From History to Intervention

Identifying Stigmatizing Language Used by Israelis and Germans With a Mild Neurocognitive Disorder, Their Relatives, and Caregivers of People With Alzheimer’s Disease

“…A recent study by Stites et al 36 using vignette methodology showed that the availability or no availability of disease-modifying treatments was not related to public stigmatizing beliefs, suggesting that trying to reduce medical futility might not be enough to reduce fatalistic beliefs and feelings of hopelessness. We suggest that to reduce the use of stigmatizing language reflecting that “nothing can be done” theme, there is a need to move away from a frame that stresses finding a cure for the disease as the ultimate and only aim of a frame that recognizes risk reduction and prevention 2 . and especially care-giving.…”

“…The tragedy discourse is based on language that expresses distress and suffering, and it is characterized by catastrophic depictions of a disease and those living with it. The biomedical discourse concentrates on the pathologic aspects of a medical condition, focusing mostly on the treatment or cure of the condition rather than on the autonomy and personhood of the individual with it 2 . The second way includes using typifying nouns that place the medical condition upfront rather than stressing the person’s identity and wholeness.…”

“…The third type of stigmatizing language includes the use of derogative or pejorative words and phrases that hurt, insult, or disparage the person with the condition. This type of language is associated with inaccurate, unbalanced, disrespectful, and inflammatory language, such as “He’s crazy,” “He’s off his rocker.” 2 Finally, militaristic metaphors that use figurative language to describe a condition and those with it as being in a war situation may increase stigma because of their masculine, paternalistic, and violent representations 3 …”

Like beauty and contact lenses, the meaning of dementia behavioral changes is in the eyes of the beholder

“…Recent studies have started moving away from an understanding of BPSD as a series of pathophysiological changes in the brain to the recognition that it involves a complex interaction between biological, psychological, and social factors (Werner et al, 2022). Today, three main models are used to explain BPSD: (a) the unmet needs model (also called the need-driven, dementia-compromised behavior model) conceptualizes BPSD as the manifestation of distress provoked by physical or psychological needs (such as pain or loneliness) that the person with dementia is unable to communicate and satisfy, often as a result of caregivers' inability to understand them (Cohen-Mansfield, 2000); (b) the behavioral/ learning model postulates that BPSD is the result of a conditioning process emerging in response to environmental triggers, especially caregivers reinforcing disruptive behavior This model led to the development of the Antecedent-Behavior-Consequence (A-B-C) approach for the management of BPSD which seeks to identify and reduce the antecedents by providing adequate responses; (c) the environmental vulnerability/reduced stress-threshold model explains the manifestation of BPSD as a reaction to discrepancies between the needs and capacities of the person with dementia and the over-or understimulating environment (Cohen-Mansfield, 2000).…”

“…Language shapes the way we conceptualize, perceive, and feel the world and other people. The choice of language or terminology we use can either empower or undervalue the identity, self-esteem, and behavior of a person, and intentionally or unintentionally generate or perpetuate the stigma ascribed to a person or a group with a disease or disability (Werner et al, 2022). This is especially true in the case of BPSD.…”