Recognize Alzheimer’s as a Social Disease
Alzheimer's Disease is a progressive and debilitating disease that often leads to a person's inability to understand and be aware of their conscious existence. As a disease it is incurable and due to its inevitable progression, leads to one of the most frightening human conditions that exists. However, Alzheimer's disease and many associated dementias is more than just a progressive neurological disorder. Too often long-term care professionals come to view this as a physical disease, a disease that disassembles that normal neurological structure of the cerebral cortex. However, in addition to the physical manifestations that are part of its pathology, it is a disease that leads to the destruction of the social soul, which behavioral scientists have often referred to as the self.
The "self" is a unique component of human beings. We are not born with a sense of self (Handel, Cahill & Elkin). Our sense of self emerges with our overall development. Individuals are born as biological entities with some primitive biological reflexes, but at birth we have no understanding of what we are and how we are separate and unique entities from our environment (Handel, Cahill & Elkin; Santrock). Therefore, at birth we are living and breathing biological entities but with no self we fail to hold many of the qualities that we come to equate with being "human." This is especially evident from many studies, both in humans and other primates that have unfortunately been victims of severe abuse, neglect, and isolation.
As individuals develop our sense of self through social interaction, we come to develop into social beings, or as Elliot Aronson has come to refer to humans as a "social animal."(Aronson) It shapes our consciousness, how we come to view the world and ourselves, how we come to think and feel about ourselves, and most importantly, how we come to obtain those traits that we come to view as making us "human." However, possibly the most important part of our sense of self is the concept of "reflexivity." This shapes our mind to come and view ourselves as an "object" to itself. As conscious human beings our ability to see ourselves as others would see themselves is critical.
For instance, we develop important emotions such as pride, envy, and embarrassment because we are able to see ourselves as an object, viewing ourselves as others come to see us. However, as those long-term care personnel who have worked with individuals that suffer from this disease know, as the disease progresses, many of the person's social skills rapidly deteriorate. Patients suffering from this disease fail to be able to view themselves as an object, and this is often found in many forms of social behavior becoming compromised, such as undressing in public or taking their teeth out and placing them on the dining room table while others are eating.
What is happening in these instances is they lose their ability for shame and embarrassment, higher level social emotions that requires the reflexivity of the self. These emotions develop when we are able to see ourselves as others do, and they allow most people to understand what is appropriate or inappropriate behavior in any given situation. With a sense of self, it allows us to understand what others expect of us and how others will view us if we fail to live up to the social norms of particular situations. The person with Alzheimer's disease, whose self is slowly dying, is unable to understand these implications.
Furthermore, it is also very frustrating for many caregivers and family members to watch, since most cannot comprehend why their resident, or why a son or daughter's mother or father, is unable to understand may of these simple social graces that most of us take for granted. They fail to realize that the disease is more than just biological, but with the slow death of self, the important social nature of the person, that which makes are truly human, is slowly degenerating as well.
Long-term care staff often face continued needs to address older adults with this disease and the antisocial behavior that is often found among these elderly as the regressive spiral leads to a infantile level of self-consciousness, which further leads to behaviors such as disrobing, wandering without any concern for themselves, or urinating in public places. What is happening here? Again, the self, which allows us to control our behavior by seeing ourselves as others do; the part of ourselves that is important for higher level emotions such as pride, envy, embarrassment, shame, empathy, and even love; the part of ourselves that is important for understanding social situations and expectations that others hold; is dying along with the neurological tissue.
This is often noticed by many who care for residents that suffer from this disease when they attempt to explain to those who suffer from the disease their socially compromised behavior and its antisocial manifestations. In the earlier stages of the disease the explanation does revive some remnants of the self, as is evidenced by the resident demonstrating some awareness of their social transgressions when they are made aware of them by the long-term care worker. However, in the later stages, as workers attempt to explain their behavior to the resident, the resident often will stare blankly at the worker, similar to very young children being reprimanded for inappropriate behavior, both of whom are not able to understand the consequences of their actions due to not having the appropriate requirements for a truly social self.
In the child's case, their self will continue to develop and they will eventually be able to understand the social significance of their behavior. However, the person with Alzheimer's will never be able to understand the ramifications of their behavior and will only continue to spiral downward. For the child the self will mature and grow; for the person will Alzheimer's, the self will continue to regress and die. Therefore, Alzheimer's disease is more than a physical disease, but also a social disease, robbing the person of the essence of their humanity.
In summary, many individuals have come to view Alzheimer's disease as an exclusively biological condition. However, probably it most egregious impact is on the social nature of the human individual. With Alzheimer's disease comes the demise of what makes us human, our social self, and with it the ability to reflexively see ourselves as an object to ourselves. This becomes such an essentially important fact to understand about our human nature, and how Alzheimer's disease obliterates our human nature through its assault and eventual destruction of the self, that to not understand it leads clinicians and practitioners that deal with this population empty in their own right.
The implication to understand the social aspects of dementia, and the obliteration of the self, makes this disease as mentioned previously not just a neurocognitive disease but a social disease as well. The implications for treatment also should follow as well toward viewing it as a social disease with needed social intervention by long-term care professionals. Although biological treatments are still essential, by themselves they do very little to humanize individuals with these diseases that are ultimately so dehumanizing. Therefore, long-term care facilities must also invest more time in keeping those with this disease engaged in their social surroundings to slow and minimize the demise of the social self, the most egregious and frightening condition that is found in humans.
References
Aronson, E. (1980). The social animal. New York, Freeman Press.
Handel, G., Cahill, S., & Elkin. F. (2007). Children and society. Los Angeles, Roxbury
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Santrock, J. W. (2006). Life-span development, 10th ed. Boston, McGraw-Hill