children. Kids are tiny randomness machines and keeping them on conversational tracks can be a lot of work (and work that extends beyond the years of just learning to speak grammatically). The thing with children is that we expect this from them to some extent. The challenge with conversing with a family member with dementia is that we have years, often a lifetime, of conversational rhythm with them. The ways in which we expect conversational cooperation were broken into four main categories by Paul Grice. He called these maxims, which I always think of in the ‘guide’ sense rather than ‘rule’. They can help clarify the ways that it can feel difficult to maintain a conversation with someone who has dementia. The first that comes to mind for me is always the maxim of relation, because it does not seem relevant to return to the same story of Uncle Desmond again without new reason, and because this might lurch suddenly into a new conversational track about a cousin you haven’t talked about for 15 years. I’m sure that if I made transcripts of conversations my family have with my grandmother I’d find examples of various different ways that our conversational expectations are challenged in these small talk moments. Knowing about conversational cooperation has made me far more relaxed about approaching these conversations, in one of the more unusual ways my linguistics training has giving me a weird sense of peace about a process I have no control over. This is where my thoughts on this topic had arrived at. I was talking to my colleague Tonya Stebbins about these experiences the other day and she introduced me to the concept of validation theory. Validation theory is an approach to interactions with people who have dementia that starts from the assumptions that you need to consider the emotive content of what they’re saying, rather than the informational content.  This allows you to engage with their emotional state. There’s an overview at this website, but I’m yet to dig into any literature on the efficacy of this approach. To illustrate validation theory with an example I still remember from when I was very young and we were visiting my great grandmother: When a person with dementia is worried about her young grandson getting off the bus after school, even though she’s sharing these concerns with that grandson who is actually a middle-age man visiting with his own small children, the idea is to not simply point this out to her, but to attend to the underlying anxiety that has surfaced as this particular and temporally disjunct concern. Regardless of the fact that it’s been decades since her grandson stopped going to school on the bus, taking a conversational approach that spoke to her concern would be a way to address whatever anxiety she had.  What I immediately like about validation theory is that it re-balances the onus of cooperation in the conversation. In this approach, the conversational partner without dementia is responsible for ensuring they are not failing at the maxim of relevance by attending to the implicit anxieties, worries or joys in the conversational eddies of the interaction.  Chatting to my grandmother is both one of the most normal and most challenging things. It is as once unremarkably familiar and exhaustingly surreal. I’m grateful that a linguistic perspective on conversation has given me some coping mechanisms for navigating the more surreal moments. See also: Lingthusiasm episode 11: Layers of meaning - Cooperation, humour, and Gricean Maxims Hamilton, Heidi E. (2019). Language, Dementia and Meaning Making. Navigating the Challenges of Cognition and Face in Everyday Life.  Palgrave Macmillan.

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