by Laura Dietl
Dementia has, thus far, received little attention in Disability History. This post aims to change that. Firstly, dementia’s relevance to the field will be established, along with key methodological challenges. A brief historical overview of how dementia has been perceived and dealt with from antiquity to the present will follow.
Why focus on Dementia?
Dementia is an increasingly pressing societal issue as the risk of common forms like Alzheimer's disease rises with age. While dementia is undoubtedly a key challenge for aging societies today and in the future, it has not been given sufficient prominence, either in traditional historiography or in Disability History.
The symptomatic decline of intellectual and mental abilities is a phenomenon that has persisted throughout human history and can be traced through various sources (Karenberg/Förstl 2003). A crucial aspect is how societies have included or excluded individuals with dementia symptoms, positioning the condition between "normality" and "deviance" and constructing it as a "disability" or "illness".
Methodological Challenges
A major challenge is thus the issue of terminology: historical terms for dementia symptoms varied widely, and "dementia" itself has evolved in meaning, complicating historical analysis (Karenberg/Förstl 2003).
Another difficulty lies in the sources. Relevant source material on dementia is scarce and fragmented. Most existing sources are medical-historical, while sociohistorical and personal accounts remain limited.
A key issue is the absence of autobiographical records. Dementia inherently impairs memory and self-expression, making first-hand narratives rare. This absence may reflect both societal marginalization and the nature of the condition itself. Regardless of interpretation, this scarcity presents a fundamental challenge: acknowledging individuals with dementia as historical subjects despite predominantly third-party sources.
"Senectus ipsa morbus est" (Terenz): "That Senescence itself is an Illness"? – Dementia in the Greco-Roman Period
In Greco-Roman antiquity age-related cognitive decline received only periodic attention in philosophical, literary, medical, and legal texts. Dementia symptoms were ambiguously classified, reflecting the debate over whether cognitive decline was simply an inevitable consequence of aging – and thus inherently pathological – or a distinct phenomenon.
Philosophers like Plato, Aristotle, and Seneca the Younger viewed old age and illness, including dementia, as inseparable (Berchtold/Cotman 1998). Plato's Timaeus ("Dialogue") describes symptoms of age-related forgetfulness resembling modern dementia. In Nomoi ("Laws") he cites a proverb likening cognitive decline in old age to a return to a childlike state. Aristotle similarly addresses age-related cognitive decline in De generatione animalium ("Generation of Animals") and De anima ("On the Soul"), which frame old age as a pathological condition. In contrast, Cicero, in Cato Maior de Senectute ("Cato the Elder on Old Age"), attributes mental decline to moral weakness and rejects a blanket pathologization of aging. Overall, dementia in antiquity was perceived as being somewhere between normal aging and pathological deviation, with the idea of aging as a disease becoming more widely accepted.
Between "Caritas" and Exclusion – Dementia in the Middle Ages and Early Modern Period
Unlike antiquity, which lacked institutionalized elderly care (Eckart 2022), the emerging medieval hospitals, rooted in Christian caritas, likely served as places of care for dementia patients (Schuhmacher 2018). Despite limited sources, care for individuals with mental and physical disabilities (such as dementia) or chronic illnesses in the Middle Ages and Early Modern Period was largely provided by family members and relatives – there is no evidence of collective exclusion of those affected (Frohne/Nuckel/Büttner 2012).
However, literary sources from the late Middle Ages and Early Modern Period suggest a negative societal view of old age, often linked to mental decline. In Moriae encomium ("In Praise of Folly”) Erasmus of Rotterdam highlights forgetfulness and the regression of the elderly to childhood, reinforcing ancient stereotypes. Dementia symptoms could carry stigma and even make individuals vulnerable to witch trials (Berchtold/Cotman 1998). Additionally, madhouses which emerged during the Early Modern Period, likely housed those whose symptoms were seen as socially deviant (Schuhmacher 2018).
Developments in the 19th Century
Inspired by psychiatry pioneers like Philippe Pinel, the 19th century saw a gradual shift in the perception of the mentally ill, including dementia patients (Berchtold/Cotman 1998). No longer indiscriminately housed with criminals, they came to be recognized as patients. Enlightenment and humanist ideals promoted more humane treatment, though coercive measures such as starvation diets, cold showers, or straitjackets remained common. (Schuhmacher 2018).
The medical reclassification also spurred research: In Des maladies mentales ("Mental maladies. A treatise on insanity") Jean Étienne Dominique Esquirol provided the first systematic definition of dementia in 1838. However, age-related cognitive decline was still not widely seen as a medical condition, as reflected in the term Altersblödsinn ("senile foolishness") used for this purpose (Karenberg/Förstl 2003).
Who was Auguste Deter? – The Discovery of Alzheimer's Disease
In 1901, 51-year-old Auguste Deter was admitted to the Asylum for the Insane and Epileptic in Frankfurt am Main due to dementia symptoms. There, physician Alois Alzheimer took interest in her case, documenting their conversations in her medical records. After her death in 1906, he examined her brain histologically, identifying the pathology now known as Alzheimer's disease. The term "Alzheimer's disease" was introduced by Emil Kraepelin, a leading psychiatrist of his time, in the eighth edition of his textbook on psychiatry published in 1910. Unlike today's unified concept of dementia and Alzheimer's, a distinction between presenile and senile dementia persisted until the 1960s and 1970s, with Alzheimer's disease classified as the presenile form. However, Alzheimer himself increasingly questioned this dualistic classification as no differences beyond age at onset could be identified between the two forms (Karenberg/Förstl 2003).
While Alzheimer’s name is widely recognized, Auguste Deter remains largely unknown - a disparity worth addressing. Her recorded statements, such as "I have lost myself," offer rare insights into self-perception in dementia (Maurer/Maurer 1999).
Alzheimer’s discovery did not immediately change dementia treatment but successfully emphasized its biological basis, shifting medical and societal views. This shift is reflected in the gradual transition from the stigmatizing term senile foolishness to Alzheimer’s disease.
Dementia Patients as Victims of Nazi "Euthanasia"
During the era of National Socialism, debates arose over whether senile dementia constituted a krankhafte Erbveranlagung ("hereditary pathological disposition") (Karenberg/Förstl 2003). It is highly likely that individuals with dementia symptoms were among the victims of Nazi “euthanasia”.
Although research on this specific group as victims of persecution and mass murder remains limited, "senile diseases" were listed as selection criteria on reporting forms sent to Heil- und Pflegeanstalten ("sanatoriums and nursing homes") from October 1939 onwards (Cording 2000). The recorded data was reviewed to select “euthanasia” victims, explicitly targeting those with dementia or senile illness, particularly if severely confused or incontinent. Work capacity was crucial; individuals capable only of mechanical tasks (a criterion often met by advanced dementia patients) were marked for “euthanasia”.
However, some restraint was shown in targeting elderly patients. To avoid public unrest, war veterans, elderly individuals, and foreigners were occasionally spared (Schmuhl 1992). Specifically, elderly people who had been socially and economically integrated before developing age-related illnesses were largely excluded. Notably, dementias occurring before old age and conditions with dementia-like symptoms (e.g. progressive paralysis) were not covered by this exemption.
Sample analyses indicate that age-related illnesses accounted for only 1–2% of “euthanasia” cases in certain institutions (Schmuhl 1992). Nonetheless, these numbers confirm that age-related conditions were not categorically exempt.
Growing Societal Interest – From the 1970s to the Present
Since the 1970s, dementia has gained prominence in research and public discourse. In 1980, the first Alzheimer's Association was founded in the USA, followed by similar organizations worldwide, evolving into advocacy groups for patients and families.
In many industrialized Western societies, elderly individuals (with dementia) are increasingly placed in nursing homes, reinforcing a form of (spatial and societal) separation. Even today, old age and dementia remain linked to social exclusion. Moreover, dementia is understood differently across cultures— for example, in Ghana, affected individuals are confined to "witch camps," isolated from their families (further information: https://www.worldpressphoto.org/collection/photo-contest/2023/Lee-Ann-Olwage/1).
Conclusion
Dementia illustrates how concepts of normality, illness, and deviance are shaped by culture and society. The historical approach is not a linear success story but a process of societal negotiation, resulting in varied interpretations. Cognitive decline has been seen as a natural part of aging, a character flaw, or a pathology. History reveals both care and exclusion, stigma and violence, as well as instances of integration and self-empowerment.
Laura Dietl studied German and History at the University of Regensburg and currently works as a teacher.
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References:
Berchtold, N.C./Cotman, C.W. (1998): Evolution in the conceptualization of dementia and Alzheimer´s disease: Greco-Roman period to the 1960s. In: Neurobiology of Aging 19, 173–189.
Cording, Clemens (2000): Die Regensburger Heil- und Pflegeanstalt Karthaus-Prüll im „Dritten Reich“. Eine Studie zur Ge-schichte der Psychiatrie im Nationalsozialismus. Würzburg: Deutscher Wissenschaftsverlag.
Eckart, Wolfgang (2022): Alt werden und am Alter kranken – Lust und Last des Alterns von der Antike bis in die Neuzeit, in: Ho, Anthony D./Holstein, Thomas W./Häfner, Heinz: Altern: Biologie und Chancen. Alter und Altern individuell, kollektiv und die Folgen (Schriften der Mathematisch-naturwissenschaftlichen Klasse, Bd. 27). Wiesbaden: Springer Spektrum, 123-140.
Frohne, Bianca/Nuckel, Ivette/Büttner, Jan Ulrich (2012): Ausgegrenzt und abgeschoben? Das Leben körperlich und geistig beeinträchtigter Menschen im Mittelalter. In: bonjour.Geschichte 2, 1–25.
Karenberg, Axel/Förstl, Hans (2003): Geschichte der Demenzen und der Antidementiva. In: Förstl, Hans (Hrsg.) (2003): Anti-dementiva. München/Jena: Urban&Fischer, 5–52.
Maurer, Konrad/Maurer, Ulrike (1999): Alzheimer. Das Leben eines Arztes und die Karriere einer Krankheit. 2. Auflage Mün-chen: Piper.
Schmuhl, Hans-Walter (1992): Rassenhygiene, Nationalsozialismus, Euthanasie. Von der Verhütung zur Vernichtung „le-bensunwerten Lebens“ 1890-1945. Kritische Studien zur Geschichtswissenschaft, 75. 2. Aufl. Göttingen: Vandenhoeck & Ruprecht.
Schuhmacher, Birgit (2018): Inklusion für Menschen mit Demenz. Exklusionsrisiken und Teilnahmechancen. Wiesbaden: Springer VS.
Recommended citation: Laura Dietl (2025): Perspectives on the Historical Approach to Dementia. In: Public Disability History 10 (2025) 4.