Dementia can be a devastating neurological disorder which many of us fear. Michael Ignatieff, a Canadian academic, author and politician, explores the territory of dementia in this thoughtful novel, which was shortlisted for the Booker prize. This is a son’s story of his mother’s dementia and a moving meditation on the effects of loss and the nature of personhood. The narrator is a philosophy professor whose observation of his mother’s intellectual deterioration and its effects is contrasted with his brother’s views as a neuroscientist. Ignatieff explores the meaning of care and of memory.
The narrator observes a nurse, Miranda, caring for his mother and is perplexed that:
‘... some nurses seemed possessed of an intuitive natural tenderness towards their patients while others did not ... There were others, not necessarily less decent people, who had to have procedures to behave decently, who had no natural intuition for what would insult the honour of strangers.’
He contrasts the detachment of some healthcare professionals with the empathy of those like Miranda:
‘It was as if some knew how to feel the pain of their patients without being frightened of it, while others had to keep it at a proper professional distance’.
Doctors continue to struggle to balance detachment and connection with their patients. It is salutary to read that as a relative, the narrator can tell as soon as a nurse approached his mother whether they had this ‘secret capacity’ or whether it was ‘just a job for them’.
Friends often ask the relatives of a person with dementia, does she recognise you? As the narrator’s brother said ‘... if she failed to recognise you, you ceased to exist’.
The narrator explores the complex process implicit in recognising a face by referring to the last Act in King Lear. The confused Lear whispers to his daughter Cordelia and his trusted Kent: ‘Methinks I should know you ...’ As the narrator points out, his mother was simultaneously aware that she should recognise him and yet was sometimes unable to do so; vision and recognition are distinct capacities.
Scar Tissue is a profound novel which deepens our understanding of dementia and its effects on a family. It is a powerful teaching resource for doctors, nurses, and students. It challenges our practice and stimulates our thinking on empathy. It is a powerful and moving exploration of a son’s experience of his mother’s dementia.
- © British Journal of General Practice 2016