How to be Alone. Jonathan Franzen

out, and, because she already had a steel plate in her leg from an earlier fracture, she was facing complicated surgery followed by prolonged recovery and rehab. Her letters from late 1990 and early 1991 are marked by paragraphs of agonizing over whether to have surgery and how to manage my father if she did.

      Were he in the house alone more than overnight with me in the hospital I would be an absolute basket case as he leaves the water running, the stove on at times, lights on everywhere, etc.… I check & recheck as much as I can on most things lately but even so many of our affairs are in a state of confusion & what really is hardest is his resentment of my intrusion—“stay out of my affairs!!!” He does not accept or realize my wanting to be helpful & that is the hardest thing of all for me.

      At the time, I’d recently finished my second novel, and so I offered to stay with my father while my mother had her operation. To steer clear of his pride, she and I agreed to pretend that I was coming for her sake, not his. What’s odd, though, is that I was only half-pretending. My mother’s characterization of my father’s incapacity was compelling, but so was my father’s portrayal of my mother as an alarmist nag. I went to St. Louis because, for her, his incapacity was absolutely real; once there, I behaved as if, for me, it absolutely wasn’t.

      Just as she’d feared, my mother was in the hospital for nearly five weeks. Strangely, although I’d never lived alone with my father for so long and never would again, I can now remember almost nothing specific about my stay with him; I have a general impression that he was somewhat quiet, maybe, but otherwise completely normal. Here, you might think, was a direct contradiction of my mother’s earlier reports. And yet I have no memory of being bothered by the contradiction. What I do have is a copy of a letter that I wrote to a friend while in St. Louis. In the letter, I mention that my father has had his medication adjusted and now everything is fine.

      Wishful thinking? Yes, to some extent. But one of the basic features of the mind is its keenness to construct wholes out of fragmentary parts. We all have a literal blind spot in our vision where the optic nerve attaches to the retina, but our brain unfailingly registers a seamless world around us. We catch part of a word and hear the whole. We see expressive faces in floral-pattern upholstery; we constantly fill in blanks. In a similar way, I think I was inclined to interpolate across my father’s silences and mental absences and to persist in seeing him as the same old wholly whole Earl Franzen. I still needed him to be an actor in my story of myself. In my letter to my friend, I describe a morning rehearsal of the St. Louis Symphony that my mother insisted that my father and I attend so as not to waste her free tickets to it. After the first half of the session, in which the very young Midori nailed the Sibelius violin concerto, my father sprang from his seat with miserable geriatric agitation. “So,” he said, “we’ll go now.” I knew better than to ask him to sit through the Charles Ives symphony that was coming, but 1 hated him for what I took to be his philistinism. On the drive home, he had one comment about Midori and Sibelius. “I don’t understand that music,” he said. “What do they do—memorize it?”

      LATER THAT SPRING, my father was diagnosed with a small, slow-growing cancer in his prostate. His doctors recommended that he not bother treating it, but he insisted on a course of radiation. With a kind of referred wisdom about his own mental state, he became terrified that something was dreadfully wrong with him: that he would not, after all, survive into his nineties. My mother, whose knee continued to bleed internally six months after her operation, had little patience with what she considered his hypochondria. In September 1991 she wrote:

      I’m relieved to have Dad started on his radiation therapy & it forces him to get out of the house every day [inserted, here, a smiley face]—a big plus. He got to the point where he was so nervous, so worried, so depressed I knew he had to make some decision. Actually, being so sedentary now (content to do nothing), he has had too much time to worry & think about himself—he NEEDS distractions! … More & more I feel the greatest attributes anyone can have are (1), a positive attitude & (2), a sense of humor—wish Dad had them.

      There ensued some months of relative optimism. The cancer was eradicated, my mother’s knee finally improved, and her native hopefulness returned to her letters. She reported that my father had taken first place in a game of bridge: “With his confusion cleared up & his less conservative approach to the game he is doing remarkably well & it’s about the only thing he enjoys (& can stay awake for!).” But my father’s anxiety about his health did not abate; he had stomach pains that he was convinced were caused by cancer. Gradually, the import of the story my mother was telling me migrated from the personal and the moral toward the psychiatric. “The past six months we have lost so many friends it is very unsettling—part of Dad’s nervousness & depression I’m sure,” she wrote in February 1992. The letter continued:

      Dad’s internist, Dr. Rouse, has about concluded what I have felt all a long regarding Dad’s stomach discomfort (he’s ruled out all clinical possibilities). Dad is (1) terribly nervous, (2) terribly depressed & I hope Dr. Rouse will put him on an anti-depressant. I know there has to be help for this … There have been disturbing, distressing things in our lives the past year, I know that very well, but Dad’s mental condition is hurting him physically & if he won’t go for counseling (suggested by Dr. Weiss) perhaps he now will accept pills or whatever it takes for nervousness & depression.

      For a while, the phrase “nervousness & depression” was a fixture of her letters. Prozac briefly seemed to lift my father’s spirits, but the effects were short-lived. Finally, in July 1992, to my surprise, he agreed to see a psychiatrist.

      My father had always been supremely suspicious of psychiatry. He viewed therapy as an invasion of privacy, mental health as a matter of self-discipline, and my mother’s increasingly pointed suggestions that he “talk to someone” as acts of aggression—little lobbed grenades of blame for their unhappiness as a couple. It was a measure of his desperation that he voluntarily set foot in a psychiatrist’s office.

      In October, when I stopped in St. Louis on my way to Italy, I asked him about his sessions with the doctor. He made a hopeless gesture with his hands. “He’s extremely able,” he said. “But I’m afraid he’s written me off.”

      The idea of anybody writing my father off was more than I could stand. From Italy I sent the psychiatrist a three-page appeal for reconsideration, but even as I was writing it the roof was caving in at home. “Much as I dislike telling you,” my mother wrote in a letter faxed to Italy, “Dad has regressed terribly. Medicine for the urinary problem a urologist is treating in combination with medication for depression and nervousness blew his mind again and the hallucinating, etc. was terrible.” There had been a weekend with my Uncle Erv in Indiana, where my father, removed from his familiar surroundings, unleashed a night of madness that culminated in my uncle’s shouting into his face, “Earl, my God, it’s your brother, Erv, we slept in the same bed!” Back in St. Louis, my father had begun to rage against the retired lady, Mrs. Pryble, whom my mother had engaged to sit with him two mornings a week while she ran errands. He didn’t see why he needed sitting, and, even assuming that he did need sitting, he didn’t see why a stranger, rather than his wife, should be doing it. He’d become a classic “sundowner,” dozing through the day and rampaging in the wee hours.

      There followed a dismal holiday visit during which my wife and I finally intervened on my mother’s behalf and put her in touch with a geriatric social worker, and my mother urged my wife and me to tire my father out so that he would sleep through the night without psychotic incident, and my father sat stone-faced by the fireplace or told grim stories of his childhood while my mother fretted about the expense, the prohibitive expense, of sessions with a social worker. But even then, as far as I can remember, nobody ever said “dementia.” In all my mother’s letters to me, the word “Alzheimer’s” appears exactly once, in reference to an old German woman I worked for as a teenager.

      I REMEMBER my suspicion and annoyance, fifteen years ago, when the term “Alzheimer’s disease” was first achieving currency. It seemed to me another instance of the medicalization of human experience, the latest entry in the ever-expanding nomenclature of victimhood. To my mother’s news about my old employer I replied: