REVIEW ARTICLE De-constructing de-mentia: a personal and person oriented perspective of de-personalization and moral status Julian C. Hughes: Thinking Through Dementia. Oxford University Press, New York, 2011, 312 pp, £37.58, ISBN: 978-0-19-957066-9 Joseph Lehmann • Yechiel Michael Barilan Published online: 6 December 2014 Ó Springer Science+Business Media Dordrecht 2014 Julian Hughes, a geriatrician, an astute clinical observer and a philosopher has written a very impressive and much needed book on dementia. The detailed case studies (first chapter) and his practical agenda for care and research (end of ch. 9 and ch. 10) are a must-read for everybody involved in the care of the aged. The explication of the author’s Situated Embodied Agent approach is highly stimulating for everybody who is concerned with the ethical dimen- sions of ‘‘the human person’’ and ‘‘embodiment’’ (ch. 2 and 3). Our review will focus on the book’s central thesis—an attempt at a phenomenology of dementia and its ethical implications. Literally, ‘‘dementia’’ means being out of [one’s] mind. Julian Hughes rejects this language, arguing instead for conceptualizing the range of dementia syndromes as being of different kinds of minds. Even though dementia typi- cally involves difficulties in the biological functions of cognition, the non-demented should think through the mind of the demented, and reclaim spaces of shared meaning, of shared humanity. ‘‘If we cannot get our thoughts about the patients’ thoughts right, we cannot get our thoughts about her right’’ (p. 136). If we get our thoughts about her right, and realize the significance of ‘‘We-Relationship’’ as a factor predicating every thought ‘‘about’’ the person in front of us (See Schutz 1967, 163–172), we actually rehabilitate mental capacities affected by the patient’s brain lesions. Meaning is not a fixed code within one’s brain. ‘‘To forget the face of a loved one is to have lost a part of one’s world; but it is not the whole of the human world… The text is always open to further interpretation’’. (p. 152). The vocabulary used in this short and exemplar sentence points in the direction of two rich philosophical traditions, Hughes’s project relies on. The first is the philosophical stream of phenomenology, going back to Husserl and Heidegger. The second is Wittgenstein’s late philosophy and its theory of meaning and rule-following. Familiarity with key terms such as ‘‘transcendental’’, ‘‘normativity’’, ‘‘externality’’, ‘‘meaning’’ and ‘‘interpreta- tion’’ might help the reader grasp fully the book’s key philosophical arguments. Steven Crowell’s book Norm- ativity and Phenomenology in Husserl and Heidegger (Crowell 2013) (which was published after Thinking Through Dementia) may be an excellent preparatory reading. Another two very relevant books (not cited by Hughes) are Simon Glendinning’s On Being with Others (Glendinning 1998), and John McDowell’s Mind and World (McDowell 1994). The effort is worth pursuing, because Hughes’s arguments, insights and suggestions are well crafted and quite pertinent. In these pages, we will try to sketch out a simplified account of Hughes’s thesis. This thesis has a dichotomous structure whose epistemic foundations are Karl Jaspers’s distinction (inspired by Leibnitz) between ‘‘explanation’’ (erkla ¨ren) for casualty in the natural sciences, and ‘‘understanding’’ (verstehen), which refers to meanings in the human realm (p. 64). The fundamental philosophical presumption behind this dis- tinction is the irreducibility of the latter to the former. Whereas the medical sciences might explain the causes of dementia, and quantify some of its manifestations, they miss its constitutive essence, which, according to Hughes is the qualitative phenomenology of ‘‘being demented’’. This reminds us of another clinician-philosopher, Raymond J. Lehmann School of Philosophy, Tel Aviv University, Tel Aviv, Israel Y. M. Barilan (&) Department of Medical Education, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel e-mail: ymbarilan@gmail.com 123 Med Health Care and Philos (2015) 18:153–158 DOI 10.1007/s11019-014-9613-6