Abstract
When, in the 1980s, Alzheimer’s disease became a disease of major public concern, ‘personhood’ also became an important, related topic of discussion. Those in caring professions (psychology, social work, etc.) and caregiver groups advocated for the ‘person within’ who was getting lost in a forgetful body and in a reductionist biomedical system. This essay aims to critically approach the dualism of this kind of argument by focusing on the moral positioning of claims such as personhood or biomedical reductionism.
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Notes
Those specialists, who once were dealing with the deep mysteries of the psyche, are still of importance, but, argue the authors, “In this new distribution of personhood, they have a new vocation: managing the ways in which the somatic individual conducts him or herself in relation to their particular risks and habits” (Novas and Rose 2000:508).
See, for example, Joel Paris’s description of the two opposed sciences within psychiatry: “Psychiatry remains a house divided. In the 1950s, Hollingshead and Redlich described a striking division of clinical psychiatrists into “2 cultures”—one biologically oriented, the other psychologically oriented. I wish I could say that this is a thing of the past. As a teacher, I try to promulgate a single, eclectic psychiatry. Although the split is less dramatic today, it still exists. Residents continue to be confused by the contrast between two very different sets of teachers…. In the struggle between these two cultures, biological psychiatry seems to have triumphed” (Paris 2000:36).
Biomedical malpractices, such as the medicalization of the lifecourse and the objectification of the patient, and modern biomedical paradigms (e.g., post-DSM-III psychiatry) are often automatically linked to each other. The question is whether the paradigm itself (e.g., “mindlessness” in psychiatry [cf. Eisenberg 1986]) resulted in making doctors and other health professionals less caring or whether the changes in medicine in the last 50 years are just changes—before and now with good and bad consequences for patients and doctors (cf. Buckley et al. 2006). After 5 years of working with and observing psychiatrists directly, I am convinced that the increasing commercialization of the medical profession is a much greater factor in malpractice than the paradigm that orients a health professional. This commercialization includes the temptation of enrichment of professionals (such as well-paid and potentially dangerous clinical trials, especially in poorer countries), the increasingly profit-oriented policies structuring health systems, the profit-oriented expansion of markets for medical items (e.g., medications) and simply types of personalities of health professionals.
I am referring here to a poem that was repeatedly published in U.S. Alzheimer Society newsletters, in which a female caregiver describes her husband as an ‘empty shell’ (quoted in Gubrium 1986).
On a different level, the very notion of Alzheimer’s disease as a brain disease can be perceived as a “flat” notion within neurology/psychiatry (and some authors think that it is not a disease at all but, rather, brain aging [e.g., Whitehouse and George 2008]). Alzheimer’s is generally explained as being caused by genetic factors—often in combination with a lifestyle that underuses the brain—and where the use of the brain is usually restricted to cognitive activities, often merged under the category of “education” (“use it or loose it” [cf. Ortega and Vidal 2008]). This kind of aetiology can result in a moral stance toward an “imperfect individual.” Such a notion would be considered ‘flat’ by scientists who consider life and human biology to be enrooted in nature and unreducable to only materialistic factors, such as ‘deep ecologists’ or ‘deep bioethicists’ (cf. Whitehouse 2001). This kind of thinking allows the inclusion of, for example, environmental toxins and nutrition in the etiology of Alzheimer’s, as some researchers do (e.g., Lahiri et al. 2007). I am grateful to one of the reviewers who alerted me to this argument.
Butler (1993:9) defined mattering as “a process of materialization that stabilizes over time to produce the effect of boundary, fixity, and surface we call matter.”
Some authors have written how organs have lost their interiority and “deepness” because of modern visuality technologies (Dumit 2004).
Also in the following quotation from St. Augustine: “In you I breathe a little when I pour out my soul by myself in the voice of joy and praise…. And still my soul is sad, because it slips back again and becomes a deep, or rather it realizes that it is still a deep” (1963:325; original italics).
During interviews, doctors in Rio de Janeiro, Brazil, all acknowledged something akin to personhood. These doctors generally did so by referring to a certain quality of life that could be maintained until an advanced phase of the disease (see Leibing 2008b).
For a more detailed analysis see Leibing (2008a).
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Leibing, A. Entangled Matters—Alzheimer’s, Interiority, and the ‘Unflattening’ of the World. Cult Med Psychiatry 32, 177–193 (2008). https://doi.org/10.1007/s11013-008-9091-5
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DOI: https://doi.org/10.1007/s11013-008-9091-5