Book Review : Self, senility, and Alzheimer's disease in modern America: a history

In this persuasive and interesting monograph, Jesse Ballenger argues that the narratives that describe ageing have reflected the rapidly changing socio-cultural landscapes of the modern United States. Taking fear of senility as his starting point, Ballenger questions the assumption that people have always feared dementia or understood mental diminishment in the same way. Drawing upon medical, political, popular and even contemporary academic sources, he then demonstrates generation-by-generation that the interaction between the various understandings of ageing, senility, and Alzheimer's disease have historically been inextricable from contemporaneous incarnations of biomedical knowledge and practice, as well as anxieties about the status of “selfhood”. Thus, this book is a cultural and intellectual history of ageing. It explores, for example, how the meaning of the word senility, which initially and innocuously denoted old age, came to represent in social and scientific discourses, first a lessening of vital energy, then became “a waste-basket term for a variety of discrete” (p. 80) diseases, and achieved finally, partial synonymity with Alzheimer's disease. The result, Ballenger concludes, is that today dementia is “emblematic” of our times (p. 153) and the “stories we tell about Alzheimer's” have become “the stories we tell about ourselves in a culture characterized by the subversion of narrative, the contingency and instability of language and meaning, and an often fractured, disjointed experience of subjectivity” (p. 172). This is a powerful, lucid account. It is at times emotionally challenging and disconcerting, but Ballenger handles his documentation carefully, never wallowing too much in the dramatic source material but always offering enough to keep the reader focused on the human element in his argument. In the spirit of offering a balanced commentary, I have certain qualms about Ballenger's title and analysis. In many respects, the title feels somewhat misleading. The argument and narrative focus mainly on the continental north-eastern United States. Are readers to presume that the Mid-West, the Deep South, the Pacific Northwest, as well as Canada are covered in this account? True, some of the sources Ballenger uses circulated en masse throughout “America”, but many of his more provocative statements, for example, “Senility haunts the landscape of the self-made man” (p. 9), would require several careful local analyses before the generalizations could be sustained. Such observations also raise my second concern about this analysis. The sources on ageing, senility, and Alzheimer's disease are often rhetorical howitzers, which especially weaken the defences of those of us who have experienced dementia first-hand. The claim, after the fashion of Sander Gilman (p. 30), that the salience of these sources for historians may lie in the way they construct a contingent but none the less authentic and historicized picture of “selfhood”, demands a reciprocal question. Namely, to what degree are these sources perhaps not reflective of how people in modern America understand their bodies, minds, and “selfs”? Much of the evidence used throughout this study—e.g. “more people outlive their brains” (p. 38)—provides us with a depiction of the “self” that is generated in a literature rife with ulterior (or at least incidental) motives. Indeed Ballenger admits as much, yet he continually creates a binary opposition between “the normal and the pathological” (pp. 3, 44, 74, and 135) and ultimately depicts senility as the definitive diseased Other from which we can reconstruct a historicized “normal” selfhood. Before we can be sure that such evidence posits an authentic expression of a normal Other, it seems reasonable, if not imperative, to examine how people understood the decline of their “physical self” in the presence of a “normal” mind as well. Here a comparative approach measuring discourses of senility against similar ones readily available for such physical diseases as multiple sclerosis or dystonia would have been useful and might well have demonstrated that the discourses of senility were indeed unique. As rendered in this account, however, we cannot be certain. Nevertheless, Ballenger can be congratulated for a truly fascinating exploration of ageing and senility. This book will appeal to physicians and historians, and the author (or the publishers) should consider marketing it to a broader public audience.