Losing the thread of life
Nicholas Harman
THE FORGETTING: UNDERSTANDING ALZHEIMER'S by David Shenk
HarperCollins, £15.99, pp. 290, ISBN 0002571749
D
can Swift, the master of despair, pretty certainly had Alzheimer's disease at the end, when he became incontinent, forgot his friends and frightened his attendants with fits of senseless rage. He had foreseen such a fate 20 years before when, in the least child-friendly episode of Gulliver's Travels, he imagined the Struldbrugs. They were immortals who grow old but cannot die, forced for ever to endure their growing inanity of body and of mind.
'The unique curse of Alzheimer's is that it ravages several victims for every brain that it infects,' says Mr Shenk in his admirable, quite short, American account of the disease. Most of those victims are old women, bereft of their minds in their eighties, and the daughters who look after them. Since modern people in rich countries are better fed, housed and serviced than their forerunners, the numbers trapped in that degradation increase every year.
In 1901 a Frankfurt doctor, Alois Alzheimer, was puzzled by the onset in a 51-year-old patient of the symptoms of what was then called senile dementia. She got worse for three and a half years, then died, whereupon he whipped her brain out. With new-fangled microscopes and specimen-stains he identified a tangle of plaques and threads where healthy tissues should have been — physical damage, not one of the contemporary Dr Freud's life-generated traumas. A few years later a colleague gave the finder's name to that sickness of the mind.
Medical folk, confronted with sicknesses they can't explain, tend nowadays to name them syndromes or disorders. That is harmless enough, since those words mean nothing much. The word disease is weighti
Cr. A proper disease has a cause, a diagnosis and a cure. So far Alzheimer's has none of those — no known cause, certainly no cure, and since other forms of age-related degeneration exhibit similar symptoms, the only sure diagnosis is posthumous, by examination of the patient's brain. The living have 'probable Alzheimer's'.
On the implicit claim that the word disease carries with it, many honest physicians, a few quacks and a handful of pharmaceutical companies have built a trade that exploits vain hopes and rakes in vast amounts of cash. Mr Shenk rightly insists that 'universities do not make drugs; pharmaceutical companies make drugs'. As he watches a nasty academic spat, a participant whispers, 'An important subtext of these battles is that all of these scientists have patents on their discoveries. There's a lot of money at stake.'
Billions of dollars' worth of secretive research have so far produced some expensive palliatives, no more. Meanwhile false rumours and fabricated scoops inflate and pop both the prices of shares and the hopes of the survivors. Mr Shenk describes one such episode, at the stage where the boffins were giving mice Alzheimer's and claiming to cure them. In early February, on the eve of his book's publication, the huge company concerned lost half its stockmarket valuation overnight when the hype turned out to be hollow. The clinical part of this book is clear, concise and unflinching.
But the author is too kindly a fellow, and too aware of his book's potential market, even to mention the obvious cure for Alzheimer's — merciful, unlawful, selfinflicted death. He interviewed people facing their own degeneration, and those condemned by love, by family duty, or by career to share that death-in-life. Their affliction drove him into consoling babble about 'the disease's essential humanity', a claim he tries to boost by imprudent ventures into literary-historical musing. (There is far too much about that classic American bore, Ralph Waldo Emerson.) Worse, he misrepresents Darwin's hypothesis (he miscalls it a law) of natural selection, by claiming that its purpose is 'to maximise long-term survival'.
Life is a terminal condition. All living things end up dead. The easier that end, the happier everyone is, dead and living alike. No decent dog-owner allows an old animal, racked by pains in the joints and shamed by fouling the carpet, to endure its natural span. Yet when it comes to people the law of the land perpetuates the cruel laws of religion, enforcing, enhancing and prolonging the sour pain of the end. They say that, if you are lucky and watchful of your speech, you can see Alzheimer's coming. That is why some of us take care to keep the shotgun permit up to date. The final big bang could be messy, but far less so than the Alzheimer's I hope to evade, in my own interest and that of those I love.
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