Mechanisms of conflict and aggression in the dementia context

Abstract

It is proposed that conflict is an almost inevitable outcome, when, as in dementia communication, the delicate relationship between linguistic processing and pragmatics is upset. This relationship has been little researched, even though much is known about the two components in isolation. Making particular use of key observations and claims from the papers in this special issue, a macro-conceptualisation of the dynamics of conflict and aggression in the dementia context is developed. It is proposed that the cognitive and linguistic processing problems experienced by a person with dementia (PWD) can undermine her capacity to manage her spoken output in the way necessary to match the situational pragmatics, resulting in failure to achieve her interactional goals. The mismatch will create internal dissonance that may be expressed as aggression. Importantly, caregivers will also experience dissonance when their communicative agenda is not fulfilled. This may happen when their expectations of the situational pragmatics (e.g., old versus new information) are contradicted by the behaviour of the PWD. Here too, the dissonance may result in aggression or conflict. Modelling the mechanisms of ‘Communicative Impact’ (CI) offers a way to capture the relationship between processing and pragmatics and to examine how speakers attempt to resolve the dissonance. The CI model gives insights into how the risk of conflict in interaction between people with dementia and their caregivers might be minimised.

Formulaic Sequences as a Regulatory Mechanism for Cognitive Perturbations During the Achievement of Social Goals

“…However, repairs that draw on an incomplete or compromised system (as with both people with dementia and language learners) may well be nonoptimal, and thus unintentionally create confusion. Since confusion directly impacts the contextual environment within which subsequent speech events occur, pragmatic disruptions affect the communicative effectiveness of both the impaired and unimpaired party (Wray, ). It is for this reason that formulaic language is considered both beneficial and damaging to effective communication in challenging circumstances.…”

“…To put it another way, a preemptive fix may be so effective as to be absorbed into the fabric of the message—creating an alternative reality. This may create confusion and stress for the hearer (Wray, , , , , ).…”

“… The Communicative Impact model is complex and, in its entirety, entails consideration of many different theories and lines of evidence. Aspects of the model relating to the management of conflict in dementia care are outlined in Wray (). …”

Communication Empowerment Framework: An integrative framework to support effective communication and interaction between carers and people living with dementia

“…In dementia, communication is a significant casualty ( Wray, 2018 ), with associated impact on the mental health of carers ( Watson et al., 2012 ). The intricacies of effective communication, easily disturbed by changes in language patterns and relationships, are further undermined by the conflicts arising from unmet goals, as laid out in PCT.…”

“…This article maps the broader context of interaction, by demonstrating the main determinants of communication breakdown or challenge, and how they might be addressed in practice. Three existing models are integrated: Mentalization Theory (Fonagy, 1991;Fonagy & Target, 1997), Perceptual Control Theory (PCT) (Powers, 1973) and the Communicative Impact model (Wray, 2016). All three have in common the reciprocity of effective engagement with others.…”