Self, Senility, and Alzheimer's Disease in Modern America: A History (review)

Alzheimer's disease is considered to be the most dreaded condition that faces the aging population in the twenty-first century. In Self, Senility, and Alzheimer's Disease in Modern America, Jesse F. Ballenger locates the dread surrounding dementia in its historical context, examining its origins, its connection to broader social and cultural developments in America, and the way in which it has shaped knowledge about dementia, health policy, and the experience of caregivers and persons with dementia.

Chapter one traces the emergence of the negative stereotype of senility in the late nineteenth century to the material and ideological forces of an expanding market economy and the broad democratization of American society. In the context of industrial production, the market revolution, mass consumption, and the triumph of a liberal social order, selfhood shifted from an ascribed status to being intentionally constructed by the individual. With these changes, selfhood became more dependent upon the ability of individuals to sustain a coherent self-narrative—with the result that the impairment of this ability by dementia now threatened one's fundamental status as a human being. As Ballenger so eloquently states, "senility haunts the landscape of the self-made man" (9).

Chapter two examines early research into senile dementia and Alzheimer's disease and the rising influence of psychoanalysis as a response to the unclear and unresolved classification of senile dementia as either a product of aging or a product of disease. In the mid-1930s, a group of American psychiatrists forged a new approach to senile dementia that emphasized psychosocial factors over brain pathology in the etiology of dementia. As further discussed in chapter three, the locus of senile mental deterioration was no longer the aging brain but instead broader structural factors such as mandatory retirement and the disintegration of traditional family ties, which denied the elderly roles that had provided meaning in their lives.

In the wake of the development of new techniques in the neurosciences to study the structure and function of the brain, and more rigorous correlations of brain pathology and clinical dementia, Alzheimer's disease, as described in chapter four, came to be conceptualized as an entity distinct from the aging process. Yet, despite the absence of conclusive evidence that Alzheimer's disease was distinct from aging, Ballenger points out that the reframing of Alzheimer's disease as a scientific rather than a social problem was necessary in order for it to be deemed cutting-edge medical science, worthy of funding.

In chapter five, Ballenger analyzes the political and policy ramifications of the ideological transformation of senile dementia into Alzheimer's disease. Advocates of a disease model of senility juxtaposed the positive appeal of the "gerontological persuasion" (56), whose central tenet was that old age ought to be as healthy and productive as any other stage of life, with graphic images and descriptions of the suffering the disease caused at a personal level, and extolled increased funding for biomedical research as the solution. The representation of the Alzheimer's sufferer as a ghost, a shadow, or, in effect, a nonperson was central to securing public resources for Alzheimer's disease research. The loss of self that the disease supposedly entails became a dominant trope of the Alzheimer's disease movement and was crucial to the success of the "health politics of anguish" (128).

In chapter six, the final chapter, Ballenger draws on the literature produced by professional and family caregivers, and persons with dementia who have sought to restore the dignity and humanity of individuals living with this illness. The basis for the claim that persons with dementia retain their selfhood emanates from the assumption that selfhood does not reside in cognitive abilities alone. For example, social constructionist theory is drawn upon to emphasize the social and interpersonal nature of the illness and the importance of social interaction for sustaining the selfhood of persons with dementia. As Ballenger notes, social constructionist arguments rest...