Body and Mind: The Patient as Object

Both on a textual and a narrative level, John Bayley looks for shared continuity in the couple’s life together under the spell of Alzheimer’s disease.[1] Incessantly, he reformulates motifs that were important in the couple’s past - like swimming in the river, and water in general. Their contextualisation in the present emphasises the life-changing impact of the condition, when Bayley, for example, states that their ‘communication seems like underwater’ (41). To describe the lingering in memories of his own childhood, he depicts himself as ‘[s]ailing my little boat slowly down the stream of memories’ (271). This expression, in turn, picks up on Murdoch’s own assertion of ‘sailing into the darkness’ (194). It also hints at the husband’s attempt to make their experiences mutual: their frequent loss of understanding, their silence in front of the other.

In line with this observation, the most striking symbol for attempted continuity reveals itself in the way Bayley praises ‘the joys of solitude’ in their marriage, meaning ‘ [t]o be closely and physically entwined, and yet feel solitude’s friendly presence’ (94). Only a few pages later, the scholar admits:

Now we are together for the first time. We have actually become, as is often said of a happy married couple, inseparable [... ]. It is a way of life that is unfamiliar. The closeness of apartness has necessarily become the closeness of closeness. And we know nothing of it; we have never had any practice. (96)

These different notions of silence and solitude resonate with Hadas’s experience of lost companionship. But in comparison to the American poet, the British writer zeroes in on the raw fact that Iris is not able to choose her lifestyle; that her former independent lifestyle has turned into full dependence on Bayley and his care.

Bayley transports the momentous nature of this disease-imposed transformation on a textual and narrative level: the second, much shorter part of his account is composed of diary-like entries in the present tense. They tell about the challenges of daily care, and employ images that convey

Murdoch’s dependence on Bayley. Amongst others, we read about the couple’s ‘child talk’, and gather that:

She never showed any interest in children before. Now she loves them, on television or in real life. It seems almost too appropriate. I tell her she is nearly four years old now - isn’t that wonderful? (201)

As previously mentioned, Bayley’s narrative has obtained its prominence in conjunction with Richard Eyre’s movie adaptation: both critical reception and didactic use of his memoir have been aided by the film’s outreach and message.[2] Yet, the film is considered ‘to transform Iris Murdoch into a mascot for dementia’.[3] This fact might have supported professional interest in the movie.[4] But it also favoured the almost undisputed use of Bayley’s narrative to illustrate how the illness reduces the patient not only to a child but also to a living death. With reference to Paul John Eakin’s assertion that Alzheimer’s represents ‘the death of the self, Lisa Diedrich, for example, writes that ‘[i]n the case of Bayley’s narrative of Murdoch, the first death is the death of the self through Alzheimer’s that precedes the death of the biological body’. Diedrich puts her claim specifically in the context of Murdoch’s achievements as a philosopher and novelist. As such, one could argue that in Murdoch’s case the loss of self becomes particularly apparent, because the reader reflects on her illness in the light of her past achievements, or, as Diedrich puts it: ‘Bayley’s task [... ] is to describe what happens [... ], but, in describing the losing that occurs with Alzheimer’s, he must also describe that which has been lost’.[5]

Confirming this general take on Bayley’s trilogy, the German journalist Tilman Jens compares, amongst others, his father’s need for close contact with Iris Murdoch’s ‘terror of being alone, of being cut off for even a few seconds from the familiar object’ (96 in Bayley).[6] That Jens appropriates Bayley’s metaphors may anticipate his feeling uncomfortable with his own picturing: while the British scholar presents us with a highly crafted illness memoir, organising it by the motif of Alzheimer’s disease on the levels of story, text and narrative, Jens centrally speculates that his father’s vascular dementia conveniently covered up his unwillingness to comment on his potential membership in the national-socialist party.

Against Michael Holroyd’s ponderings on writing about his aunt, Tilman Jens’s writing must seem highly unethical: it lacks any sensitivity in the context of discussing the father’s past, which, unavoidably, contributes to the loss of the literary historian’s reputation. These considerations become even more pressing in view of the fact that, as Claudia Mills has observed, the success of memoirs ‘as a literary genre has sometimes been linked with a growing culture of narcissism’.[7] Indeed, the rage speaking from Gertrude Himmelfarb’s commentary or A. N. Wilson’s memoir reflects the heated atmosphere surrounding the publication of Bayley’s texts at a time when his wife was still alive or her death still fresh (this judgement shifted for critics like Roger Lewis with the study of Murdoch’s letters published in 2015).[8] Wilson, in particular, identified ‘resentments, envy, poisonously strong misogyny and outright hatred of his wife’ in Bayley’s memoirs, and claimed that Bayley had publicly admitted that ‘[he has] never set much store by the truth’.[9] The philosopher Galen Strawson, by comparison, believed that

‘Bayley moves very close to truth’ and saw a distinction between ‘the whole truth’ and the ‘nothing-but-the-truth truth’.[10]

Strawson’s perspective resonates with what psychoanalyst Donald Spence calls, and Arthur W. Frank refers to, as an exercise of narrative truth. By this, Spence means that the narrator attempts to re-establish the connection of past to present in the present of illness that was not planned in the past. This process does not involve the reinvention of the past, but ‘the sense of what was foreground and background in past events can shift to recreate a past that displays [... ] greater “continuity and closure”’.[11] This insight, in turn, is in line with our earlier observations of Bayley’s search for continuity. Diedrich, who reads Bayley’s memoir against Murdoch’s philosophy, brings these moral considerations to the point, as she suspects that:

Murdoch would view the proliferation of memoirs in contemporary culture with weariness at best, not necessarily because it is a popular, democratic rather than a high literary form, but because it is a form that often privileges the cultivation of a unified self.[12]

Tilman Jens’s poetic choices, indeed, appear self-serving, and only add to the father’s undignified presentation. He frequently selects verbs associated with a child’s behaviour (like ‘begging for a tranquilliser tablet’ or ‘having to obey’), without explicitly owning up to such comparison. This strategy, which is as evasive as it is systematic, enhances the reader’s impression that the son forces the father into inescapable diminishment. What is more, Tilman Jens claims himself to be aware of the ethical implications associated with writing about a living family member, when confessing: ‘Ich ertappe mich immer wieder, wie ich [... ] meinen demenz-kranken Vater, statt ihn im Prasens leben zu lassen, ihn im Prateritum [... ] einsarge’ [I catch myself out again and again how I (...) bury my dementia afflicted father in the past tense (...), instead of letting him live in the present tense; 24]. However, he specifically uses the present tense when referring to the father’s confrontation with his past rather than to explore his continued activity within the illness. This strategy forces the reader to witness and judge the father personally. Reflected against Bayley’s choices, this strategy becomes even more problematic: Bayley (and Gillies after him) uses the present tense to take us into the sense of despair pertaining to the day-to-day confrontation with Alzheimer’s disease as such.[13]

This passivity enforcing presentation runs strongly counter to concepts of hegemonic masculinity and independence.[14] Furthermore, as males are usually identified with their legacy, Jens’s rendering the father’s condition as mental rather than bodily further enhances the reader’s aversion.[15] This is particularly true, since the son’s emphasis on the father’s loss of intellectual abilities and agency deprives Walter Jens of his former social identity as a mind-defined philologist; it literally reduces him to a ‘living dead’.[16] In this respect, the reception of Jens’s narrative was very similar to Bayley’s. But Bayley’s writing is permeated by allusions to the shared history of matrimony. In fact, the gravity of Tilman Jens’s presentational choices becomes even clearer when reading about Inge Jens’s memories of the couple’s ‘ideal of a partnership’. In her autobiography, Walter Jens’s wife particularly emphasises the need to be able to resort to a ‘durch die Krankheit nicht zerstorbare Vergangenheit’ [past indestructible by the illness] with her husband.[17]

In a second book, Jens claims that his intentions had been to write against the taboo of dementia.[18] He specifically compares himself to the medical journalist Sylvia Zacharias. Zacharias had reported on her famous father’s memory loss in a book, whose publication was championed by the Hirnliga

[Brain alliance], an organisation supporting Alzheimer’s disease research.[19] But in doing so, Jens overlooks that Zacharias had written her report ten years earlier, when the societal awareness regarding Alzheimer’s disease was much smaller than at his time of writing: compared to the 1990s, the number of mentions of ‘Alzheimer’ in the two largest German broadsheet newspapers, Suddeutsche Zeitung and Frankfurter Allgemeine Zeitung, tripled between 2000 and 2009. Moreover, the reader’s preconception of males as preferring to act in a planned and rational manner will not facilitate Tilman Jens’s efforts to encourage a more lenient judgement, especially, since a father-son relationship is often viewed as competitive.[20] In fact, it may be the sum of these impressions that led to Tilman Jens’s work being set in the context of an alleged Oedipal relationship with his mother, not least since his dedication reads ‘Fur Mami’ [for mommy].[21] Thinking in psychoanalytical terms, Tilman Jens’s damaging narrative tactics could also be read as his inability to deal with the loss of the father as a powerful and allied figure. In any event, such controversial debate further removed both text and reader from the ostensibly intended discussion of dementia that already seemed a pretext rather than the purpose of Jens’s writing.

Against these considerations, we would expect a son’s account of his mother’s Alzheimer’s disease to be differently accentuated. The Canadian Jean Grothe chronicles his mother’s illness in fourteen photographs and related short notes, literally presenting portraits of her, as she is passively seated in nine of these images.[22] Laying down the contrast between their former contentment and the life under the spell of Alzheimer’s disease, the journal opens with a scene witnessing the life-long affectionate mother- son relationship: the mother wears an elegant dress, and, seated at the laid table of a restaurant opposite the photographer and son, directly focuses on Grothe; her charming smile signals full awareness of him and her being photographed (13).

I began a seminar on dementia pharmaceutical care using this photograph; the overwhelming student response described this take as depicting ‘an elderly lady having lunch’. When I later showed a sequence of further photographs (17, 31, 33, 37), seminar attendants interpreted the less and less elegant dress and fashionable hairstyle, and the reduced eye contact as well as growing distance to the photographer as the photographer’s way of documenting the lady’s aging process; a process of decline and loss.[23]

The choice and reception of this portrayal bring home that Grothe equates dementia with aging and considers it a condition of loss and decline. Moreover, Grothe exposes his mother’s frailty without any reservation. He reveals the precariousness of her condition in an again blurred photograph taken from an angle, which shows her as if on a sinking ship (25); depicts her on a hospital stretcher, following an ischemic attack that accelerates her decline (26); and shows her, dressed in a nightgown, in a dishevelled state (33). But even though the text completes this image of inescapable dissolution, Grothe’s photographs provoke an ambiguous reading: he observes the mother’s glum decline, but equally senses the hope in her continued identity within the illness.[24] Grothe achieves this effect by visually dissociating the illness from the person, as he continues to focus on the mother’s gaze, while letting the surrounding objects and her shrinking body sharply determine her departure. Especially in the series of photographs I used for teaching, Grothe shows his mother on the impersonal settee (17), and later a chair of the nursing home (31), and, finally, two types of wheelchairs (33, 37).

The most telling photo is taken in a big white exhibition hall, in whose centre the small figure of the mother appears as a misplaced object without relation to the surroundings, let alone the photographer (21). The distance between patient and photographer visualises the pair’s mutual helplessness, especially as they are both exposed to the oppressive emptiness of the hall; the isolating consequences of the condition. The accompanying text reveals the core of this pain that explains Grothe’s experience of loss in psychological terms: ‘elle en vienne a fabuler, me prenant pour son mari. [... ] Nous sommes revenus tous deux epuises, peines, troubles’ [she begins to make up stories, taking me for her husband (...) we came back both of us exhausted, pained, disturbed; 20]. Aware that his mother is about to forget him, Grothe clings to the mother as perceiving of him as her son, continuing his documentation with a close-up portrait in which his mother clearly and lovingly focuses on him (23).

But considered from this perspective, this photographic series turns into a study on the eye contact a mother maintains with her son as a metaphor for a dementia patient’s mental acuity. Consequently, we as onlookers - like the son and photographer - must wonder, and that more and more with every photograph, whether Mme Grothe continues to be cognitively aware; whether she continues to recognise her son, or whether her smile occurs in the reflex of having been a life-long age-old and now old age object of the son’s camera. Grothe himself obviously ponders this question: he shows his mother as laughingly covering up her face, playfully peering through the slits formed by her fingers (19), while perceiving of her as ‘jamais [... ] si gamine auparavant’ [never before (having been) so childlike; 18].

Grothe uses here a term that evokes notions of aging as a process of regression into a second childhood, with this understanding coming close to Tilman Jens’s view of his father, and both explainable in psychoanalytical terms. But he links this expression to a photograph that takes in Mme Grothe’s continued identity. In this way, Grothe signals, unlike Jens, that he keeps seeing his parent in the individual of changed behaviour and bodily appearance. In addition, the temporal immediacy conveyed in Grothe’s photographs is less exposing than Jens’s use of the present tense, because Grothe remains focused on the mother’s presence as such, rather than the father’s acts in the past. Indeed, Jens hardly lingers on the father’s condition as one of aging, or decline in aging. Much rather, he emphasises the father’s loss of agency.

That said, also Grothe’s photographs transport concepts of mental confusion and passivity, and they picture dementia as a condition intricately linked to bodily decline. Having shown concern about how the film adaptation of Bayley’s memoir presents embodiment, some critics might take issue with Grothe’s work, because it reduces his mother to the body. Specifically in relation to Richard Eyre’s Iris, Josephine Dolan and colleagues have asserted that:

‘Iris’ increasingly becomes her body as the Alzheimer’s takes hold, no longer cerebral but physical. Murdoch’s status as a highly intellectual writer is eroded by the image of her as an abject female body - and by the patholo- gization of that body as a site of mental and moral decline. The figure of the active, independent and fiercely intellectual younger woman is systematically replaced by that of the passive and dependent older one.[25]

That said, critics like Pia C. Kontos have viewed such a perspective on embodiment more positively, because it can further the viewer’s empathy.[26] This interpretation perhaps furnishes an explanation for the engagement by students when I used Grothe’s photographs in my teaching.

On the other hand, David Orr and Yugin Teo have, in negotiation with the work by Kontos and Dolan and colleagues, criticised the movie for foregrounding John Bayley’s attempts to maintain Murdoch’s selfhood as a writer.[27] Bayley’s tendency to privilege the intellectual aspects of his wife’s identity (despite perceiving of her as childlike) counters Jens’s intellect- denying approach. Tilman Jens denies his father what I would like to term an extra-intellectual or, as Jens Brockmeier would say, pre-narrative identity. Grothe’s photographs, by comparison, offer in their imagery per se such a pre-narrative identity, which, at its core, tells about the nurturing mother-son relationship. Concurrently, however, the presentation of portrait-like photographs neglects the fact that ‘the displays of [the patient’s] personality and character [... ] require, for their very existence, interpersonal interaction and the social recognition given by others’.[28] We have seen such a recognition speaking from Judith Fox’s presentation - an enormous achievement if we take into account that Fox writes with the added pressure of caring for her husband, while also losing him to dementia.

In summary, the visual image of a patient relates the condition as embodied. Given that concepts of the aging process seemingly fit those of the disease trajectory, a patient’s visual image may, therefore, quickly emerge as one of an elderly person. In addition, presentations of passivity and dependence in a female patient are perceived of as less ethically problematic because cultural concepts link being female by itself to such characteristics. On a second consideration, the core stigma attached to dementia, however, relates to it being perceived of as a condition of the mind. I suggest that this fact offers an explanation as to why, as G. Thomas Couser has observed in ‘Memoir and (lack of) memory’, the Alzheimer’s narratives that achieve larger sales and reviewer recognition centre on male patients: the loss of the male mind appears more profound. Regardless of the patient’s sex, though, the conceptualisation of patients losing their mind can easily turn them into passive beings without their own voice or continued personhood. It is such images, in particular, that will not enhance a positive attitude within society towards the ill - who are mostly, but not always, the elderly - and neither towards their condition and their need for empathetic and identity-affirming accompaniment on their journey.

Contrasting this viewpoint, I will now illustrate how two narrators rise above the disease-imposed temptation to objectify the patient’s body, or to see their mind destroyed. Both Phillip Toledano and Arno Geiger follow the conviction expressed by psychiatrists and philosophers that patients ‘should be treated as wholes’.[29] They perceive of dementia as an integral part of their parents’ personality and natural aging.

  • [1] An earlier version of this chapter has been presented at a workshop on ‘MedicalHumanities and Aging’, King’s College London, 10 December 2014.
  • [2] For example, Bayley’s trilogy and Eyre’s film set the end point in the ‘Illness narrative as lifewriting’ seminar series at King’s College London in 2010/2011; they also featured in my owngraduate seminar series; see: Burkhardt et al., ‘Literature and science’ (Burkhardt et al. 2012).
  • [3] Amelia DeFalco, Uncanny Subjects. Aging in Contemporary Narrative (Columbus:The Ohio State University Press, 2010), p. 70 (DeFalco 2010).
  • [4] See, for example, Robert E. Yahnke, ‘Old age and loss in feature-length films’, TheGerontologist, 43 (2003), pp. 426-428 (Yahnke 2003), and Kurt Segers, ‘Degenerativedementias and their medical care in the movies’, Alzheimer Disease and AssociatedDisorders, 21 (2007), pp. 55-59 (Segers 2007).
  • [5] Eakin, How Our Lives Become Stories, p. 46 (Eakin 1999); Diedrich, Treatments, pp. 118,142 (Diedrich 2007).
  • [6] Tilman Jens, Demenz. Abschied von meinem Vater [Dementia. Farewell to my father](Gtitersloh: Gtitersloher Verlagshaus, 2009), p. 42 (T. Jens 2009); further references incorporated in the text.
  • [7] Claudia Mills, ‘Friendship, fiction, and memoir: trust and betrayal in writing from one’sown life’, in The Ethics of Life Writing, ed. by Paul John Eakin (Ithaca: Cornell UniversityPress, 2004), pp. 101-120, pp. 114, 111 (Mills 2004).
  • [8] Gertrude Himmelfarb, ‘A man’s own household his enemies’, Commentary Magazine,108 (1999), pp. 34-38, p. 35 (Himmelfarb 1999), and Richard Freadman, ‘Decent andindecent: writing my father’s life’, in The Ethics of Life Writing, ed. by Eakin, pp. 121-146(Freadman 2004); Roger Lewis, ‘Oversexed, overpaid and underworked’, The Times, 14November 2015 (Lewis 2015).
  • [9] A. N. Wilson, Iris Murdoch as I Knew Her [2003] (London: Arrow Books, 2004), pp. 9,257 (Wilson 2004).
  • [10] Galen Strawson, ‘Telling tales’, The Guardian, 6 September 2003 (Strawson 2003); for arounded summary of contemporary critical reception, see: Anne Rowe, ‘Critical reception inEngland of Iris: A Memoir of Iris Murdoch by John Bayley’, Iris Murdoch Newsletter, 13(1999), pp. 9-10 (Rowe 1999).
  • [11] Frank, Storyteller, p. 61 (Frank 1995).
  • [12] Diedrich, Treatments, p. 140 (Diedrich 2007).
  • [13] Zimmermann, ‘Journeys’, p. 387 (Zimmermann 2013b).
  • [14] James A. Smith et al., ‘“I’ve been independent for so damn long!”: independence,masculinity and aging in a help seeking context’, Journal of Aging Studies, 21 (2007),pp. 325-335 (Smith et al. 2007).
  • [15] Fine and Asch, ‘Introduction: beyond pedestals’ (Fine and Asch 1988).
  • [16] Gert Ueding, ‘Tilman Jens begrabt den lebendigen Vater’ [Tilman Jens buries the livingfather], Die Welt, 18 February 2009 (Ueding 2009).
  • [17] Inge Jens, Unvollstdndige Erinnerungen [Incomplete memories] (Reinbeck bei Hamburg:Rowohlt, 2009), pp. 287, 283 (I. Jens 2009).
  • [18] Tilman Jens, Vatermord. Wider einen Generalverdacht [Patricide. Against a general suspicion] (Gutersloh: Gutersloher Verlagshaus, 2010) (Jens 2010); the small number of Germancaregiver texts could support Jens’s claim, but numbers are not higher in other non-Englishspeaking European countries. The only truly German taboo I see is, given the dramatichistorical context, the question of assisted suicide.
  • [19] Sylvia Zacharias, Diagnose Alzheimer: Helmut Zacharias. Ein Bericht [DiagnosisAlzheimer’s: Helmut Zacharias. A report] (Cologne: Hirnliga e. V., 2000) (Zacharias2000); ‘Hirnliga e. V. - Deutschlands Alzheimer Forscher’, http://www.hirnliga.de/index.html (accessed August 2016).
  • [20] Kory Floyd and Mark T. Morman, ‘Human affection exchange: affectionate communicationin father-son relationships’, The Journal of Social Psychology, 143.5 (2003), pp. 599-612(Floyd and Morman 2003); Karen L. Fingerman et al., ‘Ambivalent relationship qualitiesbetween adults and their parents: implications for both parties’ well-being’, The Journals ofGerontology, Series B: Psychological Sciences and Social Sciences, 63.6 (2008), pp. P362-P371(Fingerman et al. 2008).
  • [21] Iris Radisch, ‘Der Mann seines Lebens. Tilman Jens verklart und denunziert semen anDemenz erkrankten wehrlosen Vater Walter Jens’ [The Man of his life. Tilman Jens distortsand denounces his demented defenceless father Walter Jens], Die Zeit, 19 February 2009(Radisch 2009).
  • [22] Jean Grothe, Alzheimer. Un journal photographique [Alzheimer’s. A photographic diary](Montreal: Les 400 coups, 2007) (Grothe 2007); references incorporated in the text.
  • [23] Zimmermann, ‘Integrating medical humanities’, p. 3 (Zimmermann 2013a).
  • [24] Ed Kashi’s photographs reveal a similar ambiguity that embraces both the possibilities andlimitations linked to aging, with their ambivalence being carried by their serving differentsocietal or political connotations of aging; see: Carol Squiers, ‘Ed Kashi. Aging in America’,in The Body at Risk. Photography of Disorder, Illness, and Healing (Berkeley: University ofCalifornia Press, 2005), pp. 192-209 (Squiers 2005).
  • [25] Josephine Dolan, Suzy Gordon and Estella Tincknell, ‘The post-feminist biopic: re-tellingthe past in Iris, The Hours and Sylvia’, in Adaptation in Contemporary Culture. TextualInfidelities, ed. by Rachel Carroll (London: Continuum, 2009), pp. 174-185, p. 178(emphasis original) (Dolan et al. 2009).
  • [26] Pia C. Kontos, ‘Embodied selfhood in Alzheimer’s disease. Rethinking person-centred care’, Dementia, 4 (2005), pp. 553-570 (Kontos 2005).
  • [27] David M. R. Orr and Yugin Teo, ‘Carers’ responses to shifting identity in dementia in Irisand Away From Her: cultivating stability or embracing change?’, Medical Humanities, 41(2015), pp. 81-85 (Orr and Teo 2015).
  • [28] Sabat, The Experience of Alzheimer’s Disease, p. 18 (Sabat 2001).
  • [29] Hughes, Louw and Sabat, ‘Seeing whole’, p. 4 (Hughes et al. 2006).
 
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