It feels inappropriate to even evaluate this book. What does it mean to say that it deserves my praise? Such an appraisal feels so shallow, so superficially inconsequential when I think about the pain so palpably imbued into this novel. Scar Tissue is beautiful. I wept at its many difficult moments, either because I, like many other readers, have a dear relative whose life I have watched the unmerciful hands of dementia slowly destroy, or simply because its meditative prose, philosophical perceptiveness, and spiritual caress moved me unlike most of the literature I typically read. “We remain creatures of the word,” the narrator realizes just before his mother’s death. Only the word can save us, only that with which we communicate our desires, fears, and most intimate pain. “Believe in the word,” another character, Moe, tells the narrator, for it is with God—it is God.
Of course, the narrator, an introspective man who seeks to live the examined life praised by Socrates and most philosophers, does not believe in God, and so his inability to lose himself, to deliver himself up and out of the depression into which he descends after the death of his parents, to surrender his sense of self entirely to . . . what? is rather difficult. Death, rather than God, becomes that which he feels “deserves awe,” and only a resolute openness to one’s death, it seems, will afford the authentic existence that he so desperately seeks. To summarize the novel briefly, the narrator’s mother has severe dementia that transforms her into a person whom he barely knows and, ultimately, kills her. His father, a hard, disillusioned Russian exile and prolific soil scientist, also succumbs to his wife’s illness, not because he also suffers from dementia, but because he cannot endure the trauma associated with her descent into painful anonymity. In a certain sense, dementia destroys the narrator’s life as well; whereas he once seemed to have found the kind of existence he wanted—replete with a tenure track philosophy position, a beloved wife, and two children—it all slips away from him so quickly as the illness starts to take over his life. This is not a happy book. It is too true to be joyful.
Scar Tissue does not describe a woman’s descent into Alzheimer’s. Nor is it a book that offers any kind of real advice about what to do when a loved one falls prey to the vile machinations of dementia. In many ways, it seeks to answer a simple set of questions: if I know more—that is, with respect to science and medicine, with what happens inside the brain, with what scar tissue, that mass of protein buildup that eradicates one’s core consciousness and sense of self, looks like on a brain scan—will this help me cope, as I watch another’s life decay before my eyes? Does it make the situation any better? Most importantly, for all its explanatory accounts, can science tell me what it is like for my mother, my Nana, my loved one, to be her? What it feels like to lose one’s mind? Science, it seems, cannot answer that question. In fact, we may never know the answer, not until one who does feel the deterioration, who self-consciously reflects on the self that continues to elude them, describes it to us. The narrator nods toward this potentiality at the end of the novel, when he realizes that he will die his mother’s death: “This room will soon become a prison. The doors will be locked. I will try the handles. I will not be able to escape. The faces of my wife, my children and my brother will blur, decompose and then reform into the image of jailers. My own hands, my own face, my own thoughts will seem alien to me. The words I utter will make no sense, not even to me. I will be dying, but with my eyes open.”
How should we be with such a person, especially a parent? Do we play the role of the dutiful child, only to watch an insatiable illness consume our lives as well? Scar Tissue testifies to the destructive vulnerability this kind of response leaves us open to. Do we remain distant, like the narrator’s brother, only to realize that we have decided to be there too late, when the mind of our beloved has been lost forever? This seems equally unsatisfactory. There is no easy answer, and Scar Tissue does not necessarily favor one over another. Rather, it seeks to demonstrate how we are on an existential level is just as important as what we are on neuroscientific level. Therein lies its beauty and power.