“Dana, am I going crazy? You would tell me if I had lost my marbles wouldn’t you?” I’ve heard these questions many times. Repetition. Anyone who lives with Alzheimer’s knows from repetition. As her rudder, I always supplied my mother, Alice, with the same steady answers. “No. You’re not crazy. You have Alzheimer’s Disease so you can’t remember what just happened.” “Oh. I forgot. What a lousy thing to have.” “Would you like a cup of tea?” “Okhh, I would love a cup of tea.” This ritual soothed us both. As an anthropologist, I know from ritual and how it uses repetition to soothe worries, to fill in the unknown, to make things better.
I’ve asked medical students to consider the ways that rituals, repetitive actions with symbolic meaning, heal. What do the white coats they always wear, or the repetitive sequence built into the ritual of the physical exam, say to their patients? Hand washing protects from germs, but it is the white coat that grants permission for those cool clean hands to linger and squeeze the soft vulnerable throats of a sick person clad only in a loose gown. White coats, the disinfectant bite in the air of the exam room, the rustle of the roll of paper on the exam table; these never fail to transform my mother into to a trusting patient. Even in the thick of Alzheimer’s, these clinical rituals have somehow always helped her find her marbles.
Endless repetition of questions alone does not make for a ritual. But add a dose of symbolism, a hero or two, and a ritual is born. Our three grown sons joined my mother, Peter, and me, for dinner only on occasion. At almost every meal she repeated her question: “Where are the boys?” For weeks, Peter gamely fielded the question with all kinds of stories about who they were with, or how they got where they were. But the breakthrough moment, the transformation into ritual, took place when he typed up a little story, just a paragraph, about each son. Below the boys’ bios, he added pithy quotes by some luminary, such as Mozart: “Love, love, love, that is the soul of genius.” When she asked, “Where are the boys?” we gave her the paper. The magic of reading neat typed text, the sheet of paper, a dash of Mozart, the silence while she read, satisfied her as none of our verbal exchanges ever could. “Thank you. This is very helpful. What a good idea to write this up.” Then with the paper beside her, the repetitive questions settled down for the rest of the meal, till it was time for a cup of tea. “Okhh, I would love a cup of tea.”