Alzheimer’s Gift

Barrett L. Dorko, P.T. 

“We know, both from first hand reports of de Kooning’s studio assistants and from the closely studied patterns of Alzheimer’s disease, that de Kooning’s signature brushstroke did not erode at the same time that he had trouble remembering what he had eaten for breakfast. His muscle memory remained intact for a long while, and the act of painting remained important to him.”

From The Forgetting by David Shenk 

“Indeed, she is more often confused than not and speaks little except to agree with my father or comment tersely in a variety of ways that she doesn't remember recent events and is not sure about the present. As I watch her sitting silently, she appears to be listening to something and the fingers of her right hand move in a precise and intricate pattern across her knee. I asked my mother if she was playing the piano. She smiled, laughed a little, and said yes, stopping for a few moments before returning to complete the piece, some tune learned decades ago and uniquely expressed through her hands. Hands that never forget. The therapist in me wonders what this movement provides her that no amount of exercise, positioning, or manual care could. Perhaps she is in some fashion growing younger through her body though her faculties age.”

From “The Piano Lesson” by Barrett L. Dorko 1993 

Once again I’ve been captivated by a book, and, again, it’s because the book is very much about me and the work that I love. Of course, as usual, the author never heard of me, but that doesn’t stop me from feeling that we should meet and enjoy a long talk. I have a lot I want to say about what they’ve written. This time the author is a science writer named David Shenk and the book is The Forgetting-Alzheimer’s:  Portrait of an Epidemic (Doubleday 2001). 

If there’s a central idea in this wonderfully diverse but economical text (256 pages) covering an enormous and complex subject, it is that this is a disease like none other and its manifestations are never completely understood from a purely anatomical or physiologic point of view, but they are invariably human in the largest sense of that word. Shenk covers the subjects of historical perspective and the intricacies of the neuroscience with equal ease and clarity. Through the use of anecdote, interview and solid scientific evidence he weaves a tale of an epidemic brought on by our culture’s tendency to overcome through medical science the maladies that would normally end our lives before this devastating disease has time to gather its forces. He also points out that significant aging is not always necessary. After all, “Frau D.” described by Dr. Alzheimer as massively impaired in 1901 was just 51. I will be the same age very soon, and sometimes I wonder about my own transient confusion. 

Listen to some of these chapter titles: “The God Who Forgot and the Man Who Could Not,” “One Thousand Subtractions,” “We Hope to Radio Back to Earth Images of Beauty Never Seen.” I don’t know about you, but these alone indicate to me that the subject is being handled in a readable and compelling fashion, and I wanted immediately to read the book. I wasn’t disappointed. 

I’d like to address one aspect of the disease with which I’m most personally familiar. It’s included in  Shenk’s description of the master Abstract Expressionist painter Willem de Kooning as he began to struggle with the earliest stages of the disease. Simultaneously, his canvas came to life after a period of distinct creative decline. This form of art is thought to be most closely associated with emotion, and the decreasing resistance of de Kooning’s conscious mind to express his emotion through his brush resulted in some of his greatest work. For months after he could no longer function efficiently in a normal setting his ability to paint endured. Like others chronicled in this book, the loss of memory brought him closer to the present moment, and that is often the most important aspect of authentic expression. 

The quote from “The Piano Lesson” above describes my mother’s movement during the earlier stages of Alzheimer’s. Years later I realized that she was moving therapeutically in much the same fashion I would try to encourage my patients. I said then that my problems with the traditional therapeutic community had something to do with my inability to ignore this odd, immeasurable and poorly defined movement. This remains the case today, but I just couldn’t help wondering what my mother was trying to teach me. When I read of de Kooning’s breakthrough toward even greater art my notions about my mother’s self-care and how that might be employed in my office were reconfirmed. If there are any gifts in this disease, and surely there aren’t many, this was the one my mother gave to me. With this wonderful book David Shenk has wrapped it for me and I think every therapist should own it.