If you watched Secrets from the Asylum on ITV1, you will have seen me chatting away to actress Claire Sweeney about her ancestor, John Sweeney. He was admitted to Ballamona Asylum on the Isle of Man with a diagnosis of ‘senile dementia’ in 1902. She was surprised to find out that old people with dementia were admitted to lunatic asylums, and so are many other people.
Over the next few days I’m going to be answering some of the questions I commonly get asked about dementia, old age and the asylum.
1. How old is the term ‘senile dementia’?
Of course, this wasn’t the first time that someone recognised that people in old age sometimes showed signs of mental disorder and deterioration: terms like dotage and fatuity had a long history, and were often used to describe mental decline in old age.
Prichard took the term ‘senile dementia’ – or démence sénile – from French psychiatrists Phillipe Pinel and Jean-Étienne Esquirol. For them, and for psychiatrists throughout the nineteenth century, ‘dementia’ was not just a disease of old age. It was a form of insanity which was characterised by progressive cognitive impairment, which was usually incurable, and which could be brought on at any age by mental exhaustion or shock.
By the same token, senile dementia was not the only ‘senile’ diagnostic label used by British psychiatrists. Senile mania, senile melancholia, senile epilepsy…pretty much any form of insanity could have the word ‘senile’ attached to it when the disease appeared in an older person. However, as the nineteenth century wore on, the association between senility and dementia became increasingly tight. By 1904 – the year John Sweeney died – senile dementia was the only officially recognised form of senile insanity in the UK.
At the same time, in Germany, a new disease category was being formed which would have a huge impact on the understanding of dementia. In 1901, a German psychiatrist and neurologist called Alois Alzheimer met a patient, Auguste Deter, in an asylum in Frankfurt. She was losing her memory, and was confused. After she died in 1906, he examined her brain, finding lesions which he identified as neurofibrillary plaques and tangles – the pathological hallmarks of the disease which would later bear his name. In 1910, the term ‘Alzheimer’s disease’ appeared for the first time.
In the mid-nineteenth century, the term ‘senile dementia’ was replaced with more precise and supposedly less stigmatising terms. The term ‘senile dementia’, it was argued, suggested that all old people were potentially demented. It reinforced the idea that dementia was caused by a general, irreversible, ‘natural’ process of ageing, rather than a disease. Now, there have even been moves to replace the 250-year-old word ‘dementia’ with new terms: major and mild neurocognitive disorders.
Coming up…How and where were older people cared for in Victorian England, when they needed looking after? Why was senile dementia described as a form of lunacy?