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©2011 by Paula J. Caplan All rights reserved
Where to Draw the Line Between Ordinary Forgetting and Alzheimer's
A phenomenon colloquially called Medical Students' Disease plagues physicians-in-training: They think they have every disease they study. In the United States, a heavily psychiatrized culture in which nearly every aspect of behavior and emotion is readily labeled abnormal, Medical Students' Disease is even harder to avoid...and not just by medical students but by everyone. But at our peril do we assume that we know much about where to draw the line between normal and abnormal when it comes to mental and emotional processes. [1]
As our culture becomes increasingly youth-obsessed, we are at high risk for panicking at any sign that we might have one of the signs of diseases typically associated with aging. Among such diseases, one of the most frightening is Alzheimer's Disease (AD), because it robs its sufferers of memory and often dramatically destroys their very sense of who they are, as well as their ability even to recognize those with whom they have shared their lives.
So it is understandable that we would panic at the possibility that we or someone we care about might have Alzheimer's Disease. But these intense fears are all the more troubling, because even diagnosing Alzheimer's and distinguishing it from dementia can be difficult or impossible until it is far advanced. And until ways are found to reverse or delay AD significantly, what point is there in attempting to go beyond taking note that sometimes one has memory lapses? In fact, given that Public Citizen recently called on the Food and Drug Administration to remove from the market the higher of two doses of Aricept, which is marketed and widely used as allegedly delaying the progress of AD, there is a risk of being tempted too easily to take a drug in hopes of keeping our memory functioning well. Public Citizen pointed out that Aricept in the higher dose not only has not been shown to be beneficial but often has serious negative effects, including severe weight loss, nausea and vomiting, diarrhea, dizziness, and disorientation.[2] What the drug companies would prefer that we not consider is that drug effects that appear at a high dose can of course, depending on the individual patient, have the same negative effects and lack of beneficial ones at a lower dose.
An important feature of the terror of even minor memory lapses is that ageism feeds the fear, according to ageism expert Margaret Morganroth Gullette. Her terrific New York Times piece, "Our irrational fear of forgetting," sheds light on the role of ageism in exacerbating this fear. [3] Gullette, whose book, Agewise: Fighting the New Ageism in America, became an instant classic, worries about what she calls an "epidemic of anxiety" that many adults in this youth-obsessed culture become part of when they forget where they put their keys or cannot retrieve the name of someone they know well ... and instantly assume that they have Alzheimer's Disease.
Because our culture is so intensely ageist, it is no surprise that we tend not to realize how ageism feeds our anxiety. Ageism operates by making ageism seem normal. We owe a debt to Gullette, then, for pointing out that forgetting - which to some degree happens to nearly everyone - scares us only partly because memory loss is a sign of horrible diseases and, in the case of Alzheimer's, a future in which the symptoms will only become worse. It also scares us because it is hard to think of ageing in a positive way.
How, you might ask, is it possible to think of loss of any faculty, no matter how minimal, as anything less than alarming, an indication that one is on a downhill slide? We can change the mental set we adopt for understanding why we forget things as we get older. As Margaret Randall has suggested, we can stop using a deficit model, stop assuming that forgetting something is solely a sign of loss. Instead, it can be a consequence of the sheer number, variety, and richness of all we learn and experience as we go through life: We cannot remember everything at all times, and sometimes, a memory lapse may be frustrating, but why should be embarrassed about it, when it happens to most of us? And where might it lead us if we focus instead on the richness of our lives that makes total remembering impossible? If this seems like a strange suggestion, then that very strangeness is a manifestation of ageism.
[1] Paula J. Caplan. (1995). They say you're crazy: How the world's most powerful psychiatrists decide who's normal. Addison-Wesley.
[2] http://www.citizen.org/hrg1950
[3] Margaret Morganroth Gullette. (2011). Our irrational fear of forgetting. New York Times, May 22, p.9.
