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What is ‘Alzheimer’s Disease’? The ‘Auguste D’ Case Re-opened

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Abstract

What is Alzheimer’s: an organic, neuropathological psychiatric disease, caused by plaques and tangles in aging brains or/and an existential condition affecting the minds of aging persons experiencing disconnection from meaning-bearing networks of social relations? Reviewing current research and revisiting Alzheimer’s original case of ‘Auguste D’ this paper offers an historical–sociological genealogy that raises fundamental questions of causality, and even of the ontological status of Alzheimer’s and the dementia reputed to it as a disease entity. Drawing on Kuhn’s notion of ‘science as usual’ and Foucault’s notion of the discursive formation of ‘regimes of truth’, our analysis seeks to understand how a sole medical focus on either bio-markers of neurological disease or genetic association was accomplished in the absence of sufficient and robust evidence. To counter the exclusion of psychosocial considerations, this paper offers two original hypotheses on the iconic case of ‘Auguste D’, taking into account the social milieu in which she lived and the specific circumstances of her life. It goes on to suggest the way in which the contemporary socio-cultural context may have dementiagenic tendencies. This research supports Gaines and Whitehouse’s argument that research into the phenomenon and symptoms of Alzheimer’s should focus on extracorporal and psychosocial factors.

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Notes

  1. “One of the things a scientific community acquires with a paradigm is a criterion for choosing problems that, while the paradigm is taken for granted, can be assumed to have solutions. To a great extent these are the only problems that the community will admit as scientific or encourage its members to undertake. … A paradigm can, for that matter, even insulate the community from those socially important problems that are not reducible to the puzzle form, because they cannot be stated in terms of the conceptual and instrumental tools the paradigm supplies” (Kuhn 1962:37).

  2. The Nun Study is an ongoing longitudinal epidemiological study, commenced in 1986, led by David Snowdon at the University of Kentucky Medical School, and since 2009 at the University of Minnesota. It involves 678 nuns of the School Sisters of Notre Dame from convents in the American mid-west who have agreed to undertake regular psychometric testing and to donate their brains postmortem for autopsy. One of the startling anomalies found by the Nun Study is that brains that are riddled with plaques and tangles, the classic Alzheimer’s biomarkers, belong to nuns who have been entirely free of dementia. For discussion see Keohane (2017).

  3. Fritz Lewy, of the eponymous ‘Lewy bodies’ was Jewish (the name is a variation of Levi). Lewy worked alongside Alzheimer in the Munich laboratory, but, it would seem, he did not enjoy the same favor as other colleagues, as it was not Kraepelin, but Spanish-American neuropathologist G. R. Lafora who paid him the honor of attributing the important identification of the cellular inclusions and their association with Paralysis agitans (Parkinson’s disease) to Lewy; and Lewy was subsequently forced to flee to the USA when endemic anti-Semitism consolidated into National Socialism (Rodrigues et al. 2010).

  4. Alzheimer’s subject of specialized interest was not senile dementia at all, but General paresis –syphilis.

  5. Goethe, Soothsayings of Bakis, cited in Kölbl-Erbert (2007:156).

  6. Steadman’s Medical Dictionary, 28th edition.

  7. See also Lerner, B.H. “Rita Hayworth’s misdiagnosed struggle” LA Times November 20th 2006.

  8. Weber’s famous book was first published in German in 1905.

  9. We are grateful to a reviewer for this point.

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Authors and Affiliations

  1. Moral Foundations of Economy & Society Research Centre (UCC & WIT), Department of Sociology, School of Sociology, Philosophy, Criminology, Government and Politics, University College Cork, National University of Ireland (UCC), Western Road, Cork, Ireland

    Kieran Keohane

  2. Department of Sociology and Anthropology, University of Canterbury, Christchurch, New Zealand

    Victoria Grace

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  1. Kieran Keohane
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Correspondence to Kieran Keohane.

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Keohane, K., Grace, V. What is ‘Alzheimer’s Disease’? The ‘Auguste D’ Case Re-opened. Cult Med Psychiatry 43, 336–359 (2019). https://doi.org/10.1007/s11013-019-09622-z

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