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Author’s Note

On the canted ceiling above my desk is a map of the brain. It
shows the frontal lobe and temporal lobe and parietal lobe and occipital
lobe as if they were places to visit–Rome, Milan, Trieste,
San Remo. The map, of course, is dumb. It says nothing about what
goes on in those places: that deep in the middle of the temporal
lobe, which itself is deep in the middle of the brain, there is a tiny,
cashew-shaped region called the hippocampus that is essential to
forming new memories, or that the prefrontal cortex, which sits behind
the eyebrows, is vital to foresight and being polite and paying
attention, or that the occipital lobe, which brings up the rear of the
brain, is central to sight itself.

I look at that map sometimes and think about how it is my own
brain apprehending it, and that to do so, it is traveling express. And
then my mind, declaring its independence from my brain, begins to
wander among the events of the day, past and future, and plans for
summer vacation, and concern for a friend who is sick and the dog
in the yard, but never getting so far afield that it doesn’t heed its
own call back.

Near the map, tacked to the wall, is a picture of the brain that is
doing all of that and all of this–this writing, thinking, typing,
seeing–my brain, in bright colors, which was taken a few years ago
in California. When I look at that picture I am not only seeing it,
but recalling that day, or aspects of it, so much has gone out with
the tide. I took notes on that trip, and carried a digital recorder, and
have read and reread those notes over the years, and listened to the
conversations, so I remember that day better than most, and what I
remember comes with a certain confidence, but even so it is fuzzy. I
cannot say, for instance, what kind of rental car I drove, or what
book I was reading later that afternoon when I went to the beach,
or which beach, specifically, it was.

We rely on memory not only to remember, but to walk and dream
and talk and smell and plan and fear and love and think and learn
and more and more and more. Memory is how we know the world–
that is a tree, this is a sentence–and know ourselves–I like chocolate
ice cream, I am a singer–and know ourselves in the world. Amnesiacs
make the case well: it is not, simply, that they don’t remember
their name or where they live, it is that absent memory, they are
strangers to themselves. The English philosopher John Locke believed
that we came into the world with our mind a blank slate, a
“tabula rasa,” ready for the pen of experience to inscribe. It’s a perfect
metaphor (even if it’s not exactly true), because it works to describe
what it’s like to gain knowledge, and what it’s like to lose your mind.
Stroke by uneven stroke, the eraser plies the board.

My father, before he died at the age of seventy-seven, had begun
to know this intimately, though never to the extent that the board
was wiped so clean that he approached Locke’s natal state. He
knew, and he talked about it–about how frustrating it was to read
the newspaper and then have to read it again, or to stare at a can
opener, not knowing what it was for, or to pick up the phone to call
a friend, whose funeral he’d attended two years earlier.

While it might have been natural for me to worry that my father’s
fate someday would be my own, I didn’t, really. The doctor
said he didn’t have Alzheimer’s disease, and since Alzheimer’s disease
tends to run in families, I figured I was safe. This was not one of
those calculate-your-odds kind of conclusions. It wasn’t a calculation
at all. At best it was a passing thought. Call it denial, call it repression,
or maybe arrogance, I just figured that if he didn’t have
AD, what was it to me?

But later, after he was gone, and all that was left were my memories,
some photos, and the key-chain recorder my mother made
him carry like a pair of military dog tags at the end in case he got
lost, into which he spoke his name, his phone number, and his
street address in the flattest of voices, I began to wonder. What if
the doctor had been wrong? Almost everyone I knew had a parent
or an in-law or a favorite aunt or a colleague or a neighbor or a
grandfather or a friend or a friend of a friend who had Alzheimer’s,
as if the standard six degrees of separation had been universally
abridged to one or two. But another question bothered me more:
what if the doctor had been right? What I mean is: what if my father
hadn’t been sick?

This was not a wishful fantasy about what my father’s last years
would have been like if, when going to the basement to sort the recycling,
he didn’t lose track of which items went in which bin and
stood there, paralyzed by confusion, for half an hour, or if he hadn’t
thought he’d filed his income tax when he hadn’t. He knew who his
children were. He remained interested in politics. He had never
needed to activate the key-chain recorder. The question, rather,
was a kind of private, one-person, one-vote referendum on sickness
and health: if he wasn’t sick, what was going on?

Since it is the nature of questions to beget more questions before
they yield answers, I soon stopped thinking about my father,
specifically, or about myself, even when I wondered why, for instance,
the memory of a forty-four-year-old was generally better
than the memory of a seventy-seven-year-old (or was it?), and why
the memory of a twenty-six-year-old was better than both. The answer
to this was not as obvious as it might appear. If age were the
culprit, what, precisely, was it stealing?

In the popular literature I kept coming across references to the
brain that made it sound like a muscle. “Use it or lose it” was the standard
dogma. I read countless self-help books that promised to help
their readers “use it,” and compiled a stack of newspaper articles
that touted crossword puzzles and sudokus as the mental equivalents
of jogging and strength-training, and the more of these I looked at,
the more curious it all seemed to me: I understood that these activities
were supposed to be good for you because, apparently, they
built mental muscle, but why was that? Was there a physiological
response to crossword puzzles, something that happened to the body
by doing them, and just whom did they help? Anyone of any age?
People with mild memory problems? The worried well? People who
were sick? And if they were beneficial for people who were sick as
well as people who were not, was that because the same thing was
going wrong in the healthy brains that had already gone awry in
pathological ones?

The questions piled up in my notebook, a sign, perhaps, that I
was using my brain, but to what end? Books evolve idiosyncratically,
their single law of natural selection being, it seems, that they
choose you. I began calling up neuroscientists and spending time
with doctors and sometimes their patients. They were in New York,
New Haven, San Francisco, Minnesota, Massachusetts, Chicago,
Los Angeles, and Irvine. They were in England and the Dominican
Republic and Canada and Italy and Iceland. To friends or acquaintances
who, upon hearing what I was doing, told me their particular
memory complaint or expressed a more generalized worry, I could
tell them how many smart and committed people were out there
looking for genes and molecules, developing drugs and vaccines,
searching out cures and therapies in plants and minerals already at
hand. These bench scientists and clinicians were making headway.
Moore’s law–the one about the speed of microprocessors doubling
every eighteen months–didn’t quite apply, but there was progress
being made and I was seeing it. (I was also seeing rogues and patent
medicine salesmen, but doesn’t every court have its jesters?)

The other thing I kept running into was lots of exclamations. A
week couldn’t go by, it seemed, without an announcement of a breakthrough
drug, a breakthrough gene, a breakthrough gene mutation, a
breakthrough cognitive therapy, a breakthrough food, a breakthrough
herb–so many breakthroughs that it seemed as though whatever
wall there had been between us and the dark should have come
down already, letting us bask in the sunshine of the eternal mind
cure. But hey, not so fast.

Before a drug can come to market, before a therapy can be designed,
and (more often than not) before a body can be healed, you
have to know where the problem lies. In medicine that knowledge
is often found at the cellular or molecular or genetic level, somewhere
in the mix of proteins of which we are made. To get through
the hyperbole and hype and promises and platitudes that now attend
to most public discussions about memory (which almost always,
these days, seem to be about memory impairment), I had to
find out what the molecular biologists and cell biologists and biochemists
and geneticists knew. This meant spending time in brainscanning
suites and chemistry labs and mice nurseries and hospitals
and pharmaceutical companies, and attending scientific meetings,
and reading research papers with unintelligible titles. Because there
are now many ways to look at the brain, I also made sure mine was
examined using each of them, in honor of one of the first scientists
of memory, Hermann Ebbinghaus, who made it a point to experiment
upon himself. Still, as a neuroscientist at Yale pointed out to
me, “you can’t tell much from an N of 1.”

In our own lives, by definition, we are always Ns of 1, which is
one reason why the prospect of getting sick can be so scary, and why
being sick is scarier still, especially if either of those conditions
entails the loss of self. (Can there be an N of −1?) If we’re lucky,
of course, our Ns connect–directly, contiguously, through each
other–which is how families and communities are formed. It is also
how, in science, evidence mounts and findings are made and then
confirmed.

In the years that I was writing this book, crucial findings about
memory loss and Alzheimer’s and normal memory and medicines
and cognitive therapy were made and confirmed, and even where
they were not, the ball was pushed farther up the pitch. From my
seat the view has been outstanding, and from what I have seen
there are many reasons to cheer.

Ripton, Vermont
November 2007