Under the floorboards: Examining the foundations of mild cognitive impairment

Philosophy, Psychiatry, and Psychology 13 (1):75-77 (2006)
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In lieu of an abstract, here is a brief excerpt of the content:Under the Floorboards:Examining the Foundations of Mild Cognitive ImpairmentMichael Bavidge (bio)KeywordsAlzheimer’s disease, culture, dementia, normal aging, science"Building a mystery: Alzheimer disease, mild cognitive impairment, and beyond" (Gaines and Whitehouse 2006) is an absorbing and important case study of how Alzheimer's disease (AD) came to be seen as a disease and how mild cognitive impairment (MCI) has been constructed in recent years as a related incipient condition.The interdisciplinary approach taken in the article produces findings of very different sorts, which are then marshaled to challenge the status of AD and MCI. The factors identified as contributing to the emergence of dementia as a disease include the inconclusive nature of the empirical evidence relating to the causes of dementia, the divergence in the paradigms of the biological sciences, the social pressures resulting from the aging of the population, consumerism in medicine, research funding, the profit motive in the pharmaceutical industries, and our "hypercognitive culture."There is a danger in a short article drawing on detailed work in different disciplines that no single argument is conclusive and the combination of inconclusive arguments remains unsatisfactory. Nevertheless, the picture that emerges is convincing. It is interesting to follow the details of a particular case history to track the intricate interlacing of clinical findings and social decision making that enter into the construction of a disease. The article traces the factors that encouraged the identification of dementia as a widespread, treatable condition and the diagnostic techniques and treatments that determined the delineation of the disease.In the case of AD and MCI, the implications of this process of construction extend beyond taxonomy. They call into question our attitude to aging. Do we see aging as itself a pathology? When Professor Tom Kirkwood writes "from a biological point of view, there is nothing necessary or inevitable about aging" (2001, xi), he does not mean to deny that as the years pass people get older (inevitably); he means that the deteriorations that at present we cannot but see as normal features of aging, are not inevitable. Do we have a spurious ideal of competence based on a time-slice taken from what we like to think of the prime of our lives? Why do we not think of the "cognitive [End Page 75] impairments" of childhood and adolescence as pathological? These are fundamental questions about our experience and understanding of living, aging and dying and they add layers of significance to the topic of the paper (Bavidge 2006).The main focus of the article is to expose the complex process involved in the classification of dementia as "a degenerative, biological, clinical entity" (Gaines and Whitehouse 2006, XX) and to raise doubts about its distinction from normal aging. Not everyone will be happy that so much weight is placed on disease as a dysfunctional clinical entity. Nor will everyone think that so much hangs on the disease status of dementia and MCI. However, on any account, the contrast between disease and normal aging has become less clear because our understanding of both terms of the comparison has become less secure. The question "Is dementia a disease?" is matched by the question "Is aging normal?"Many of the disabilities or degenerations associated with aging are now understood to be conditions that could be avoided, cured, or controlled. So although the article raises doubts about the stability of the category of AD, parallel problems have arisen about normal aging. If important elements of what we classify as dementia should be seen as normal human development, it is equally the case that some aspects of what we accept as part of the normal aging experience should be seen as pathological. The authors assert "we have not argued that there is no 'there' there. Rather, we suggest that the mystery of the 'there' (i.e., AD, MCI) may not be much different (if at all) from, and probably is, the mystery of the 'everywhere' (i.e., aging)" (Gaines and Whitehouse 2006, 61).The article is an exercise in the sociology of knowledge. This will be enough in itself to raise some hackles. It is interesting how an historical and sociological approach to the sciences has...

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