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The last book in my October series of haunting books is Turn of Mind, by Alice LaPlante. I would not have known about this book, except that it was a Stanford Alumni Association Book Salon choice for September 2012.

When I learned Turn of Mind was the September selection, I knew I had to read it – it’s a murder mystery (which I always enjoy), and it’s about a woman with Alzheimer’s (which my mother has).  I read the book in two days, almost in tears the entire time, because I could see my mother’s behavior in the main character.

The protagonist, Dr. Jennifer White, is a retired orthopedic surgeon who has Alzheimer’s and who is suspected of killing her best friend Amanda. The victim had her fingers surgically removed after death, and Dr. White was a hand surgeon.

But because of her dementia, no one – not even Dr. White – knows whether she is guilty. In fact, some days she doesn’t even remember her friend, let alone that her friend was murdered.

The book is haunting because of its portrayal of an irrational mind. Dr. White retains ever-shifting facets of reality, but her world disintegrates more and more each day. She can speak eloquently and in great detail about medical procedures, but cannot remember her children’s names. She grieves again each time she hears that Amanda died.

Alice LaPlante has captured the oddities of the Alzheimer’s mind very well – the moments of lucidity and humor; the ability to carry on a conversation about someone else or professional issues, but not about their past; the “hallucinations” of people and things not really present; the deviousness they exercise to avoid what they do not want to do.

Like the narrator I described in last week’s post on Gone Girl, the narrator in Turn of Mind is unreliable. How could she not be when her memory is destroyed? We hear her voice, we read her journal, we read what her children and caretaker write for her. But we’re never sure what is real and what is hallucination.

Typically of Alzheimer’s patients, Dr. White’s memory erodes as the book progresses. In the first part of the book, she still lives at home, albeit with a full-time caregiver whom she hired when her dementia first appeared. Later in the book, she moves into an assisted living facility. She adapts reasonably well to the assisted living facility, although as her condition worsens, she escapes for a day of demented freedom. At the end of the book, she has been placed in a state facility for the criminally insane. By that point, her personality is mostly gone.

In addition to being haunted by the progression of dementia, we are also haunted by how Dr. White’s family and friends treat her. Her son and her daughter both make unreasonable demands on their ailing mother. We’re not quite sure whose intentions are good and whose are evil. Dr. White’s caregiver has her own secrets.

We learn that even the deceased Amanda betrayed her – was that the motive for murder or not? Colleagues and friends and lovers from the past enter the scene and disappear; sometimes we are not quite sure what is real and what is imagined or forgotten. Sometimes strangers are the kindest toward her.

I had problems with this book’s depiction of the legal system. The police interview Dr. White without her attorney present, even after her attorney has made an appearance and both Dr. White and her children have said that she is represented by counsel.

We do learn who committed the murder at the end of the book. But I’m not going to tell you. Frankly, the mystery in Turn of Mind was less compelling than the depiction of the disease.

Like the other books in my October series, Turn of Mind deals with violence and man’s inhumanity to man – first, because it involves murder, and second because it involves betrayal of someone who cannot defend herself.

Also, the book raises important questions about how our society treats dementia patients.  Families, caregivers, and the legal system all judge them by standards the patients can no longer understand. Alzheimer’s and other dementia patients are stripped of their identity and independence, first by the disease and then by those who arguably speak for them. Alice LaPlante’s mother suffered from Alzheimer’s for twelve years, and she writes like someone who has dealt with these issues first hand.

So I was haunted by the book’s applicability to my own family. As we worry about how to care for my mother, I ask myself how much are we taking control because it is safer for her, and how much because it is easier for us. I know we patronize my mother at times. I know we are avoiding discussions about what will happen in the next phase of her illness.  We say we want for her to be safe and happy, but are we usurping decisions she should make?

Haunting questions for every family faced with this cruel illness.