La « démentification subjective » comme effet de l’idéologie Alzheimer

Abstract

ObjectivesIn clinical practice, there is a strong tendency to interpret any elderly patient's disorder as dementia. The purpose of this paper is to identify the origins, the operating mechanisms, and the subjective consequences of this. It also seeks to propose a model for understanding and dealing with this gerontological doxa. MethodBased on our clinical experience in institutions, we will analyze the articulation between current geriatric ideology and subjective dementia assessments in gerontological practices. We will first outline the theoretical and contextualized reconceptualization of Alzheimer's disease, aging, and the cognitive symptom. Then, we will identify the impact of these conceptions in practices with elderly subjects. Finally, we will identify the individual and institutional attitudes that can result from this. ResultUntil the 1970s, the diversity of international geriatric conceptions was proportional to the clinical complexity of the aging process and to the demential state of the elderly subject. The reconceptualization of senile and pre-senile dementia as a disease that is specific to aging, combined with decisive socio-cultural transformations, imposed a biomedical reading of the problems of aging. Stemming from an American leadership that completely shaped the orientation of the emerging dominant discourse, the model of an expanded Alzheimer's disease is now conditioning the monocentric ways of approaching the variety of geriatric clinical phenomena. In practice, this results in the elderly adult's behavior being consistently interpreted as dementia, resulting in a subjective dementification. DiscussionSubjective dementification is what we refer to as the delirious psychic effects of this dementia interpretation as applied to clinical situations of the aging subject, regardless of whether or not there is a probable cerebral problem. It is the product of a double mechanism that we call psychic decerebration and push-to-dementia. The phenomenon of subtraction from the faculty of thinking is thus linked to the process of stripping meaning from the manifestations of the elderly subject and replacing them with dementia identity elements via the discourse and attitudes of the social circle. Depending on the clinical situation, this double operation will have various subjective effects that oscillate between two poles: an increase in symptoms in the case of a probable neurodegenerative pathology, and the creation of an artificial dementia-like picture that is more or less marked in the case of a misdiagnosis or abusive labeling. In this context, support for the elderly subject involves the need to treat the Other. In the vein of the etiological model supported by the British psychiatrist Martin Roth at the dawn of psychogeriatrics, we posit that only a simultaneous questioning of the organic, psychic, and toxic dimensions – through a clinical practice rooted in a relationship with the Other – can effectively grasp geriatric problems and challenges. ConclusionFaced with the diversity of aging disorders, clinical practice with geriatric subjects must, above all, be introspective. The guarantee of the subject's dignity and freedom is in fact conditioned by the ability of those who surround and accompany the elderly adult to resist Alzheimer's ideology.