11. Divided Gazes: Alzheimer’s Disease, the Person within, and Death in Life
Annette Leibing
Abstract
SCENE 1: It was my first day of observation at a small psychogeriatric outpatient clinic, part of the Institute of Psychiatry at the Federal University of Rio de Janeiro (UFRJ). 1 This was one of my field sites for my study of the psychiatry of aging. 2 In came the first patient, a small, friendly woman of sixty-four. She sat down in front of the attending psychiatrist, Dr. Fisz, and told him in a coherent manner that lately she had been feeling constantly depressed. 3 She explained that her family had once been large, but now the kids had left home and her husband did not like to go out. "I withdrew from life." The psychiatrist asked her questions about her general health and requested that she come back for a battery of medical and neuropsychological tests, an electroencephalogram ("just in case"), and some blood tests. He prescribed an antidepressant and recommended that she attended a church group. He told me, after she had left, that he was considering the possibility of Alzheimer's disease, something that astonished me, since the woman's narrative had made sense to me and her selfdiagnosis of depression fit exactly into my lay diagnostic schema. SCENE 2: Some weeks later, a Canadian visitor came to the clinic. She was a social psychologist responsible for a World Health Organization (WHO) project in Brazil. She accompanied me one morning to observe some psychogeriatric treatments. A resident in psychiatry was applying the CAMDEX (Cambridge Examination for Mental Disorders of the Elderly) neuropsychological test (Roth et al. ) to an older woman who was sitting at a small table with her daughter. The young resident was charming and the patients liked her, but she was a bit bored by the repetitive task of administering the test to almost everybody