Related Topics: •  Alzheimer's Disease

If Memory Serves


Reviewed by Roz L. Spafford
CONSUMER HEALTH INTERACTIVE

Hard to Forget: An Alzheimer's Story
By Charles P. Pierce
Random House
213 pp $25

Elegy for Iris
By John Bayley
Picador
276 pp $13

Alzheimer's disease is a haunting illness: it goes straight to the heart of the self, transforming those we love into living ghosts, both painfully familiar and unutterably strange.

Because Alzheimer's cuts so close to what it means to be a person -- to accumulate memories, to come to know those we love, to function in a relationship -- it invites those who have lived close to it to contend with it in literary terms.

For Charles P. Pierce, who wrote Hard to Forget about his father's descent into Alzheimer's, the disease ruptures personality: his father ceased to recognize him and also became unrecognizable to him. Paralyzed by grief and rage, Pierce's mother, too, became a different person.

For John Bayley, however, who wrote Elegy for Iris in honor of his wife, the novelist Iris Murdoch, what matters is the essential continuity of the self, and the continuity of a quiet, quirky marriage.

What does have continuity in Pierce's account is the progress in scientific research; he deftly interweaves the scientific and historical background of Alzheimer's disease with the narrative of his own journey through it with his father. He dwells a bit excessively on the bitter competitiveness within the scientific community; in this the journalist in him is apparent, fascinated by controversy.

Pierce does an exceptional job of explaining the physiology of the disease. As he explains it, Alzheimer's is caused by a mutation in one or more of five genes -- not by aluminum, not by "hardening of the arteries." While the patient is living, it can be diagnosed only by exclusion, ruling out strokes, vitamin deficiencies, viruses, and endocrine problems (although scientists recently discovered that magnetic resonance imaging, or MRI, may soon make it possible to detect signs of Alzheimer's in its earliest stages).

Alzheimer's tends to run in families, and Pierce also maps the genealogy of various families who have dealt with it over generations: if you have not yet drawn your family tree, he will push you to do so.

Pierce uses the metaphor of the burned city to describe Alzheimer's, and indeed that picture does describe what happens both in the brain and in the lives of those he knows who care for someone with the disease. The real hero in this story is Pierce's wife, who develops a rapport with his drifting father, contends with the hostility of his mother, does a great deal of the hands-on care, and challenges Pierce's persistent denial.

In form, the book sometimes feels repetitive, circling around the same material again and again until a reader realizes that the book echoes the way one must talk with a person who has Alzheimer's, repeating the same statements. Pierce thereby conveys not just the facts of the experience, but the sensation of it.

The writing in the book is extraordinary throughout, clear when he is explaining medical issues or arguments, volatile when he describes the family's struggle with the disease, revelatory when he discovers something especially significant. He describes, for example, the one moment when his father seems to realize what has happened to him: "Then, one bright afternoon, a single neuron fires through the plaques and the tangles, and the amyloid, and the aberrant genes, and, in a clear and agonized fragment of a second, you know."

Iris Murdoch, too, seems to have had flashes of awareness amidst the disease: she tells a friend that she is "sailing into the darkness." But in this moment, as throughout the book, Bayley and Murdoch's experience seems much quieter than Pierce's -- and, for the most part, peaceful.

At the beginning of his relationship with Murdoch when they are both quite young, Bayley writes, she reminds him of the myth of Proteus, and says, "Just keep tight hold of me and it will be all right." In the myth, Proteus has the power of changing into many frightening shapes, but Hercules knows to hold tightly to him and so Proteus must return to his human form.

Murdoch's advice was prescient, and Bayley appears to have followed it; as his elegy to her shows, he certainly held tight.

Unlike Pierce, Bayley is not lost in loss, but bemused at Murdoch and at himself. But like Pierce, he uses the form of the book to express his experience of the disease: it is calm, meditative, circular; he explains, "the condition seems to get into the narrative, producing repetition and preoccupied query, miming its own state."

The book is thus not sequential, jumping from their first encounters to their lives together late in Murdoch's life (she died in February 1999). In this way it emphasizes the continuity in their lives -- their fondness for swimming in rivers and for clutter, the simultaneous distance and closeness that characterized their marriage. Bayley describes Murdoch as unworldly, not self-assuming, but childlike, both within the first days of their relationship and the late days of her disease, when the two of them watch the Teletubbies together.

Bayley's love for Murdoch -- a subtle, profound, accepting love -- seems undiminished over the course of her illness, expressed through the many rueful details he includes. But though he appears to honor her in sickness and in health, at times his observation of her is jarring; he describes her as a person with great reserve, yet he reports on matters such as her sexuality, discussions which surely would have troubled her had she known about them.

As a reader, one also wishes Bayley were less interested in his wife's various manifestations and more conscious of the tragic. He may see continuities, but Murdoch in at least one crucial regard really is entirely changed: she can no longer write or remember any of the 27 novels she has written.

For the most part not overwhelmed by caregiving, Bayley appears to offer Murdoch what people with Alzheimer's are said to need: familiar surroundings, reassurance, companionship and care -- though the pair appear often to be cared for by their friends, like foundling birds. And so Bayley's memoir lacks the anguish of Pierce's. He does report difficult times -- being driven to distraction by Murdoch's anxiety, characteristic of Alzheimer's patients, and flying into a rage, which he knows is unfair, at her behavior.

But he does not describe grief or loss, only a kind of wonder. It is a state of mind which only a rare caregiver could achieve, but Bayley communicates it well in the book, which is meditative, almost hypnotic, putting the reader into a dream that one can imagine resembles Murdoch's own.

-- Roz L. Spafford teaches creative writing and English literature at the University of California at Santa Cruz. She has reviewed books for the San Francisco Chronicle, the San Jose Mercury News, and many other publications.

First published October 20, 2000
Last updated March 13, 2008
Copyright © 2000 Consumer Health Interactive

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