Hideki Muramatsu
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A Commentary on
Dignity of older persons with mental health conditions: why should clinicians care?
by Banerjee D, Rabheru K, Ivbijaro G, Mendonca Lima CAD. Front Psychiatry (2021) 12:774533. doi: 10.3389/fpsyt.2021.774533
1 Introduction
Banerjee et al. (1) highlighted the importance of dignity as a central component of mental health care for the elderly. They also emphasized the need for research addressing mental health interventions [including dignity therapy (DT)] in the context of ageism, rights, respect, and equality. This paper builds on the work of Banerjee et al. (1) by introducing the culturally sensitive framework of flat recovery process (FRP) (2) into recovery-oriented and person-centered practices to further the dialogue regarding the necessity for service providers to consider and incorporate human dignity into the care of their clients. This paper is also an educational resource for mental health care professionals working with geriatric populations. This commentary serves as an innovative material for fostering constructive discussions on human dignity through the lens of cultural diversity.
2 Conceptual use of ableism
An increasing proportion of the elderly experience mental illness, including chronic medical conditions, geriatric depression (3, 4), anxiety (4), and poorer cognitive functioning (4, 5). Concepts such as independence, respect, autonomy, and rights are crucial for functional recovery and optimal management, most of which originate in Western paradigms (1). The need for a global paradigm of mental health care for the elderly that supports their universal human dignity is growing (1), in support of their dignity as universal dignity. Interventions such as DT, aligned with the United Nations Sustainable Development Goals for 2030 (6), may address this need.
The definitions of ageism are broad and cover interdependent and distinct qualities from ableism (7). Disability is cast as a diminished state of being human (8), whereas ableism is discrimination against diminished human abilities. Furthermore, as aging is associated with a change in mental and physical abilities, the connotations of being elderly tend to be negative (9). Accordingly, this study focuses on the non-able nature of ageism and ableism.
To protect universal human dignity while respecting cultural diversity, the current article introduces the concept of FRP for mental disorders (2), a framework to serve as an educational resource (1) for mental health care professionals working with the elderly, to hopefully facilitate constructive discussions. FRP introduces a different perspective on the recovery process, shifting attention away from upward and downward mobility to a less hierarchical perspective. As time passes, one naturally moves deeper into the interior of their psyche, resulting in change or development across their lifespan (2). The downward shifts in life do not represent backsliding but rather a normal change or development across the lifespan.
The FRP reinterprets, aligned with the United Nations Universal Declaration of Human Rights (UDHR) (10), and rejects the evaluation of human worth based on superiority or inferiority during life’s ups and downs (11) or diminished abilities across the lifespan. It challenges the notion that aging represents a descent into a less valuable state within life’s ups and downs (11). The change in physical and cognitive functions due to aging can cause various non-able biases. Ageism exacerbates the stigma of mental illness in neurodegenerative diseases and is also associated with the stigma of dementia and mental illness (1). These biases often stratify individuals into hierarchies of superior and inferior abilities based on diminished capacities due to aging or mental illness, calling for specialized education and training for medical and social professionals to address individual psychological barriers and social obstacles stemming from ableism. The concept of FRP is meaningful for elderly people with mental illnesses and as a human rights perspective on human life and existence that does not define the meaning of existence based on arbitrary human authority. Therefore, the concept of the FRP should be introduced into discussions on ageism.
The FRP reinterprets recovery from a social constructivist perspective (12) to mitigate feelings of guilt or shame from a perspective that does not evaluate humans, whatever their illnesses or age, in terms of superiority or inferiority. It seeks to reduce ableism by emphasizing a non-hierarchical view of human abilities. Aging is a challenging process (13) involving physical and cognitive change (1), often undervalued or overlooked by society (13). Introducing the concept of the FRP into ageism may alleviate the ableist climate in which human values change in the life process in relation to the change of physical, mental, and cognitive abilities. Tackling these issues may help combat ageism.
For instance, the recovery process for individuals with mental disabilities acknowledges that everyone experiences crises (14). From the perspective of the life process, the change in capabilities of the elderly has commonality with the discussion on “non-able” in terms of impairment or mental illness. As Muramatsu (15) states: “Humans are existential beings, finite, and in constant flux as they interact with the environment. This leads to a change in physical functioning, aging, cognitive change, dementia, and ultimately death” (p. 14). Their shared dignity does not evaluate human worth based on ability or productivity (2). The FRP concept (2), developed from the perspective of an expert-by-experience (2, 15, 16), can be used as an educational resource to expand a reader’s responsiveness profile, a comprehensive list of factors to which an individual responds (17).
3 Discussion
Considering universal human dignity in the context of ageism and ableism, as outlined in the UDHR (10), requires recognizing that egalitarian strategies must coexist with hierarchical strategies (18). This article supports the approach of Banerjee et al. (1), which emphasizes human dignity. Furthermore, introducing ableism and ageism supports this dignity-centered perspective and may contribute to generating a new global outlook for mitigating and balancing hierarchical strategies. Although this paper does not delve deeply into every aspect, it serves as a meaningful introduction to concepts related to ableism. It emphasizes the importance of improving clinical empathy among mental health professionals (15) and medical staff caring for older adults (1, 19). Additionally, academia needs to teach and train people (20) to address the overlapping dangers of ageism and ableism (21), fostering mutual respect in interpersonal relationships. I believe this article serves as a meaningful introduction to concepts related to ableism and makes a modest contribution toward advancing the discussion of human dignity (1) within the social structure, particularly as an educational resource. I hope that new findings from various interdisciplinary studies will further promote the ideal of universal human dignity, transcending the confines of age-related frameworks.
Author contributions
HM: Writing – original draft, Writing – review & editing.
Funding
The author(s) declare that no financial support was received for the research and/or publication of this article.
Acknowledgments
I would like to thank Editage for the English-language editing.
Conflict of interest
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declare that no Generative AI was used in the creation of this manuscript.
Publisher’s note
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References
1. Banerjee D, Rabheru K, Ivbijaro G, de Mendonca Lima CAD. Dignity of older persons with mental health conditions: Why should clinicians care? Front Psychiatry. (2021) 12:774533. doi: 10.3389/fpsyt.2021.774533
2. Muramatsu H. Flat recovery process in mental health: A qualitative analysis of autoethnography. Issues Ment Health Nurs. (2024) 45(12):1278–85. doi: 10.1080/01612840.2024.2401136
3. Shao M, Chen J, Ma C. Research on the relationship between Chinese elderly health status, social security, and depression. Int J Environ Res Public Health. (2022) 19:7496. doi: 10.3390/ijerph19127496
4. Petrova NN, Khvostikova DA. Prevalence, structure, and risk factors for mental disorders in older people. Adv Gerontol. (2021) 11:409–15. doi: 10.1134/S2079057021040093
5. Shankar A, Hamer M, McMunn A, Steptoe A. Social isolation and loneliness: Relationships with cognitive function during 4 years of follow-up in the English longitudinal study of ageing. Psychosom. Med. (2013) 75:161–70. doi: 10.1097/PSY.0b013e31827f09cd
6. United Nations. Department of economic and social affairs. The 17 Goals . Available online at: https://sdgs.un.org/goals (Accessed September 11, 2021).
7. Van der Horst M, Vickerstaff S. Is part of ageism actually ableism? Ageing Soc. (2022) 42:1979–90. doi: 10.1017/S0144686X20001890
8. Campbell FA. Inciting legal fictions: ‘Disability’s’ date with ontology and the ableist body of the law. Griffith L Rev. (2001) 10:42.
9. Harris K, Krygsman S, Waschenko J, Laliberte Rudman D. Ageism and the older worker: A scoping review. Gerontol. (2018) 58:e1–e14. doi: 10.1093/geront/gnw194
10. UN General Assembly. Universal declaration of human rights. Paris: UN Gen Assembly. (1948) 1:71–7.
11. Llewellyn-Beardsley J, Rennick-Egglestone S, Callard F, Crawford P, Farkas M, Hui A, et al. Characteristics of mental health recovery narratives: Systematic review and narrative synthesis. PloS One. (2019) 14:e0214678. doi: 10.1371/journal.pone.0214678
12. Gergen KJ. Relational being: beyond self and community. New York: Oxford University Press (2009).
13. Kang H, Kim H. Ageism and psychological well-being among older adults: A systematic review. Gerontol Geriatr Med. (2022) 8:1–22. doi: 10.1177/23337214221087023
14. Anthony WA. Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosoc Rehabil J. (1993) 16:11–23. doi: 10.1037/h0095655
15. Muramatsu H. The “ableism” behind mental health professionals’ perceptions of support. Patient Exp J. (2024) 11:11–5. doi: 10.35680/2372-0247.1987
16. Muramatsu H. Commentary: Experiences of being cared-for: The perspective of an expert-by-experience in mental health. Front Psychiatry. (2024) 15:1460365. doi: 10.3389/fpsyt.2024.1460365
17. Dings R, Strijbos DW. Being in a position to know: Attuned responsiveness as the hallmark of experiential knowledge and expertise in mental healthcare. Front Psychiatry. (2025) 15:1490489. doi: 10.3389/fpsyt.2024.1490489
18. Ivbijaro G, Kolkiewicz L, Goldberg D, Brooks C, Enum Y. Promoting dignity in the care of the older adult. In: de Mendonça Lima CA, Ivbijaro G, editors. Primary care mental health in older people. Springer, Cham (2019). p. 73–82. doi: 10.1007/978-3-030-10814-4_8
19. Halpern J. What is clinical empathy? J Gen Intern Med. (2003) 18:670–4. doi: 10.1046/j.1525-1497.2003.21017.x
20. Lee T. How to spread empathy in healthcare (2014). Harv Bus Rev. Available online at: https://hbr.org/2014/07/how-to-spread-empathy-in-health-care (Accessed September 11, 2021).
Keywords: dignity, human rights, the elderly, ageism, mental health, recovery
Citation: Muramatsu H (2025) Commentary: Dignity of older persons with mental health conditions: why should clinicians care? Front. Psychiatry 16:1553697. doi: 10.3389/fpsyt.2025.1553697
Received: 31 December 2024; Accepted: 18 March 2025;
Published: 03 April 2025.
Edited by:
Cristiano Capurso, University of Foggia, ItalyReviewed by:
Pablo Bagnati, Fundación Para la Lucha Contra las Enfermedades Neurológicas de la Infancia (FLENI), ArgentinaMoira Law, Saint Mary’s University, Canada
Copyright © 2025 Muramatsu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Hideki Muramatsu, d3JhcC5oaWRlQGdtYWlsLmNvbQ==