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The essence of dementia

The essence of dementia

Required reading

Who: Martin van Boxtel, associate professor at the department of Psychology and Neuroscience

Book: Out of Mind, J. Bernlef

Target group: students of Medicine and Psychology

“I know of no other book that describes the process of dementia as well as Out of Mind.” A dramatic story, but a true one, says associate professor Martin van Boxtel. “Students get things from this novel (published in 1984, ed.) that they would not come across in professional literature. It is admirable how the author managed to included the clinical scientific element in the novel. On the other hand, Bernlef makes the reader feel what it is like to slowly disintegrate as a person. It is unbelievable how fragile someone’s identity is. Patients with advanced dementia don’t have an identity. They have become an empty shell.” According to Van Boxtel students learn enough about cognitive disorders (the core business of old age psychiatry) from their textbooks, “but it is so very different when you read what it does to a person, seen from the inside. The panic that is there initially, when you think your wife is your mother, or when you have no idea where you are.”
Bernlef writes the story using the first person, Maarten, 71 years old. He and his wife live in America. His roots are in the Netherlands. In the beginning his main problem is some minor forgetfulness, says Van Boxtel. “Something that could be put down to age. Slowly but surely, however, he forgets more and more. He cannot even remember the most recent things, takes steps back in time, goes even further back until there is nothing left.”
In the beginning there is mainly guilt. “He apologises to his wife when he mixes up things or people, or when he has been socially awkward. He leaves the house, and at the end of the day he thinks that he has been for a short walk, but appears to actually have been lost. His wife is emotional but slowly starts to accept it. She cannot stop the process.”
Bernlef translates Maarten’s confused mind into his style of writing. “At the end there are mainly short sentences, fragments, observations. He registers, cannot be touched, no longer feels emotion.”
Dementia - a collective term for illnesses of which Alzheimer is one - is “the decline of higher cognitive functions,” says Van Boxtel. “In the case of Alzheimer, a protein builds up in the brain resulting in the long term in neurons dying off. Everyone has a chance of getting the disease, but some people are genetically more protected than others.”
Can it be prevented? “Monitor your lifestyle. That is what we also emphasise in our workshop ‘Keep your brain vital’. Promote cognitive hygiene, exercising sufficiently, limiting alcohol intake and not smoking. In fact, all those things that should also prevent cardiovascular diseases.

In this column lecturers recommend a novel that throws a different light on their field than textbooks do





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