It’s easy to forget that until recently, dementia was accepted as a normal consequence of old age. Poets, playwrights and philosophers have brooded for centuries over the humiliating mental deterioration the elderly are prone to suffer. Xenophon lamented during the fourth century B.C. that he would someday grow “dull of wit, slower to learn, quicker to forget.” And Ecclesiastes implores sons of an aged father to show forbearance “even if he is lacking in understanding.” Though Shenk organizes his narrative around the clinical stages of Alzheimer’s disease, “The Forgetting” is at root a chronicle of how our view of senility has changed in recent decades.
When the German physician Alois Alzheimer described the condition that now bears his name, he assumed he was on to something very different from ordinary dementia. Why? Because the patient, a woman he called Auguste D., was only 51 years old. Frau D.’s husband had brought her to a Frankfurt hospital in 1901, disoriented and unable to write her own name without losing track of her intentions. When she died four years later, mute and incontinent, Alzheimer examined her brain tissue under a microscope, where it revealed a bizarre and distinctive syndrome. The cortex was littered with clumps of brown plaque, and a third of the neurons had filled with tangled filaments and disintegrated.
For the next five decades, few experts imagined that garden-variety senile dementia might involve the same pathology. But the elderly population grew rapidly during 1960s, triggering an explosion in geriatric research. And by the late 1970s, researchers had realized that what Shakespeare called our “second childishness” was in fact a disease with an unknown cause and a grimly predictable course. As in Xenophon’s time, anyone surviving beyond 65 was at risk. But now, thanks to recent improvements in living standards and medical care, surviving beyond 65 was the norm. Like the Struldbruggs of “Gulliver’s Travels”–who endured eternal life without eternal youth–people throughout the developed world now faced the prospect of skirting early death only to end up in Auguste D.’s condition. “If doctors in 1910 could have envisioned the appall-ing side effects of medical progress,” Shenk observes, “they would have found this very difficult to reconcile with their work.”
The irony grows more bitter every year, as our increasingly aged society drifts toward an Alzheimer’s pandemic. If current trends continue, the number of afflicted Americans could rise from 4 million today to 14 million by 2050. Foundations, governments and drug companies are spending billions on the search for effective treatments. But for the foreseeable future, the diagnosis will hold only terror for most of the families confronting it. Shenk’s greatest feat in “The Forgetting” is to evoke other possible responses. Without discounting the pain of this affliction, he finds in some people an ability to relinquish gracefully what it takes away. Few have succeeded better than Ralph Waldo Emerson. Born too soon to view his dementia as a disease, he adjusted to it by eating pie before breakfast and assuring his friends, “I have lost my mental faculties but am perfectly well.”
Other sufferers have managed, while fully aware of their predicament, to find liberation in it. As Alzheimer’s robbed the painter Willem de Kooning of abstract thought during the 1980s, his work became lighter, freer and more lyrical than it had been in a decade. One dazzled critic dubbed his new style “Alzheimer’s Expressionism.” Morris Friedell discovered a similar consolation. The southern California sociologist was just 59 when his memory lapses were diagnosed as probable Alzheimer’s two years ago. “There is pain in forgetfulness,” he told an online support group in 1999, “but sometimes there is something delicious in oblivion. Recently I spent some time with a 3-year-old grandson of a friend of mine. He has Down’s syndrome. I could enjoy sharing with him his friendly little nonverbal world in a way that I never could have before.” A small consolation to be sure, but one we would all do well to contemplate. Until we learn to prevent or treat Alzheimer’s disease, the challenge is to find meaning in it.
