Abstract
In some conversations involving persons with Alzheimer’s disease, the participants may have to deal with the difficulty that they do not share a common ground in terms of not only who is alive or dead, but even more, who could possibly be alive. It is as if the participants face a reality disjunction. There are very few empirical studies of this difficulty in conversations involving persons with Alzheimer’s disease or other kinds of dementia diagnoses. Often studies of confabulation have a focus on the behavior and experience of the healthy participants, but rarely on the interaction and the collaborative contributions made by the person with dementia. In the present article, we discuss various strategies used by all participants in an everyday conversation. The material consists of an hour long everyday conversation between a woman with Alzheimer’s disease and two healthy participants (relatives). This conversation is analyzed by looking at the organization of the interaction with an emphasis on how the participants deal with instances of reality disjunctions. The result from the analysis demonstrates that both the healthy participants as well as the person with dementia together skillfully avoid the face threats posed by reality disjunctive contributions by not pursuing argumentative lines that in the end might jeopardize both the collaborative and the personal relations.
Introduction
An older woman – diagnosed with Alzheimer’s disease (AD) – is having coffee with her daughter and daughter-in-law. In their conversation, the old lady repeatedly talks about and refers to her parents as if they still are alive (she herself is 87 years old). Both younger women object and explain that the old lady’s parents are dead and that they cannot logically be alive given what we know about normal biological life expectancy. As if she is summarizing the discussion, the old lady says, “so they are not alive?”, still not convinced.
The difficulty in conversation that all three participants must deal with is that they do not share a common ground in terms of not only who is alive or dead, but even more, who could possibly be alive. That is, it is not just a question about knowing facts – who is alive or dead – but also about existential presuppositions: given that the participants jointly assume that they live in and talk about the same world, what counts as possible events in this world (cf. Levinson, 1983). It is as if the participants face a reality disjunction with many implications: (i) the insight that they do not have a common ground although they assumed that they had, something that may affect their relations and view of each other; (ii) the further insight that one participant obviously does not share their fundamental existential presuppositions and thus stands outside their shared world; (iii) pointing out and discussing the reality disjunction might imply a severe, face threatening, criticism of the participant holding a deviant view; (iv) the participants must deal with the reality disjunction in a practical way, presumably without ruining the ongoing conversation and their relations.
Conversations involving reality disjunctions are not uncommon when one participant have a dementia diagnosis (Morris & Becker, 2004). It is disheartening and difficult conversations for all participants and often results in what has been called a “communicative breakdown” (Orange, 1995; Small, Geldart, & Gutman, 2000).
One of the reasons for the difficulties is that persons with a dementia diagnosis, especially AD, will face problems with finding words, constructing utterances and finding references to episodic and autobiographical memories (Morris & Becker, 2004). Both persons living with AD as well as significant others often try to find ways to deal with these challenges. One way for persons with AD can be to either put in a word, a name or a “memory” that is like the one they cannot find (Hydén & Örulv, 2009; Örulv & Hydén, 2006). Although this is a creative strategy, it often results in interactional problems with other participants in conversations, and at least two problems may occur in the interaction. First, the person with AD tells about an experience that the other person claims did not happen. That is, the interlocutors are faced with what the ethnomethodologist Pollner called a reality disjunction: two persons present two contradictory experiences of the world that both claim are true (Pollner, 1975, p. 411). The disjunction challenges the common ground of the conversationalists and they must deal with this challenge: they think they are living in, and talking about the same world – but are not. The interlocutors must negotiate to find a solution to this problem and thus place themselves in a shared world again.
Second, arguing that the person with dementia is making up things would imply questioning the status or the personhood of him or her, and would also imply actively questioning the face of the person. At the same time, not arguing against the person with dementia but accepting something that does not seem right could potentially challenge the status of the healthy participant – not least in his or her own eyes. So, a situation involving reality disjunction might threaten the faces of all participants, implying that they can work together to minimize these threats to their faces and sustain their relation (Goffman, 1967). In this way, a breakdown of communication could be avoided and relations and interactions could be sustained.
As far as we are aware, there are very few empirical studies of this frequent problem in conversations involving persons with AD or other kinds of dementia diagnoses. Often studies of confabulation have an emphasis on the behavior and experience of the healthy participants (see for instance, Lindholm, 2015; Tallberg, 1999), but rarely on the interaction and the collaborative contributions made by the person with dementia. Thus, in the present article we will discuss various strategies used by all participants – a woman with AD and two healthy participants (relatives) – in an everyday conversation. The ambition is to point out and describe the face-work that is going on in the interaction, both by the woman with dementia and the other healthy participants. The analysis is based on the concepts of common ground and reality presuppositions and disjunctions (Clark, 1996; Levinson, 1983; Pollner, 1975), and how participants manage reality disjunctions without losing face.
Common ground and confabulations
Conversations are dependent on the participants being able to remember, access, “retrieve” and use their common ground. In conversations, participants share assumptions about each other’s knowledge concerning the situational, biographical and cultural knowledge (A knows that B knows that A knows X; B knows that A knows that B knows X; X thus belongs to their common ground). Common ground can be viewed as a set of knowledge that each participant represents individually, although from an interactionist perspective, it also entails the shared assumptions participants have about each other’s situational, biographical and cultural knowledge. Common ground is thus not just about cognitive representations, but also about normative expectations.
Family members or other persons who have known each other for a long time might assume that the other participant knows and is familiar with their shared life and experiences: the identity of family members and friends, date of birth of family members, first time they met, what they usually do on Saturday nights, etc. Having a common ground, one spouse can for instance tell a story about the first time the couple met, i.e. something she can assume and expect to belong to their common ground, and expect the other spouse to either (tacitly or explicitly) acknowledge the correctness of the assumption.
Accessing and using this common ground is what becomes a challenge for the person with AD, as one of the primary symptoms is problems with working and episodic memory, and later also semantic memory (Morris & Becker, 2004). Thus, what assumptions to make and what to expect become less evident, and consequently it becomes more difficult to use the common ground as a resource. The person with dementia will face increasing challenges using the situational common ground, that is, to remember what has been said previously in the ongoing conversation. The person with dementia will also be challenged in referring to the social and cultural common ground, as it will be increasingly difficult for him or her to recognize generally known persons, dates and places.
Over time these challenges and problems will increase and involve most areas of everyday life, and both the person living with AD as well as other participants will try to find ways to deal with the challenges to common ground. One way to do this is for the person with dementia to find the “facts” (dates, names, persons) and stories (events) as well as words that will fill the gap of those “facts”, stories and words not accessible. This strategy may be effective in the sense that potential gaps in the slots attributed to the person with dementia in the turn-taking activity, can be filled. Thus, the silence following on an inability to fulfill the expectation of a designated slot may be avoided. On the other hand, other conversational participants may become confused or even affronted as the person with dementia – according to them – obviously is mistaken about identities of persons, or treating long-dead persons as being present, or telling about events that never has taken place or is telling about experiences that the teller never had.
When describing situations involving confused identities, it is often tempting to adopt a third person perspective, that is, to describe what is going on in the interaction by categorizing these actions as symptoms of dementia, for instance, as a case of confabulation. In the broad sense, the term confabulation has been used about false narratives or statements about world and/or self, due to pathological mechanisms or factors, but with no intention of lying (for a review, see DeLuca, 2000; Berrios, 1991, for an overview on the conceptual history). Confabulation provoked by questions in conversations or interviews often consists of what is described as temporal displacements, that is, persons and events are placed in the wrong temporal context (DeLuca, 2000). Confabulations could also be approached from a functional perspective, focusing on the positive, adaptive or productive aspects of the meaning of confabulation (cf. Örulv & Hydén, 2006; Weinstein, 1996; Weinstein, Kahn, & Malitz, 1956).
To describe how persons engaged in interaction deal with radically different experiences of the world it would be of less interest to argue who is right or wrong, but rather to describe and understand how the participants deal with a situation where the basic perception and experience of the world comes into question – that is, to use a second person perspective (Schilback et al., 2013). One way to conceptualize the problem the participants face is to use the term reality disjunction, a term introduced by Pollner (1975): In the full-fledged disjuncture, each participant treats his experience of the world as definitive (…). If consensual resolution is to be achieved, one of the protagonists will have to abandon the use of his experience as the incorrigible grounds of further inference. (Pollner, 1975, p. 419)
The radical disjunction between positions is of course severely face threatening for the person being accused of not being able to perceive the world correctly, but it is also a very aggressive act to accuse someone of being unable to perceive the world correctly and thus also the accuser might lose face (Goffman, 1967). For this reason, both participants might become involved in what Goffman calls “face work”, that is, attempts to repair and sustain face (Goffman, 1967).
Material and methods
The analyzed material is part of a larger ethnographic study, and the present study is a single case study of an older woman with dementia (M) living in a residential home. The woman has her own small apartment with a kitchenette. Data consist of video recordings of a visit by two relatives (S and B), total time 1:20:14. The researchers arranged the camera and started the video recording in the woman’s apartment and then left the room. There are no indications in the recording that the participants noticed or commented the video recording equipment or activity.
All material was transcribed in accordance with Conversational Analytic (CA) conventions (Ochs, Schegloff, & Thompson, 1996). Each line of original language (Swedish) is followed by a translation into English, marked by italics. The recordings were watched and listened to repeatedly and subsequently transcribed. CA informed the present study in terms of it being driven by “unmotivated” looking (Sacks, 1984), and it was during viewing, listening to, and transcribing recordings, that potentially face threatening sequences were identified and singled out as interesting for further scrutiny.
To identify sequences involving troubles that could be characterized as involving reality disjunctive contributions in the interaction, a first step was to identify instances of interactional trouble, that is, occasions when one of the participants (either the talker or the listener) indicates that something is problematic in the ongoing interaction. Some of these sequences were judged to involve reality disjunctions. These instances were followed by sequences similar to what is called interactional repair sequences (Schegloff, Jefferson, & Sacks, 1977). The aim of these sequences is to deal with the interactional troubles in face saving ways. A criterion for categorizing a trouble and repair sequence as involving disjunctions was that it seemed disjunctive either from what has been said earlier in the conversation or from what could be expected with respect to probability and possibility.
Results
The analysis revealed that the identified instances in the material involving reality disjunctions could be classified into three different types:
reality disjunctions connected to hearing problems; reality disjunctions connected to working memory problems; reality disjunctions originating from challenges to autobiographical memories and episodic memories.
The first two types were generally found in second positions, that is, when the person with dementia attempted to understand a contribution from the healthy person; the third type were found when the person with dementia made a contribution (first position), for instance told a story. These three types will be discussed in the following text.
Troubles originating from hearing problems
Although the interactional troubles we are discussing here are related to identifying the reference of names or pronouns, or identifying the names of persons, some of these troubles appear to be related to hearing problems. In the material M, the person with AD also has a distinct hearing problem manifesting itself as a problem hearing certain words. Because of this, she must either initiate a repair sequence requesting a repetition or she could substitute a word herself. Finding a substitute word implies activating a set of relevant lexical possibilities and then choosing one of these words and using it in the utterance. Potential problems then are to choose a set of relevant lexical possibilities and then a specific word.
The three participants have been talking for about 10 minutes, mainly about the event of the daughter eating with her workmates. The following sequence emanates from a passage where the participants have been talking about the village where they all come from, and where the event with the dinner with the workmates is also taking place, and S is talking about a man who came from that village, and whom they all have knowledge.
In this example, the
The fact that S indicates that something is wrong with M’s utterance (line 285) can be supported by at least circumstantial evidence. The first is that the word choice lacks a semantic connection to S’s word “stan”. Second, it is apparent from the preceding discussion that the man is quite old. Further, both M and S are familiar with the man they are discussing, and they are discussing him on M’s initiative. Thus, S’s singling out of M’s utterance as a trouble source has to do with the fact that it challenges their common ground: given that they both are familiar with the man in question M’s lexical choice is unexpected and out of line with their shared knowledge. M’s utterance is further strange because it violates some of the specifics of their common ground – the man is old and could thus not be expected to live on his own with a child – and could be seen as a repair attempt that involves a reality disjunction.
When S corrects M, this could be treated by M as a threat to her face. Interestingly, she backs down from her suggested word (“barn”) by just saying “jaha”, without commenting her mishearing or suggested word. M does not correct herself, but just leaves S’s repair without comment.
Another possible hearing problem is demonstrated in Example 2. It is taken from the beginning of the visit, as M initiates a conversation by asking S about her work. S telling about going out with her workmates to thank a colleague who is retiring.
Obviously, M has a hearing problem like the one in Example 1, something she indicates (line 38), and S repeats her utterance (with a minor elaboration). M has difficulties in hearing, and on line 43 M possibly hears the “tacka” in “avtacka” as “pappa”, which also are quite similar in number of syllables, and in the syllable structure with consonant-vowel sequence (CVCV) and the same vowel in between. M’s choice of word is again semantically strange: the ladies were not talking about M’s parents, neither does “daddy” fit with S’s utterance. This possible mishearing gets corrected by S in the adjacent turn; however, in this short sequence, this correction is followed by a pause and it is not confirmed by M. M then suggests another possibility instead of “pappa” (daddy): on line 48 she suggests that it is S that should be “thanked” (“you instead”). When S continues her explanation, M then confirms her understanding also by prosodic means (line 52), and the sequence ends with an acknowledgment by S (line 53).
This proposed version of S’s utterance, where “thank” is possibly replaced with “daddy”, is like the mishearing in Example 1 where the selection of a replacement word is taken from a set of words that is too wide but has phonological resemblance. The selection of the word “daddy” flouts what M and S know, since both M’s dad and her husband, which M also sometimes refers to as daddy, are dead a long time ago. This is confirmed by S who directly treats M’s suggested replacement word as a trouble source and corrects it in the same way as she did in Example 1.
Many mishearings in this material follow a similar pattern: (i) M cannot hear a word and must find a substitute word. (ii) She selects the substitute word from a set of words that is too wide and consequently contains potential substitute words that are unlikely. (iii) As M’s selected words are unlikely, because they are not updated in terms of the participants’ common ground (in this case, who is living and who is dead, and what they already have talked about), the healthy participant marks it as a trouble source. (iv) M deals with the face threatening aspects of the conversation by (a) either accepting a repair, as in Example 1, however, without acknowledging the correction or (b) she continues to pursue her own line of thought by avoiding a fight over her interpretation but rather returns with a new suggestion (as in Example 2), thus silently sticking with one of her own interpretations of S’s utterance ignoring the discussion about a possibility reality disjunction.
Troubles connected to challenges to working memory
In other cases, the reference problems do not seem to be related to mishearing, but rather to cognitive challenges, especially related to attention and working memory. In Example 3, the discussion about S going to a party continues.
In the example, S starts by telling M that she and her workmates are going out for dinner using the pronoun “we” (line 01). Obviously, M has a problem with this reference and asks if she is included in the “we” after a pause (lines 02 and 03). S clarifies by stressing that she is going out to eat with her workmates – that is, she specifies the reference of the pronoun “we” (line 04). This clarification does not get any confirmation from M, so S continues with a further clarification that it is with her workmates later (line 04). M confirms her understanding, but focuses on the temporal aspect (“later”), not the explanation of the original problem with the reference to the “we” (line 05). The issue is also confirmed by both S and B (lines 06 and 07). After a long pause (lines 08 and 09), S does not continue her story, but instead states that they are there now, again using the pronoun “we”, but now referring to her and her sister-in-law (line 10), and this is confirmed, and expanded upon by M (lines 12 and 14), with seemingly no referential problem.
In this example, the referential problem of M does not seem to be about mishearing but rather about attentional and working-memory problems, since M does not seem to be aware of the fact that they are talking about what S is going to do in the evening. Thus, M does not seem able to make use of the situational common ground. Even if this interpretation is true, M’s problem with the pronoun “we” at the same time implies that she does not include information about the actual social situation: there are no signs neither in the ongoing activity nor in the physical setup on the table that would indicate that they would be expected to eat. So, when S clarifies who are included in the “we”, this might be face threatening to M. This is something that M deals with quickly and saves her face by focusing on the temporal aspect (“later”), and somewhat later (lines 12 and 14) M says that her daughter and daughter-in-law are here and having coffee – that is, “eating”. Thus, S successfully objects to M’s referencing of the original “we”, and M as successfully accepts S’s objection while at the same time saving at least a part of her original referencing of the “we”, namely “we are eating”.
In the instances involving reality disjunctions in connection with hearing and referential problems, the interactional sequences followed a similar pattern: (i) the healthy participants makes a conversational contribution; (ii) the person with dementia comments or responds; (iii) the healthy person identify and indicate the response from the woman with AD as a source of trouble; (iv) the healthy participant initiates a repair, often a repetition of her original utterance; (v) the person with dementia gives an affirmative response to the repetition, and the sequence stops there.
In all the examples about challenges to working memory as well as in the examples having to do with mishearing it seems as if the lady with AD tend to select words and referents that are close to herself in case she had to fill in a word in an utterance construction. In doing that, it is as if she chose from a small set of words and persons: her parents, the persons visually present now or close to her. She does not rely on the common ground, that is, what the other women could expect her to know (drawing on episodic memory) or could be seen as implications of things already said.
Challenges to autobiographical and episodic memories: Existential presuppositions
Several times during the conversation, M proposes that people who have been dead for many years are present that she still is a school girl, etc. In most instances, she does that when she tells a story about an event. When M talks about her parents as if they are alive, it seems to be the result of operating within a temporal frame for understanding what is going on in the present, rather than being about mishearing or mistaken references. This temporal frame is not shared by the other participants, i.e. the temporal frame M uses is not part of the common ground. This results in episodes in the conversation where M and the other two women are facing reality disjunctions.
Example 4 is taken from a sequence where the woman with dementia, M, and her daughter, S, talk about M’s mother and father (Sigvard), and S explains that they are dead a long time ago. M agrees to this fact with no particular surprise or concern, but she gives an account for being mistaken about this, indicating that she does not completely accept being corrected by her daughter.
In this example, M asks if her mother and foster father is at home (line 01). After a pause (0.8 s), S replies after that they are not alive anymore (line 03). This seems to start the negotiation about the possibility of M’s parents being alive based on logical possibilities. The fact that the parents are not alive is questioned by M (line 04), but is further confirmed and developed by S (line 05). There is then a longer pause as if M considers this fact and she then gives a minimal response (line 07). S orients to this pause as hesitant by continuing to explain that they are dead and how this happened (lines 08–24). Her explanation takes on the form of a slowly built logical argument around why M’s parents cannot be alive.
The first step for S is to state how M’s father died (lines 5 and 8). Next step is to introduce M’s mother, where she lived (lines 11 and 12), and the fact that she almost turned 100 when she died (lines 14 and 15). The phrase “the last years” (line 12) is a way to emphasize that she is dead as well as the evaluating phrase on line 15 (“she was old then”). Then S introduces the next premise in her argument: M’s present age (line 17) and the logical conclusion, “so then can’t grandma be alive”. This is the logical argument showing that why M is wrong. M responds affirming to this, but S backtracks her argument by emphasizing M’s age (line 20), and reaching the same conclusion although differently phrased: “then grandma would be superold”, implying that this would be impossible. M gives a weak affirmative response again, and then uses an idiomatic (Swedish) phrase saying that time passes so quickly. M’s conclusion that time flies may be considered as a face-saving act for both M and S. This last remark also gives an account for M being mistaken about her parents, but it also indicates that she does not completely accept that it was odd to ask about her parents in the first place, demonstrating her conversational competence. In this sequence, both participants avoid face threat, demonstrated by the fact that none of them upgrade the reality disjunction; they merely both engage in reasoning about facts in a logical manner.
The next example is from a later sequence of the conversation between M and her daughter, S. M returns to the death of her parents, and the daughter explains that they died a long time ago, but M is not convinced about having been around when it happened.
Example 5 is initiated by M asking a question about the death of her parents with a slightly surprised rising intonation (line 01), indicating that she is surprised to hear that her parents are dead, which potentially makes the contribution disjunctive with regard to S’s expectation about their shared common ground around temporality. That this is the case is indicated by the fact that M’s question is followed by a pause and then a negative response by her daughter (lines 02 and 03). After another pause, M confirms the negative response but in a hesitating, whispered way (line 05) followed by a minimal response and a pause (lines 06 and 07). The daughter explains that this happened a long time ago (line 08), which is confirmed by M after a pause (lines 09 and 10). The daughter adds an epistemic argument: M was present when it happened (line 11). This is first confirmed, but later slightly questioned by M (lines 14 and 16), indicating that M is not completely convinced about this (line 16). Thus, M saves her face by referring to her ambiguous epistemic state: she is not sure about whether she was present or not when her mother died, and thus by implication she does not know if her mother is dead or not.
Another example of dealing with reality disjunctive contributions is presented in Example 6. This example is also one out of rather few where M initiates a topic of her own, by telling a story about having fallen.
In Example 6, M initiates a topic by telling that she has fallen on the way to the care home (line 01). Both B and S operate from the assumption that M has not been outside for a while, and further that if M had fallen both B and S would have been informed about it. Thus, to both B and S, M’s claim that she fell over is probably taken by them as a reality disjunction, confabulatory, contribution. Consequently, S responds to M’s proposition with a request for clarification (line 03). M then adds further information (line 05) by saying “daddy and I”. This addition obviously makes M’s first utterance (line 01) even more problematic for both B and S. Potentially, M could be talking about an event in the past when fell over being out together with her father, but it could also refer to her being with her father in the present and falling over. This ambiguous state of her claim is probably one of the reasons for the long pause (3.1 s, line 06). After this pause, S requests confirmation of understanding (line 07) dropping the possibility of M’s father being present, and possibly also requests a continuation of the subject. This is confirmed and developed by M (line 09). This is confirmed in a slightly surprised way by B (line 12). In this example, M’s face is saved by the fact that S asks for clarification as if this sequence really happened despite the fact that it is reality disjunctive.
In this third group of examples, the initiating move is often the person with dementia saying something involving persons who are dead (her own parents). These claims are singled out by one of the healthy participants as a trouble source as they object to it. Their objection has the form of a counter claim (your parents are dead). This objection is then followed by further arguments aimed at backing up the counter claim and sometimes even an elaborated, logical argumentation. Again, the sequence often ends with an affirmative, non-committal response by the lady with dementia.
In all these examples of presenting reality disjunctive propositions, it seems that M is using a different time frame compared to her two interlocutors: people who are dead are present in her conversation as potential referents for recent events. Both B and S operate with a narrower time frame implying that only persons alive can take part in events. The reality disjunctions in the conversation are a result of the participants taking these different time frames as given. The daughter and daughter-in-law deal with these reality disjunctions by attempting to correct M, and thus sustain their own conception of what time frame to use. Potentially, this correction could be experienced by M as a threat of her face. Although, in order for it to be a threat, both B and S could have criticized M’s memory abilities, and thus question whether M could be considered to be a reliable conversational partner. But neither B nor S try to vindicate their positions by attacking M’s abilities. Consequently, the face threat of opposing M’s reality disjunctive propositions becomes less serious: M is still considered to be a competent conversational partner. This competence is also used by M when she turns B and S’s corrections into possible misunderstandings or conceptions of the situation. Thus, M can continue to sustain her position although B and S consider it to be reality disjunctive.
Discussion
What this study demonstrates is that both the healthy participants as well as the person with dementia together skillfully avoid the face threats posed by reality disjunctive contributions by not pursuing argumentative lines that in the end might jeopardize both the collaborative and the personal relations. There are a number of issues that we would like to raise in relation to our findings.
First, a general observation is that what we have called reality disjunctive contributions to conversations involving persons with dementia can be quite frequent – at least in some cases – and are thus familiar to most relatives to persons with dementia as well as to care staff.
Second, we could show that reality disjunctive contributions appear in different contexts: in relation to mishearing, related to working memory or to episodic memory; as part of meaning-making efforts and repair, and as part of contributions from the person with dementia. As discussed below, this results in different interactional strategies.
Third, our findings indicate that disjunctive contributions rarely are left unnoticed by the other participants. Contributions that may be classified as reality disjunctive are almost always marked as trouble sources by other participants. This was also found in Lindholm’s (2015) study. One reason for the healthy participant to mark an utterance as a trouble source is that to ignore something that is blatantly wrong or untrue, might be face threatening to the healthy person. Thus, not indicating a possible trouble source might come across as either disrespectful to the conversation or as carelessness.
Fourth, all healthy participants indicated the reality disjunctive contribution as a potential trouble source and to a certain degree dealt with it in a similar way: they attempted to avoid confrontation by using some politeness strategy. Lindholm (2015) in her study found that members of the care staff used interactional strategies that ranged from acquiescence to non-committance. That is, they either ignored the contribution or they responded with implicit challenges. As far as it is possible to understand from the article, the staff responded to the reality disjunctive contributions by indicating them as trouble sources. In the present study, we found a wider range of strategies as the participants used different strategies depending on the context. In connection to mishearing, the healthy participant makes a correction which is accepted by the person with dementia without notice; in connection to challenges to working memory, the healthy person’s correction is affirmed by the person with dementia, and finally, in connection to challenges to episodic memory, there is a negotiation about the status of the reality disjunctive utterances. Thus, the participants use strategies from implicit acquiescence to negotiation.
Fifth, in our study, we found that not only the healthy participants pursued a politeness strategy, but also the person with dementia. This is something that is different from Lindholm’s study (2015). In all our examples the person with dementia avoided confrontation with the healthy partner. Thus, the person with dementia would pursue a politeness strategy, and not only the healthy participants. This is important as persons with dementia – especially if they could be seen confabulating – often is not regarded as active participants making independent contributions to the conversation based on the same conversational norms as the healthy participants. At the same time, the strategy of the person with dementia can be interpreted differently. Her conversational strategy could be seen not only as a politeness strategy to avoid confrontation, but rather as an effect of an asymmetrical relation between the participants. It is possible that the person with dementia is oriented towards the healthy partners being more competent speakers, and thus acquiesced to their linguistic competence.
Finally, a general conclusion is that both the person with dementia and the healthy person avoided trouble indications and repairs that potentially could expose the person with dementia as a person with cognitive failures. Questioning the cognitive status of a person in a conversation is to jeopardize his or her social status as conversational participant and thus the conversation as a joint activity. In the present study, the participants appeared to focus on the importance of their joint commitment to the conversation as well as on their interpersonal relations, and skillfully avoided questioning the status of any of the participants. Consequently, it was possible for the participants to jointly sustain social status or the personhood of the person with dementia, in the conversation.
An obvious limitation of this study is that it is a case study. As the phenomenon of reality disjunctive contributions to conversations involving persons with dementia is frequent and well known, but under studied, it is important to establish larger sets of examples. This would make it possible to identify and compare a wider variety of strategies used by conversational participants. Of particular interest would be examples of more confrontational strategies and their interactional consequences.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.