The Real-Life Truman Show

There’s often a troubling gap between understanding educational principles in the abstract and applying them in real-life situations. To help bridge the gap, the next three posts will offer detailed examples drawing on the design and structure of several of my philosophical workshops. I hope this will be useful to teachers, philosophers, dialogue facilitators and others with a live interest in what we do at The Philosophy Club.

Cartoon by Teresa Burns Parkhurst. Caption by Aaron Bacall, with apologies.

To activate emotions, to induce perplexity, to challenge intuitions, to ignite controversy, to elicit reasoned argument: these, I’ve argued, are what give a philosophical stimulus its juice. And these are the ambitions that inform my curation of stimuli when I’m designing new workshops. To illustrate, here’s an overview of The Real-Life Truman Show, my high school workshop about therapeutic deception in the context of dementia care.

I begin the workshop by playing excerpts from a fictional audio drama that invites students to imagine how it would feel to experience the confusion and temporal disorientation of advanced dementia. This activates emotions, helping students to empathise with dementia patients and begin to think about what kind of care would honour their dignity. The fictional story also enlivens the issue of therapeutic deception in the context of dementia care.

Photo by Philip Montgomery, The New Yorker

Next, I describe some real-life cases in which dementia carers have routinely engaged in deception, for instance “by suggesting that a loved one has visited [the patient] recently, while knowing this to be untrue; by playing a recording of a loved one’s voice on a telephone, presenting it as a ‘live’ conversation; or by stylistically presenting a care home with domestic interiors that are intended to disguise the institutional nature of the setting”. I then induce perplexity by raising the central question of the workshop: If allowing dementia patients to continue believing falsehoods promotes their emotional wellbeing, is this a sufficient reason to sacrifice the moral norm of truth-telling? I introduce the concept of epistemic autonomy as a rationale for truth-telling, and I challenge intuitions by having students reason together about whether—and under what circumstances—this norm may justifiably be suspended. 

Students then watch a short video about Hogewey, a care facility in the Netherlands designed for elderly people with advanced dementia. Hogewey, which employs all-day reminiscence therapy, has been described as

a gated model village, complete with town square, post office, theatre, hair salon, café-restaurant and supermarket—as well as cameras monitoring residents around the clock, and well-trained staff working incognito… [for instance] as post-office clerks and supermarket cashiers…. Every detail of this ‘fake reality’ has been meticulously designed to ensure that the residents can experience life as close to ‘normal’ as possible.

I ignite controversy by counterbalancing the video’s positive spin on Hogewey with the observation that critics have compared the care facility to The Truman Show, a movie in which the protagonist is unaware that he lives on an elaborate film set.

The Truman Show movie poster

Hogewey’s director herself draws an analogy to the theatre, in which the nursing care occurs backstage whilst residents on stage feel as though they are leading an ordinary, non-institutionalised life. This acknowledgement that Hogewey generates a fantasy world for its residents is at odds with the denials by other proponents of all-day reminiscence therapy who argue “it is about creating real environments, not these fake environments that we currently have as institutions”. I induce perplexity by inviting students to explore what constitutes a ‘real’ environment and why such an environment may be desirable.

The concluding segment of this workshop involves a card-sorting activity in which students compare the Hogewey model to a conventional model of dementia care and assess each model against a range of criteria. This elicits reasoned argument as students appraise how truthful and respectful each model of care is, and how each model of care is likely to affect patients’ dignity, epistemic autonomy, wellbeing and freedom.

In my next post, we’ll journey on to explore one of the basic patterns I use in designing philosophical workshops.

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Further reading on the subject of therapeutic deception:
Larissa MacFarquhar, The comforting fictions of dementia care. The New Yorker, 01/10/2018.

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This is the third in a series of five posts (beginning here) adapted from my article ‘Unveiling and Packaging’ (pre-print available) which is published in the journal Human Affairs as follows: Sowey, Michelle. Unveiling and Packaging: A model for presenting philosophy in schoolsHuman Affairs31(4), 2021, pp. 398-408. 

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The Philosophy Club works with teachers and students to develop a culture of critical and creative thinking through collaborative enquiry and dialogue.

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