Jason Karlawish is a physician and writer.
He researches and writes about issues at the intersections of bioethics, aging, and the neurosciences. He is the author of The Problem of Alzheimer’s: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It and the novel Open Wound: The Tragic Obsession of Dr. William Beaumont. His essays have been published in The Wall Street Journal, The New York Times, Forbes, The Hill, The Los Angeles Times, The Philadelphia Inquirer, STAT, and The Washington Post. His STAT column Neurotransmissions examines the vast problem of dementia. A Professor of Medicine, Medical Ethics and Health Policy, and Neurology at the University of Pennsylvania, he is co-Director of the Penn Memory Center, where he cares for patients, and executive producer of the Age of Aging, a podcast that examines how to live well with an aging brain. He lives in Philadelphia.
Jason Karlawish writes STAT’s Neurotransmissions column
How surrealism helps us make sense of and live with dementia
A 20th century artistic philosophy can help us tackle 21st century diseases of the brain
Nancy’s blue eyes scanned the page I held before her.
“What do you see?” I asked.
Her concentration was the intense gaze of a student before a painting in a museum. Her lips parted. She was thinking. “I see … S’s.” She traced these images with her right index finger. “S’s,” she repeated. “Many S’s.”
“Anything else?”
She steadied her gaze, leaned in a bit, and then she shook her head.
There was something else. A 6-inch-tall, 5-inch-wide black capital letter “H” constructed out of a collage of 1-inch by ½-inch letter “s’s.”
It’s called a Navon Figure, named after the psychologist David Navon, who developed it as a test of visual attention. Nancy couldn’t see the whole picture. Her struggle to perceive reality — the inability to see the capital “H” — is an astonishing example of how Alzheimer’s disease impairs her ability to perceive and navigate the world. The likely cause of Nancy’s misperception is damage to her brain networks that transform complex visual information into a coherent whole.
In 1924, when French writer Andre Breton issued his “Manifesto on Surrealism,” I doubt he had in his mind the mental experiences of people like Nancy as she struggled with the Navon Figure. But as I recently toured “Dreamworld: Surrealism at 100,” an exhibition at the Philadelphia Museum of Art commemorating the 100th anniversary of Surrealism, I experienced the thrill of discovery. Surrealism is an aesthetic to make sense of what it is like to be a person living with dementia.….
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The ACED tool
Why have thousands of psychologists, physicians, caregivers and social workers from all over the world requested a copy of the ACED? Because they know that to promote the well-being and dignity of a person with marginal capacity, the person needs an assessment of the capacity for everyday decisionmaking.