Received: July 18, 2022; Published: August 01, 2022
Corresponding author: Arpita Ghosal, Research fellow/Psychologist, Department of Psychology, Middlesex University, UK
If we want to understand the psychological impact of Alzheimer, then we need to explore our understanding of Alzheimer’s existence in a patient’s life and its threatening features. An Alzheimer affected patient not only compromise and challenge their identity and independence but are also threatened by social isolation and loose the purpose and meaning in life. James , argued that among older people, diagnosed with Alzheimer fear is greater than diagnosed with cancer fear. Therefore, this essay will focus on the meaning, existence and the potential threat in human’s life with Alzheimer’s.
Degenerative brain disease like Alzheimer’s has predominant effect on cognitive functions like language and memory. According to Alzheimer’s Association , brain scan is able to detect any changes in the brain that can lead to Alzheimer’s even fifteen years before the symptoms are present. Alzheimer’s can be diagnosed as vascular or major and mild. Noticeable symptoms under mild Alzheimer’s are difficulty in transferring thoughts into speech, unable to recall recent affair and familiar locations, difficulty in coordination like writing. With the progression of the symptoms major confusion emerged, noticeable extreme mood swings, further deterioration in remembering, physical symptoms like mobility and bowel control become difficult. There is no cure for Alzheimer’s, however, medication can support to slow or reduce the symptoms.
In the diagnosis and treatment of Alzheimer’s, Psychiatry has been utilised due to increasing cognitive deterioration. According to Lebowitz & Evans , many professionals believe that Alzheimer’s should not be considered under mental health but under brain disorder. As the early symptoms often categorised symptoms under mental health disorders, patients generally start their treatment under psychiatry unit. Moreover, Regan , argued that disorders like depression, anxiety and psychosis has high volume of comorbidity with Alzheimer’s. According to Burgener & Berger , patients with Alzheimer’s reported feeling of extreme stigmatisation and shame compared to other patient with neurocognitive disorder and cancer. Kontos , stated that Alzheimer’s patient often feels the loss of dignity and they often hide the diagnosis until the progression of disease makes it difficult to hide . The caregivers and families also expressed the feeling of stigmatisation and shame by the association of Alzheimer’s . After the diagnosis of Alzheimer’s, patient often lost the purpose of their life not only because of the symptoms but the stigmatisation too.
According to Yalom , death, existential isolation, freedom and meaninglessness, these are the basic four concerns that have greater influence on all people’s life. He also stated that we often neglect these above-mentioned elements, however they are still influential and pervasive on our lives . Yalom attempted to explain these elements as ultimate concerns. Despite the fundamental human desire to remain exist in the world, death is inevitable fact that we all aware of . The strain between realisation the desire to continuing living and inevitable death is the central existential conflict. Lack of external structure referred as freedom from existential view. It’s absurd that despite individual’s daily experience, humans refused to reside in wellstructured and ingrained designed universe. Instead, he decides to be total orchestrator of his own chosen world, choices, actions and design. From existential view there is no ground beneath us for freedom and it implies terrifically. In this sense, the key part of existential dynamic is the conflict between our desire for structure and ground and our encountering groundlessness. The conflict between our realization of uncertainty and lack of support and self-determination aspiration decides human’s reality of freedom. This sense of freedom comes when human realise that the things happening in their life is up to themselves.
Isolation is the ultimate concern according to Yalom . From existential perspectives, this kind of isolation is not related to intrapersonal such as isolation from oneself and interpersonal such as loneliness. In existential sense, it considered as fundamental isolation where we realise, we are on our own no matter how close we are from other person. We are alone when it comes to our existence in the world and exit from it. Therefore, this existential conflict is the desire of protection, contact to be included in the larger group and the realisation of our absolute fundamental isolation . The fourth concern which is meaninglessness, is the accumulation of other three realities. Life tends to be considered as meaningless when death is only certainty of life in this world where there is no such thing to be considered as absolute truth. To formulate the meaning in life, human cling unto concepts and values. According to Yalom , essentially life will be meaningless if we become fundamentally isolated, if our world will be constituted by ourselves only and if death become inevitable. Yalom  also stated that the dynamic of existential conflict emerged when meaning seeking creature put into a meaningless world. We can argue that all human being experiences these existential realities in one way or another. However, few people experience these existential threats in profound manner and people with Alzheimer’s are one of such group.
According to Baldwin and Capstick , Alzheimer is person’s existential plight and it’s not a problem that can be managed through technical speciality. Alzheimer has considered not to be a brain illness but a disorder of the whole person . Alzheimer can be considered as an element of existential threat due to its social and health related problems and deteriorating condition leading towards death . Changes in biographical factors (changes related to old age) has been experienced by Alzheimer’s patients. Some Alzheimer’s patients experience their illnesses with mostly past supported and unblemished mechanisms and some experience the illness through disheartening and diminishing sequence of changes with the decline of their personal resources in greater manner. These personal resources are developed by the person inherently including every aspects of social learning such as our strategies to manage loss, crisis, modifications, defence against anxiety or stress and willing to accept help from others . Alzheimer’s patients’ sense of safety, value and personal being could be diminished or enhanced by the element that made through the social psychological factors of everyday life. According to Kitwood , under the purview of ‘malignant social psychology’, these have been framed and encountered such as disempowerment, treachery, condemnation, infantilisation, stigmatisation, intimidation, invalidation, objectification, outpacing and banishment .
According to Cheston , Alzheimer’s is an existential threat, patients’ existing self-concept deny any smooth adjustment into them. He also stated that Alzheimer patients threatened cognitive ability loss could be an influencing factor to understand their self-esteem and the way they see the world . He further argued that existential realities are very prominent, and they are evidenced through subjective experience among Alzheimer’s patients. Alzheimer’s patients often seek for purpose and meaning in life, seek for attachment and suffered from identity loss Steeman , Caddell and Clare , Caddell and Clare . This can be considered as their coping mechanism to absorb from encountering existential realities. Many researchers suggested that there can be adverse effects of existential threat on person’s meaning in life, selfesteem, social connections, affect and general wellbeing. Similarly, we can argue that Alzheimer as an existential threat potentially has similar effects on patients with such disorder . Moreover, several research suggested that after the diagnosis of Alzheimer with early stages, has profound psychological impacts on patients’ purpose or meaning in life, self-esteem and general psychological wellbeing [14,17].
As an existential threat, patients with Alzheimer often experience adverse psychological impacts on their general psychological wellbeing, social connectedness, threats to identity, purpose and meaning in life [18,19]. Consequently, Alzheimer’s patients recall past events as a mechanism to cope and buffer these psychological effects of Alzheimer [20,21]. To provide psychological function to Alzheimer’s patients, some conventional approaches have been employed such as life review activities that have been used in the past as a way to understand the present. However, these activities are questionable due to their efficacies . For instance, some systematic reviews and randomised controlled trials stated that these approaches can be beneficial for the psychological wellbeing of Alzheimer’s patient. And some research denied this concept [23-26]. Resulting from memory decline in Alzheimer and merging past events stimulates the positive image, accomplishments and pleasure to boost self-esteem and self-concept among patients with Alzheimer . If the recalling past events deliberately evoke nostalgia, then it cannot be an ideal way to improve or enhance psychological wellbeing effectively of patients with Alzheimer.
On another note, nostalgia as a buffer against existential threat has been proposed psychologically [28,29]. According to Juhl et al. , in a study, participants with less nostalgia proneness exhibited significantly low positive signs towards death anxiety, identity threat, low social connectedness, low self-esteem, low affect and low meaning in life. Research supports that nostalgia enhances the existential and psychological function by supporting the sources of life experiences that are meaningful which people use as defend strategy against death concern (existential threat) . According to Routledge et al. , experimental study with undergraduate students as participants, revealed that induced nostalgia enhanced the positive mood, self-esteem, meaning in life, social connectedness as a comparison with normal autobiographical memories. However, similar desirable psychological functions with the use of nostalgia among Alzheimer’s patients are not very clear because it has not been tested on Alzheimer’s patients’ population.
The process of formulating the meaning of inevitable threat or despairing event by human is explained by existential psychology. To restore the psychological balance, various mechanisms applied by individual against their existential threats. According to Dröes et al. , the important aspect of wellbeing is the purpose and meaning of life and that is greatly appreciated by Alzheimer’s patient. According to Robertson, research highlighted the fact that even in the progression of cognitive decline Alzheimer’s patient engage in the process of meaning making to convey the important message as part of their communication regarding life. In order to concur the diagnosis, usually Alzheimer’s patients are in search for meaning and purpose in their lives [18,19]. According to Steeman et al. , this search of meaning is often linked with identity establishment among patient with Alzheimer’s. Cognitive decline is one of the main symptoms in Alzheimer’s. Research found the association between cognitive decline and decline in the aspects of wellbeing, importantly purpose and meaning in life. Moreover, meaningful purpose in life at advanced age among Alzheimer’s patient, is associated with the reduction of pathologic changes effect due to cognitive decline. Existential functions serve great purpose in life is supported and evidenced by Longitudinal studies Boyle. Reduction of risk of disability, mortality, cognitive impairment and Alzheimer’s disease are significantly associated with meaning and purpose in life among older adults who live in [31-69].
We can conclude this with the belief that many important elements are present to reframe Alzheimer’s as existential threat. It is helpful for many researchers to discuss some interesting possibilities. For health care professionals, it helps to think in new ways about supporting and engaging to distressed patients with Alzheimer’s. Moreover, this discussion may support the coping strategy by understanding the possibilities of the existential threat that faced by patients with Alzheimer’s.
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