Thinking About Dementia: Culture, Loss, and the Anthropology of Senility (Studies in Medical Anthropology)

Cultural responses to most illnesses differ; dementia is no exception. These responses, together with a society’s attitudes toward its elderly population, affect the frequency of dementia-related diagnoses and the nature of treatment. Bringing together essays by nineteen respected scholars, this unique volume approaches the subject from a variety of angles, exploring the historical, psychological, and philosophical implications of dementia. Based on solid ethnographic fieldwork, the essays employ a cross-cultural perspective and focus on questions of age, mind, voice, self, loss, temporality, memory, and affect. Taken together, the essays make four important and interrelated contributions to our understanding of the mental status of the elderly. First, cross-cultural data show the extent to which the aging process, while biologically influenced, is also very much culturally constructed. Second, detailed ethnographic reports raise questions about the behavioral criteria used by health care professionals and laymen for defining the elderly as demented. Third, case studies show how a diagnosis affects a patient’s treatment in both clinical and familial settings. Finally, the collection highlights the gap that separates current biological understandings of aging from its cultural meanings. As Alzheimer’s disease and other forms of dementia continue to command an ever-increasing amount of attention in medicine and psychology, this book will be essential reading for anthropologists, social scientists, and health care professionals. Contents 6 Acknowledgments 8 Introduction: Thinking about Dementia 12 Part One: Changes in Clinical Practice 32 Chapter 1: Dementia-Near-Death and "Life Itself" 34 Chapter 2: The Borderlands of Primary Care: Physician and Family Perspectives on "Troublesome" Behaviors of People with Dementia 54 Chapter 3: Negotiating the Moral Status of Trouble: The Experiences of Forgetful Individuals Diagnosed with No Dementia 75 Chapter 4: Diagnosing Dementia: Epidemiological and Clinical Data as Cultural Text 91 Chapter 5: The Biomedical Deconstruction of Senility and the Persistent Stigmatization of Old Age in the United States 117 Part Two: The Role of Genomics in Alzheimer's Research 132 Chapter 6: Genetic Susceptibility and Alzheimer's Disease: The Penetrance and Uptake of Genetic Knowledge 134 Part Three: The Organization of Voice, Self, or Personhood 166 Chapter 7: Coherence without Facticity in Dementia: The Case of Mrs. Fine 168 Chapter 8: Creative Storytelling and Self-Expression among People with Dementia 191 Chapter 9: Embodied Selfhood: An Ethnographic Exploration of Alzheimer's Disease 206 Chapter 10: Normality and Difference: Institutional Classification and the Constitution of Subjectivity in a Dutch Nursing Home 229 Chapter 11: Divided Gazes: Alzheimer's Disease, the Person within, and Death in Life 251 Chapter 12: Being a Good Rojin 280 Contributors 300 Index 302 Dementia-near-death and "life itself" / Sharon R. Kaufman The borderlands of primary care : physician and family perspectives on "troublesome" behaviors of people with dementia / Ladson Hinton ... [et al.] Negotiating the moral status of trouble : the experiences of forgetful individuals diagnosed with no dementia / Andre P. Smith Diagnosing dementia : epidemiological and clinical data as cultural text / Janice E. Graham The biomedical deconstruction of senility and the persistent stigmatization of old age in the United States / Jesse F. Ballenger Genetic susceptibility and Alzheimer's Disease : the "penetrance" and uptake of genetic knowledge / Margaret Lock, Stephanie Lloyd, and Janalyn Prest Coherence without facticity in dementia : the case of Mrs. Fine / Athena Helen McLean Creative storytelling and self-expression among people with dementia / Anne Davis Basting Embodied selfhood : an ethnographic exploration of alzheimer's disease / Pia C. Kontos Normality and difference : institutional classification and the constitution of subjectivity in a Dutch nursing home / Roma Chatterji Divided gazes : Alzheimer's Disease, the person within, and death in life / Annette Leibing Being a good rojin : senility, power, and self-actualization in Japan / John W. Traphagan. Bringing together essays by nineteen respected scholars, this volume approaches dementia from a variety of angles, exploring its historical, psychological, and philosophical implications. The authors employ a cross-cultural perspective that is based on ethnographic fieldwork and focuses on questions of age, mind, voice, self, loss, temporality, memory, and affect. Taken together, the essays make four important and interrelated contributions to our understanding of the mental status of the elderly. First, cross-cultural data show that the aging process, while biologically influenced, is also culturally constructed. Second, ethnographic reports raise questions about the diagnostic criteria used for defining the elderly as demented. Third, case studies show how a diagnosis affects a patient's treatment in both clinical and familial settings. Finally, the collection highlights the gap that separates current biological understandings of aging from its cultural meanings. As Alzheimer's disease and other forms of dementia continue to command an ever-increasing amount of attention in medicine and psychology, this book will be essential reading for anthropologists, social scientists, and health care professionals.

Bringing together essays by nineteen respected scholars, this volume approaches dementia from a variety of angles, exploring its historical, psychological, and philosophical implications. The authors employ a cross-cultural perspective that is based on ethnographic fieldwork and focuses on questions of age, mind, voice, self, loss, temporality, memory, and affect. Taken together, the essays make four important and interrelated contributions to our understanding of the mental status of the elderly. First, cross-cultural data show that the aging process, while biologically influenced, is also culturally constructed. Second, ethnographic reports raise questions about the diagnostic criteria used for defining the elderly as demented. Third, case studies show how a diagnosis affects a patient's treatment in both clinical and familial settings. Finally, the collection highlights the gap that separates current biological understandings of aging from its cultural meanings.