Jonathan Franzen tells the story of his father’s slow and
inexorable decline from Alzheimer’s disease. His story is a familiar one, and
one that millions of people can now tell: at first the initial odd behaviors
and memory failures attributed to various causes other than dementia, then the
diagnosis and medical interventions to stem the inevitable, and finally the
inevitable. While Franzen also describes the toll his father’s dementia exacts
on the immediate family—as well as some truths it uncovers about his parents’
marriage—he does not put a significant emphasis on family effects.
Interwoven in Franzen’s
recounting of his father’s plight are a few digressions on Alzheimer’s disease.
In one he wonders, as many others have, about whether Alzheimer’s disease is
more a medicalization of certain behaviors than the result of brain pathology, or
otherwise just “ordinary mental illness being trendily misdiagnosed as
Alzheimer’s.” (p. 19) In others, he briefly summarizes the well-known theory
involving plaques and neurofibril tangles as a cause of Alzheimer’s, and thoughts
on how memories form and work in the brain. In yet one other digression, Franzen
reminds us that Alzheimer’s disease as originally described in 1906 was a rare
type of dementia characterized by early onset in middle age and rapid
progression. He further notes that it was not until the latter part of the 20th
century when Alzheimer’s disease was tagged as the fifth leading cause of death
and the disease of the century, and only through the efforts of a coalition
comprising clinical scientists, politicians, and patient advocates.
