Since the second edition of this article, no ground-breaking scholarly work has been published that may challenge the historical hypotheses propounded therein on the development of the concept of dementia (Berrios, 2000a); indeed, the ‘constructionist’ view has gained support from the way in which the nosological surface of ‘dementia’ has been redrawn during the last 10 years.
All clinical categories, including those pertaining to the dementias, are the result of the coming together in the work of an author of selected behavioural markers, explanatory concepts and terms to refer to them. Complex social and economic variables will determine whether or not the ensuing ‘convergence’ will last. For reason that have to do with the rhetoric of science, these social acts are sold to the throng as pure ‘scientific acts’. For example, it would be naïve to believe that the decision to consider a symptom-cluster such as, for example,’Lewy body dementia’ as a ‘new disease’ is solely based on the ‘discovery’ of powerful, ineluctable and replicable correlations (Perry et al., 1996). Given that not all correlations are privileged in this way, and that there is no clear theory linking all the symptoms to each other and to the Lewy bodies themselves, it is not difficult to surmise that such consideration is also driven by social variables. The current model of science as a pure pursuit of truth, however, leaves no space for broader explanations and hence all manner of social variables remain understudied.
This is not a new phenomenon, for the same complex mechanisms operated at the time when Kraepelin constructed the concept of Alzheimer’s disease (AD) (Berrios, 1990b).
The crucial issue here is that there is nothing wrong with the fact that social forces shape ‘scientific facts’ and hence contribute to the construction of psychiatric diseases. Indeed, understanding such mechanisms would render psychiatry more complete, the psychiatrist wiser and doctoring more useful to patients.
Hopefully, the time will come when denying social processes may be considered as unethical and offensive to patients.
Knowledge of the history of dementia as a word, a concept and a behavioural syndrome is a precondition for scientific research. Successive historical convergences have shaped the current notion of dementia. A full study should map the changes in the history of ‘dementia’ at least since Roman times.
For the purposes of this section, however, it should suffice to study a shorter period, say, the one stretching from the work of Boissier de Sauvages (1771), who still offered a static view of disease to Marie (1906) whose great treatise would read as very modern to anachronistic eyes. The former defined ‘dementia’ as a generic term; the latter saw in dementia a ‘syndrome’, which could be enacted by a variety of ‘diseases’ each with its recognizable phenomenology and putative neuropathology.
Alistair Burns MPhil, MD, FRCP, FRCPsych
Professor of Old Age Psychiatry,
John O’Brien MA, DM, FRCPsych
Professor of Old Age Psychiatry,
Institute for Ageing and Health,
University of Newcastle upon Tyne,
Newcastle upon Tyne, UK
David Ames BA, MD, FRCPsych, FRANZCP
Professor of Psychiatry of Old Age,
University of Melbourne, St George’s Hospital, Melbourne,
German Berrios BA (OXFORD), MD, DM H.C. HEIDELBERG, FRCPsych, FBPSS
University of Cambridge Department of Psychiatry,
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