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Kitwood, T. (1987). Dementia and its pathology: in brain, mind or society?. Free Associations, 1(8):81-93.

(1987). Free Associations, 1(8):81-93

Dementia and its pathology: in brain, mind or society?

Tom Kitwood

Another Name for Madness, by Marion Roach, Boston: Houghton Mifflin, 1985, 241 pages, $14.95.

Almost overnight the name of Alois Alzheimer, a German neurologist working around the turn of the century, has sprung into prominence in gerontology. A dementing illness associated with the specific forms of neuropathology first identified by Alzheimer has now been nominated as ‘the disease of the century’. According to some statistics almost a quarter of the population over 80 years old in the industrial societies of the West suffer from this affliction, and there appears to have been a remarkable and disturbing increase in what is neurologically the same condition among those of a younger age (Heston and White, 1983).

Before the ‘silent epidemic’ of Alzheimer's disease was proclaimed, it was more common for clinicians to use terms such as confusion and senility to describe the common psychological disabilities of old age; there were also ‘organic brain syndromes’, both ‘reversible’ and ‘irreversible’. The name of Alzheimer was kept for a specific pre-senile condition associated with degenerative plaques and neurofibrillary tangles in the brain. Now the psychological afflictions of old age have been reclassified, and the majority of cases of dementia are claimed to be due to Alzheimer's disease. The change has been accompanied by the formation of new caring agencies, such as the Alzheimer's Disease Society in Britain, and the Alzheimer's Disease and Related Disorders Association in the USA. This medicalization of dementia has not, however, gone unchallenged. Recently, at a symposium of the Gerontological Society of America, a group of doctors argued specifically against it (see Klass, 1985).

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