WISERD, School of Social Sciences, Cardiff University, Cardiff, UK.
Department of Sociology, University of York, York, UK.
Soc Stud Sci. 2019 Apr;49(2):208-226. doi: 10.1177/0306312719834069. Epub 2019 Mar 5.
This article examines the strategies by which the different and variable signs of failing mental powers become known sufficiently for 'dementia' to be made into a stable bio-clinical entity, that can be tested, diagnosed and perhaps one day even treated. Drawing on data from ethnographic observations in memory clinics, together with interviews with associated scientists and clinicians, we document the challenges that clinicians face across the clinical and research domain in making dementia a stable object of their investigation. We illustrate how the pressure for early diagnoses of dementia creates tensions between the scientific representations of early dementia and its diagnosis in the clinic. Our aim is to highlight the extent to which the work of diagnosing dementia involves an intricate process of smoothing out seemingly insurmountable problems, such as the notoriously elusive connections between brain/mind and body/person. Furthermore, we show that a part of this process involves enrolling patients as minded, agentic subjects, the very subjects who are excluded from dementia science research in pursuit of biomarkers for the pre-clinical detection of dementia.
本文探讨了不同且多变的心智能力衰退迹象是如何被充分了解的，从而使“痴呆”成为一个稳定的生物临床实体，可以进行测试、诊断，也许有一天甚至可以治疗。本文利用记忆诊所的民族志观察数据，以及对相关科学家和临床医生的访谈，记录了临床医生在将痴呆症作为其研究对象时在临床和研究领域所面临的挑战。我们说明了早期诊断痴呆症的压力如何在早期痴呆症的科学表现及其在临床中的诊断之间产生紧张关系。我们的目的是强调诊断痴呆症的工作在多大程度上涉及到一个复杂的过程，即消除看似无法克服的问题，例如大脑/思维与身体/个体之间难以捉摸的联系。此外，我们还表明，这一过程的一部分涉及到将患者招募为有思想、有能动性的主体，而这些主体正是在追求痴呆症的临床前检测生物标志物的研究中被排除在痴呆症科学研究之外的。
