Dementia as an Existential Threat

  • Richard ChestonEmail author
  • Gary Christopher


A diagnosis of dementia threatens not only many of the core aspects of what it is to be human, but leads, through a progressive deterioration, to death. Dementia thus represents an existential threat that creates profound emotional and psychological challenges for those who are directly affected by the illness. In this chapter, we argue that the psychological threat dementia represents needs to be viewed within the context of research from social psychology, and in particular Terror Management Theory (TMT). TMT proposes that humans experience a basic psychological conflict that results from having a self-preservation instinct on the one hand while on the other hand also knowing that death is inevitable. As a way of managing the distress that would otherwise arise from this knowledge, a series of defences operate to build psychological resilience and to reduce or to eliminate awareness of death. These defence strategies include the person investing themselves in religious and cultural belief systems which hold the possibility of spiritual immortality, as well as internal psychological processes such as repression and avoidance. We explore how the TMT framework might help us to make sense out of the experiences of people living with dementia.


Dementia Terror management theory Existential threat Identity Self Defence mechanisms 


  1. 1.
    Kessler, E., Bowen, C. E., Baer, M., Froelich, L., & Wahl, H. (2012). Dementia worry: A psychological examination of an unexplored phenomenon. European Journal of Ageing, 9(4), 275–284. Scholar
  2. 2.
    Ouimet, M. A., Dendukuri, N., Dion, D., Beizile, E., & Elie, M. (2004). Disclosure of Alzheimer’s disease: Senior citizens’ opinions. Canadian Family Physician, 50(12), 1671–1677.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Bamford, C., Lamont, S., Eccles, M., Robinson, L., May, C., & Bond, J. (2004). Disclosing a diagnosis of dementia: A systematic review. International Journal of Geriatric Psychiatry, 19(2), 151–169.CrossRefGoogle Scholar
  4. 4.
    Pinner, G., & Bouman, W. P. (2003). Attitudes of patients with mild dementia and their carers towards disclosure of the diagnosis. International Psychogeriatrics, 15(3), 279–288.CrossRefGoogle Scholar
  5. 5.
    Albinsson, L. (2002). A palliative approach to dementia care: Leadership and organisation, existential issues and family support, Comprehensive Summaries of Uppsala Dissertation from the Faculty of Medicine, 1196.Google Scholar
  6. 6.
    Albinsson, L., & Strang, P. (2002). A palliative approach to existential issues and death in end-stage dementia care. Journal of Palliative Care, 18(3), 168–74.CrossRefGoogle Scholar
  7. 7.
    Albinsson, L., & Strang, P. (2003). Existential concerns of families of late-stage dementia patients: Questions of freedom, choice, isolation, death and meaning. Journal of Palliative Medicine, 6(2), 225–235.CrossRefGoogle Scholar
  8. 8.
    Solomon, S., Greenberg, J., & Pyszczynski, T. (2015). The worm at the core: On the role of death in life. London: Allen Lane.Google Scholar
  9. 9.
    Becker, E. (2007). The Denial of Death. Simon and Schuster.Google Scholar
  10. 10.
    Greenberg, J., Pyszczynski, T., Solomon, S., Rosenblatt, A., Veeder, M., et al. (1990). Evidence for Terror Management Theory II: The effects of mortality salience on reactions to those who threaten or bolster the cultural worldview. Journal of Personality and Social Psychology, 58, 308–318.CrossRefGoogle Scholar
  11. 11.
    Harmon-Jones, E., Greenberg, J., Solomon, S., & Simon, L. (1996). The effects of mortality salience on intergroup bias between minimal groups. European Journal of Social Psychology, 26, 677–81.CrossRefGoogle Scholar
  12. 12.
    Nelson, L. J., Moore, D. L., Olivetti, J., & Scott, T. (1997). General and personal mortality salience and nationalistic bias. Personality and Social Psychology Bulletin, 23, 884–92.CrossRefGoogle Scholar
  13. 13.
    Alicke, M. D., & Sedikides, C. (Eds.). (2011). Handbook of self-enhancement and self-protection. Guilford Press.Google Scholar
  14. 14.
    Greenberg, J. (2008). Understanding the vital human quest for self-esteem. Perspectives on Psychological Science, 3(1), 48–55.CrossRefGoogle Scholar
  15. 15.
    Greenberg, J., Pyszczynski, T., & Solomon, S. (1986). The causes and consequences of a need for self-esteem: A terror management theory. In Public self and private self (pp. 189–212). Springer, New York, NY.Google Scholar
  16. 16.
    Kitwood, T. (1997). The concept of personhood and its relevance for a new culture of dementia care. Care-Giving in Dementia: Research and Applications, 2, 3–13.Google Scholar
  17. 17.
    Kitwood, T. M. (1997). Dementia reconsidered: The person comes first. Buckingham: Open University Press.Google Scholar

Copyright information

© The Author(s) 2019

Authors and Affiliations

  1. 1.Department of Health and Social SciencesUniversity of the West of EnglandBristolUK

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