Cormac Gallagher – Blessed are the Pacemakers – Dementia, Psychosis, and the Psychoanalytical Discourse

THE LETTER 55 & 56 Spring/Summer 2014, pages 1-11

Dementia has been described as the major mental health epidemic of the 21st century.   Yet far from being the living death it was seen as up to the 1980s, revolutionary new research, lead by Tom Kitwood, has shown that, while people suffering from the illness have undergone severe cognitive impairment, they retain a deeply subjective, visceral intelligence that allows carers to communicate with them to a degree formerly thought impossible.  Psychiatrists and psychoanalysts who work with psychotic patients have much to learn from this re-discovery of the subjectivity of dementing patients and the need to counteract the ‘malignant social psychology’ that affects both groups. In return they have much to contribute to an enrichment of ‘reminiscence therapy’ now seen as a key technique in the treatment of dementia.

Keywords: Dementia; psychosis; Kitwood; reminiscence therapy; malignant social psychology; Lacanian psychoanalysis.


This paper was intended to be a discussion on psychosis in Lacan’s L’tourdit as reread by Christian Fierens.  But it was blown off course by a chance en-counter with what, for me at least, were new ideas and research which brought back a memory that took me in an unexpected but I hope fruitful direction.

More than 30 years ago in the late 70s or early 80s, immediately after a conference like this, Oliver FitzGerald one of the princely physicians who in those days presided over most matters in this hospital buttonholed me and said challengingly:  ‘This talk about anorexia’ –  or whatever the subject of the conference was – ‘is all very well, but what are you psychiatrists doing about dementia?’

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