Who Am I?

Understanding Tom Kitwood's Theory of Personhood in Dementia Care

If you've worked in dementia care for any length of time, you'll have probably heard the name Tom Kitwood mentioned in training sessions or spotted it in a care plan. But who was he, and why does his thinking still matter so much to the work we do every day?

Let's have a proper look.

Who Was Tom Kitwood?

Tom Kitwood was a professor at the University of Bradford who, back in the 1980s and 90s, started asking some questions that were, at the time, quite radical. At a point when dementia care was largely focused on managing behaviour and slowing physical decline, Kitwood asked something much more human: what is it actually like to be a person living with dementia?

His background was in psychology and theology, which gave him a really interesting lens. He wasn't just thinking about brain cells and medication. He was thinking about meaning, dignity, and what it means to be a person at all.

His most important work, Dementia Reconsidered: The Person Comes First, was published in 1997, just a year before he died. It's still widely read today and has genuinely shaped the way dementia care is delivered across the UK and beyond.

The Big Idea: Personhood

At the heart of Kitwood's work is the concept of personhood. He defined it as a standing or status that is bestowed on one human being, by others, in the context of relationship and social being.

In plain language: being a person isn't just about what's going on inside your head. It's something that happens between people. We confirm each other's personhood through the way we treat one another.

This matters enormously in dementia care, because it means that even when someone's memory is severely affected, even when they can no longer recognise their family or hold a conversation, they are still fully a person. Their personhood doesn't diminish with their cognitive ability. It just becomes more dependent on the people around them to hold and honour it.

That's a responsibility, but it's also a privilege.

The Old Culture vs. The New Culture

Before Kitwood came along, what he called the "old culture" of dementia care was pretty grim by today's standards. People were often managed rather than cared for. Behaviour that challenged staff was seen as a symptom of the disease, something to be controlled, rather than a form of communication.

Kitwood challenged this head-on. He argued that much of what we label as "challenging behaviour" is actually a person trying to meet unmet needs. They're not being difficult. They're trying to tell us something.

He introduced the idea of a malignant social psychology — a list of ways that carers (often without realising it) can strip a person of their dignity and personhood. These include things like:

Treachery — using deception to get someone to do something, even if it seems harmless.

Disempowerment — doing things for someone rather than with them, taking away their sense of control.

Infantilisation — speaking to someone as though they're a child, using a sing-song voice or overly simple language.

Ignoring — carrying on a conversation about the person as though they're not in the room.

Labelling — reducing a person to their diagnosis. "She's a dementia patient" rather than "She's Margaret, who used to be a headteacher and loves jazz."

None of these things are done out of cruelty. Most of the time they happen when staff are rushed, undertrained, or simply haven't been helped to see things differently. But they have a real impact on the wellbeing of the people in our care.

The Five Psychological Needs

To help us understand what people with dementia actually need from us, Kitwood described five core psychological needs. He placed love at the centre, with the other four surrounding it like petals on a flower. You'll often see this referred to as the "Kitwood Flower."

Comfort — feeling safe, warm, and soothed. Knowing that someone is there.

Attachment — having bonds with other people. Feeling that you belong to someone and someone belongs to you.

Inclusion — being part of the group. Not being left on the edges, forgotten or overlooked.

Occupation — being involved in something meaningful. This doesn't mean having to be busy all the time, just having a sense of purpose and engagement with life.

Identity — knowing who you are. Having your history, your values, your personality acknowledged and respected.

When these needs aren't met, distress follows. When they are met, even people living with advanced dementia can experience real moments of joy, connection, and wellbeing.

Person-Centred Care in Practice

Kitwood's work gave rise to what we now call person-centred care, and if you work in a UK care setting, you'll have heard this phrase constantly. But what does it actually look like day to day?

It looks like taking time to learn someone's life story before you start planning their care.

It looks like getting down to eye level when you speak to someone, not rushing past.

It looks like calling someone by the name they prefer, not the name on the notes.

It looks like noticing that someone becomes agitated every afternoon and wondering what's going on for them, rather than just reaching for a distraction technique.

It looks like remembering that the person in front of you was once a mother, a soldier, a baker, a teacher, and letting that shape every interaction you have with them.

Why This Still Matters

You might be thinking, "We know all this already." And in many ways, yes, the principles of person-centred care are now embedded in CQC standards, in the Care Act, in dementia training up and down the country. But knowing something and truly living it out in the middle of a busy shift, when you're short-staffed and someone is very distressed, are two very different things.

Kitwood's legacy isn't just a set of ideas to be read about and ticked off a training checklist. It's a daily practice. A commitment to seeing the whole person, every time.

When we do that well, we're not just delivering better care. We're doing something profound. We're saying to another human being: I see you. You matter. You are still you.

And in a world that can be very quick to write people with dementia off, that is a radical and beautiful act.

A Final Thought

Tom Kitwood didn't have dementia himself. But he had the imagination and the compassion to try to step into the shoes of those who did, and to ask the people around them to do the same. In doing so, he changed an entire sector.

The next time you sit with someone who can no longer tell you their name, who looks frightened or lost or far away, remember what Kitwood was really saying: their personhood is in your hands. Handle it gently.

If you'd like to explore Kitwood's ideas further, his book "Dementia Reconsidered: The Person Comes First" is well worth a read. The Bradford Dementia Group also carries on his work and has a wealth of resources available.