Riding and Reading for Climate Action

Over the next four days, my 12-year-old daughter and I will be biking to Washington D.C. with four other riders from Pennsylvania Interfaith Power and Light, an organization engaged in a faith-based response to climate change. The ride is aimed at raising awareness about the need for action on the climate.

bike trip

I’ve asked my friends and social network to consider supporting our effort in two ways. If you have a good understanding of the climate issue and the need for action, consider making a contribution to PA-IPL or to support its excellent work, or sharing your thoughts and prayers about climate change for my daughter to deliver to our congressional representatives. You can find out how to do that at the PA-IPL page dedicated to the ride.

But I’ve also asked friends who are skeptical of climate change or its importance, or who don’t feel they know enough about it, or don’t feel a personal connection to it, to take our ride as a challenge to learn more about the issue. For them and anyone else interested to learn more about the issue, I wanted to briefly note some things to read on climate change.

If you need to start from scratch and want a quick primer on the basic scientific ideas involved in climate change, the group of climate scientists who blog at RealClimate.Org have put together this excellent list of resources that can bring you quickly up to speed.

From my point of view as a scholar working in science and technology studies, beyond having a grasp of the basics, rather than trying to learn a lot more of the science (i.e., pouring over IPPC reports), I wuld encourage people to learn more about the science – how do scientists know what they know? what is the larger historical and social context? In this connection, I can recommend two excellent books.

The first is The Discovery of Global Warming by historian of science and physicist Spencer Weart. It’s a short book, very readable, and gives a compelling account of how scientists from diverse different fields gradually forged the conceptual framework of climate against the larger social context of an emerging ecological consciousness that recognized it was possible for human activity to have an impact on global natural systems. Weart has also put together an incredible website with separate historical essays that go into topics in more depth, and link to the key primary documents in climate science.

For those a bit more ambitious, I would recommend Paul N. Edwards’s A Vast Machine, a fascinating account of computer models, climate data and the politics of global warming. Edwards documents and analyzes in far greater detail than any climate change denier ever has all of the complexities and uncertainties of gathering, storing, and communicating basic data about the climate, but shows how climate scientists have developed computational and conceptual tools for working that data into increasingly consistent and reliable climate models. He concludes with an argument about why climate science has been so politicized, and how such knowledge could and should be used to inform policy.

Crucial to understanding the “controversies” that have surrounded climate science is to understand the world of climate deniers. Merchants of Doubt by historians of science Naomi Oreskes and Erik Conway shows that the same small circle of scientists who, with funding from the fossil fuel industry,  have opposed the consensus of climate science concerning anthropogenic climate change, had earlier, with funding from big tobacco companies, opposed the scientific consensus about the health risks of smoking. The connecting threat was an ideological commitment to free market economics that led them to oppose any scientific research that made some form of regulation seem necessary.

If you’re all good on the science, but aren’t sure why you should care, I’d recommend the work of environmentalist Bill McKibben and his activist organization 350.org. You can find many of McKibben’s essays online, but I’d recommend his essay on “Global Warming’s Terrifying New Math” as a good overview of why we should be concerned. His book Eaarth: Making a Life on a Tough New Planet is a clear sighted and, by the end anyway, a surprisingly optimistic vision for how societies might adapt as the effects of climate change unfold.

Finally, for a religious perspective since we are riding as part of a group motivated by their faith, the website for the national Interfaith Power and Light (of which PA-IPL is a chapter) provides some excellent resources. Virtually all faiths have mounted a response to the moral challenge of climate change. As a Catholic, the Catholic Climate Covenant’s website as pulling together many documents and resources from a Catholic perspective. And on our trip, which will include several stops at churches along the way, I’ll be reading Sacred Acts: How Church’s are Working to Protect Earth’s Climate.

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Bless Me Father, for I have Sinned. It has been Six Months since My Last Blog Post….

If it’s self-indulgent to write a blog (and it certainly is), it’s doubly self-indulgent to apologize for failing to keep up with it. But to the extent that returning to the task of regular blogging is going to be worth anything to me or my imagined readers, I feel that I need to begin by explaining the long absence – especially since the point of this blog was to chronicle and thus focus my thoughts on the development of my second scholarly book project on the history of Alzheimer’s disease. Letting the blog drop seems like a bad sign regarding the prospects for that book. And, to be triply self-indulgent, dammit, I intend to write that book and more!

confusion-cr

So, the obvious and unfortunate thing to say is that the blog has not gone dormant because I’ve been all on fire with research and writing. Rather, my time and energy has been absorbed with the usual sorts of things that keep mid-career academics from research and writing – teaching and administrative demands and obligations to family, friends and the wider world. Plus, for me, there has been the additional challenge and anxiety of trying to figure out my job situation in the wake of Penn State’s elimination of the Science, Technology and Society Program in the face of state budget cuts. At this point, my future at Penn State remains unclear, and the academic job market is tough even (or perhaps especially) for a mid-career academic, even one who has published a well-regarded book.

But I am starting to question whether it is helpful to characterize all these things as mere distractions that take me away from my work. At this point, I think the only way I will be able to move forward with this project, my career and my life is to think about how  all these seemingly disparate demands and desires are connected. That’s perhaps obvious. Tracing the connections between individual experience and larger structures and meanings in society unfolding in time has always been the attraction for me of historical inquiry. My first book argued that the experience of dementia and the diagnostic category of Alzheimer’s are not only a personal tragedy and a medical concept, but are connected to a profound historical transformation in the meaning of selfhood and the politics and policy of disease in an aging society. More broadly, understanding the way that my individual struggles and occasional triumphs are connected to the wider world is essential to living a conscious, good life. But it’s no less challenging for being obvious. The tendency to ignore or obscure such connections has become perhaps the defining feature of late capitalist society.

All of which is to say that as I turn my attention back to this blog, I will be moving away from my original intention of keeping it focused strictly on my work on the recent history of dementia and Alzheimer’s. I’ll continue to write plenty about that as I continue to follow the field and hopefully do begin to make some progress in framing and research the book. But I’ll also be blogging about concerns ostensibly far afield from dementia that draw or demand my attention – like climate change, or global poverty, or the political economy of the modern research university, or biking or music – and about how they all might somehow link up on the faith that wherever my work and my life take me from here, it will be the richer for the inquiry.

As the working title of my book, To Conquer Confusion describes both the ostensible goal of finding an effective treatment or prevention for Alzheimer’s and other dementias, and the challenge of creating and maintaining coherent intellectual and institutional frameworks that could connect and coordinate the diverse experiences, interests and efforts of the many different kind of people connected to each other in the dementia field. As the title of my blog, To Conquer Confusion will also describe my own struggles to develop this work while answering the conflicting demands of life.

Book Review: Mind Wars by Jonathan Moreno

For LibraryThing Early Reviewers

Jonathan Moreno, Mind Wars: Brain Science and the Military in the 21st Century. Bellevue Literary Press, 2012. 

In this book, the influential bioethicist Jonathan Moreno sets out to make the case for what he calls an “ethics of neuroscecurity.” By neurosecurity he means 1) the ways that science and technology targeted at the brain and nervous system should be managed for the public good, and 2) a strategy by which democratic states must use advances in neuroscience to protect themselves from their adversaries. Neurosecurity is complicated by the principle of “dual use,” which U.S. security agencies officially adopted in the early 21st century of giving funding priority to projects that promise both a military and civilian payoff, particularly in economic growth. Dual use, Moreno argues, has encouraged neuroscientists to focus on the potential of their work to advance medicine and science while ignoring the potential military applications. Moreno argues that we need university scientists to become more engaged with difficult ethical questions regarding military interest in and potential application of advances in neuroscience.

Most of the book is devoted to a description of the wide variety of actual and potential applications of neuroscience to the military context – ranging from futuristic cyborg super-soldiers and chimeras, through pharmacologically enhancements to make soldiers more alert, less subject to psychic trauma, and more masterful in challenging combat situations, non-lethal weapons that operate on the nervous system to disable hostile forces (or quell popular protests), to low-tech applications of psychology in the interrogation of prisoners or influence of populations. At times, Moreno seems near to a kind of “gee whiz!” enthusiasm for the possibilities, but he is careful to note at several points that researchers are often inclined to hype. And he is always attentive to the often frightening ethical dilemmas that are raised by the militarization of neuroscience.

Given the dangers and dilemmas of what he has described, Moreno acknowledges that some will be understandably inclined to completely separate academic neuroscience from the military. But he argues that this would be a great mistake for two reasons. First, he does think that America does face dangers that make the cautious development of military applications of brain science a necessity. Second, and for him more importantly, if civilian academic scientists withdraw from involvement with the military, the military will pursue the development of these technologies within its own agencies, shielded from any public awareness and oversight. Moreno argues that the best way to avoid the sorts of ethical nightmares he spends much of the book exploring is for neuroscientists in academia to be fully engaged with the U.S. security apparatus, insisting on tht the transparency and openness that are core values of civilian science continue to operate as military applications of neuroscience are explored.

Moreno may be right that the active involvement of civilian scientists in the development of military applications of neuroscience is far less dangerous than allowing these applications to developed completely within the military, but I am far less sanguine than he is that the best norms and practices of science will withstand the pressures of involvement with the military. If the history of ethical catastrophes in science proves anything, it is that the ethical norms of science are fragile and vulnerable, and that under pressure from entanglement with government and corporate interests make academic scientists all too likely to abandon their commitment to transparency, the ethical treatment of research subjects, and other norms and values of the humane practice of science.

Whether you ultimately agree with Moreno’s conclusions, he is surely right about the dangers and dilemmas ahead, and the need for scientists and the public to remain awake and ethically engaged with neurosecurity.

Book Review – Richard Noll, American Madness: The Rise and Fall of Dementia Praecox (Harvard 2011)

Reviewed for the h-madness blog. 

As indicated by the controversies swirling around the proposed revisions of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders due to be published next year, psychiatry is probably more concerned with the categorization of diseases under its purview than any other medical specialty. Yet solid knowledge of the causes and precise pathological mechanisms that might define mental illness remains more elusive than with any other sort of human affliction. In this richly detailed book, Richard Noll explores the historical predicament of psychiatry through the efforts of America’s early twentieth century psychiatric elite to integrate their field with the main currents of an emergent scientific medicine by creating a scientific classification of mental illness.

Read full review on h-madness. 

Scrutinizing Alzheimer’s Science

A couple of weeks back, I wrote a post that offered some constructive criticism to Allen Power.  As I said then, I have great respect for Power as a leader in the efforts to change the culture of dementia care.  Today I want to applaud him for an insightful post on the need for critical scrutiny of science claims in the Alzheimer’s  field, which was picked up in post by by Howard Gleckman at Forbes.

Power asserts that in the magnitude of funding and the frenzied media hunger for reporting the big breakthrough in Alzheimer’s research has led too many scientists to ignore  some of the basic principles of good science. To his credit, Power does not just bash  pharma studies of drug treatments which he has criticized in his  highly regarded book. He starts instead by criticizing an inflated science claim by Dutch researchers and trumpeted in an email bulletin sent out by WebMD that the incidence of dementia has been falling as a result of  increased cardiovascular health—a theory of non-medical prevention that Power strongly endorses. But the findings in the study were not statistically significant; in other words, by the standard of sound science, it proved nothing.

Power then goes on to argue that a combination of  dodgy scientific claims  and groupthink have been the basis for much of the wide acceptance  in the Alzheimer’s field that anti-psychotics and cholinesterase inhibitors are safe and effective, and that amyloid clearance is the only rational route to pursue in treatment and prevention.

Gleckman’s piece in Forbes went even further, making an argument that many critics of the Alzheimer’s field agree with:

One consequence is that precious dollars are pumped into research aimed at a cure or prevention while almost no resources are available to help learn how to better care for people who already have dementia or for training or other assistance for their caregivers.

This battle over dollars has been going on for a long time. Drug companies, academics, and high profile advocacy groups such as the Alzheimer’s Association focus almost entirely on increasing research dollars for cure and treatment.”

Gleckman acknowledges the value of biomedical research on Alzheimer’s, but argues that it should not longer be virtually the only thing that the federal government will spend money on to address dementia:

So far, research is teaching us that these diseases are very complicated and progress towards cures or treatments is very slow. That’s why we should be working a lot harder to learn how best to care for people with these diseases.”

 

Will Failure of Plaque Clearing Drugs Bring Change in the AD Field?

With the news that Pfizer and Johnson & Johnson are scrapping further study of the drug bapineuzumab (bapi) after its second failure in a major clinical trial, and expectations no better for solanezumab, a similar drug under development by Eli Lilly, it now appears conclusive that the amyloid vaccine approach fails to provide any significant benefit for patients who have dementia.

The amyloid cascade hypothesis has been the dominant (though hardly exclusive) theory of the pathogenesis of Alzheimer’s for twenty years,and the idea of a vaccine targeting amyloid in the brain has been highly hyped for a decade.  It’s worth recalling the sort of enthusiasm surrounding bapi in a typical news story when clinical trials were just getting started in 2009:

It’s not yet clear what such a high profile failure will mean for the AD field. Not surprisingly, pharma leaders continue to defend the amyloid vaccine approach that they have bet so heavily on. The New York Times story on the bapi failure quotes a scientific spokesman from Johnson & Johnson reiterating the company’s belief “that targeting and clearing beta amyloid remains a promising path to potential clinical benefits for people suffering from this disease.”

Meanwhile, other academic and industry leaders are spinning out modification of the amyloid hypothesis that refine the drug target. In 2010, as prospects for drugs like bapi that target amyloid plaques began to look increasingly poor, some researchers began to argue that the problem was free floating amyloid, and that the formation of plaques might be the body’s attempt to limit the damage by sequestering amyloid.

Many others have argued that the problem is not that the drugs are ineffective, but that treatment must begin much earlier in the disease, perhaps even before patients show any clinical signs of dementia. To investigate this, the National Institute on Aging has funded the Dominantly Inherited Alzheimer Network project, which will try to capitalize on the fact that the very rare early onset form of Alzheimer’s is caused by a known gene mutation, which will allow researchers to identify and test drugs on people who will develop dementia before any symptoms have appeared. But even if positive results are found in trials with early onset cases, it is not clear that these will be relevant to the much more common late-onset form of dementia since a different set of genetic factors are involved. More importantly, nothing is known about the potential risks of long-term treatment with anti-amyloid drugs. In the best case scenario, an Alzheimer’s drug would work less like a magic bullet, and more like the anti-cholesterol drugs — with all of the costs and controversies included.

Given these costs and barriers, and the fact that it clearly established by repeated studies that maintaining good overall health through exercise, mental stimulation and social engagement can significantly lower the risk of dementia as we age, I am inclined to join Peter Whitehouse in hoping that the failure of the anti-amyloid drugs will result in a fundamental re-orientation of our approach to Alzheimer’s that emphasizes more positive and realistic attitudes about aging and focuses on maintaining a rich life world.

But, to paraphrase Winston Churchill’s famous aphorism, given the great economic, intellectual and cultural investment that has been made in finding a medical solution to dementia, we are not likely to pursue such a simple, sensible course until we have exhausted all other possibilities.

For now, the amyloid hypothesis and the broader pharmacological approach to dementia may seem to many people like one more thing in our society that is just too big to fail.

The Neuroscientific Turn: Transdisciplinarity in the Age of the Brain

Book Announcement

Cover Image for The Neuroscientific Turn

Neuroethics, neuroeconomics, neurohistory, neuroliterature, neuromarketing, neurophilosophy, neuropolitics. We are well beyond the decade of the brain, and deep into the era of the neurologism. Is there any field of human knowledge  or endeavor which has not sought enhancement by adding the prefix neuro?

Melissa Littlefield and Jenell Johnson  have put together what looks like an intriguing and important tour of  the  emerging cultural neuroterrain: fourteen essays by a diverse array of scholar from the humanities, social and the neurosciences.

Full description and table of contents from the University of Michigan Press.

Pe-order from Amazon.com

In Memory of Joseph M. Foley, a Great Humanizing Voice in Neurology

I was saddened recently by the news that Dr. Joseph M. Foley died in Cleveland at the age of 96. Joe was a leading figure in neurology, serving as president of the American Neurological Association in 1974-75, a legendary teacher at Case Western Reserve University where I did my doctoral work, and a genuine hero in the community.  His rule of life was to “make sure you love people and behave in a way that you can be loved.” As the many published tributes to him attest, he was deeply beloved.  In 2011, Foley was interviewed for the American Academy of Neurology’s oral history project, and his warmth, humility, humor and considerable gifts as a storyteller shine through the transcript of the interview.

I wish I’d had the opportunity to get to know Joe better, but I am indebted to him for a conversation we had about my research very early in my career that quite literally turned me around. Though his primary scientific research never concerned dementia, he became interested in it and gerontology in general toward the end of his career and into his retirement. He was a co-founder of the Cleveland Chapter of the Alzheimer’s Association. Thus, when I settled on the history of the concept of Alzheimer’s disease as a topic for my MA thesis in history, I thought it would be good to contact him for advice and he generously invited me to lunch to talk about my project. He spent most of our time drawing me out and listening to my ideas. At the time, I was hopelessly captive to sources in the recent history of the Alzheimer’s field, and accepted the conventional wisdom that little of consequence had happened before the 1970s.

He approved of the critical questions I wanted to raise about the current period, but at the end of our conversation he told me that I really needed to take a look through the American Journal of Psychiatry and the Annals of Neurology and Psychiatry during the 1930s and 1940s for the work of a guy he remembered called David Rothschild. He didn’t say more, and I couldn’t imagine it would amount to much, but I dutifully followed up on this lead and what I found profoundly changed my assumptions about the history of dementia. Rothschild was a Boston area psychiatrist who developed an approach to dementia, grounded in the psychobiology of August Meyer, that was radically different than the approach of the present. Though his work has been virtually forgotten by the current generation, at the time it was widely influential in American psychiatry and even more so in the emerging field of social gerontology, where it had important consequences for the history of aging and the eventual emergence of Alzheimer’s as a major public issue.

So this nudge from Joe drove home for me the fundamental ethos of history: never take the past for granted – always look and be open to the ways in which it may be richer and more complicated than those in the present would like to believe.

From the AmericanAcademy of Neurology’s oral history interview, I gather that a young Joe Foley was disenchanted with the “mish-mash of psychoanalytic jargon” that Rothschild’s work was grounded in and turned to a biological study of the brain. But later in his career as a clinician he wrote of dementia in a way that reminded me of the best, most humanizing aspects of Rothschild’s work. Foley believed that the physician had an obligation not merely to dispense cures but to provide care: “Even when the dementia is neither arrestable nor reversible, it is still possible to guide the family and aid the patient. There are still many incurable diseases; there are no untreatable patients.”

He also shared my profound discomfort with the idea, widely circulated in the public discourses of the Alzheimer’s movement, that selfhood was destroyed by dementia, and he was committed to understanding the experience of the patient:

It is important to identify functions that are lost, but even more so to identify functions that are preserved…. In the formulation of public and institutional policy we must beware of simplifications and generalizations; we must recognize that individual demented persons have their own unique attributes and that, despite metaphors loosely thrown around, they each remain a person, with their own gratifications and frustrations, their own unique background, and their own unique destiny.”

As neurology and the neurosciences pursue the brave new worlds of biological understandings of the brain and human behavior, I hope there will remain a place for the humanizing concerns of a Joe Foley.

Forgetting Defines Us

If, as is often claimed, Alzheimer’s disease is “the disease of the century,” or at least one of the peculiarly emblematic diseases in America at the turn of the twenty-first century, it is not just because of its rising prevalence and  devastating symptoms, but because it has a  strong  resonance with some of the deepest concerns of contemporary culture. This is one of a series of occasional posts that will explore this  cultural resonance. 

One of the most salient concerns in contemporary culture is memory, and it is clear that the prominence of Alzheimer’s is in large part a result of the prominence of memory failure among its many symptoms. But the authority of medicine in popular discourse on Alzheimer’s has fostered a reductive  approach to memory, regarding it essentially to the ability to store and recall information. In this post, I want to gesture toward the broader meanings of  memory and memory by considering how they are used in two important songs in the oeuvre of   one of my heroes — indie music  goddess Ani Difranco. The songs are the title tracks to Dilate (1996) and Little Plastic Castle (1998).

“Dilate” (complete lyrics)  is essentially a song about love gone wrong, but it is lifted above the banality of countless songs on that theme by its images of  memory failure and confusion that reach toward a characterization of the human condition in late modernity.

Lifted out of the context of the song, the imagery of memory failure and confusion could be taken as  a fairly standard description of  nightmarish memory failure in dementia:

i wake up in the night 
and i don’t know where the bathroom is 
and i don’t know what town i’m in 
or what sky i am under 
and i wake up in the darkness and i 
don’t have the will anymore to wonder 

….

and i learn every room long enough 
to make it to the door 
and then i hear it click shut behind me 
and every key works differently 
i forget every time 
and the forgetting defines me 
that’s what defines me” 

But in the  context of the song, these images have a quite a different meaning.  Though the song is meticulously evasive about what is actually going on in the narrator’s life, nothing in it  suggests that the forgetting which defines the narrator is a literal inability  to recall information, or that the problem is a defect in her brain. Nor is she simply using memory loss and confusion as a metaphor for the feelings that accompany a bad love affair. Rather, the song suggests that the banality of life has come to defy her ability to render it meaningful, and that this  disruption of meaning has come to define her. The song concludes by embracing this situation, painful as it may be.

“Little Plastic Castle” (complete lyrics) is a celebration of unorthodox sexuality, articulating the joy to be experienced and the social price to be paid for for violating heterosexual norms of femininity, for simply being different.

But the song begins with an evocation of  quotidian memory failure. The problem is not  with the narrator’s mind or brain, but with  a mass culture that replicates experience endlessly so that location and time are blended together into an undifferentiated now.

in a coffee shop in a city
which is every coffee shop in every city
on a day which is every day
i picked up a magazine
which is every magazine
read a story, and then forgot it right away”

The next verse goes further to suggest that this sort of forgetfulness is not an accident, but a structured, imposed feature of  a modern social life that is full of little plastic castles.

they say goldfish have no memory
i guess their lives are much like mine
and the little plastic castle
is a surprise every time
and it’s hard to say if they’re happy
but they don’t seem much to mind”

This is the trap, the false promise of late modern consumer culture that leads the narrator to to forget where she is, to forget the hostility that she will inevitably have to endure and that she describes in the remainder of the song.

In these songs, memory  is not merely the ability to recall information and be oriented in time and place. It is the ability to make meaning, to connect the past, the present and future together into a meaningful life story. And memory failure is not caused only by something gone wrong in an individual body and brain, but also by the oppressive banality and social contradictions of contemporary experience in late modern consumer culture.  Keeping these broader meanings of memory and forgetting in mind can deepen the way we think about the experience of confusion and memory loss in dementia.

Marginalizing the Psychiatric in Dementia Treatment

I recently came across an interesting  post written by Allen Power that raised the question of whether dementia is better thought of as a psychiatric or a neurological problem. Power argues that dementia is increasingly viewed as a psychiatric illness, with symptoms of distress and analogous to mental illness. Psychiatrists are brought in as “expert pill jockeys” to control behavioral problems with antipsychotic drugs. Power thinks this approach is wrong:

Dementia is not a psychiatric illness. It is a change in one’s experience of their surroundings and how they process information, based on structural neurologic changes. It is as much a psychiatric illness as would be a stroke. And people’s interpretations of the world around them may seem confused to us, but they are nothing like the symptoms of an organized psychosis.”

According to Power, the tendency to psychiatrize dementia leads us to overlook non-pharmacological interventions, which he argues have been shown to be the safest, most efficacious and most enduring ways to manage the behavioral problems associated with dementia. He concludes that it would be much better to view dementia as “a neurological disability with secondary psychological challenges,” and that psychiatry’s role should not be simply prescribing pills to control behavior  but helping with the broader psychosocial challenges that dementia entails.

I follow and admire Power’s work as a geriatrician and one of the leading critics of the dominant drug-based approach to treating dementia. But I think that there is an important historical issue that structures the problem he raises. Without understanding and explicitly confronting this issue, efforts to change the dominant approach are not likely to have much traction.

In arguing that that dementia is a neurological rather than a psychiatric condition, Power follows the dominant modern medical approach to dementia in placing cognitive symptoms, attributed to “structural neurological changes,” at the center and relegating emotional and psychological changes  to the periphery — mere epiphenomenal reactions to the primary cognitive damage. This is somewhat arbitrary since, for patients and family members at least, the emotional and psychological symptoms are often as prominent and disturbing as the cognitive ones. But it follows a deep historical tendency in modern medicine to view psychiatric symptoms and mental disorders as less legitimate because they are not clearly attributable to pathological structures in the body.

This bias emerged clearly, in the United States at least, in the late nineteenth century as the development of germ theory and microbiology created a more scientific approach to medicine. Acute, infectious diseases which could be attributed to a particular pathological agent and effectively treated with a specific drug increasingly became the paradigm of modern medicine, especially as antibiotics emerged in the twentieth century. Chronic illnesses, especially psychiatric ones, seemed less legitimate, and the medical specialties that focused on them lost prestige in the era of “the magic bullet.”

Psychiatry was further marginalized during this period by its overlap with the other medical specialty claiming expertise over the brain and mental phenomena, neurology. Though the distinction between the psychiatric and the neurological has perhaps always been somewhat arbitrary, neurologists during this period, especially in the United States,  were generally successful in associating their specialty with cutting edge science while psychiatrists struggled under the stigma of their historic association with asylums and chronic, incurable madness.

The history of psychiatry since the late-nineteenth century can be interpreted as trying to compensate for this marginalization. Leading psychiatrists of the period, especially in Germany, sought to put their field on a scientific basis commensurate with the advance of medicine as a whole by showing that mental illness could be linked to specific brain pathologies. When this approach failed, Emil Kraepelin turned toward a quantitative assessment of clinical symptoms as a more scientific means of defining psychiatric disorders. Freud and his followers meanwhile sought to provide a scientific basis for psychiatry by turning away from the intractable problem of psychosis and developing a unified, expansive theoretical framework to explain and treat the mind. In recent decades, armed with new insights into genetics and neurochemistry and new technologies for exploring the brain, psychiatry has returned to the dream of anchoring psychiatric symptoms and disorders firmly in the brain. But apparent progress in understanding the brain only perpetuates the marginalization of psychopathology that cannot be clearly associated with something specific that is wrong with the brain. Psychiatric symptoms and clinical disorders continue to have an ambiguous status unless they are clearly associated with specific pathological processes in the brain.

While Power provides a strong critique of psychiatry’s reductionist approach to managing the “problem behaviors” of dementia with antipsychotic drugs, in this post at least he ironically appears to endorse much of the mainstream medical concept of dementia that historically produced such reductionism. So long as a reductionist model of dementia as simply a brain disorder retains a near exclusive grip in medicine, so long as pathology is considered more real than psychiatric symptoms, let alone social and cultural factors, medical practitioners of all kinds are much more likely to respond with a prescription pad than with the agenda for  social and cultural change that Power calls for.