A Memory Not Forgotten
by Daniel

Reflection

You have to begin to lose your memory, if only in bits and pieces, to realize that memory is what makes our lives. Life without memory is no life at all Our memory is our coherence, our reason, our feeling, even our action. Without it, we are nothing.1

Luis Buñuel

Buñuel's powerful words encapsulate the fundamental part that memory plays in creating and sustaining one's life, in giving one a name, a family and an awareness of one's own existence.  And so, the loss of memory can so mercilessly take a life, without taking the body.

I have chosen to analyse the impact of Alzheimer's Disease as it not only encircles my interest in the philosophy of memory, but it is a concrete example of how a disease, although having a physiological manifestation, can affect human lives in many ways other than its pathological activity. My creative piece and the literature I studied look at the emotional devastation that Alzheimer's causes, not only to the patient, but also to so many others connected to the patient.

Dr. Oliver Sacks looks deeply into dementia and its emotional destruction in his book, The Man Who Mistook His Wife for a Hat. He explores the impact of memory loss physiologically, emotionally and philosophically. I shall refer back to his thoughts and theories to exemplify my own interpretations.

Sacks uses case-studies of past patients with fascinatingly unique neurological disorders which illustrate the issue of illness emerging in different domains of a biological system. As illness is seen on these different levels, interventions and treatments are needed for each domain, which can differ from one another dramatically. For example, as a practitioner, you may have to attend to the emotional needs of the distraught and scared family of an Alzheimer's patient using emotional intelligence whilst also attending to the physiological aspect of the patient themselves using academic intelligence and reasoning.

In the two-stage process of analysis and synthesis whereby you ask:

a)     What are the problems and at what levels of the system do they exist?

b)    How are the different aspects of the predicament potentially interrelated and patterned?3

The problem is then identified at the particular level, and the intervention can be drawn upon. The nature of interventions, particularly regarding emotional issues, was raised in my chosen literature, The Notebook, a film looking into the touching relationship of an elderly couple, of whom Mrs. Hamilton was suffering from severe dementia. Her resilient husband read to her the story of their lives and of how they fell in love in an attempt to bring her memories back to her. One particular scene epitomised the need to look beyond medicines and scientific theory, and consider using the patient's story to heal by connecting with them through the things that have formed their life:

Doctor: So I understand that you read to Miss Hamilton?

Mr. Hamilton: Yeah, to help her remember.

Doctor: Hmm.

Mr. Hamilton: You don't think it'll help?

Doctor: No I don't.

Mr. Hamilton: She remembers, Doc.

I read to her, and she remembers.

Not always, but she remembers

Doctor: But senile dementia is irreversible.

It's degenerative.

After a certain point, its victims don't come back.

Mr. Hamilton: Yeah, that's what they keep telling me.

But you know what they say?

Science only goes so far.4

I feel this dialogue illustrates how doctors can be blinded by the temptingly definitive answers of science, where having a textbook prognosis and treatment is supposedly the only solution. However, I don't believe life is built upon definite black and whites; it is chaotic and random in nature, consisting of decisions the consequences of which cannot be predicted. In cases such as memory loss, the answer to a problem lies far beyond numbers and calculation, as everyone is an individual who makes choices, reacts and grows differently to the next person next. Dr. Sacks words encapsulates my thoughts:

Perhaps there is a philosophical as well as a clinical lesson here: that in Korsakov's, or dementia, or other such catastrophes, however great the organic damage and Humean dissolution, there remains the undiminished possibility or reintegration by art, by communion, by touching the human spirit: and this can be preserved in what seems at first a hopeless state of neurological devastation.5

Sacks underlines the potential ability to reconnect with patients suffering from dementia through methods such as the one used by Mr Hamilton in The Notebook. Not only does this provide the possibility of the patient regaining memories, but I would also imagine offers treatment to the suffering family members who can re-walk and live those memories lost with their loved one through, for example, reading or music. These are remnants of the patients lives, things which have reason to be in their memory; music or art which they loved, or areas of the world in which they spent time, perhaps their home or old school.  

Sacks talks of Humean dissolution. He relates to the breakdown of Hume's description of a bodily system: I may venture to affirm, that we are nothing but a bundle or collection of different sensations, which succeed each other with an inconceivable rapidity, and are in perpetual flux and movement6. Hume later goes on to ask, what is life without connection?

With the median survival rate after initial diagnosis being 4.2 years for men and 5.7 years for women over 60 years of age7 and with many additional years of its manifestation before the initial diagnosis is made possible, dementia is a gradually degrading and long-lasting disease. This therefore heightens the need for an effective relationship between doctor and patient to aid effective all-round care. With dementia in particular, the family and loved ones of the patient will in fact be just as much a patient and will require a relationship and care (I will therefore refer to both as the patient). Creating an effective relationship will give the patient trust and comfort in their doctor, and it will ease their emotional strain in dealing with the disease and its effects. So, showing empathy and compassion to all involved will help enhance the relationship, which may then go on to aid treatment. For example, the family, feeling more comfortable and open with their doctor, may be more willing to broaden their share of the patient's story, therefore giving a greater scope of knowledge on the patient and their history. This will also give the patients the opportunity to explore their own emotions in dealing with the disease and allow them to express themselves within a safe space. These are all textbook signs of Emotional Intelligence, something I believe to set aside a brilliant doctor. It [EQ] is a set of skills hypothesized to contribute to the accurate appraisal and expression of emotion in oneself and in others, the effective regulation of emotion in self and others, and the use of feelings to motivate, plan, and achieve in one's life.8

Hearing the patient's narrative is essential. The narrative will give you a who as well as a what, so that you can then treat a patient; a real person in relation to the disease. When this story is told, it needs to be listened to. Surprisingly, this is not such a straightforward task as one might expect. David Reilly asks the question how do you achieve this listening, what blocks it, what helps it? How could you access it consciously?9 David talks of the room disappearing and mastering the art of being there, or being in a state of utter concentration on the conversation in hand, showing all of your enthusiasm and attention towards the story teller. This will undoubtedly help build a rapport with the patient; it shows that you are interested in what they have to say and allows them to give a broader span of information around the problem. It also gives allowance for emotional exploration; if the patient feels comfortable to do so, more can be taken from their story and you have a deeper understanding of what they are presenting.

Memory is a strange concept. It is something that we all are aware of, yet cannot possible comprehend what its absence would feel like. We can only look on at the devastation that memory loss in another causes; the trauma, confusion and fear felt by the victim, and the truly distressing and saddening effects on others, which I shall discuss in my creative piece reflection.

Cures and prevention of Alzheimer's disease are at the height of academic research, however, until that is found, taking care and treating those affected is needed, and this is not medicinal. Drugs can cure disease, but they cannot cure the emotions that disease leaves in its wake.

Creative Piece

This picture carries along with it, for me, a very deep and personal meaning. It reflects my own experience of the destructive power of Alzheimer's and the reign it had over my family. Walking through this experience made me realise the force of nature and disease, particularly of dementia and how it differs so widely from other diseases and traumas. Losing a limb, contracting a deadly infection or being diagnosed with cancer are all extremely saddening and horrific occasions for the patient and their loved ones. However, having all memories and knowledge of their family's existence, let alone their own, leaving just an empty body is an inconceivable reality.

My grandparents were a symbol of true beauty and kindness, a gem so rare in today's world. As a couple in love, they had a relationship remarkably similar to the one seen in The Notebook, explaining why I took such personal interest and relation in the film. My grandmother was diagnosed with Alzheimer's disease at a similar time to my grandfather receiving a diagnosis of cancer.

I believe this photo can be viewed from two angles; firstly that of my grandparents. I feel it encapsulates what memory represents in one's life; it is a keyhole to look through, showing the path they've taken. Where they've walked to and from, and who with. But what saddens me is the thought of what this picture would look like if the keyhole was blocked; if there was no light to look upon your life and who else was in that picture. Although the image is of my parents arm-in-arm, for me it has incredible resemblance to the relationship of my grandparents.

Looking at this from the second angle, that of my parents, it expresses the struggles and pain that Alzheimer's dealt to them, particularly my mother. This pain was not physiological, but deeply emotional; the reality of having your own mother not recognise you is what I believe caused the severest of pain. The picture also represents the journey that Alzheimer's took my parents on, essentially through the gradual degradation of a mind. It was a long journey, but she was at all times accompanied by her husband and her family.

It puts my earlier thoughts into context; my mother, also as the patient, had no hope in receiving the cure she was looking for in medicines. Simple communication did this for her; compassionate doctors and nurses showed care to her mother and put time aside to console and provide comfort.

Caring for the whole person can help recognise these struggles, it can help identify the non-physiological results of diseases and on the many different levels they can arise. So the importance of having the ability to see this, and be able to treat at these different domains is limitless and will characterise a successful doctor.

I will conclude with a quote from Kevin Arnold that for me expresses the place that memory holds in our lives and how we depend upon it so desperately.

Memory is a way of holding onto the things you love, the things you are, the things you never want to lose10

Kevin Arnold 

(an extract from a WPC Bristol Medical School assignment)

References

1  Luis Buñuel Quotes [online], http://thinkexist.com/quotation, [accessed March 25th 2011]

2 Kumar & Clarks Clinical Medicine 7th Ed, Parveen Kumar and Michael Clark

3 The Big Ideas of Whole Person Care, Dr. T. Thomson, Lecture at UoB, Spring 2011

4 The Notebook, by Nick Cassavetes, New Line Cinema, Released 20th May 2004

5 The Man Who Mistook His Wife for a Hat, Dr. Oliver Sacks, Pub. 1986 by Picador Books

6 A Treatise of Human Nature; A Critical Edition, David Hume, Pub. 2007 by Oxford University Press

7 Prospective Observational Study; Survival after initial diagnosis of Alzheimer disease, University of Washington, April 6th 2004

8 Emotional Intelligence, Peter Salovey, ICP Volume Nine, Number  / 1989-1990

9 Creative consulting: how to make the room disappear, David Reilly, sBMJ Volume 9, November 2001

10 Kevin Arnold quotable quotes [online], http://www.goodreads.com/quotes/show/321634, [accessed March 26th 2011]

 

Daniel

Whole Person Care, Year One, 2011

Comments

Helena

19 March 2012 - 11:25:01
"Of all the projects I looked at, yours had the most impact on me. At a glance, you can immediately grasp the context but also the personal tragedy of the piece. I love how the use of a single photograph can so perfectly illustrate the value of something most of us take very much for granted, at the same time highlighting the uncertainty induced by the loss of that faculty. Thank you for making me think! "

Aaminah

29 October 2017 - 17:51:36
"The whole photograph spoke to me on a personal level. For me, I see this as a loved one reminding a person going through dementia of a particular moment. The person with dementia struggles to focus on the right details and tends to pick up on details that to you and I may seem insignificant. The photograph shows this by focusing on the rust and the rim of the metal object rather than the couple in the background and the beautiful scenery. I also see this image as having to remember a moment with a close one who has past. The difficulty of remembering their face but being able to vaguely remember the moment. Thank you for capturing a beautiful image. "

Josie

06 November 2018 - 09:27:51
"I was immediately fixated on this photograph as it feels strange to not be able to focus on the image properly. I thought this was a really good way of giving the viewer insight into the frustration of memory loss attributed to dementia and the impact it can have on people's lives."