‘A middle aged man realises his father is ill. The man tells his son it is time to take his grandfather to the top of the mountain to die. Father and son sit the old man in a wheel chair and move him slowly up the mountain top where they will push him over the edge so that he can speedily meet his death.’
Sabat has written a complex, thought-provoking book which aims to give some insight into the subjective experience of Alzheimer's disease. He has drawn on his research experience working with patients who have the disease, giving detailed transcriptions of their conversations with an analysis of the content. He places the conversations in context to provide understanding amid apparent fragmentary speech and incomprehensible behaviour.
Sabat gently challenges the scientific and mental model of how Alzheimer's disease is identified and measured, in particular the traditional focus on deficit and pathology. He suggests there is value in individual experience rather than scientific averages without dismissing evidence-based medical principles. He invites a different viewpoint to reduce stigmatising and dysfunctional attitudes towards people with the disease. He asks us to focus on strengths not weaknesses, and to consider humanistic management rather than standard conventional ‘palliative’ care. He describes complicated philosophical, psychological and social construct theories to support his viewpoints. It is not a light read.
The book is interspersed with the voices of Alzheimer's disease patients and Sabat displays warmth, empathy and respect for the individuals described. The progression of their disease is clear through the narrative of the book and the outcome is no cliff-hanger. Ultimately, Sabat personalises Alzheimer's disease and confronts us with a need to change how we view people with the disease and how we can improve services to support them.
‘Just as the man is about to push his father over the precipice his son calls out to him urgently, “don't let go of the wheelchair”. The man turns to his son and asks for an explanation. His son tells him, “we are going to need it for you some day”.’
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