Malignant positioning can occur when, after a diagnosis of dementia, a person’s words and behaviour are put down to symptoms of the condition, rather than being recognised as a genuine reaction to a situation. People may talk over and for people with dementia and take over doing things they can still do for themselves.
If carers assume that people with dementia cannot work, socialise or live without curbs and limitations, they banish them to a world of helplessness and hopelessness.
Shakespeare understood this so well: In Richard II, when the King banishes Thomas Mowbray, he wails:
A heavy sentence, my most sovereign liege,
And all unlook’d for from your highness’ mouth:
A dearer merit, not so deep a maim
As to be cast forth in the common air,
Have I deserved at your highness’ hands.
The language I have learn’d these forty years,
My native English, now I must forego:
And now my tongue’s use is to me no more
Than an unstringed viol or a harp,
Or like a cunning instrument cased up,
Or, being open, put into his hands
That knows no touch to tune the harmony:
Within my mouth you have engaol’d my tongue,
Doubly portcullis’d with my teeth and lips;
And dull unfeeling barren ignorance
Is made my gaoler to attend on me.
I am too old to fawn upon a nurse,
Too far in years to be a pupil now:
What is thy sentence then but speechless death,
Which robs my tongue from breathing native breath?”
For Thomas Mowbray, being banished to a foreign country was like losing his voice. If we are not careful, when we speak for a person with dementia or assume that they are talking nonsense, we take away an essential way of expressing themselves.