Getting Old and Forgetting Things: Design Anthropology and the Medicalisation of Ageing
Mild Cognitive Impairment (MCI) is a relatively new diagnosis that describes the grey area between ‘normal’ age-related decline and dementia. Following increased interest in the developmental stages of Alzheimer’s Disease in the 1980s, MCI was first proposed as a concept in 1988 before becoming an official diagnosis in 2004. While some clinicians and researchers argue that the MCI concept helps identify the earliest symptoms of dementia, others have pointed out that it does not guarantee further cognitive decline and arguably redefines ‘normal’ ageing. Although its definition, clinical use, assessment, treatment, and relationship to dementia remain topics of heated debate and controversy, MCI has recently become a topic of interest in the emerging field of ‘design for health’.
This thesis is based on a four-year website design project called ‘Living Well with MCI’, in which I participated in as a researcher between 2015 and 2019. In this project, I worked on an interdisciplinary team alongside a User Experience (UX) designer to develop an online resource for people with MCI and their families. The purpose of this PhD was to embed ‘design anthropology’ into the co-design process to develop insights into the MCI category in real time. In doing so, the research aimed promote critical reflection on the ways in which design, as both a future-making activity and field of research, might shape and give form to new medical constructs in contemporary society. Drawing inspiration from a ‘new materialist’ philosophy, science and technology studies (STS), and combining these with recent work in design anthropology, this research considers what happens when we conceptualise MCI as a socio-material ‘assemblage’. An assemblage in this research refers to the interconnected web of practices, processes, materials, and systems that produce MCI as a ‘matter of concern’ for individuals and society. The thesis therefore explores how designing for people with MCI intersects with developments in neuroscience and pharmacology, dementia research, geriatric care, design, and broader cultural anxieties about ageing and cognitive decline. To do this embedded research, I carried out ethnographic fieldwork across a range different sites and contexts, including memory clinics and dementia research centres, while working on the design project.
The research found that older adults tend to internalise the ideas and thought-style of Western biomedicine as they attempt to negotiate what it means to age ‘normally’. In the Living Well with MCI project, biomedical discourses shaped user ‘wants’ and ‘needs’ in specific ways, making it difficult to frame the experience associated with the MCI category in non-medical terms on the web resource. Therefore, in meeting these wants and needs, the website ultimately gave physical form to the beliefs and assumptions that underpin the Western biomedical model of ageing. The research also highlighted that conventional design tools and methods, which help designers ‘empathise’ with users and their experience, failed to support a critical orientation towards the deeper historical, social, cultural, and political processes that made MCI a ‘thing’ to design for in the first place. The unique contribution of this PhD lies in demonstrating the complex ways in which designers participate in the formation of emerging (and contested) medical realities, highlighting the particular relevance of this to the field of design for health. Furthermore, it argues that design for health practitioners have a responsibility to contribute to debates about the use, validity, and ethics of new diagnostic constructs in society.