Wednesday, May 7, 2014

Who do we have to thank: Works cited

Works Cited

Alzheimers Association. 5 May 2014. 2014.
Baudrillard, Jean. Simulacra and Simulation. Michigan: The University of Michigan Press, 1994.
Callone, Patricia R. Alzheimer's disease: the dignity within: A handbook for care givers, family and friends. New York: Demos Medical Pub, 2006.
Descartes, Rene. "First meditation and excerpt from sixth meditation." The Philosophical Works of Decartes Vol.1. Cambridge: Cambridge University Press, 1967. 17-20. PDF.
Doka, Kennith J. Clinical Dimensions of Anticipatory Mourning. Champaign: Research Press, n.d.
Long, Ph. D Janie. The Aging Family. New York: BRUNNER/MAZEL, INC., 1997.
Lu Lu Miller. "The Bus Stop." Radio Lab. n.d.
Saussure, Ferdinand de. n.d. may 2014.

Who are we in the end?

The final stage of Alzheimer’s ends with when the vast majority of the cells in the cerebral hemispheres burning out, with the exception of the visual and motor cortex.
 During this final stage some patients will become totally unresponsive, and remain until death in a vegetative state. In other cases it is normal for the subjects of STAD to be seen pacing around absently, due to the still functioning visual and motor skills.
What we don't know about the personal experience in the throes of Alzheimer's is vast. Who's to say what constitutes as a life, a reality, a sense of being.
Baudrilllard states that to come into "hyperreality" there must be representation preceding the real, a reversal. We are confined by whatever reality we inhabit, weather shared or not. Is it possible that Alzheimer's is the ultimate hyperreality? In this disease there is no other instance, no other alternative. What is real for the individual, in this case, is the ultimate fake out. There is no "real" representation is all that remains:

And for the same reason, although these general things, to wit,[a body], eyes, a head, hands, and such like, may
be imaginary, we are bound at the same time to
confess that there are at least some other objects
yet more simple and more universal, which are
real and true; and of these just in the same way
as with certain real colours, all these images of
things which dwell in our thoughts, whether true
and real or false and fantastic, are formed.
To such a class of things pertains corporeal(Descartes 18).

What is Alzheimer's?

Alzheimer’s: The Final Frontier?
Alzheimer’s disease, or otherwise known as senile dementia of the Alzheimer’s type (SDAT), is growing fast to become one of the premier neurological diseases we will be facing in the coming years.  SDAT is a disease that ravages the brain, moving from location to location systematically destroying the nerve cells. It causes slow, steady deterioration of the cognitive functions and motor skills of the persons inflicted (Callone).  This deterioration, marked in the beginning stages with short term memory loss, causes the patient to become agitated, confused, and progressively unable to remain in what most would call “reality” (Long)
 I will be discussing the progression of the disease, and how a patient’s reality may shift to accommodate the alterations. I would also like to speak to the reality of not only the subject, but the family, caregivers and friends by exploring the accepted forms of psychological treatment.  We will discuss the effects of it on the patient and others involved.

    By the year 2050 there is an expected 15 million Americans that will be inflicted by this disease if we are unable to find an effective cure. This number represents a 3 fold rise in the current numbers, with two thirds of the population being represented by women (Alzheimer's Assosiation).

The substantial rise in number of cases is due to the longer life expectancy we are experiencing as time goes on. With the advancements in modern medicine we are living longer, and with that responsibility comes many new challenges in regard to our physical health. The “reality” for many American’s may be altered in greater numbers than ever anticipated.

So what is Alzheimer’s disease (SDAT)? SDAT is a disease that mostly affects persons over the age of 65, and moves in stages while slowly killing nerve cells, the first stage being in the cerebral hemisphere of the hippocampus.
The hippocampus is the area of the brain where our memories are stored, which is the reason why memory loss is the first symptom of illness.  Because of this progression being a targeted one, you may not notice anything odd other than a little forgetfulness, body functioning remains normal (Callone).

First Phase: "Where did I park my car?"

Many people who start to experience this loss of memory think of it as the “normal aging process,” chalking up forgetful tendencies to nothing more than the natural progression of time.  This propensity to overlook early warning signs is normal among most sufferers, and since the account of the individual is unreliable at best, due to the lack of memory retention, diagnosis is usually not discovered for quite some time (Long).
It is not uncommon for many subjects in this stage to hide the symptoms from their loved ones by making lists, or flat out denying that they have any issues at all. If we look at the example of making lists as a way of “holding on,” we must also realize that the list represents, for the subject, a representation of the real: “Therefore, pretending, or dissimulating, leaves the principle of reality intact: the difference is always clear, it is simply masked, whereas simulation threatens the difference between the “true” and the “false,” the “real” and the “imaginary’”(Baudrillard 3).   Thinking in regard to the first order of the simulacra, with the creation of the list the subject is imitating the “real,” allowing room for scrutiny of its authenticity.  The lack of detail and proper simulation is a red flag for those around them, tipping off the fact that a shift is occurring.

This “initial denial” of the prospective disease makes me wonder if it really could be considered denial at all.  If the subject isn’t actually experiencing “forgetting,” that is to say if there’s no inkling of forgetting something in the first place than couldn’t it just be considered a reconstruction, or a shift in reality: “’For the person with a memory impairment, life may just be like constantly coming into the middle of a movie: one has no idea what happened just before what is happening now’” (Long 213)

Stage Four: Frontal Lobe Fallout

The second to last stage of Alzheimer’s consists of the move to the frontal lobe. This is when the loss of ability to interact socially is activated, as well as loss of reasoning and judgment. It is in this time that we see patients sometimes exhibit violent tendencies, and extreme mood swings. During this phase the subject loses their social skills entirely prompting some problematic behavior (Callone): “Persons with Alzheimer’s may exhibit behaviors that are considered inappropriate, such as exposing their genitals in public. Some persons will undress completely and wander into public spaces oblivious to their behavior. Urination in public places may also occur. Some persons with SDAT will make frequent demands for sexual intercourse or will propose sexual intercourse in the company of visitors” (Long 214).
 On an anecdotal note, I myself have been witness to this behavior, and it can be rather disturbing for the outside parties involved. But I think what was the most upsetting is when, or if, the subject becomes lucid momentarily long enough to recognize what had just taken place. Sometimes in this case, the subject will become ashamed of their actions and react in a violent outburst. Unfortunately, my Uncle had dementia and I can remember the instances when he would be lucid just long enough to recognize that he had done something inappropriate. The usual reaction would be some version of self-destructive behavior, because he was unable to communicate he became frustrated and acted out.

            It was when my Uncle had jumped from his reality into ours where the problems in disassociation became real for him. Without the ability to communicate, or to have full control of motor functions, the shift into our world again was emotionally devastating. It is around this phase where, if the patient were receiving in home care, they may be more likely to move into a facility where they can have round the clock care. And it is also at this time where a significant switch might occur in the attitude of the patients loved ones.

Second Phase:"I think therefore I am."-Descartes

In the next stage of SDAT the disease continues on its rampage of well-targeted destruction in the temporal lobe. During this time is when the subject will begin to have trouble grasping words. Subjects will find it difficult, and frustrating when trying to express themselves verbally, as well as understanding the words spoken to them (Callone). It is around this time when the family members begin to feel the intensity of the coming gravity of the disease.

Like anything else, the symptoms of this stage of the disease will vary from person to person.  Some subjects may find that they are able to speak relatively fluent, but it is indiscernible for the others around them. Others could just have issues finding the “right” word occasionally, but for the most part be able to communicate effectively. (Long).  
This is where the “arbitrary nature of the sign” comes into play, Saussure states:
The bond between the signifier and the signified is arbitrary. Since I mean by sign the whole that results from the associating of the signifier with the signified, I can simple say: the linguistic sign is arbitrary. The idea of "sister" is not linked by any inner relationship to the succession of sounds s-o-r which serves as its signifier in French: that it could be represented equally by just any other sequence is proved by differences among languages and by the very existence of different languages: the signified "ox" has as its signifier b-o-f on one side of the border and o-k-s on the other (Saussure principal 1).

In Saussure’s theory he makes the point that the referent is not inherent or intrinsic to the word. And by the supposition we can argue that regardless of the ability of the second party to understand the STAD subject, meaning can still be made, even if it is only constructed by the subject themselves. Thusly, we can surmise that at this stage there is still a narrative continuing within the patient, even if that narrative does not follow a linear evolution. So I ask from the POV of the subject, does it make a difference in the subjects reality if the others around them can understand? At this point the subject has lost the ability to construct a linear narrative, so they are unaware at most times of the reality that is going on outside their own minds. They no longer live in the world of linear narratives, things are metonymic, shifting moment to moment. The subjects are also unable to communicate with others, but it is supposed that they are communicating clearly in their reality. If they are still forming ideas, opinions and experiencing feelings, then we can only conclude that they are living in reality, just not our reality. One cannot put it as well as Descartes: “I think therefore I am.”

Third stage: Good bye parietal lobes

The next stage of STAD continues with the progressive dismantling of the parietal lobes. This area of the brain controls visual, hearing and the connection between body and sensation, now is the time when the subject has a tendency to get lost or has trouble feeding themselves without assistance (Callone).
            In the NPR radio show, Radio Lab, there was a segment by the name of “The Bus Stop,” which discusses a treatment of STAD that utilizes the idea of redirection. Patients at this stage of the progression have a tendency to wander around, caught in moments of time that are no longer, or were never, relevant to their caretakers. One might find a subject in the midst of reliving a moment from their childhood, trying to find a way to get home or go to a place where they feel safe. Since STAD patients retain their long term memory best, the subjects may gravitate to signs and symbols that they are familiar with, so an institution in Germany devised a plan to input a “fake” bus station.
The bus stop will never see the likes of an actual bus, but the patients that go there are under the
impression that they will be transported to wherever moment it is that they are living in. Due to this momentary feeling of satisfaction it is easier for them to calm down, and eventually they will move on to their next immediate reality (Lu Lu Miller). The bus stop is a representation of the real, and allows for the patients to have a “real” moment of interaction within their shifting reality:
Representation stems from the principle of the equivalence of the sign and of the real (even if this equivalence is utopian, it is a fundamental axiom). Simulation on the contrary, stems from the utopia of the principle of equivalence, from the radical negation of the sign as value, from the sign as the reversion and death sentence of every reference. Whereas representation attempts to absorb simulation by interpreting it as a false representation, simulation envelops the whole edifice of representation itself as a simulacrum (Baudrillard 6).
            In the case of the bus stop, the STAD patients are under no impression that what they are seeing isn’t the genuine article. They have no cognitive ability left at this stage to be able to discern a replica from the real thing. This is further reinforced in the fact that at no point in time will they realize that the bus hasn’t come, and that the signified has not functioned in the way they are accustomed. Before they can recognize that they were never picked up the patient will have already moved onto the next moment, and the second phase of the simulacra has been introduced: Second order: The boundary between reality and representation blurs. The difference between representation and reality is not clear. In some sense, the representation has become as real as the thing it represents (Baudrillard).

         A problem that the institution faced initially was the moral dilemma of the staff, feeling that they were lying to the residents. When they played along with the bus stop recreation they had conflicting feelings of guilt, because they were essentially “lying to the patients.” If we see this problem from the theoretical standpoint of the STAD patient, one could argue that in essence there is no more perceived outside truth. With the subject having no linear time line they are living without bounds or confines. The truth of the matter for the subject lies in the moment to moment. With no point of reference to conceive of a “truth” the only people that the staff are lying to is themselves. 

Almost There: How is Death Constructed?

        In preparation for the final stage of Alzheimer’s the family and friends of the aforementioned may either consciously, or subconsciously, begin to prepare for the death of the subject. This preparation includes grieving over both “social death” and “psychological death” even before physical death has occurred (Doka).
Sudnow described social death as, ‘“that point at which socially relevant attributes of the patient begin to permanently cease to be operative as conditions for treating him and when he is, essentially, regarded as dead’” (Long 481). Meaning that because the patient is no longer regarded as a social being, able to interact and communicate in a deliberate fashion, they are essentially nonexistent in the realm of those perceiving a community oriented world. This concept, since it is based on the perception of the outsiders, seems legitimate. To be social one must interact with others regardless of what medium that may take place in. The interaction is not exclusively psychical, and in the case of an STAD patient that premise is exactly why this death is substantial. For example if we were talking about the late and great Christopher Reeve, we could argue that although he didn’t have any physical response for the most part, his brain was still surviving in the world of the collective conscious.
His legacy; totally unrelated, but lovely...and social
Because of that he was still able to be “social.” Sure we wouldn’t see him out on the dance floor tearing it up, but unlike the STAD patient he is able to connect with others on a mental level.

            The psychological death occurs when there is a “loss of individual consciousness” where the individual is no longer aware of themselves, they are perceived to no longer have a personal internalized identity:
“Psychological death has already been defined as the point at which the individual’s persona is lost” (Long 481). This statement I do take issue with. Since we do not have proof other than biological evidence (which in most cases would win me over), it is impossible to know since there has been no first-hand accounts of how one perceives themselves at that point in time, who can tell? However, looking at it from the POV of the onlookers, yes, there is a real and substantial loss when the person you know is no longer perceivable in a physical or psychological sense.