The play focuses more on Gladys’ family and how they handle her mental deterioration than on the particulars of her deterioration per se. We see how the family struggles to maintain their relationships with Gladys and among themselves. We see the emotional challenges families face in this situation, which range from anger to compassion and from frustration to concern, and sometimes all in the course of just a few minutes. But, the playwright, Kenneth Lonergan, may have had more in mind than just rendering family dynamics amidst an older family member losing her mind. He could be siding with the view that the deterioration of the mind in older people is a matter of aging and not disease.  

As such, no attention is paid to the medical dimension of Gladys’ mental problems. The words “dementia” and “Alzheimer’s” are never uttered—only reviewers and blurb writers use them. No medical terminology enters any conversation about Glady’s mental status. No doctors are ever mentioned except when Gladys needs attention for her hearing, eyesight, and diabetes. No drugs for Alzheimer’s are prescribed. No clinical trials for promising experimental dementia treatments are sought.  

To accentuate this view, Lonergan made both Ellen and Howard practicing psychiatrists, health care professionals who are involved in the medical management of dementias. He has Ellen say to Daniel at a particularly frustrating moment, “when I get senile just put a bullet through my head”—the word “senile” being associated with mental deterioration that can manifest as an ordinary consequence of aging. Another time Howard refers to older people “losing their marbles” as their mental abilities diminish with age, which is a more colloquial form of the term senile for most people. The family is following the advice King Lear’s daughter Goneril gave to those around her father: “But let his disposition have that scope/As dotage gives it,” rather than the advice treatment guidelines medical organizations prescribe.  

Without the obscuring effects of medicalization, Lonergan is able to open up room to consider what may be at work in Gladys’ mental problems. One possibility is the haunting prospect that what appears to be a global deterioration of mental function is just a speech problem. This becomes apparent through a note Lonergan uses to set up a scene.

It’s not true that if you try hard enough you’ll prevail in the end. Because so many people try so hard, and they don’t prevail. But they keep trying. They keep struggling. And they love each other so much; it makes you think it must be worth a lot to be alive.