As we clock up the years, moments of forgetfulness can trigger feelings of dread – dread of impending memory loss.
A new study by Stephen Katz (with Simon J. Williams and Paul Higgs) examines cognitive decline against the backdrop of an emerging neuroculture. It explores the shifting boundaries between standards of normality and abnormality, and practices of therapy and enhancement. It also sheds light on how modern science is recasting the older brain.
Dr. Stephen Katz is an award-winning scholar and leading thinker in the field of gerontology. He is a professor in the department of sociology at Trent University in Peterborough, Ontario.
Katz is author of the groundbreaking book Cultural Aging: Life Course, Lifestyle, and Senior Worlds (University of Toronto Press). His study appeared online in the journal Sociology of Health & Illness (June 20, 2011).
AHB reached Dr. Katz at Trent University in Peterborough.
Ruth Dempsey: Some experts are talking about "an epidemic of anxiety around memory loss". What’s going on?
Stephen Katz: I think there are three factors to consider here. First, the population is aging and the longevity curve is stretching out, with both processes creating new health and social issues. So, memory loss and other normal cognitive changes associated with aging are becoming more familiar, but so is dementia.
Second, as chronological and traditional markers of aging lose their status, others are taking their place, cognitive decline in particular. In other words, one of the most poignant markers today of the slide from an active later life to dependent old age is cognitive decline. So, our fear of memory loss is understandable.
And, third, memory in our society has become a vital resource in itself. The computer is our central model of intelligence with its unfailing and increasingly larger storage capacities. Recall memory is also important to consumerism, the military and productivity. This is one reason why Stephen Post says we live in a hypercognitive society. So, again, memory loss creates legitimate anxiety.
RD: Older adults seek help for the kind of day-to-day forgetfulness that once was considered normal.
SK: This is an important point, where do we draw the line between memory loss as normal and as pathological?
Historically, senility was considered normal to old age; it was a non-medicalized and rather acceptable problem. There was no cure and no hope for it.
At the turn of the century, when Alois Alzheimer began working with young patients, who showed symptoms of severe memory loss and other conditions akin to senility, he rightly concluded that these were pathological because of the patient’s age.
However, beginning in the 1970s, especially as Alzheimer’s Disease as a medical category became the label for dementia for all age groups, senility began to be seen as an outmoded idea.
Over time, more aspects of memory loss were deemed to be pathological rather than normal, until today we have new categories such as Mild Cognitive Impairment as a medical problem.
Researchers, such as Anne Davis Basting and Peter J. Whitehouse, have raised concerns about the medicalization of memory loss and the impact on patient care. Whitehouse says, "We owe it to those who have aging brains not to reduce their humanity to one organ." A mantra to abide by.
RD: Around the globe, research centres and commercial companies are teaming up to nab a piece of the booming brain fitness market.
SK: This is true. More and more, we see cognitive health and exercise included with physical health and exercise.
Does anything really work to reverse cognitive decline? Probably not and certainly nothing so far. Yet, there are dozens of pharmaceutical companies with trials underway because any drug that even promises the vaguest hope of brain-protection would be highly profitable.
What is rarely understood, however, is that cognitive health is boosted through socializing and interacting with others. Many studies have demonstrated how social engagement is the way in which memories are established, enjoyed and embellished.
RD: Today, brain health is seen as an individual accomplishment – something to be worked at – but you argue cognitive well-being is a broader social issue. How so?
SK: Cognitive health, like any other kind of health, has a social foundation. For example, social inequalities have consequences for cognitive health in ways we are only just beginning to understand:
- poor working conditions;
- environmental degradation;
- industrialized food;
- trauma and violence;
- overexposure to electronic devices; and
- the long-term effects of certain medications.
Society also shapes our expectations and the way we prioritize certain kinds of cognitive skills over others. In large part, we tend either to misunderstand or simplify the complexity of real cognitive processes. For example, we assume that cognition can be artificially "enhanced", but why? Where did we get this idea that cognition is "enhance-able"?
RD: The study paints a fragmented picture of old age. For instance, it says contemporary society distinguishes between active independent older adults and those who are frail and dependent. Why is that?
SK: There are many reasons. We could look at economic, moral, political and cultural reasons, for example.
But much of it comes down to gerontology itself: to concepts like "successful aging," an accomplishment marked by what you list – active, healthy, self-reliant and independent. Which means that "unsuccessful aging" is the reverse: decline, dependency and decrepitude.
The problem is the social and political realities underlying these seemingly obvious distinctions are spawned by individualized lifestyles of aging. In other words, neoliberal society has placed such value on the individual to be independent, responsible, risk-managing and devoted to health and fitness, so that anything short of these looks like personal failure.
Yet, this same society is the one voting for increasingly conservative governments that cut supports and augment the social inequality and marginalization of older persons.
Our society also tends to hide the realities of aging, not only out of fear, but because they are contrary to the youth-based ethics of consumerism.
RD: So where does this leave frail old people in the future?
SK: There will be more frail old people in the future so their voice and conditions of life will become more visible and politically charged.
And the future is not fate. So, despite the warnings of the doom-and-gloom demographers, there are inventive ways of including and acknowledging the frail old. For one thing, we can urge our communities and governments to boost age-friendly and supportive environments because we see where this happens, care-giving becomes less isolated and more integrated into the social fabric of everyday life, where it belongs.
RD: Finally, the fear mongering about memory loss casts a shadow over old age. What can be done about it?
SK: We are already doing something about it – movies, books, new schools and programs, new forms of artistic expression.
And rethinking humanity itself in the "shadow of dementia". We have a great deal to learn, all of us, about life itself by being in touch with those with cognitive loss, we not only learn to care but we learn about resilience, courage, imagination, compensation and small everyday triumphs.
What can be done about it, in other words, is to change the way we think and relate.
Editor’s note: Discover this author’s favourite image of aging. You might be surprised. See AHB May/June 2007.