"The Forgetting" by David Shenk

Far beyond, perhaps: "I am now working on immortality," Shenk quotes a biologist interviewed in the pages of Wired. Is this for real, I asked a friend who follows these developments. Oh yes, she told me, "Immortality is their killer app." Not a bad reply, I thought: The Delphic Oracle would have relished the paradox.

But then, scientific innovation is often veiled in paradox. Wondrous improvements exaggerate intractable old problems. Longer lives remind us of ancient questions of how to live well. And high-tech solutions do little to untangle the riddles of social and family life, care and responsibility.

For some answers to these questions, Shenk looks to contemporary Alzheimer's sufferers and their families and looks back to some real and imagined forebears. Although relatively few people lived to be very old before the 20th century, aging and senility have appeared in literature and mythology since the earliest times. After the Egyptian sun god Ra created the universe and all the other gods, he became old and senile, easy prey for usurpers. The notion of body outlasting mind and identity speaks not only to our astonishment at our mixed, mysterious natures, but to our fears about the limits of love and obligation.

"King Lear" is of course based on ancient legend, but according to Shenk, it's only in Shakespeare's version that the king enters a senile fog. Shenk speculates that Shakespeare might have been inspired by the case, two years before "Lear" was first presented, of a wealthy courtier who began publicly losing his wits. His oldest daughter, Grace, sued to have him declared a lunatic so she could take over his possessions; his youngest daughter, Cordell, succeeded in placing the estate in the custody of a loyal friend, ensuring "that he would have the most comfortable and dignified descent possible."

Financial worries (and sometimes conflicts) will plague many families, but it's the nature of mind and memory itself that makes Alzheimer's so difficult for caregivers. Novelty stimulates the brain while redundancy numbs it. And yet, as Shenk says, "As their forgetful loved ones repeatedly stumble over the same tasks and information, caregivers must suffer through the oppressive repetition." Order and category are natural and necessary, but sometimes a caregiver must sacrifice them. This quote that Shenk found in a caregivers' listserv seems to me a small but remarkable achievement of the spirit: "I no longer scolded her but thanked her for bringing the frying pan into the bathroom. After that, life changed very much for the good."

Shenk found evidence of a more ambitious spiritual quest on the same online discussion group: One of the caregivers, Morris Friedell, had himself been diagnosed with the disease. Friedell, a sociologist, used to teach a course called "Human Dignity," examining the Holocaust and the work of authors like Martin Buber and Elie Wiesel.

Friedell is a pioneer, a sort of astronaut, part of a new class of Alzheimer's sufferers who are developing the disease in full knowledge, "diagnosed," as Shenk observes, "so early as to still be able to speak for themselves, to eloquently describe their experience, and to champion their rights." The essays -- personal and theoretical -- on Friedell's Web site combine a breadth of research on the brain and disability with a lifetime of study about humanity in extremis. Friedell says that in person he's not so coherent anymore, but I found his writing profoundly articulate and thought-provoking, smart, humorous, humane and helpful. Consistently inspiring and not at all "inspirational," Friedell continues, through his writing and by example, to teach the subject of "Human Dignity."

We're fortunate, these days, to have firsthand guides like Friedell, brilliant caretaker-memoirists like John Bayley ("Elegy to Iris"), and compassionate chroniclers like David Shenk. Of course no one will stop hoping fervently for a cure -- and I don't know if the lessons gained from suffering ever justify the suffering itself. Still, it wouldn't be so bad if an understanding of Alzheimer's made its way into the general culture. As perhaps it's beginning to do.

Certainly we think a lot about memory these days: "Memento" has a devoted cult following; a surprising number of people are attempting Proust's huge, slow meditation on memory, "In Search of Lost Time." Shenk finds Alzheimer's compelling because the gradual pace of deterioration "causes us to experience life's constituent parts and understand better its resonances and quirks." Imagining death is difficult, but Alzheimer's forces us to try: "What is usually a quick flicker," Shenk writes, "we see in super slow motion, over years. It is ... perhaps the most poignant of reminders of why and how human life is so extraordinary." Which, in a culture of quick fixes and killer apps, wouldn't be such a bad thing to remember.

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