Publishing the Biotechnical Futures of Alzheimer’s Disease

Abstract

In “Journeying to Ixtlan,” Peterson and colleagues (2023) evaluate some of the potential ethical implications of treating Alzheimer’s disease (AD) with psychedelic medicines. In this commentary, I suggest a need to critically engage with such bioethical appraisals of promissory biotechnologies because, whether deliberately or inadvertently, they often have a biopolitical function and perform certain types of symbolic work. Most concerningly, they can sometimes advance the interests of private stakeholders at the expense of people affected by AD. They do so by simultaneously simplifying and sensationalizing the nature of the problem, while also substantiating the proposed future solution. Peterson and colleagues may be falling into both traps when they appraise the ethics of prospective psychedelic treatments. Beginning with the former issue, representations of dementia, be they academic, political, artistic or public, often rely on and hence emphasize the gravity of AD as a problem. This problem can be highlighted in reference to loss of self, carer burden, state expense and other familiar tropes (Fletcher and Maddock 2021). Peterson and colleagues continue in this tradition, claiming that “issues are magnified when psychedelics are viewed through the lens of Alzheimer’s disease and related dementias.” Here, semi-implicitly, the argument is made that this paper matters because of the excessive badness of AD as a “death before death.” AD functions as a particular type of problem that raises the stakes. Maximizing effect, contentious notions of “autonomy” and “self” are presented as intrinsic and disease-affected entities, almost as though self is a neuronal network that is killed off by toxic protein aggregation. Such simplifications of psychosocial concepts are emblematic of the straightforward attribution of complex problems to disease entities. These types of arguments are widely rejected across contemporary dementia research, which instead understands such phenomena as contextually constituted processes. Distressing transformations of self, agency, identity, autonomy, etc. are experienced by many people in later life irrespective of neurocognitive conditions and are hence difficult to attribute to a particular disease. In practice, such matters are contingent on a wide range of extrinsic determinants, from stressful family relationships (Fletcher, 2020a, 2020c, 2021b) through to systemic racism (Fletcher 2020b, 2021a; Fletcher, Roche and Zubair 2022) and discriminatory disability legislation (Fletcher 2021c, 2023). Hence, the authors’ appeal to “whatever theory of identity and autonomy one adopts” is wrong. Their approach, which I would characterize as a “dread disease” framing, is at odds with much dementia scholarship over the past three decades. Nonetheless, a “dread disease” framing enables authors, both in this instance and generally, to underscore the terribleness of AD as a master-affliction. The simplification of human life that is manifest in such arguments is not mere sloppiness. It is instrumental because it takes the many problems associated with AD and translates them into a straightforward biotechnical problem. This conceptual wizardry is known as “ontological gestalt switching,” taking one type of thing and replacing it with another thing that better serves one’s purposes (Fletcher and Birk 2019). The payoff of switching is that a daunting collection of evils may be amenable to a comparably straightforward biotechnical solution. Acknowledging phenomena such as family relations, structural racism and legislative discrimination would weaken the rationales underpinning psychedelics, whereas a direct “X disease causes X problem” framing offers fertile terrain for extolling the feasibility of said treatments. The problem here is not that AD is misrepresented as bad (for many people it is awful), but rather that the nature of that badness is mischaracterized. The