At sundown

The disintegrating physical and mental situation of an elderly best-beloved recently has led me back (after a brief pause) to readings in neurology and consciousness. It has also led me to reflect on the tasks memory accomplishes for us and how the need to tell a story seems to reside deep in whatever “makes us human.” Many poems, perhaps most of them, are “inspired” by memories and a need to tell. So I will indulge myself by giving a narration here, and perhaps poems will follow later.

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The best-beloved has been in and out of hospitals, rehabilitation centers, and so-called independent living placement and appears to have developed a very common but not-commonly-talked-about cognitive disarray, or hospital-induced delirium, that medical personnel call “sundowning” when it occurs in Alzheimer’s patients. But my patient does not have Alzheimer’s disease. Her meshing of realities must have been triggered by something else, but the possible factors are many. We may never figure out what it was that pitched her into delusion and lack of compassion, turning her into a person we barely know.

She took good care of her body. At 90, her physical self is in better shape than many people 20 years her junior. Her brain–and hence, her mind–has not stayed as healthy as the rest of her. Several small strokes deep in her brain began to alter not just her gait but her personal focus. Long years of hearing loss no doubt altered how her brain processes input. The reading I have been doing (most recently Carr’s The Shallows, Sacks’ On the Move, and Damasio’s Looking for Spinoza) indicates that the human brain is “plastic” but not necessarily “elastic.” It can modify in response to damage or training, but that does not mean it will spring back to the way it was before. In extreme old age, the process of adaptation slows. The brain becomes less resilient. For reasons no one really understands–a host of possible culprits includes hormones, glutamates, serotonin production, medicines, genetic predispositions, and environmental factors among others (a perfect storm…)–persons who have been sharp and cogent may suddenly experience delusions, often leading to paranoia, confusion, loss of affect, lack of social filters, violent and contrary behavior.

And we ask, “What happened to the soul I love?”

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If we believe in souls, we have faith that somewhere under the changeling is the best-beloved. In flashes, she may return to us. If we believe that the brain is the person, the transition from best-beloved to aggressive complainer is harder to accept. Damasio seems to believe the brain is the person. I find it hard to agree with him fully, though I have been learning a lot about neurology in the process.

Metaphors or analogies for the situation seldom seem, to me, quite to capture the wrenching feeling I have when encountering sundowning. The idea of disintegration seems inappropriate in this case, because she recalls who we are and her mind is not collapsing so much as morphing in unaccountable ways. Threads unraveling? No, not really; the metaphor of a quilt coming undone, maybe, or an intricately-woven tapestry shredded apart–but that’s far too simplistic.

Think of the mind: it encompasses the brain with its regions for motor, somatosensory, auditory, and visual processing; the body, which takes in those physically-produced inputs; memories; thoughts; feelings, which are thoughts spurred by emotions; and a host of complex inter-relationships we cannot even begin to map. Somewhere in all of this is the person, the “self.” At least, as far as we have so far been able to speculate (though not everyone agrees; see my post on Hofstadter & Parfit. Parfit suggests personal identity is an invalid construct).

Perhaps an environmental analogy would suffice, being complex enough for comparison. She is the planet Earth, aging and adaptable, but not endlessly adaptable; her healthy balance has been thrown off by things she may not have had any control over. In whole regions, she becomes inhospitable. Poisoned. Dry. Hot. Overrun with invasives. She seems not to like us anymore, but that is not what’s going on at all. In fact, she’s dying.

Maybe that’s taking the metaphor too far. But in difficult times, one reaches far. There is hope she may recover at least some of her Self, and in the meantime, we have stories in which she plays a role. Mnemosyne–awaken in the consciousness of those who know her. Telling the stories is a step toward letting go.

 

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