The Senile Body

Senility, senile dementia, and Alzheimer's are not stable and invariant terms within several of the contexts we have begun to discuss. The putative lingua franca of the world of electron microscopes and white-coated researchers pictured in India Today quickly disaggregates into the different ways of engaging old age and different projects of materializing the senile body evidenced in Zagreb. The easiest response to these differences—indeed, the classic anthropological strategy—is to read them as variations in something called culture . In making sense of Zagreb, for example, one could draw upon the frequently cited insight of ethnographers that within a comparative context many Americans and Europeans act and experience themselves as autonomous and bounded entities, highly individuated selves within quite separate bodies, while many Indians act and experience themselves primarily in terms of their relations with others, as linked and interdependent selves continually sharing and exchanging substance with other bodies.^[43] Along such lines, the more embodied and individuated senility of Americans versus the more social and comparative senility of the Indians at Zagreb makes a bit more sense. At times I will draw upon such "culturalist" logics, if in somewhat less grand formulations, when they seem particularly compelling.

But the immediate move to culture as the ground sufficient for situating difference obscures many other and more immediate forms of understanding and collapses more nuanced analyses into a necessarily misread totality, reinstating the

anthropological predicament James Clifford and others have been addressing for some time.^[44] Against both camps in Zagreb, each convinced the other was missing the point, and against their easy reification only into two discrete moral worlds, I draw upon some additional tools. I begin by constructing an ideal type from the one word that momentarily appeared to link the Zagreb conferees: senility .

I use senility precisely because of the contested and shifting meaning of the term. I refer by it to the attribution of difference or discontinuity to an old person or to old people as a group, when this difference is embodied as behavior—as actions or utterances—and when it is to some degree stigmatized . For the moment I will use "old" loosely, begging for now the specifics of how it translates, taking it as a generalized way of marking and signifying someone whose body, demeanor, behavior, social position, or history is suggestive of the later decades of the life course in a given place or time.

This definition of senility puts aside the question of causation, or in medical terms etiology , by suggesting that it may be useful to look at senility as a process, something that is articulated in time.^[45] In part, the processual nature of senility is comprehensible within the frame of the various physiological models that we will examine below, whether we are speaking in terms of progressive disorders like Alzheimer's disease, of bad families, of nineteenth-century European theories of the male climacteric or tropical softening, or of Indian Ayurvedic discussions on the excess of wind. But a processual analysis of senility is not exhausted by any of these models. Colleen and Frank Johnson have shown how the timing of the diagnosis of Alzheimer's among the American families they studied in the 1980s was correlated more closely with levels of family stress than levels of dementing illness as measured by a mental status examination.^[46] Caregivers appeared to defer diagnoses for family members until such time as they felt they could no longer care for them. One of the implications of the Johnsons' study is that the practice of diagnosing dementing illness functions as a critical legitimation for institutionalization. Bodily events—diagnosis, institutionalization, and their beneficial or traumatic outcomes—cannot be reduced solely to a body's internal workings. Senility is acutely attributional: it almost always requires two bodies, a senile body and a second body that recognizes a change in the first. As with the politics of madness, discussions of medical ontology are inseparable from the culture and politics of attribution. Without dismissing the material nature of senility, we need to recognize that "going sixtyish" in Varanasi or "being a victim of Alzheimer's" in the United States are fundamentally dialogic processes, involving both an old person and some other.

Thus the types of knowledge and practice that structure the experience of senility and make it comprehensible emerge within a particular relation of desire between the senile and the attributing body. Is the senile body the speaker's own? Knowledge of and engagement with and within one's own body I term first-person . Is the body in question that of some known other, whether parent, spouse, relative, or friend, or of someone differentiated from the speaker along axes of class or caste or gender? Knowledge of and engagement with another's body I term second -

person . Or is the senile body generalized, a body we can imagine as universal? Here the lines of desire between speaking and senile bodies get blurred, encompassed by some form of universalizing reason. The senile body emerges as a collective representation, as a fact in the world. Knowledge of and engagement with such a body I term third-person . Like my use of senility , these types of knowledge and practice are at best heuristic tools. Like any tools, they will come in handy at some times and not others, when it may be more useful to collapse them or ask different sorts of questions.