In psychiatry there is no sharp boundary between the normal and the pathological. Although clear cases abound, it is often indeterminate whether a particular condition does or does not qualify as a mental disorder. For example, definitions of ‘subthreshold disorders’ and of the ‘prodromal stages’ of diseases are notoriously contentious. Philosophers and linguists call concepts that lack sharp boundaries, and thus admit of borderline cases, ‘vague’. This overview chapter reviews current debates about demarcation in psychiatry against the backdrop of key issues within the philosophical discussion of vagueness: are there various kinds of vagueness? Is all vagueness representational? How does vagueness relate to epistemic uncertainty? What is the value of vagueness? Given the immense social, moral, and legal importance of demarcating the normal from the pathological in psychiatry, what are the pros and cons of gradualist approaches to mental disorders, that is, of construing boundaries as matters of degree?

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Existing accounts of the early history of Alzheimer’s disease have focused on Alois Alzheimer’s (1864–1915) publications of two ‘peculiar cases’ of middle-aged patients who showed symptoms associated with senile dementia, and Emil Kraepelin’s (1856–1926) discussion of these and a few other cases under the newly introduced name of ‘Alzheimer’s disease’ in his Textbook of Psychiatry. This article questions the underpinnings of these accounts that rely mainly on publications and describe ‘presenility’ as a defining characteristic of the disease. Drawing on archival research in the Munich psychiatric clinic, in which Alzheimer and Kraepelin practised, this article looks at the use of the category as a diagnostic label in practice. It argues that the first cases only got their exemplary status as key referents of Alzheimer’s disease in later readings of the original publications. In the 1900s, the published cases rather functioned as material to think about the limits of the category of senile dementia. The examination of paper technologies in the Munich psychiatric clinic reveals that the use of the clinical diagnosis of Alzheimer’s disease was not limited to patients of a certain age and did not exclude ‘senile’ cases. Moreover, the archival records reflect that many diagnoses of Alzheimer’s disease were noted in the medical records as suspicions rather than conclusions. Against this background, the article argues that in theory and practice, Alzheimer’s disease was not treated as a well-defined disease entity in the Munich clinic, but as an exploratory category for the clinical and histopathological investigation of varieties of organic brain diseases.

This paper examines medical scientists' accounts of their rediscoveries and reassessments of old materials. It looks at how historical patient files and brain samples of the first cases of Alzheimer's disease became reused as scientific objects of inquiry in the 1990s, when a genetic neuropathologist from Munich and a psychiatrist from Frankfurt lead searches for left-overs of Alzheimer's 'founder cases' from the 1900s. How and why did these researchers use historical methods, materials and narratives, and why did the biomedical community cherish their findings as valuable scientific facts about Alzheimer's disease? The paper approaches these questions by analysing how researchers conceptualised 'history' while backtracking and reassessing clinical and histological materials from the past. It elucidates six ways of conceptualising history as a biomedical matter: (1) scientific assessments of the past, i.e. natural scientific understandings of 'historical facts'; (2) history in biomedicine, e.g. uses of old histological collections in present day brain banks; (3) provenance research, e.g. applying historical methods to ensure the authenticity of brain samples; (4) technical biomedical history, e.g. reproducing original staining techniques to identify how old histological slides were made; (5) founding traditions, i.e. references to historical objects and persons within founding stories of scientific communities; and (6) priority debates, e.g. evaluating the role particular persons played in the discovery of a disease such as Alzheimer's. Against this background, the paper concludes with how the various ways of using and understanding 'history' were put forward to re-present historic cases as 'proto-types' for studying Alzheimer's disease in the present.