ABSTRACT
In this chapter, I argue that dementia studies should build on traditional critiques of the (bio)medical model, as outlined in the previous chapter, to develop a new focus on the neuropsychiatric biopolitics of dementia. I begin by outlining several reasons that a focus on a (bio)medical model is limited, both conceptually and in relation to the real-world circumstances of dementia and those affected by it. I then show how the neuropsychiatric biopolitics of dementia differs from (bio)medicalisation, contending that an alertness to those differences can lead us to engage with dementia research in newly productive ways. Central to this argument is the assertion that the neuropsychiatric biopolitics of dementia is fundamentally a political process, and while it relies on appeals to science as a means of legitimation, it is often at odds with basic science and should not be conflated with it. Importantly, I do not suggest that all dementia studies work relating to anti-(bio)medicalisation critiques should be abandoned as inadequate, but rather that we might build upon it.
Nonetheless, I go on to show that, with anti-(bio)medicalisation firmly embedded in its intellectual heartlands, much dementia studies has developed a “neuro-agnostic” disposition. By this, I mean that a lot of dementia studies scholarship too rarely addresses biopolitical claims head-on. An emphasis on humanist critiques of institutional medicine, a (bio)medical model and its symbolic effects on relationships, has failed to engage substantively with neurocognitive research, neuropsychiatric biopolitics and related normative prescriptions of dementia. I situate this lack of critical engagement within broader social scientific trends toward the acceptance of knowledge claims regarding neurocognitive science, or at least the dismissal of them as being somehow illegitimate subject matter for dementia studies. I argue that neuro-agnosticism not only fails to robustly challenge poor science and spurious associated claims but repeatedly aids its proliferation by reiterating its core assumptions as justifications for doing dementia studies.
In response, I suggest that the critical traditions of psychiatry and gerontology can provide us with the analytic tools to uncover and challenge the biopolitical reordering of dementia. I briefly introduce some key tenets of critical psychiatry and critical gerontology. I highlight the longstanding deficit of critical psychiatric engagement with dementias in comparison with other psychiatric disorders and explicate contemporary work on the biopolitics of successful ageing. Together, these insights raise questions about how prescriptions of brain health and cognitive ableism in later life become publicly salient, the consequences of that salience and whose interests are at stake. I conclude that by combining critical psychiatry and critical gerontology, a critical dementia studies could engage more robustly with the neuropsychiatric biopolitics of dementia. However, this is not a matter of outright refutation but rather an attempt to constructively critique and strengthen those commitments that have proved fruitful in other areas.
