Janet Adkins, a fifty-four-year-old English teacher, decided to make herself gone before the disease got the chance. Diagnosed with early-onset Alzheimer’s disease, she was Dr. Jack Kevorkian’s first client.

A minister friend asked me recently about my grandfather. I told her about his move to the nursing home. Her reflexive response: “Oh, so he’s gone.” Gone.

In the 1980s and 90s, the British social psychologist Tom Kitwood developed a new model for providing care to persons with dementia. Kitwood challenged the old culture of care that viewed dementia patients as problems to be managed, as bodies in need of physical care and little else.

Kitwood understood malignant social psychology as “in the air”—part of our cultural inheritance, not a phenomenon to be blamed on individual caregivers. Malignant responses to dementia, in his analysis, revealed tragic inadequacies in our culture, economy, and medical system, which often define a person’s worth in terms of financial, physical, and intellectual power.

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