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Wednesday, October 17, 2012

Mama and Alzheimer's

My mother-in-law has Alzheimer's. Mama’s symptoms began with mild cognitive impairment, but lately, following the deaths of two brothers which succeeded each other in rapid order, she has entered a shocking and steep decline.  Preparing for the second funeral, she upbraided my father-in-law for the clothes he'd laid out.  A suit and tie, she said, were not appropriate for a woman.  She had mistaken my father-in-law for her own mother.  I have to admit, when I heard about this, I couldn't help laughing, it was so bizarre and unlikely.

Then, while staying at my sister-in-law Donna's house, Mama woke up Donna in the middle of the night, insisting that "something was wrong with Mama."  Again, she thought the man sleeping in bed with her, the man she's been married to sixty-plus years, was a woman who's been dead last twenty years.

Now these episodes, which at first were mere aberrations, have become a regular feature of her mental landscape.  She habitually calls Dad, "Mama." When Nancy was down in Macon recently, Mama became agitated whenever Nancy corrected her, that, no, that person over there with the mustache is not your mother, but your husband.  Your mother is dead.  Other times, Mama will imagine that her mother has taken one of the cars and driven off somewhere, and that they must call 911 to prevent an accident.  My father-in-law is hurt and saddened by his wife's failure to recognize him or believe him when he says her mother is gone, but his patient efforts to explain sometimes further upset her.

Delusions are common among Alzheimer's victims, a typical one being that something has been stolen from them.  Perhaps in a way, something has.   Freud, I'm sure, would have a ready explanation for the shape Mama's delusion has taken--unconsciously she knows that she has become helpless and dependent on others.  This knowledge is unacceptable; a preferable belief is that she is still quite capable and the helpless dependent person in the house is her own mother, a woman who in her final years did indeed depend on Mama's care giving.

I once asked my brother Homer, a neurologist, why we are conscious?  Why do we perceive the world around us, instead of being just meat-robots going through cycles of nourishment and reproduction, responding to but not aware of texture, light, and sound?  Why do I have this movie projector playing a video of my surroundings in my mindscape?  

As Homer explained it, or at least as I understood his explanation, the sensory data that we imagine comes in as a steady stream like light pouring into a camera lens, actually only arrives in isolated bits and specks; our consciousness serves to stitch these fragments together, to fill in the missing gaps - gaps which are much wider and more numerous than we'd be comfortable believing - and making a seamless narrative out of what isn't much more than intermittent Morse Code bursts of data.  Given this, it's no wonder Mama's losing touch with reality; what's remarkable is that most of the rest of us maintain touch with it as well as we do.

It's easy to look at Mama with condescension, and even anger; how is it possible she can mistake her husband, a man, for a woman whom she knows has been gone for decades?  How is it possible to persist in this in spite of reasonable people reasonably pointing out what is only obvious?  Mama's plaintive remark to Nancy, after finally emerging from one of these delusional episodes was, "But it seems so real."  There's the rub.  It seems real.  And that's all any of us has as a test of reality.  It seems real.  Our hold of reality is no firmer than Mama's, perhaps; we're just lucky enough to share the same reality as most of the other people around us.

A watershed in my mother-in-law's decline occurred a couple of years ago during a summer vacation with the family.  She'd gone to her room to get her shoes.  When she hadn't returned after an inordinate time, my daughter, Spencer, went in to see what was keeping her.  She found Mama sobbing, sitting in the closet, unable to remember what she'd gone in her room to look for in the first place.

How vital is the real world of objects, things, purposes, and people.  How fragile our grasp of it.

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