In lieu of an abstract, here is a brief excerpt of the content:

Reviewed by:
  • Self, Senility, and Alzheimer's Disease in Modern America: A History
  • Lisa Boult
Jesse F. Ballenger . Self, Senility, and Alzheimer's Disease in Modern America: A History. Baltimore: Johns Hopkins University Press, 2006. xvii + 236 pp. $43.00 (0-8018-8276-1).

Alzheimer's disease inspires a particular dread in modern Americans—a fear of "death in life," a fear that, by stealing the memories that allow one to craft a coherent life narrative, the disease essentially steals one's "self" as well. Although much previous historical work about Alzheimer's focuses on the untangling of the disease's biology, Jesse F. Ballenger's Self, Senility, and Alzheimer's Disease in Modern America focuses instead on the cultural meaning of the terror it evokes. Using textbooks, scholarship from diverse fields, conference proceedings, and first-person accounts as sources, Ballenger has produced a nuanced conceptual history of the relationships among old age, senility, dementia, and Alzheimer's disease, showing how increasingly frightening representations of dementia have come to mold perception and ultimately to influence research and health care policy.

Drawing on work by Carole Haber and Thomas Cole, Ballenger begins by reexamining the pathologizing of aging during the late nineteenth century, tracing the metamorphosis of "senility" from neutrally denoting old age to connoting physical and mental deterioration as well. Seemingly inevitable "senile" changes noted postmortem in aged organs (especially brains) reinforced the long-problematic [End Page 146] conflation of aging with disease. Notions of selfhood also changed during this increasingly hurried and industrialized period, with identity no longer "ascribed" but rather constructed from one's experiences and social role. Ballenger shows how these trends converged to induce hopelessness about old age, especially in men of retirement age, when loss of social role appeared to foster despondency that predisposed to senility, impairing the ability to sustain a coherent self-narrative or to present a stable "self" to others.

In the early twentieth century, pathologic changes noted in aged brains could not differentiate those dying demented from those dying cognitively intact, a problem that stymied psychiatrists treating the patients with senile dementias who were beginning to crowd mental institutions. In chapter 2, Ballenger shows how the resulting nihilism allowed a psychodynamic approach to understanding (and thus treating) senile dementias to fill the void, at least in the United States, and to dominate discourse about dementia between 1920 and 1950, a period often elided in more biologically focused accounts, and toward understanding which Ballenger contributes significantly.

By mid-century, new techniques revealed that dementia and brain pathology were in fact connected, thereby allowing dementia's construction as a disease and—crucially—as a biologically understandable entity, although problems of aging brains still appeared insufficiently urgent to attract research funding. Ballenger traces how a campaign to portray dementia, specifically Alzheimer's, as a dreadful, biologically investigatable disease that could steal the selves even of productive middle-aged people effectively garnered federal funding, especially when buttressed by "apocalyptic demography" (119). Chapter 3 reveals the ironic consequences of the anti-ageist ideology of the 1970s and '80s that reframed old age as fundamentally healthy and decrepitude as the consequence of specific diseases, including the further marginalizing of people with dementia; here, Ballenger shows how the language of the "gerontologic persuasion" paradoxically perpetuated the very stereotypes about old age it ostensibly battled. Chapter 4 contextualizes the research agenda of the late twentieth century and the recasting of Alzheimer's as a disease of memory, potentially explainable as a defect in the brain's cholinergic system. Meanwhile, tensions grew among nascent Alzheimer's activist groups and family associations between those seeking funding for research and those needing help with care. The book's final chapter examines writings by sufferers, caregivers, and professionals that reaffirm the personhood of the severely demented, critiquing the tropes equating cognition with humanness and memory with self.

Ballenger has written a persuasive account of a complicated subject, confronting the problem of dementia compassionately but unflinchingly, and attending throughout to issues of gender, class, and ethnicity. This book locates Alzheimer's disease within the intersecting histories of aging and dementia rather than among those of other dread diseases, like cancer, that have inspired fear...

pdf

Share