Iris Murdoch--A Case Study of an Individual’s Tragic Battle with Alzheimer’s Disease

Elegy for Iris
By John Bayley (Picador USA, 1999)
275 pages

Iris and her Friends-A Memoir of Memory and Desire
By John Bayley (Norton, 2000)
275 pages

Reviewed by: Dr. Michael J. Taylor

The staggeringly high incidence of Alzheimer's disease (AD)--an estimated 5-10% amongst the over 65 age group--is well known to clinicians working within all fields of adult medicine. The incidence of Alzheimer's and other forms of dementia, in those over 85, is estimated to be as high as 47%. With shifting demographics creating a rapidly expanding cohort of patients over 65 years of age, the absolute numbers of those suffering from AD will make the collective tragedy of this devastating disease more apparent. In dealing with the myriad medical, behavioural and psychosocial problems stemming from the increase in the number of Alzheimer's patients, it may become increasingly difficult for clinicians, particularly those working in long-term care facilities, to recognize the devastating impact that dementia can have on both patients and their loved ones. It may also become more difficult to stay aware of the fact that the patient's individuality is lost within the common symptoms of advanced dementia. In two recent books about his wife, Iris Murdoch, also an Alzheimer's disease patient, the writer and literary critic John Bayley elegantly describes the full impact of this devastating disease; he manages to remind the reader that love and devotion can be unfailingly strong even in the face of adversity. The book also serves as a powerful reminder of the individual tragedy of AD.

Born in Dublin in 1919, Iris Murdoch began her career as a fellow and tutor in Philosophy at Oxford. She went on to obtain international acclaim as a writer of philosophy, and of plays and works of fiction that included The Sea, The Sea, which won the prestigious Booker Prize for literature in 1978. The first sign of Iris' Alzheimer's disease appeared in 1994 while she was at a literary conference at the University of the Negev in Israel. This episode is painfully recalled in John Bayley's first novel dealing with his wife's disease, Elegy for Iris. Published in 1999, the New York Times' best-selling Elegy for Iris met with a great deal of both critical and popular success, and justifiably so. The book is a moving and honest portrayal of Bayley's daily struggle in caring for his wife, accompanied by touching accounts of the couple's courtship, marriage, and early life together. Throughout the book, Bayley effectively juxtaposes episodes from his present with episodes from the past. Perhaps most memorable is the account of Bayley swimming with his wife in their earlier days in a small nook that was part of a river near their home. The reader is presented with a tranquil scene of two young lovers finding refreshment in a quietly flowing river surrounded by lush vegetation on a hot summer day. Abruptly, this scene shifts to a more current one that is almost pitiable but ultimately rather moving. This time we find Bayley trying to undress his wife, who is now in an advanced stage of her disease, and coaxing her into the river so that they may continue the ritual swim that had, in the past, been so important to them.

Elegy for Iris is so full of frank and honest observations about Iris Murdoch's disease that it will sound familiar to anyone having had contact with Alzheimer's patients. Surprisingly, the tone throughout much of the book is rather positive, although there is an underlying melancholy. This melancholy is apparent as Bayley discusses his life with Iris prior to the onset of her disease, meditates on the complexities of their relationship, and describes the dutiful, at times seemingly heroic, way in which he cares for his ailing wife. It is a tone that changes rather noticeably in Bayley's follow-up to Elegy for Iris titled Iris and her Friends. Those expecting more of the same as in Elegy for Iris will be greatly surprised by this much darker book, that continues where Elegy for Iris left off, with an account of Bayley's struggle to care for his wife as her disease progresses. Though Bayley's technique of changing rapidly between past and present remains easily recognizable, in Iris and her Friends, Bayley has lost the gentle and almost passive tone he previously used when describing the experience of caring for his wife. In place of this tone, the voice of Iris and her Friends expresses Bayley's frustration and despair in dealing with the daily struggles of being a caregiver. It is a voice that is at times shocking. For instance, when Bayley loses his patience with his now silent wife while having difficulty dressing her, he finds himself suppressing a desire to actually strike her, staring at her with an ironic smile and saying "do you know how much I hate you?"

The "friends" of the title is not a reference to Iris' companions but is used by Bayley as a somewhat elusive metaphor to describe the silence and passivity that "visit" his wife as her disease progresses. It is these "visitations" that allow Bayley to explore his own memories as his wife's memory continues to decline. It is in these recollections, full of engaging anecdotes, that the reader may find respite from the, often upsetting, accounts of Bayley's situation. It soon becomes apparent that living within his own memories is Bayley's method of coping with the tragedy surrounding him. What the reader of both books cannot fail to notice is that while in Elegy for Iris Bayley's reminiscences were concerned with his life with Iris, in Iris and her Friends, Iris is completely absent from any account of his early life. It is as though Bayley is suggesting that he himself must forget his wife in order to escape from the pain of his current situation. However as the book draws to a close, Bayley's love and dependence on his wife are clearly reaffirmed through a touching description of his fear and anxiety of losing Iris as her condition deteriorates to the point where she must be transferred to a nursing home. What follows is a heart-breaking but beautifully rendered account of Iris' final days.

Despite their short length, neither Elegy for Iris nor Iris and her Friends make for light reading. In both books, Bayley brilliantly uses his skills as a writer to lead the reader on an emotional journey, throughout which the most intimate and personal details of his life before and after his marriage to Iris, and during the long course of her illness, are divulged in a fluid and literary style. Of course it is impossible for Iris Murdoch not to lose some measure of dignity, given that both books focus so heavily on her in an advanced stage of dementia. This is particularly true of the latter of the two novels. It is in the first novel that Bayley's balanced juxtaposition of the past with the present serves to remind the reader that his ailing wife was a dynamic, vibrant and intellectual woman before the onset of her disease.

Though intended for a general audience, caregivers of patients with Alzheimer's disease may find solace in Bayley's honest portrayal of his own experiences. In the end, Bayley has provided an unforgettable account of the full impact of Alzheimer's disease, and a reminder to anyone encountering patients with this disease that behind what Bayley refers to as the "mask" of Alzheimer's disease are unique individuals who lived, loved and were loved in return. Certainly, no one reading Bayley's two courageous accounts of his own experiences, can fail to notice that the tragedy of Alzheimer's disease affects both patients and their loved ones. Indeed, both books may offer a great deal to clinicians who, in encountering this disease on a daily basis, may forget that Alzheimer's is a tragedy which is unique to every individual afflicted with it.