Strangers in unfamiliar environments: Struggles for subjectivity in a dementia care ward

During fieldwork on dementia care in a nursing home, I was struck by the complex and layered orderings of space, time and subjectivity in daily life on the wards, and the struggle this implied for people with dementia.

On her ‘daily rounds’ strolling through the nursing home ward, Mrs Hansen repeatedly expressed great relief and pleasure on meeting a familiar face, and hopefully also a friend, on her way. “What a surprise!” she would exclaim. “Fancy meeting you here! What a coincidence! Puh, I am so pleased to meet you! Where are you going? What’s your errand?”

As our conversations unfolded, she would reveal that she herself was on her way to visit someone, a family member or friend. She would then inquire about me: How come we were travelling on the same bus or ferry? Did I have origins or connections in the area or community we were passing through or travelling to?

Although we in (at least) one sense shared the same space – to my mind the typical institutional layout of a nursing home ward (long corridors with individual residents’ rooms, collective living rooms and the necessary facilities for bodily care work) – there were obviously different spaces and different times being enacted at the same time. What was going on?

Mrs Hansen would be seated on a bench running along the wall, in waiting mode, in a corridor or a public living room. This was not very different from the typical situation of the ferries that transport people across the fjords in Norway. People appear, either to enter and sit down with the crowd of passengers or to perform some work, and after a while they leave again, probably to get off and get on with their different errands. There is no obvious shared purpose or connection among those present, except for the fact that they all happen to find themselves in the same transitional situation.

Mrs Hansen found herself to be among strangers. A stranger in an unfamiliar environment. No wonder she was struggling to make sense of where she was and how to move and behave herself acceptably. Garfinkel and Sacks’ renowned work on what it takes to “do being ordinary”, i.e. passing as normal and competent, comes to my mind.

But ordinary according to what? If someone in such a public space were to behave in a more private manner, for instance by lying down on the couch or putting their feet up on the table or chair in front, this would likely call for reactions. It would be interpreted as a transgression: this is not your home!

Mrs Olsen, however, inhabited the collective space of the ward in a quite private way. She was a pastor’s wife and had spent much of her life caring and catering for other people’s needs. She was always alert and ready to assist in laying the table, making tea or coffee or lending a helping hand. If it was late and dark and cold outside, she would fetch a blanket and a cushion and offer fellow residents or carers to stay over and sleep on the couch. To her, the ward was home, her fellow residents were her guests, and the kitchen and living room were arenas where she could take part in caring for others. As such, they offered Mrs Olsen access to familiar and recognized subject positions. This resonated with a more recent discourse that the nursing home was trying to accommodate: reinventing the institution as a home.

Even if the architectural and material premises of the nursing homes I visited as a researcher were older and shaped by other ideas than the most recent discourse in care policy, furnishings as well as practices and relations on the ward had been and were being mobilized to make things more home-like. Residents’ rooms were being redefined as private spaces and residents and their families were encouraged to bring private furniture, photos and other objects that could create a sense of home.

The objects that most often accompanied residents into the ward were photos. This applied to Mrs Hansen and Mrs Pettersen, who could often be spotted in the corridor waiting for their partners to visit. They were watching out for a handsome young man, a fiancée or husband. Individually, they would invite the carers and myself into their rooms to show us their pictures and recall their stories. They would show photos of elegant young couples or young men in uniform.

Along with historical photos decorating the corridors, these private photos continued to enact a life and a time past, right in the middle of the here-and-now of life on the ward. The only thing missing seemed to be the handsome young men, who still hadn’t shown up.

Ingunn Moser is rector and professor of sociology and social studies of science, technology and medicine at VID Specialized University in Oslo, Norway. Her research is centred on relations between subjectivity, embodiment, materiality, different knowledge practices, and normativities. These theoretical interests have been explored in empirical fields ranging from disability to care for the elderly and dementia care in particular. Her current projects focus on telecare technologies and care service development for people living at home, and on the transition to the home as the preferred arena for future health and social care service provision. She is co-editor of an edited book on ways of home-making in elderly and end of life care, with Bernike Pasveer and Oddgeir Synnes, forthcoming with Palgrave 2019.

This post is a contribution to ‘Daily life’ in the Somatosphere series ‘Thinking with dementia.’

Read the next story in the series here. 

Read the refraction of the theme here.

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