Alzheimer's Disease (AD), named after German researcher Alois Alzheimer in 1907, is a dreaded affliction of our time. Not only do its causes and cure elude us, but it encapsulates an intense cultural fear about ageing itself. Historian Jesse Ballenger focuses on the modern self to address AD as an emergent crisis and describes how scientific expertise, gerontological advocacy, and American individualism combined to push AD to the forefront of the health research agenda. During the late 18th century, American physician Benjamin Rush considered dementia a natural consequence of ageing in the face of which older people could preserve their moral stature even as their incapacities grew. During the 19th and early 20th centuries, traditional values of moral selfhood gave way to the progressive, liberal soul of modern industry and science, prompting influential figures such as neurologist George Miller Beard and proto-geriatrician Ignatz Nascher to characterise senility as a pathological condition. Here Ballenger elaborates the scholarship of other historians of ageing, such as Carole Haber and W. Andrew Achenbaum, to claim that the contemporary problems of ageing developed as a consequence of modernity.

Ballenger is more original when he examines the transformation of the vague notion of senility into AD and accents issues of gender. While initially considered a disease suffered by patients too young to experience senile dementia, AD grew as a category that eventually colonised all cognitive losses associated with ageing. So defined, AD galvanised the efforts of neuropathology, psychiatry, microscopy and pharmacology to act upon national health policy. As what Ballenger refers to as ‘the gerontological persuasion’ optimistically recast ageing as healthy and positive, dementia became an ever-greater stigma in 20th century American retirement culture. Here the book challenges readers to question whether AD is brain pathology with an indeterminate relation to ageing, or rather an expression of the ageing process, the causes of which can be multiple. As brain pathology, AD has been intensely researched and the different fields point to different primary causes. Neurochemistry theorised the cholinergic hypothesis, genetic research proposed that the risks of AD are traceable to genetic variables, and advances in microscopic technology have allowed it to probe, scan and display the brain, revealing the destructive effects of AD's plaques and tangles. Treatments such as cholinesterase inhibitors and memory-medicines have, however, produced only moderate results in early-stage AD.

These chapters provide rich historical detail, but need balancing with a more prominent theoretical framework. Ballenger's charting of the ‘discursive framework’ that has shaped AD research and treatment is valuable, but could have substantially benefited from the work of Bourdieu, Foucault, Hacking and Latour, amongst others who have engaged in social studies of science. Their critical literature on the practices of scientific fields examines the interplay of discourse, power and authority; all highly relevant to Ballenger's positioning of AD as an exemplary case of the bio-politics of ageing. A wider perspective of the theoretical debates about the making of scientific truth in late capitalist society would both strengthen Ballenger's core argument and provide a fuller structural background from which to discuss American neo-liberal health policy and the governance of risk, both crucial aspects of the current management of AD.

The book's final two chapters consider some of the social and personal consequences of AD. During the 1980s, it became the focus of a well-publicised national advocacy campaign that promoted the disorder as a ‘killer’ that rivals cancer. Even President Reagan was not immune. Despite the apparent democracy of the disease, the campaign emphasised selective middle-class anxieties about productivity, ageing, health status and functionality. Here Ballenger is very sensitive to the ways in which dominant representations and metaphors of AD affect people – both those afflicted with it and those who care for them. Since large funding is pegged to research, care becomes secondary and AD communities are left adrift from the grand ideals of ‘medical triumphalism’. For those whose resistant voices are emerging from the AD communities, however, they are often overwhelmed by new literary and media representations of dementia that celebrate individual expression, creativity and entitlement. Here Ballenger suggests an important issue, which is that such genres tend to conflate all cognitive losses because of the impossible standards of our hyper-cognitive society, against which all manner of enabling narratives and technologies are brought to bear.

Self, Senility, and Alzheimer's Disease in Modern America is a lucid and thoughtful history and a timely contribution to understanding how AD has altered the meaning of ageing. Ballenger digs beneath the story of a disease category to question the foundations of the modern self, where coherence, rationality, performance, and memory have become the hallmarks of successful personhood. Such reflection will appeal to readers from all professional backgrounds as providing a way forward away from the medical pathologising, cultural stereotyping, and gerontological idealism that have dominated the AD experience.