‘The problem with Leonard’: A critical constructionist view of need-driven dementia-compromised behaviours

This critical constructionist case study of ‘Leonard,’ a man with frontotemporal dementia living on a special care unit predominantly populated by people with Alzheimer’s disease and related dementias, explores how healthy others’ perceptions of the prevailing physical and psychosocial environment were influenced by Leonard’s behaviour which, in turn, was influenced by people’s perceptions of him as a ‘problem’. Data were obtained through participant observations, individual interviews with staff and residents, and focus groups with family members and nursing staff. Leonard’s ‘needs-driven dementia-compromised’ behaviours are not recognized as such by many of the healthy others with whom he co-creates his psychosocial environment; rather he is constructed as deviant, which undermines his selfhood as well as his quality of life. Education of staff and family members as well as broad organizational change is needed to address the issues underlying the problems for which Leonard is blamed but instead arise largely from the environment within which Leonard is situated.