The Diseased Brain and the Failing Mind, by Martina Zimmermann

When this book arrived on my doorstep, I must admit to a slight internal groan at a cover that features an MRI scan of a brain. It reminded me of the bound conference proceedings that used to be handed out by pharmaceutical companies at large meetings of US psychiatrists. However, this is very much not a reductive biomedical analysis of dementia but rather an account of ageing, dementia and Alzheimer’s disease stretching from the late 19th century to 2020.

Martina Zimmermann does a magisterial job of interweaving the scientific study of Alzheimer’s with its depiction in literature, starting with Timothy in John Galsworthy’s The Forsyte Saga (1906-21). I kept reflecting on how recently we have begun to think about dementia as a medical and social problem. Since I am a middle-aged clinical academic who went to medical school in the 1990s and worked in neuropsychiatry in the early 2000s, dementia has always been an important element of my training and practice, yet this might not have been the case even 20 or 30 years before (even though Alois Alzheimer’s case study of Auguste D was presented in 1906). Indirectly, through Zimmermann’s account of research, advocacy and funding structures, we get to see how Alzheimer’s disease begins to come into focus in the 1970s and 1980s and to separate itself off from ageing and “senility”.

Although the author herself doesn’t use the term, it sounds as if a language of “crisis” was developed, allowing research groups to form and funding to be channelled to address this urgent problem. There was optimism that the illness could be prevented or treated. Indeed, I can think of lectures I’ve been to in recent years where speakers assured the audience that there would be a cure for Alzheimer’s within the next decade, although with the caveat that, since the pathology leading to the illness is laid down in early middle age, research needs to study and intervene earlier in life. As yet, however, curative treatment seems as far away as ever, and many of my colleagues who work in dementia research also stress the importance of caring for those with the illness properly.

In parallel with the exciting scientific history, Zimmermann charts how dementia is portrayed in literature. I really enjoyed the in-depth discussions of novels, of how ageing is related to wider notions of decline and degeneracy in society, and of the value put on those who are economically active. The book also describes many caregiver and second-person accounts of dementia, although it is only in the past few decades that the voices of the people with dementia themselves appear in published writing. We can see a parallel here in the growing emphasis on a reconfiguring of research and practice that emphasises the person in dementia and their experience, and goes beyond seeing it as a purely deficit state. Zimmermann argues for the role of the humanities in supporting this and advocates for a holistic and non-objectifying account of the illness, which allows the person to remain an agent with valuable knowledge of their condition.

Matthew Broome is chair in psychiatry and youth mental health, and director of the Institute for Mental Health, at the University of Birmingham.

The Diseased Brain and the Failing Mind: Dementia in Science, Medicine and Literature of the Long Twentieth Century
By Martina Zimmermann
Bloomsbury Academic, 240pp, £85.00
ISBN 9781350121805
Published 23 July 2020