Am I Here? – Reflections on Alzheimer's
In the penultimate chapter of his book, Wayfinding: The art and science of how we find and lose our way, author Michael Bond gives some fascinating insights into Alzheimer’s disease:
'Alzheimer’s is commonly understood to be a disease of memory, and its effect on memory is certainly catastrophic: sufferers start to forget the names of friends or what they were doing a minute ago and end up remembering nothing but the distant past. More fundamentally, it is a disease of orientation, a slow severing of ties with our surroundings.' P. 201 (Emphases mine)
Alongside the more familiar question of identity, Who am I?, Bond challenges us to think about another question, Where am I? and in particular for those for whom it is not idle philosophical speculation but existential anguish. Framed as Am I Here? because it was his grandmother’s constant refrain at the very end of her life, the question draws attention to our need to be sure not just of where we are (our location) but also of our very being and existence.
Often this issue arises when an older person is moved from the familiar surroundings of their own home into residential care. Exacerbated by the onset of Alzheimer’s, the struggle to make sense of their strange surroundings may contribute to the course of the disease.
The abbreviated question Am I? encapsulates both the question of identity and the question of location or orientation and the dynamic interplay between them. The impact of Alzheimer’s is not only on the individual who lives with the disease but also upon their family, friends and carers. Relationships and communication are put under enormous strain. Our normal modes of communication through conversation can become extremely problematic.
Most normal everyday conversations are based upon an implicit set of shared assumptions that we take for granted, usually without realising it. A conversation is an exchange of messages that occur within a particular context of shared experiences and understandings.
The British philosopher of language Paul Grice explained this by his cooperative principle, which:
'Describes how people achieve effective conversational communication in common social situations – that is, how listeners and speakers act cooperatively and mutually accept one another to be understood in a particular way.'
The cooperative principle is divided into Grice's four maxims of conversation, which refer to the length and depth of the content of what is said, (be informative), the truth of what is said, (be truthful), the relevance of what is said, (be relevant) and the clarity of what is said, (be clear).
These four maxims describe specific rational principles observed by people who follow the cooperative principle in pursuit of effective communication. The maxims can however be flouted or violated, either deliberately or unintentionally, sometimes leading to a breakdown in communication.
Meeting a friend in the pouring rain we sometimes say: 'Lovely weather', each understanding its ironic intent. Those living with Alzheimer’s, however, will often flout or violate the maxims, unaware that they are so doing. They will rarely appreciate irony.
It is helpful if conversations with someone living with Alzheimer's are kept straightforward, and topics kept specific and concrete, relating to the immediate surroundings.
As their sense of identity appears to recede, remember that for the Christian our ultimate identity is in Christ; we are created in the image of God and our citizenship is in heaven.
Michael Bond, Wayfinding: The art and science of how we find and lose our way (Pan Macmillan, 2020).
Jason S. Wrench, Narissra M. Punyanunt-Carter and Katherine S. Thweatt, 'The Importance of Everyday Conversations', Interpersonal Communication: A mindful approach to relationships (Open SUNY, 2020). (socialsci.libretexts.org/@go/page/66581).
Paul Watzlawick, Janet Beavin Bavelas and Don D. Jackson, Pragmatics of human communication: a study of interactional patterns, pathologies, and paradoxes (W. W. Norton, 1967).
J. L. Austin, How to do things with words (Clarendon, 1962).
John R. Searle, Speech Acts: an essay in the philosophy of language (Cambridge University Press, 1969).