Images of older people with delirium are represented through oral and written language, as well as other media, for example photographs. Photography is omnipresent in
contemporary life and frames advertising messages, captures personal moments, as well as adorning book covers, magazines and newspapers. The use of photography is viewed by Short (1997) as a cultural practice that provides us with meaning about something. Short (1997) goes on to suggest that photography is inherently truthful and has the ability to create and/or portray bodies in a certain way to a particular audience. This statement emphasises the powerful influence that photographic images have on the social construction of delirium.
For analysis I have chosen three different images depicting delirium in the older population. Each has been published and is available in the public arena. As such, all three can be accessed by health professionals, in particular nursing, as well as the general public. The first image (Illustration 1 – see page 124) was published as a poster that was to be used to raise the profile of delirium within a hospital setting. In addition, it served to promote and encourage the utilisation of a delirium service. The caption reads that delirium will affect three out of 10 hospitalised older people. It is blatantly obvious who these people are. They appear as ghostly figures, a pale turquoise colour, almost invisible to the eye. Each person is sitting, and all are seated in the semi-shade with bright light behind and small shafts of light to the front. While all three look as though they are interacting in some way, smiling, laughing, looking, they are not. Closer analysis reveals they are looking in different directions.
To me the image represented in the poster appeals to Descarte’s notion of the mind/body split discussed earlier in this thesis. Beard (2004, p. 416) identifies that we live in a “hypercognitive society” where older people are defined by their mind. The three older people portrayed in illustration 1 are depicted as having delirium. In biomedical terms they are defined as cognitively impaired, and are therefore reduced to a ghostly physical shell. However, another representation could be the difficulty in detecting delirium in older populations. This is evidenced in the literature identifying the nosological confusion and difficulty in distinguishing delirium from dementia and depression (see earlier chapters for an in-depth discussion on this issue) (Arnold, 2004).
The second image (Illustration 2 – see page 125) was used to illustrate the cover of a special issue of the Journal of Gerontological Nursing (April, 2001). This illustration conveyed to me impressions of disturbances associated with a satellite map of a
meteorological service. The face and subsequent person is once again almost undiscernible. The lines below the eyes that radiate out from the nose could be isobars. Isobars that appear on a meteorological map that are close together, as in the imagery shown on the cover of the journal, indicate stormy conditions and rough weather. The florid red and yellow/orange tones indicate extreme disturbances.
The third and final image (Illustration 3 – see page 126) was used to illustrate a feature article on delirium in Critical Care Nurse. The picture portrays an aspect of the neurological system, probably a neuron. The representation of delirium in this way does not include an older person who is part of a cultural and social context but rather promotes delirium as a cellular process. Representing delirium as neuronal activity implies that the implementation of scientific measures is the only mechanism that could be used to overcome this health issue.
The illustrations presented suggest support for a discourse of delirium as a syndrome while continuing to marginalise and subjugate a personal discourse of delirium. Any representation of the older person with delirium as a human being with emotional and social needs is absent. The older delirious body, its signs and its images, as portrayed in the media, has the potential to influence nurses as they determine and operationalise nursing care. The above representations are firmly embedded in dominant western discourses of ageing which depict old age as a time of deterioration, a set of physiological problems that need to be managed (Reed & Clarke, 1999).
Gilmour’s (2001) thesis on dementia found similar representations to those presented above. However, this researcher was able to juxtapose the biomedical construction of dementia with the utilisations from Kitwood’s (1997) text, and focus on the promotion of personhood in people living with dementia, to draw attention to the power of different discursive images as a means to disrupt the status quo. In the present study, no imagery has currently been published with the capacity to cause trouble for the discourse of delirium as a syndrome. What Gilmour’s (2001) findings highlight is the possibility for resistance and the importance of foregrounding the social, cultural and historical contexts of older people through the deployment of a personal discourse of delirium, as presented earlier in this chapter.
Illustration 1: Poster advertising a delirium service. Used with permission from the Medical Consultant responsible for the delirium service.
Illustration 2: Cover illustration for the April 2001 edition of the Journal of Gerontological Nursing. Used with permission from the publisher.
Illustration 3: Illustration accompanying feature article in the April 2003 edition of Critical Care Nurse. Used with permission from the publisher.
6.6 Summary
This chapter set out to foreground the personal discourses of delirium through the texts generated by people who had been delirious and their families/significant others. Two subcategories were apparent from the textual analysis. These were I was different once
and how I came to be where I am now. The juxtaposition of these categories with clinical notes and literature demonstrated the powerful and pervasive influence the discourse of delirium as a syndrome has on the older delirious body.
The speech acts of older people and family members captured in the texts revealed how important it was that they could socially, culturally and historically contextualise themselves and their family member as part of their illness experience. Doing so deployed a personal discourse of delirium and provided opportunities for resisting the discourse of delirium as a syndrome. In addition, these people were also interpellated by the ever present discourse of delirium as a syndrome, which was always there, always competing and jostling to banish any personal discourses of delirium to the margins, silenced and subjugated.
Attention has also been drawn to the visual images of delirium as they appear in the public arena through poster presentation and journal articles. These images constitute powerful discursive representations of delirium that are partial and contestable. Currently they offer limited and negative subject positions of delirium. However, their contestability offers possibilities for resistance through the interpellation of nursing by the personal discourses of older people who have been delirious. The next chapter deals with ageism and the associated ageist practices that older people who have been delirious experience.