Just got a comment from Charles Macknee on my last post that needs its own space, so I’m putting it here for all to read. Thanks for the perspective, Charles, but even though you meant to cheer me by mentioning that my own book wasn’t attacked, I’m sure its only because she’s never heard of it!
As I mentioned a few weeks ago, things seemed a little “too quiet” when I first took my show on the road. I am, however, kind of glad for the backlash. It’s about time these disparate visions of age and mind are exposed and hashed out in public, rather than simply through the private, quiet stigmatization of those who are unable to join the debate.
Here’s Charles’ comment in full:
Unlike the local unversities, my town’s library (Multnomah County Library, Portland, OR) has only a very modest selection of books on aging; much less those specifically addressed to the sub-area of dementia/caregiving. But prominent on it’s shelves is a new book by journalist Susan Jacoby called, “Never Say Die: The myth and marketing of the new old age”.
Perhaps y’all have heard of it. In a chapter called “A Mind is a Terrible Thing to Lose,” after previously making some very astute comments about the futility of biomedicine’s attempts to “conquer” ADRDs, Jacoby issues what I would call a virulent attack at those who engage in what she labels as “junk thought.”
Before I quote Jacoby on her junk thought hypothesis, I should mention that on the back cover there is “advance praise” for her new book; for example, Marcia Angell, MD, no less than “editor emeritus” for the New England Journal of Medicine, wrote:
“Jacoby, one of our most perceptive public intellectuals, examines the myth that it is possible to transcend the vicissitudes of old age by living right. It is no service to older Americans to demand that they conform to current notions of a serene, wisdom-packed, if passionless, old age. We need to deal with it as it is, not as we would like it to be.”
And “as it is” for Jacoby in this book, at least, apparently means:
“…wouldn’t you know it – there is an anti-biomedical school of thought that objects to labeling Alzheimer’s as a disease and views dementia as a social construct rather than a physiological reality. Psychologists and sociologists make up most of the advocates for what is called the social constructivist model of dementia, in which the loss of mind is viewed as the product of society with distorted social relations and market-oriented values…With proper, focused care, the course of Alzheimer’s patients may be arrested or even reversed ‘by interacting with them in a way that evokes positive emotions.’ These people [who, US?] are right about one thing – that focus on research should not be used as an excuse for failing to devote money and thought to improving the care of people suffering from irreversible dementia and providing support (now nonexistent) for exhausted caregivers. But just about everything else that antagonists of the biomedical model within the “helping professions” have to say is a perfect example of what I call junk thought in “The Age of American Unreason (2008)…”
Now hang in there with me; this gets even more convoluted…next, Jacoby wrote:
“The British psychologist Tom Kitwood argues that even – or especially – the demented have important lessons to teach the rest of society. One of those lessons: ‘Reason is taken off the pedestal that it has occupied so unjustifiably, and for so long; we reclaim our nature as sentient and social beings. Thus from what might have seemed the most unlikely quarter, there may yet emerge a well-spring of energy and compassion.’ The idea that reason and compassion are at odds is a stellar example of junk thought, most frequently articulated by exponents of the most antirational forms of religion in an effort to bolster their conviction that religious believers treat their fellow human beings in a much more kindly manner than do reason-obsessed atheists and agnostics.” [Jacoby is an active atheist, author of the “Spirited Atheist,” a blog for the washington Post]
Jacoby goes on to quote more from Kitwood: “Thus, when the interpersonal field surrounding the beginnings of ‘dementia’ is looked at this way, the problem is by no means focused on a single person whose brain is failing. Those others who have face-to-face contact are also involved; and in the background, so also is the prevailing pattern of social relations.”
Then, amazingly, Jacoby wrote:
“Translation: when you think about it, we are all demented in some way, and even the concept of dementia is demented. All of this is reminiscent of the psychiatric view, widely held in the 1950s and 1960s, that cold, ungiving mothers were responsible for childhood autism. [!] The shrinks did not stop adding their own junk thought to the anguish of mothers seeking help for autistic children until research, beginning in the 1980s and continuing to this day, established genetic and biochemical bases for autism. Now a new generation of junk thinkers suggests that caregivers, given the right attitude, might be able to stop or even reverse the degenerative course of Alzheimer’s in their loved ones…”
Wow. And I won’t even quote her slam on the notion of “eldertopia”!…
There are two really disturbing aspects to this (beyond the wild and far-fetched comparison of AD to autism and cold mothers); one is that, according to Jacoby’s line of ‘reasoning,’ because some of us religious fanatics (who, US?) see excess disability resulting from the misguided social treatment of persons labeled with ADRD and would like to curtail it, we are now blaming caregivers for the disease!
Also, given Jacoby’s prominence in the published world of books on aging, it is indeed disheartening to know that thousands of people will read this and perhaps be persuaded to cease trying to contemplate the rather obvious role that stigmatization and social withdrawal has on the persons struggling with the disease. Or worse yet, ceasing efforts to fund research that has psychosocial, rather than solely biomedical approaches to support. Even Jacoby herself wrote, on page 103 in this book that, “There is also a great deal of social shame and stigma surrounding Alzheimer’s, as there once was surrounding cancer.” But then, perhaps realizing that this would weaken her upcoming diatribe against those caregiver-hating religious nuts who claim that such stigma is demonstrably harmful, on page 105 she wrote, “Yet there is no doubt that the stigma attached to Alzheimer’s has declined significantly in recent years, and much of the credit goes to former first lady Nancy Reagan…”
As I continue to add to my new blog on this site (NewAging – Paradox in Later Life) I will be sure to examine what I see as a superb collection of paradox in Jacoby’s book. (Not “junk thought” mind you; I wouldn’t be so crass as to poison HER well with such a descriptor…) For a writer who mentions such important issues as the biomedicine’s impotence in the face of AD, Jacoby sure places a lot of faith in biomedicine, and for some reason (junk thought?) seems obsessed with dismissing other approaches. For one who dismisses the social effects on persons labeled with the disease and those who may currently lack traditional quantitative, positivist types of evidence to support their claims, she sure spends a lot of time and words describing her own personal anecdotes and qualitative, case evaluation with regard to her (self-admittedly limited) experience with ADRD.
Paradox, in my view, abounds when examining later life in America. If so, then let’s go ahead and take a close look at it, and in so doing, perhaps learn from it…
And by the way, Al…good news! Jacoby didn’t have a word to say about YOU.