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We are Not in Kansas Anymore:
Putting Alzheimer’s in Perspective
By Shelly Moss

(Page 1 of 2)

“There is no place like home; there is no place like home.” We can all relate to Dorothy’s sentiments. She was surrounded with enchantment—talking animals and vivid colors—yet she still longed for black and white Kansas. In Kansas lived the people she knew and loved; things were familiar and predictable, and Dorothy knew where she fit in. Her eyes were filled with joy and relief when she saw Auntie Em, Uncle Harry, Hank and Zeek.

Now consider this scenario: Dorothy’s shoes suffered a technical difficulty and she had to stay in Oz for 40 or 50 years before she is able to return home. When she opens her eyes, she discovers that the farm was repossessed by the bank in the Dust Bowl, and the house has been moved to town. Oh, and by the way, her body was repossessed as well and was replaced with a smaller, weaker version.  Auntie Em and Uncle Henry are dead and the farmhands are long gone. Dorothy recognizes the house, and yet, nothing is the same.  She longs for the familiar—the smell of Auntie Em’s cooking, the sound of pigs grunting in the yard, and the voices of the farmhands talking and laughing. She wants to go sit on the fence and watch Zeek feed the pigs, but there is no fence, no pigs and no Zeek. And she couldn’t climb a fence if she tried.  Dorothy is lost once again and she cries to go home to Kansas.  She is told over and over again, “This is your home, Dorothy.”  But she knows in her heart that she is not home.

MGM would never have ended a movie on such a hopeless note.  But life is a different story.  Alzheimer’s and other forms of dementia play a cruel trick on their victims. The memories of rich, full lives are slowly and insidiously stolen from them. Alzheimer’s attacks the short-term memory first.  An individual may, in the process of driving to the bank to make a deposit, forget halfway there why they are going. She may go to the grocery store and see a friend of many years and be unable to call her name.  He may ask the same question over and over again.

Entire passages of time may be erased in the last stages of Alzheimer’s. “Joe” lives in a nursing home and worked as an accountant for many years, yet he tells people he is a mechanic. His family wonders, “Where did that come from?” and Joe receives the label “confused.” Yet, looking into his history would have revealed that he worked his way through college as a mechanic. He really isn’t confused; he is just living within the confines of his own memory.  The disease has eroded the past 45 years of his life and he does not remember being an accountant or getting married or having children. Thus, when his son Tom comes to see him, he decides this familiar looking man must be his younger brother Jimmy.  When his wife comes to see him later, Joe tells her that Jimmy came to see him today.  His wife knows that Jimmy died in an accident several years ago and she tells the nurse that Joe is having another bad day. The nurse then tries to explain to Joe that it was his son Tom that was here to see him earlier.  Joe argues angrily with the nurse; he does not remember having a son, so the nurse must be either stupid or a liar, and he proceeds to call her both. The scenario above explains why it is fruitless to try “reality therapy” on an Alzheimer’s patient in this stage of the disease.


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