“One has to just – I don’t know myself – I don’t know at all – oh goodness gracious, what is it all?”
This was spoken by a woman called Auguste D during an interview with a doctor at the Frankfurt lunatic asylum in 1901. They were recorded in her case notes, which still survive. The doctor’s name was Alois Alzheimer, and he was rather puzzled by Auguste’s case. She was presenting symptoms of memory loss and confusion, as well as agitation and delusions – her first symptom was reported to be irrational jealousy of her husband. He had seen such symptoms before, he thought, in cases of senile dementia, but not with such severity, nor in someone so young (Auguste was in her mid-50s).
When Auguste died, Alzheimer had already moved across the country to another job, but he sent for her brain so that he could dissect and analyse it. Using the latest microscopy and staining techniques he found, he thought, a new configuration of pathological lesions: “neurofibrillary plaques and tangles” were both present in Auguste’s brain and remain to this day the neuropathological hallmarks of the disease which was to bear his name. In 1910, just four years after Alzheimer had published the case of Auguste D, and when less than a dozen similar cases had been identified, the great psychiatric theorist Emil Kraepelin announced that a new disease had been discovered: Alzheimer’s disease.
There are many different ways to tell the story of the genesis of Alzheimer’s disease – the one recounted above is just one of them. Why I chose today’s quote was not so that I could get into the question of how Alzheimer’s disease came to be, but because I always find reading Auguste D’s case notes quite an emotional experience. As a historian of mental health, I think that the way that we understand and even experience mental illness is very much influenced by the context we are in. I have some sympathy with the idea that no one suffered from Alzheimer’s disease before 1910 because such a thing did not exist. However, when reading first-person narratives of mental illness, whether by someone living with mental illness or an observer, I sometimes come across things which seem so instantly familiar, which speak so directly to my own experiences with mental illness, that they seem to suggest eternal, universal forms of human suffering. I don’t think the two approaches are irreconcilable. We can be aware of how strongly the ideas which surround us shape our lives and our understandings of ourselves, while still allowing for the possibility that sometimes an experience or a story will reach across that historical language barrier. History, and perhaps the history of medicine in particular, has more than one job to do: the analytical task of showing how different categories and concepts came to be formed and accepted, but also a more humanistic task of connecting people with their ’emotional ancestors’, and reminding them that, in their experiences of suffering and tragedy, they have never been alone.