Dear Alex,

Thank you for your letter, concerned and thoughtful letter which just arrived,
which gives me much to think about, and which I answer by return
composition, if not by return mail, because my 85 year old memory has
a standing order not to be burdened with ideas that can and should be 
put in writing.

Janet arrived about half an hour ago, sat silently by Margaret's bedside
before she asked: I've brought a book of mother's poems, would you like
me to read it to you? Margaret's answer was a plain and simple No.
Perhaps I should leave it at that and let Margaret speak for herself;
but it's from respect and affection for you that I risk your considering
me arrogant and condescending when I explain my understanding of the 
dynamics of Margaret's dementia, prefacing this explanation with an 
admission that I may be wrong. Please don't hesitate to correct me.

You wrote:

"Oh how I wish that music has been helpful to her. In the situation 
you describe it seems to me that music would be good but I know you've 
tried that and it really hasn't been helpful. Would a picture from a 
book or from a photo album be visible to her and in any way comforting?" 

"What about reading to her from a book: even if she can't distinguish 
all the words with the intonation of your voice the soothing over a 
period of time? what about reading to her from a book: even if she 
can't distinguish all of the words would the intonation I love your 
voice be reassuring to her?"

Let me be specific and distinguish between therapy: a) by recorded music, 
b) by familiar voice, c) by recitation i) of unexperienced history
or ii) of experienced history. d) i) unfamiliar images, or ii) familiar
images. So far as recorded music is concerned Nathaniel brought over a 
stack of CDs, including a rendition of Schumann's haunting "Dichterliebe" 
to poems of Heine, compositions with which Margaret should be intimately 
familiar because we've listened to them often enough on the long drive 
to Konnarock, when I've also bellowed them loud enough to keep me from 
driving off the road in the middle of the night. I don't think they had
any effect on Margaret in her dementia. When I have asked Would you like 
to hear some music, she's consistently said No. I might have experimented
by putting a CD on the player without asking and observing the result.
I haven't done that. The fact is, however, that Margaret isn't musical;
I've never heard her try to sing even a single note, and she's so
consistently asked me to turn down the volume when I listen for my
own benefit, that I've resorted to earphones, the implicit isolating
effect of which has not seemed to trouble her. 

As for my voice, I know that this comforts her, at the same time that
difficulty in hearing and interpretation challenge her understanding.
My words must be simple, direct, loud and clear. But are such easily 
understood words, worth the interruption of her slumber?
 
The meaning of (hi)story to a mind afflicted with senile dementia is
an issue of much interest to me. I've been thinking much about the
mathematical modeling of nature in physics, such as quantum mechanics.
I propose the following parable as a model to explain how I understand 
Margaret's dementia.

The mind is like a room with uncounted shelves lining the walls and 
both sides of multiple partitions. This library has as its curator 
the human soul, a librarian intent on maintaining an irreplaceable 
collection of books with an almost infinite number of precise cross-
references in impeccable order. The dementia is like a brutal storm
which tears off the roof, shatters the windows, scatters all of the
books many of which are soaked and destroyed by torrential rains.

The poor librarian is in tears. She tries to restore order by replacing
the tattered books that she can find on the shelves, but she can't
really remember what goes where. "I'm all mixed up, I'm all mixed up."
she repeats to herself, and to the sympathetic bystander, over and over
again. Finally she has replaced the books on the shelves, far from
perfectly but in sufficient order to make it possible for her to
continue to function albeit at a much reduced level.

The librarian has friends, perhaps even relatives, who are sympathetic 
and who want to help. "A" tells the librarian that the books which were
irreplacable should nonetheless be replaced by books that are similar
in appearance even if their content is different and their value much
less. "A" also says that she should forget about the cross-references 
which were, after all, seldom used. "B" has different advice. "B" offers
her many photographs of the library's shelves with the correct arrangement
of the books. "You should look at these," she says, "to get this place back
in order." "C" says "this is hopeless. Throw out everything and replace
it with a complete set of the National Geographic which I have at home,
which I will donate to the cause, and if that doesn't seem right turn the 
place over to McDonalds or Starbucks. Finally, along comes "D" who says 
"the library doesn't matter to me. YOU matter to me. I love you, I always 
have and I always will."

Which of these four do you think was the true helper?

Love, Jochen