06 July 2009

Alzheimer's Disease

One of the peculiar features of Alzheimer's disease is that few historians have realized how intrinsically interesting the condition is beyond the basic story of its discovery and subsequent construction in medical discourse. Only Jesse Ballenger has made a serious attempt to consider the topic. And he did so only through the lenses of dementia.

Many features of the disease are fascinating and worthy of close examination. The condition is hard to diagnose with certainty. Its aetiology is uncertain. It is unclear whether the characteristic plaques and tangles of the condition are causative of the symptoms, or alternatively whether they are pathological indicators of some underlying and unknown condition. Furthermore, there are genetic abnormalities in some cases. Some patients had mutations of genes that cause the disease to appear very early in life. In others, however, the condition appears spontaneously. One remarkable historical question is therefore how the familial types became synonymous with the non-familial condition.

There are also complex cultural issues: medical anthropologists have long noted that populations in non-Western cultures treat people with conditions that appear similar to dementia with reverence rather than concern. This finding implies that Western responses to Alzheimer's disease are as much a cultural phenomenon as a medical one.

Finally, it would not be appropriate to ignore the economic and social issues surrounding this disease. Patients with the condition need constant monitoring. Patients without private healthcare in the United States, for example, have almost no ability to pay for the little medical treatment that exists to alleviate the symptoms and stresses that follow from the progressive degeneration associated with it. Welfare states, by contrast, are forced to decide how much to allocate to patients with this terminal condition.

Underlying all of these historical questions remains one final one: what is it to be human without memory? Will we stop seeing these patients as living subjects and begin describing them as bodies without selfhood? Only time will tell.

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