ABSTRACT
In this chapter, I begin to sketch a neurocritical dementia studies analysis of the biopolitics of dementia. Drawing on critical psychiatry and critical gerontology, I deconstruct three core tenets of neuropsychiatric biopolitics, regarding disease, ageing and the future. I specifically alight on these three facets because of their centrality and commonality to notable biopolitical endeavours, as well as having traditionally been subsumed within the (bio)medical bogeyman. First, I investigate the claim that dementia is caused by discrete diseases of the brain and the underlying idea that specific molecular occurrences lead to cognitive impairment. From a critical psychiatric standpoint, I consider the development of this view in relation to the efforts of key stakeholders and their underpinning rationales, attending to how different conceptualisations of dementia serve different interests. I also consider some of the evidence to the contrary, including longstanding questions regarding purported associations between neuropathology and cognitive impairment, and cognitive science scholarships on distributed cognition and cognitive reserve.
Second, I explore the claim that dementia is not a normal part of ageing. I contextualise this idea as emerging from the late 20th-century rejection of senility and show that it has become an important knowledge claim across several neuropsychiatric initiatives. I critique the concept of “normal” ageing from a critical gerontological perspective, drawing on Alexander Comfort’s notion of ageing in terms of senescence and Georges Canguilhem’s sociology of the normal and the pathological. While we might intuitively have our own personal ideas about what normal and abnormal ageing and agedness are like, at the level of population health, it becomes remarkably challenging to develop robust operationalisations of normal ageing versus abnormal disease. Moreover, critical gerontology has long revealed that normative schemas regarding ageing typically serve the interests of their progenitors, from patriarchal ideas about family roles in 1950s gerontology to contemporary consumption-based ideas about third-age lifestyles.
Finally, I turn to the claim that dementia research will discover a cure. I draw on the sociology of science and technology and associated work on promissory science communication to analyse the ways in which neuropsychiatric endeavours colonise the future. I show that the fight for the future matters because it has substantial repercussions for our present, particularly in terms of where resources coalesce and what types of initiative gain support. Overall, this chapter builds on the previous one by tracing a neuropsychiatric biopolitics of dementia more specifically, to demarcate its particular divergences from a (bio)medical model and facilitate critical engagement with its core components. Rather than contesting or refuting this biopolitics per se, I instead show that, as with politics broadly, it is fundamentally a matter of normative commitments, the politics of which are semi-concealed behind a scientistic aesthetic. This means that it is open to deconstruction and transformation across numerous fronts (e.g. how might drug regulation for age-related disease be reconfigured if we were to abandon notions of “normal ageing”? Or how might investment structures shift if our biopolitics of dementia focussed on the present rather than the future?), with potentially profound implications for our experiences of dementia, and therefore should not be uncritically accepted.
