Thursday, May 1, 2014

New Yorker: Have You Read "Have You Lost Your Mind?"?

In the April 28 issue of The New Yorker magazine, Michael Kinsley offers a great piece, entitled "Have You Lost Your Mind?"  At first I thought the article was just a well written but not very surprising prediction about the looming "tsunami" of aging baby boomers.  Good research, interesting tidbits of medical fact, sharp-edged moments of social commentary and nice touches of humor.  Kinsley writes, for example: 

"I predicted [a few years ago] that the ultimate boomer rat race would be the competition to live the longest.... But, on further reflection, I think I underrated the penultimate boomer competition: competitive cognition.  The rules are simple:  the winner is whoever dies with more of his or her marbles."

But then the article gets serious, and seriously interesting.  The author reveals he was diagnosed twenty years ago with Parkinson's disease (PD) at the age of 43. That's when I, as a reader, noticed that the article was subtitled "Personal History."  For the last twenty years, Kinsley has had time and reason to think about the potential consequences of PD, not just for his body, but his mind.  He thoughtfully explores cognitive defects that can accompany PD, and which can be progressive. 

With facts, anecdotes and his own worry-driven research, Kinsley explains that not all dementias are about loss of memory:  

"[A] difference between Alzheimer's and Parkinson's is that Alzheimer's tends to starts its destruction in the parts of the brain affecting memory, whereas Parkinson's starts with what they call the executive function: analyzing a situation and your options and making a decision."

Ultimately, even though he isn't having any symptoms he can identify as PD-related cognition problems, Kinsley bites the bullet and decides, as he puts it, to have his "brain tested." Bottom line (and, really, his entire article is absolutely worth reading so I'm being unfair in skipping to the bottom line), although he scored exceptionally well on intelligence and "cognitive reserve" (meaning memory), in fact the test identified very real deficits in executive function. 

Now remember, the article is funny and, in many ways, brilliant.  This guy is functioning at a very high level.  But there's a message here, including a possible message for families and lawyers. 

As I read the article, I was remembering a conversation with someone who was asking me about alternatives under the law because he was worried about a family member.  In his explanation, at first he focused on the possibility of a memory problem, then instances of unexplainable mood changes, and then, finally, he gave me specific examples of what could be described as impairments in the loved one's "executive function."    

At what point -- especially if Kinsley and others are right about the looming tsunami of baby boomers with dementia -- do lawyers need to be much more sensitive to and skilled in the subtleties of impaired "executive function?"  Does our tendency to focus on the presence or absence of "memory problems" gloss over the biological explanations for a client's odd gifting decision?  I wonder how many lawyers would think to ask about Parkinson's disease, even if they witnessed a tremor or shake?  Do they therefore fail to ask appropriate questions of the "intelligent" client with the "clear" memory about the reasons for trusting a new "befriender" while becoming estranged from long-standing family or friends? Admittedly, I'm taking Kinsley's analysis one or two steps further.

As he winds to a close in his piece, Kinsley suggests the need for greater appreciation of age-related neurological disorders, observing:  "[W]eaknesses can be overcome, to some extent, by strengths somewhere else.... We are comfortable with the idea that physical health is not just a single number but a multiplicity of factors.  That's where we need to arrive about mental problems.  As we get older, we're all going to lose a few of our marbles."    

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Cognitive Impairment, Ethical Issues, Legal Practice/Practice Management | Permalink

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