May 2008


 

She was quite confused by the time I got back.  I sat at the table, filling out the form for claiming attendance allowance.  She sat with me, occasionally leaning forward to rest her head on the rim of her walking frame and uttering low moans.

 

‘What’s the matter, mum?’  I asked, as gently as I could, trying to disguise the tone of my irritation.

 

She raised her head.  Her gaze was heavy, vacant. 

 

‘I don’t know.  What am I meant to be doing?’

 

‘Nothing,’  I answered, ‘You can do what you like.’

 

Of course that was the wrong answer.  I knew it as soon as I said it – no – before I said it.  It was an answer born of all the unhelpfulness of reason, born out of irritation.  Mum just doesn’t know what she wants to do any more.   She really wanted to be organised.  She didn’t want to watch television because she couldn’t hear it.  She couldn’t listen to the radio because the music was flat.  She couldn’t read a book.  She could do her puzzles, but that didn’t satisfy her very much any more.  She just wanted to be entertained.  She wanted the attention of one person beamed on her the whole time, preferably me, because I was hers. I belonged.    

 

There isn’t any point of wanting to do anything.  Any desire she might have had has gone. There is just the obligation.  If others need her, even in a minor way, then her life has some use.  My ‘oh so reasonable’ answer removed any remnant of hope at a stroke.  It exposed the dreadful absence of meaning in her life.  It was cruel! 

 

I could have asked her to make me a cup of tea.  We could have played scrabble. OK, she would have struggled to know how many letters to pick up, she would not have completely grasped the idea of taking it in turns, the scores would have completely foxed her.  But finding words is a lacuna of functioning that makes her feel useful.  We could have even filled out the form together. 

 

So, why didn’t I?  Did her disabilities cause me to deny the painful reality of my impending incapacity?  Or did they impose a burden of obligation that was both overwhelming and unending?  So I responded with a gesture that was unhelpful,  meaningless, but defensible.  I went to see her, filled in her forms, made the tea, cleared up and did the business.  It satisfied my own guilt, but it didn’t give her what she really wanted. 

 

But why guilt?  Was it that, despite an all too painful an awareness of her plight, I showed a singular lack of understanding.  Or was it worse.  Was I getting at her with malicious helpfulness?

 

We can all too readily blame our parents for the disappointments in our lives.  They fuck you up, your mum and dad!, wrote Philip Larkin.  So was I fucked by her affair, the divorce, the need for my support and the subsequent abandonment?   ‘You’re old enough and ugly enough to look after yourself’, was her reaction to my teenage depression, ‘I’m not going to let you spoil my one chance of happiness.’  Now, at the end of her life, she needs me more than ever.  She has always demanded my attention, my achievement – ‘I’m so proud of you’ – I always had to be there to provide a sense of importance, but since her adoring husband died, I have had to provide the input to make life meaningful.  So do I now, fifty years later, mitigate responsibility for my own life by persecuting my poor, frail 92 year old mum with meaningless assistance.  

 

But if I am guilty of the meaningless care, the same burden of guilt must fall on the whole care system.  Let’s face it, the state is hopeless at caring for the sick and elderly. 

 

Before mum returned home, she had 4 weeks in residential care.  The home she went to had the reputation of being the best in Sheffield.  I was impressed when I visited.  It was light and efficient, the staff smiled a lot.  But the residents sat around the room in their tall chairs like monks in a chapter house, just staring or sleeping, not communicating with each other.  The home had five stars.  It ticked all the boxes; regular nutritious meals, trips out, entertainment, bright tidy rooms, excellent bathing and toilet facilities, but the staff rarely engaged with the inmates and they did little to encourage them to engage with each other.  With a resident/carer ratio of 6 to 1, there was little opportunity for one to one engagement.  Mum was desperately lonely and when the doctor came to visit another patient, she made the great escape.  She slumped and complained of chest pain and was admitted to hospital. 

 

Of course that was worse.  The assessment ward was just too busy, but the beds were blocked and she spent several days there before going to the assessment for the elderly.  But many of the patients had strokes, some were noisy and some were quite severely demented.  The nurses seemed more concerned with their reports and meetings than patient care and although mum was in direct vision from the nursing station, it didn’t prevent Bill, one of the male patients trying to climb into bed with her.  This was a very frightening experience.  

 

Mum is now back in her flat with a more intensive private care package. Ruth, her carer, smells of nicotine and has hair the same colour, but she is kind and understanding and prepared to give mum the special attention she so desperately craves.  I visit most days and now devoid of the responsibility for more practical care, can devote more time to establishing some focussed communication.

 

Is mum happy?  No, of course not.  Serious old age is rarely happy.  She seems animated and interested as long as she is holding court and listened to, but her memory is now short term, that she has forgotten the engagement within five minutes and with heavy sincerity, fixes me with baleful gaze and announces with heavy sincerity, ‘I feel so desperately lonely’.  But this does not mean she is solitary.  She has company for most of the hours she is awake, but she can‘t derive any meaning out of it.  Loneliness is a lack of meaning.  

 

But perhaps her life is stable.  Gabriel Garcia Marquez has written how in relationships, stability is more important than happiness.  Mum’s existence is predictable again.  She is back in what has been her home for the last 17 years, surrounded by her things, with the same carer coming in at the same times every day, me visiting her in the afternoons, the neighbours coming in regularly, trips to the Friday Club where she plays solo whist.  There is a predictability, a focus of grievance that domesticates an existential disappointment.  ‘Oh she’s a cheats!  She’s always trying to see my cards.’   

   

In the ancient hill villages in central Italy,  the elderly sit outside their houses and are greeted by everyone who passes.  They have their place in the community, their memories, a continuity through children and grandchildren.  Their body is supported, their mind reminded, their soul nurtured.  They belong so they exist!     

 

Unfortunately, even there, life is changing.  Many of the children have left.  People travel along the road enclosed in their cars.  Many of the cues that might have supported an identity are being eroded.  Without a sense of belonging, the soul perishes and the body must inevitably follow, no matter how well fed and cleaned it is.  We could say that our care system needs to wake up to this basic fact.  But how do you restore a family, community.  Memories need constant replenishment and reinforcement.   And if memories go, identity goes.               

 

         

 

Advertisements

 

She shuffled past me, whistling under her breath,  an anxious look on her face.  She had just completed the third circuit of her apartment. 

 

‘What’s the matter, mum’, I said kindly, overcompensating for my mounting irritation.

 

‘I don’t know.  I just can’t find it?’

 

‘But what are you looking for?’

 

‘I don’t know.’  

 

Doris is 92.  She has Alzheimer’s Disease. And she has literally ‘lost it’.  She has lost her memory and with that lost the sense of who she is.  From being an active, engaging, if somewhat nervous elderly person, she is now little more than a husk of her former self.  It is as if she has been hollowed out.  There is no substance in her identity. 

 

For Wallace, her husband, it was different.  He lost his memory as a result of a severe head injury, sustained during a crash in his fighter plane in 1941.  He had no recollection of his past, but he was young enough to reinvent himself.  But he was a different person.  As his sister commented, ‘He went to war a laughing boy and came back a troubled middle aged man.’         

 

If we lose our memory, then we lose grip on who we are. 

 

Michael Conway, Professor of Psychology at Leeds University, who appeared in the last programme in the recent Horizon series, How does your memory work?, regards memory as the content of the self.  ‘It defines who we are’, he said, ‘and allows us to travel in time.  Our past informs our decisions and determines what we become.  Brain scans have revealed how reminiscing about the past and planning for the future lights up the same parts of the brain. Memory stimulates our imagination. 

 

Memory, Conway explained, is processed in a small comma-shaped area, called the hippocampus (latin for sea horse), deep in the temporal lobes of the brain.  Peter Forbes, who featured in the programme, was born prematurely and has an underdeveloped hippocampus.  Forbes has no past and no future; he just lives in the present, but he is not distressed.  It takes imagination; the fear of what might happen, to worry.  Peter has nothing to worry about because he has no imagination.   

 

Most of what happens to us is forgotten.  We only remember the events that have emotional significance (or we impart emotional significance to – we have to make facts meaningful to recall them for exams).  Just reflect on what has happened to you over the last three months.  You will have forgotten most things, but the events, situations you do remember will have been those associated with strong emotion, anger, sadness maybe, passion, and those you will remember very clearly.   Married couples will remember certain romantic episodes in their courtship with great clarity.  The bereaved remember every detail of their partner’s death; the shock etches the images on the brain. 

 

But, bearing in mind the eventful lives most of us lead, there is an enormous amount of emotionally charged memories to be dealt with.  One of the great mysteries is how this information is processed, categorised, stored and retrieved.  Can it just be as associations, patterns stored in connections between brain cells, electrical messages or chemical codes?  

 

Upon reflection, it seems that the things that happen to us on a daily basis are filtered through our life experience.  We ascribe meaning, significance to them according to the themes of our lives and they are catalogued according to what they represent for us.  Thus they come to consolidate our life script and inform how we think about what happens.  This process determines our personality and explains why people tend to perceive what happens to them idiosyncratically and react predictably. 

 

But if that was all, we would never change.  Sometimes, something happens that is so outside our experience that it requires a major shift in attitude to accommodate out.  Also we are social animals;  we influence each other.  Just as sex allows the blending and mixing of characteristics to create a new individual, so attachment creates new ways of thinking.     

 

For events to be catalogues and stored, they have to be reworked.  Dreams seem to play a particularly important role in this process.  From what we recall on waking from dreams, it appears that they relate the important events of the day to our dreads, fears, but also joys of our lives,  creating allegories that may offer a magical resolution.  We dream as we think – using association, displacement and condensation, but dreams are irrational; they defy logic. The surrealism of dream might facilitate a more seamless conversion of event into meaning.  So we don’t have to remember millions of disconnected events.  Our personalities are constructed from no more than a score of interconnected themes.  Our memories illustrate and reinforce those themes.    

 

Thoughout our life, our bones are remodelled throughout our lives to respond to physical stresses imposed on our body.  Our memories are similarly remodelled but in response to stress of life experience.  We rework the themes and most meaningful events of our lives many times and every time we rework them through thought and dream, we change them into a form that is more acceptable to our view of ourselves and more relevant to our current experience.  Memory is malleable.  Recalling it allows adjustments to be made.  The narrative changes by increments of self deception into a mythology.  People remember the same traumatic event in very different ways  because their memories are passed through the filter of their own personal history.           

 

Not all events can be processed in this way.  If we have the misfortune of living through an event so disturbing and traumatic that it defies remodelling,  then the memory remains active, unchanged, playing again and again like a tape through the mind as fresh as if it happened yesterday, preoccupying our daily thoughts and interrupting our sleep. This is a feature of what is known as Post Traumatic Stress Disorder (PTSD).  People with PTSD don’t dream; the tension of what has happened interrupts their sleep and defies modification by dream and thought.  It can only be replayed as a too-painful narrative, inviting edition yet confounding it.  A waking nightmare, their preoccupation robs them of past, future, meaning and life.  

 

Freud recognised how many of his patients suffered from unprocessed reminiscences.  Their trauma had not been worn away by time, but in some cases the memory was repressed and played out in a physical symptom seemingly disconnected from but still representing whatever caused it. 

 

In Michel Gondry’s cult film, Eternal Sunshine of the Spotless Mind,  Joel and Clementine, underwent some kind of brain stimulation treatment to erase memories of their unhappy love affair.  In real life, as shown in How does your memory work?,  Genevieve Smith Courtois takes propranolol, a common drug, that is been in our pharmacopeia for 40 years, to dampen the memory of a sexual assault she suffered nine years previously. While recollecting the assault under laboratory conditions under the influence of propranolol,  her symptoms diminished to below the post traumatic threshold.  This illustrates the capacity of recall to remodel memory.  Propranolol is often prescribed for panic attacks.  By diminishing emotional tension, it reduces the intensity of the recall to a point where it can be allowed to wear away.  The group of tranquillisers known as benzodiazepines are commonly used to block the memory of  disturbing and painful surgical procedures.       

 

But although amnesic drugs may help us deal with trauma,  they are not necessarily such a good thing.  We all learn from experience and gain a deeper sense of ourselves.  Our identities are based on our memories.  Suppressing those memories we find painful might just convert people to cheerful automatons, Stepford wives.  With no pain and passion, there would no great literature, no great art or poetry.  Life would become meaningless.  All that might be left is a disturbing sense that we had lost it without ever knowing what it is.