A positive method of managing dementia
- rooted in person-centred care to promote well-being, 24 hours a day, every day, for life
The key to the SPECAL method lies in a simple and effective way of
explaining the experience of the person with dementia
SPECAL uses the analogy of a photograph album to describe,
in a particular way, how normal memory works, the impact of ageing,
and the single dramatic change that occurs with the onset of dementia
Once we can understand what it actually feels like to have dementia,
it becomes obvious that a commonsense approach to managing the
condition is not useful
Something different is required – SPECALSENSE
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SPECALSENSE begins with a set of general principles
that apply to any person with dementia
The next step is to move from these general principles
to person-specific dementia care through the development of
an individualised Care Profile
This Care Profile has the potential to sustain
lifelong well-being for the person with dementia
SPECAL sees dementia, once diagnosed, as a disability to be managed
rather than a progressive irreversible medical condition
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We need to set aside vocabulary such as ‘remembering’ and ‘forgetting’
as these are complicated words When we say, ‘I have forgotten to put a parking ticket on my car’
we really mean ‘I have just remembered that I have forgotten to
remember to put a parking ticket on my car’ – how complicated is that?
We also need to set aside the vocabulary of ‘short-term memory’ and
‘long-term memory’. The clinical psychologist will understand short
term memory as lasting less than half a minute, yet to most of us it has
a different meaning.
SPECAL uses a simple set of vocabulary which everyone can
understand.
The SPECAL Photograph Album was documented by Penny Garner in 2001
and further described in Oliver James’s book ‘Contented Dementia’ in 2008
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The Photograph Album
SPECAL uses the analogy of a
photograph album to represent our
memory system, with individual
memories represented by ‘photographs’
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PHOTOGRAPH ALBUM
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The Photograph Album
Each of our experiences is recorded as a photograph and stored in
our album, a split second after it has happened
Each photograph has two features: facts and associated feelings
Normal photograph:
facts-plus-feelings
facts
feelings
The taking and storing of photographs is an automatic and unconscious
process going on in the background of our life, unobserved by us and
unobservable by anyone else at the time of storage…
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The Photograph Album
The album falls open quite
naturally on today’s page
That is where the latest
photographs are flying in
It is this latest information that we
must have if we are to make sense
of what we are doing, who with,
where, when, and why
As time goes by, page after page after page of new photographs builds up
Our album becomes our most valuable resource - we consult it all the time
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The Photograph Album
Every time we say
‘Let me think…….’
we are checking in our album
for the facts we need in order to
make sense of what is
happening in our life
We can turn back to much older pages to find out what happened a long time
ago, but we very rarely do this – most of the time we are on today’s page
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The Photograph Album
What happens as we age?
The actual process of taking and
storing photographs does not
change as we age
Everything that we experience
continues to be stored in our
album as photographs in the
normal way
However, we become much
slower at finding the
photographs we need
The photographs are there, but it may take us so long to find the ones we
need that, by the time we find them, they are no longer useful!
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The Photograph Album
The problems of ageing…
We may look very silly at times
and it may appear to other people
as if we are going quite dotty
We arrive at the supermarket
without our shopping list,
we have to hunt for our keys,
and so on…...
THESE ARE NORMAL AGE-ASSOCIATED PROBLEMS
AND HAVE NOTHING WHATSOEVER TO DO WITH DEMENTIA
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SO….
WHAT EXACTLY IS DEMENTIA?
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The Photograph Album
Dementia introduces a new type of photograph in our album
– we call this a ‘blank’
Dementia photograph:
a fact-free, feelings-only ‘blank’
feelings
A blank is very different from a normal photograph - it provides us with
a record of the feeling of what has just occurred in our life,
but it contains no facts
In a blank the feelings take
up all the space where the
facts would normally have
been stored
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The Photograph Album
Now we can compare a normal album to a blanking album
At first the blank represents just an occasional blip of lost factual
information…..
Normal memory pages
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Dementia pages: Stage 1
(pre-diagnostic)
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The Photograph Album
After the arrival of the first blank in the album of a person with dementia,
further blanks will follow
Randomly, intermittently and increasingly frequently over time ………….
Normal memory pages
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Dementia pages: Stage 1
(pre-diagnostic)
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The Photograph Album
Gradually, over time, the blanks build up ……..
They appear so frequently that long ribbons of blanks begin to occur….
Normal memory pages
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Dementia pages: Stage 2
(around the time of
diagnosis)
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The Photograph Album
Until the final stage of dementia, which is represented by page after page of
feelings-only blanks…..
Interrupted by an occasional, random, normal photograph that contains
both facts and associated feelings
Normal memory pages
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Dementia pages: Stage 3
(end stage)
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The Photograph Album
The SPECAL Photograph Album makes it easy to see why feelings become
increasingly more important than facts for the person with dementia…..
Normal memory pages
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Dementia pages: Stage 3
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The Photograph Album
The person with dementia has not lost their reason, merely their recent facts
They will, very reasonably, turn back to pages in their album
from the days before dementia and will try matching certain old photographs
to provide a context to what is happening in their life today
They become expert at handling their disability in this way,
and we need to listen and learn from them
Pre-dementia pages
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Dementia pages
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The Photograph Album
Common sense relies on the other person knowing what has just happened
SPECALSENSE recognises that the other person may not know the facts of
what has just happened
SPECALSENSE begins with an easy set of general principles applicable to
every person with a blanking album
The SPECAL Photograph Album
shows us why common sense is so
unhelpful
PHOTOGRAPH ALBUM
and why we need SPECALSENSE
to communicate with a person with
a blanking album
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SPECALSENSE
Three Golden Rules
Don’t ask questions
(the facts may not have been stored)
Learn from the expert - the person with dementia
(their questions are highly significant)
Don’t contradict
(don’t argue about the photographs they choose to use)
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The Photograph Album
A simple way of understanding
the disability of dementia
A crucial insight into the plight of
the person with dementia
PHOTOGRAPH ALBUM
An introduction to
SPECALSENSE
The first step to promoting
lifelong well-being for the person
with dementia …
If you would like to find out more,
please visit our website www.specal.co.uk
and read ‘Contented Dementia’ by Oliver James (Vermilion Press)
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Promoting well-being for the person with dementia
24 hours a day, every day, for life
www.contenteddementiatrust.org
The SPECAL Centre Burford, Oxfordshire OX18 4LS
Telephone: 01993 822129
e-mail: [email protected]
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This presentation is the property of Contented
Dementia Trust
and may only be used under licence
Unauthorised copying is expressly prohibited
All rights reserved
‘SPECAL’ is a registered trademark
Contented Dementia Trust is a registered Charity no. 1088247 Company limited by guarantee no. 4186558
Registered Office: Little Orchard, Broadwell, Moreton-in-Marsh, Gloucestershire GL56 0UA
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