The Man Who Wasn't There: Investigations into the Strange New Science of the Self (7 page)

If our self-representation system is working well, then episodic memories are continually being converted to semantic memories, creating the gist of who we are. In Alzheimer’s, the process seems to be disrupted. The brain’s ability to continually update our self-
representation is compromised, evidenced by the anosognosia, but more profoundly by an alteration of one’s narrative self. The formation of the narrative slows down, or even stops. The patients reach back into the depths of their memories to a time when the keystones of their narrative arcs were formed, when their enduring identities were forged. In what can only be called a cruel twist of fate, this aspect of our sense of self that lets us travel back and forth in time, remembering or creating identity—what philosophers call autonoetic consciousness—is among the last of our cognitive abilities to mature during childhood, but one of the first to begin crumbling under the assault of Alzheimer’s.

The day I met and talked with Allan, he was surprisingly present and charming. Michaele was glad he was so—it was that time of day, she said, early afternoon, a small window of awareness before he would lapse into a state where he would be difficult, even unreachable.

“Is there anything about Alzheimer’s that worries you going forward?” I asked Allan.

“No, I think I have given up forward,” he said. “I’m seventy, seventy-one.” (He was eighty-one when we spoke, seventy when he was diagnosed.) “It’s been a good life. Things could be much worse. Solved problems of the world, have two children, now two grandchildren. That’s good. Saw the world when I was in the Air Force.” It was when he was stationed in Germany with the US Air Force that he saw the destruction wrought by the Second World War. He was deeply moved by a visit to the site of a concentration camp in Dachau, which cemented his evolving view that the world would be better off being run by gypsies and ballet dancers—his shorthand for “people with little
means and those with a love of the arts,” said Michaele—than by dictators and politicians.

Michaele had pointed out—and I noticed it too—that Allan kept going back to his strongest memories: from his time spent in the Air Force to becoming a teacher of philosophy. There’s a reason why he was doing this. It’s a time when Allan was cementing his identity. “We think you incorporate those memories more powerfully into your sense of self, and you form richer, more enduring representations,” Robin Morris told me. “Those basic building blocks—the essential concepts which define who you are—don’t change over your lifetime, or they change more subtly.”

End-stage Alzheimer’s disease will get to those too, but for the time being, Allan had reserves that allowed him to remember back to when he was eighteen, when he got kicked out of school three times for smoking cigarettes. The school counselor suggested he join the Air Force, and Allan did. He was sent to a base near Munich, Germany, where he learned to be an airplane mechanic. He came back to San Francisco at the age of twenty-two and began working for United Airlines and attending community college. He wanted to become a radio broadcaster, but one of his teachers said he didn’t have the voice to become a broadcaster, and encouraged him to take classes in philosophy. The advice turned out well—Allan loved philosophy, soon began teaching philosophy, and became a beloved teacher.

When I talked with Allan, he did not quite get the details or the sequence right (I could tell because Michaele had already filled me in).

For instance, when talking about the teacher who suggested he study philosophy, Allan said, “He was the one who said, ‘Since you got kicked out . . . cigarettes, why don’t you go join the Air Force.’” Actually, by the time he’d met the teacher, Allan had already been in the
Air Force, and the teacher had suggested that he take up philosophy classes.

If Michaele hadn’t previously told me about Allan’s past, I’d not have been able to temporally order his recollections. Toward the end of our meeting that day, Michaele left Allan and me alone to talk some more. I asked him again about his life. Here’s a fragment of the conversation verbatim, when he talked of the Air Force again, after already having mentioned it a few times.

“We joined the Air Force here, and we continued to make up situations . . . you do. Everybody wanted to be an airplane flight, but then somebody said no, you have to have algebra. Some people said I don’t have algebra. That’s what I said. OK, we’ll do something else. We got on the train in San Francisco, we went over up to Boston, got on a boat, a boat which is not much bigger than this room, and it was about twelve to fifteen people, and one of the finest things of all is that . . . many of those people . . . fallen sick. I’m one of the ones that didn’t. We had to go out and puke. I had a picture of that once, yeah.

“Then we got off the train. About two and a half days to get to Munich. Munich is the center of Germany, that’s where the place was. Making . . . Americans and Germans were together. We were there for . . . OK . . . two years . . . then we came back. I went to work for United Airlines, for years. Then everybody said, ‘Why don’t you go to college, because you are always reading books?’ Which were detective books.”

One vivid incident Allan mentioned several times during our conversation was the sight of farmers waving at the soldiers as their train sped through their fields. Allan would have been all of eighteen when he saw those farmers framed in the train window. But he couldn’t correctly recollect whether he saw these farmers in Texas or in
Germany. While Alzheimer’s disease hadn’t yet destroyed Allan’s most vivid memories, it had scrambled his narrative.

In his office in London, Robin Morris pointed out two key changes that are happening in patients with Alzheimer’s. One, as we saw earlier, is that they are not able to acquire new knowledge about themselves, and so are unable to update their narrative self. The other is that there are probably brain structures responsible for supporting our self that are under attack by Alzheimer’s, and so the person is falling back on the most resilient parts of his or her narrative. These resilient notions of oneself form during late adolescence and early adulthood—much like the version of himself that Allan was recalling during his rambling recollections.

Even healthy people, when they are asked to recall life events, will remember more events from when they were between the ages of ten and thirty, compared with their recall of events from before and after this time. Psychologists have a name for this: the
reminiscence bump.

This bump has a significant influence on our self. Martin Conway, a psychologist at City University London, has worked extensively on memory and the self. Conway envisages an individual as having a hierarchy of goals. This hierarchy is broken up into smaller and smaller subgoals, becoming more and more specific the smaller the scope of the subgoal. For instance, you might have as a goal the idea of becoming an athlete—and smaller and smaller subgoals would involve more and more specific targets, all the way down to running five kilometers today. Conway defines a notion of the “working self” based on this hierarchy of goals, and the purpose of the working self is to reconcile a specific goal (becoming an athlete) to the current state (sitting on
the sofa, say) and ensure that the discrepancy between the two states is minimal (by making you get off that sofa and run). In other words, the working self regulates behavior.

Besides this working self, Conway identifies what he calls the conceptual self, an aspect of our self that contains notions of who we are, based on our interactions with others, including family, friends, society, and the broader culture.

The job of the working self, in Conway’s model, is to regulate behavior and help in the formation and construction of memories that are consistent with the conceptual self and its goals. Consistency does not mean accuracy. For example, in the short term, it’s important for me to remember whether I turned off the gas in the kitchen. Such short-term memory has to correspond to reality with high fidelity; otherwise there is a price to pay. However, it’s impossible for the brain (at least in most of us who do not have photographic recall of every incident) to maintain such records ad infinitum. So, long-term memory is less constrained by fidelity and is more concerned with the need for “coherence”—that is, whatever enters long-term memory should not be dissonant with our conceptual self and goals, which are themselves influenced by existing long-term memories. As Conway puts it, the autobiographical knowledge in long-term memory “
constrains what the self is, has been, and can be,” while the working self dictates what goes into long-term autobiographical memory and the ease with which it can be accessed. Stories influence who we are, what we do, what we can be: certain beginnings require certain endings; stories can become our reality.

According to Conway, the neural processes that implement the working self also ensure that long-term memories that are coherent with our goals and self-knowledge are more easily accessible than
those that are not. Crucially,
memories of those experiences that were highly significant in meeting the goals of one’s life seem to remain more strongly associated with the self and its history.

This brings us back to the reminiscence bump. “There is a critical period in late adolescence and early adulthood where you are defining your self-beliefs and self-concepts,” Robin Morris told me. We form the core of our narrative self during this time.

So, the narrative self is influenced by highly significant events in one’s life, and this self—or the memories associated with these events—then influences what you do next, and so dictates how your narrative grows. The self’s need for coherence is paramount.

In patients with Alzheimer’s, this narrative self is being disrupted on multiple fronts. To start with, the ability to form new episodic memories is impaired. Also, the incorporation of these memories into one’s narrative in the form of gist or semanticized memories is failing too. Daniel Mograbi, Morris’s PhD student from Rio de Janeiro, calls this the petrified self: the story one is able to tell about oneself once Alzheimer’s takes hold is stalled. When the narrative self is functioning normally, episodes in one’s life line up to tell a story. In its early stages, Alzheimer’s prevents the narrative arc from growing any further, limiting it to whatever it was at the time of disease onset. Alzheimer’s continues to hack away at the narrative until all one is left with is a set of disconnected episodes. Eventually, even those are gone.

The term “petrified self” did not go down too well among some of their colleagues. “It suggests the person with Alzheimer’s is dead or ossified,” said Morris. “I have a lot of sympathy for that, since that is not what we meant. We should be careful how we conceptualize people. On the other hand, you can’t limit science by political correctness. You can’t hide inconvenient truths.”

And the truth is that as the narrative self petrifies first and then begins to deteriorate, the person with Alzheimer’s reverts back to the critical narrative self, to memories that were formed at a time when the self was being defined most strongly, when its essence was being etched deeply in the body and brain. Alzheimer’s, however, ultimately affects even the critical narrative self. Despite Allan’s ability to reminisce about his adolescence and early adulthood, Michaele would notice long periods when he would just “disappear, disappear.” She’d look into his eyes and find them empty, vacant. All caregivers of Alzheimer’s patients would relate to Michaele’s experience. “There was just hardly [anyone] there anymore,” she told me.

But is that something caregivers are inferring, or is the person with Alzheimer’s really unaware? Morris argues that the onus is on science to show that patients are not aware, that they have no self.