One of the most controversial non-drug therapies for people with dementia is doll therapy.
Before the work I do now, I knew this not as a ‘therapy’ but as the lady in my dad’s care home who occupied the room opposite him having dolls she would cradle, talk to, dress, put to bed and at times cuddle as if her life depended upon it. To a lesser extent my dad also found comfort within the principles of this therapy – not with dolls but with life-like soft toy farmyard animals that he would stroke and cuddle.
Back then I thought nothing of the ethical arguments around introducing items most closely associated with childhood into the world of people at the other end of life’s spectrum. All I knew was that my dad had extremely restless hands that needed something to hold onto, and he seemed to draw a lot of comfort from stroking these animals and looking at them.
Likewise the lady in the room opposite had her dolls brought in by her daughter who would talk to her about them, and leave her to hold them and ‘care’ for them when it was time for the daughter to go home. From what I observed, the lady found a great deal of pleasure in these dolls, and seemed to have a far more creative interaction with them than she did with the daytime TV programmes that would often blare out from the corner of her room.
Looking at the use of these dolls and toys now with my more objective hat on poses an interesting dilemma for me. In my work I am a staunch advocate of ensuring that we never infantilise people with dementia. A dementia diagnosis doesn’t mean you stop being an adult. Everything about dementia care should be dignified and respectful, and never treat people in any way whatsoever that belittles or demeans them.
On the flip side, do I really have any right to deprive someone who is living with dementia from finding comfort, enjoyment or familiarity from participating, of their own volition, in doll therapy? I saw first-hand how my dad’s soft toys benefited him – they were our idea as a family, we bought them, we gave them to him, and we facilitated his use of them (at the time dad had these soft toys he was immobile, so he couldn’t walk across the room to pick them up himself). He didn’t ask for them, but he actively participated in handling them.
I didn’t see his affiliation with these items as something that made him less of an adult, but arguably someone walking into his room seeing a grown man in a chair with a soft toy lamb on his lap might have thought very differently, and then treated dad as less of an adult as a result. Whilst I wouldn’t have wanted to be responsible for anything that stripped away dad’s status as an adult, I would have done anything that gave him comfort and pleasure.
In essence, this sums ups the complexities of the arguments around doll therapy. Such arguments polarise opinions and leave people like me – who pride themselves on offering balanced views, thoughtful commentary and helpful advice – with a real dilemma. I’ve never openly advocated for the use of dolls in dementia care in the way that fans of this therapy have, but equally I could never go into a care home, see dolls being used and honestly object, provided it was clearly in the best interests of the person with the dolls and something they were participating in willingly.
That last point gets to the heart of the arguments around doll therapy. The willingness of the person with the dolls is, for me, the deciding factor. If the person with dementia really takes to a doll in the way that someone else might find comfort in any other object, then that is their choice. We may present items other than a doll in the hope that they might prove more appealing, but if the doll remains the item of choice then that must be respected.
The argument about infantilisation in relation to dolls has much merit, but I think infantilisation can be avoided if the attitudes of those around the person remain respectful and adult. For most people with dementia who find comfort in having a doll, the doll is merely the physical manifestation of the person’s need to care for something, and for that something to be familiar.
We know that as dementia advances a person often retreats to memories of their early life, which may involve childhood or early adulthood, marriage and starting a family. In the present day, a doll could easily be a reminder of childhood or of starting a family. Dogs and cats could also remind a person of those landmark childhood and early adulthood years, but many care homes (not all) won’t allow animals to live within their homes unless they are of the soft toy variety.
If dolls, and indeed soft toys, are seen as props to facilitate reminiscence then they take on a different significance. The ability to reminisce is considered the mark of a life lived with all the memories and events along the way that come with adulthood. Reminiscence also draws on the wisdom and experience that is the landmark of ageing. Therefore in that context dolls could be the spark to unlock knowledge, for example about parenting, for some people.
Ultimately, whatever your views on doll therapy – and incidentally I remain largely on the fence – I suspect that being judgmental does more harm than the therapy itself. Yes, it has the potential to be disrespectful. It also has the potential to be comforting. The key to unlocking both the value of this therapy and combatting the negatives associated with it seems to be more about how those supporting the person with dementia facilitate it and react to it.
Until next time…