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I'm sure you heard about Gena Rowlands’s passing from complications of Alzheimer’s disease at the age of 94. Despite never winning an Oscar, she was one of the greatest actresses of her generation. Spanning nearly seven decades of film, stage and television, her work delved deeply into the human psyche, exploring identity, relationships and the chaotic inner lives of her characters. Unlike mainstream Hollywood, she embraced an intimate, improvisational style that prioritized character development and emotional truth, earning her rightful acclaim for her emotional depth, psychological complexity and raw authenticity.
In Minnie and Moskowitz (1971), she brilliantly portrayed the desperation of a woman trapped in a monotonous existence, yearning for meaningful connection yet doubting its possibility. Throughout the film, her character is compelled to lower her emotional defenses, confronting her need for control and self-protection. She also grapples with the discomfort of stepping outside her social and emotional comfort zones, facing feelings of class and cultural displacement.
In A Woman Under the Influence (1974), she delivered a masterclass in acting as a housewife battling mental illness while trying to conform to societal expectations. She brilliantly captured the fragility, vulnerability and unpredictability of a woman on the edge, delivering a performance that is both heartbreaking and wrenching.
In Opening Night (1977), she portrayed an aging actress confronting the harsh realities of getting older and the blurred boundaries between her onstage and offstage lives. The film serves as a meta-theatrical exploration of identity, performance and the fear of losing relevance. Rowlands delivers a compelling portrait of a woman who is perpetually performing, even in her personal life.
In Gloria (1980), she initially appears tough and detached, embodying a hardened survivor who has seen it all. However, as the story unfolds, she gradually reveals the cracks in Gloria's tough exterior, exposing a deep vulnerability and protective instinct long buried after years of living a dangerous life. Fiercely independent and fearful of attachment, she resists being tied down by anyone. Yet, she is ultimately forced to confront the sides of herself she has tried to repress.
In Another Woman (1988), Gena Rowlands stars as a woman in the throes of an existential crisis, powerfully conveying the inner turmoil of someone confronting harsh truths about her life choices and relationships.
In The Notebook (2004), she powerfully portrays the painful reality of living with Alzheimer’s, where memory loss gradually erodes her sense of self. Her performance captures the confusion and frustration of a woman who intermittently grasps at fragments of her past, only to watch them slip away. This loss of memory goes beyond forgetting names or events; it represents a profound disintegration of identity. She also conveys the fear and anxiety that accompany Alzheimer’s, when she cannot recognize her surroundings or loved ones, with heartbreaking realism. She vividly expresses the terror of losing control over her mind and the fear of being lost in an unfamiliar reality.
I just saw a musical adaptation of the 1996 Nicholas Sparks best-seller and the 2004 film. The book, now a cult classic, is treacly, mawkish, even cloying, with a plot that leans heavily on cliches: soul mates from opposite sides of the tracks, love lost, then found again, and the classic choice between Mr. Respectable and a romantic rascal. As one reviewer aptly describes it, the story is about “true, mystical, eternal love, till death do us part.”
The film adaptation substantially improves on the book, but, as the reviewer says, it still “veers between unbleached sugar and artificial sweetener.”
The Broadway musical, however, is a completely different experience. Most of the elements that critics disliked about the book and film have been stripped away. Unlike the novel or movie, the play focuses deeply on dementia and explores themes of identity, memory, remembrance and forgetting.
The Notebook is the best musical I’ve seen on Broadway since before the pandemic. The songs are memorable, the structure and casting are imaginative and the performances are stunning. It’s also the most compelling theatrical exploration of the emotional issues surrounding dementia, aging and cognitive decline.
Is it a sentimental fantasy? Yes. But it isn’t simplistic or excessively sentimental.
The musical sensitively portrays the emotional and psychological toll dementia takes on both the individual and their loved ones, capturing the confusion, frustration and fear experienced by those living with the condition. It also examines the fleeting moments of clarity that can be both heartwarming and heartbreaking, describing the struggle between the persistence of identity and the erosion of memory.
The play explores what remains of a person as memories and cognitive functions deteriorate, emphasizing the importance of human connection even as physical and mental faculties decline. It also illustrates the emotional challenges, sacrifices and depth of love involved in caring for someone with dementia.
While some critics view the film’s sentimentality as a weakness, it also serves as a strength in its exploration of dementia and aging. The emotional intensity allows viewers to connect deeply with the characters and their struggles.
By focusing on the emotional truths of love, loss and devotion, the story taps into universal fears and hopes surrounding dementia. It acknowledges the devastation of the disease while offering a narrative of hope, suggesting that love can endure even in the face of profound challenges. Though highly romanticized, the story suggests that reality is shaped not just by the present cognitive state but by the emotional truths that persist despite memory loss.
The emotional resonance of The Notebook for its many admirers suggests that it captures essential aspects of the human experience with dementia, even if in an idealized manner. The work reminds us that at the heart of dementia are real people and relationships, making it a powerful tool for fostering empathy and understanding.
A key theme in The Notebook is the power and fragility of memory, which is deeply tied to the characters’ sense of identity. The story poignantly illustrates how memory loss can strip away layers of identity, leaving both the individual and their loved ones grappling with a profound sense of loss.
Another significant theme is the therapeutic role of reminiscence in dementia care, where familiar stories, music and objects are used to trigger memories and maintain connections to a personal history, even if only temporarily.
The term “senility” was historically used to describe the mental decline associated with old age: memory loss, confusion and general cognitive deterioration. The word was vaguely applied to any decline in mental faculties, and was considered a normal, inevitable part of aging.
Although senility carried a stigma, it was not seen as a specific medical condition but rather as a catch-all term for various symptoms of cognitive decline. This led to a fatalistic attitude toward mental deterioration, seeing it as an unavoidable consequence of aging.
Today, “dementia” is the preferred term, describing a range of neurocognitive disorders that result in a progressive decline in cognitive function. Unlike senility, dementia is recognized as a specific medical condition, not a normal part of aging, but the result of underlying diseases or brain disorders. Dementia is characterized by symptoms such as memory loss, impaired reasoning, language difficulties and behavioral changes. It can stem from various conditions, including Alzheimer’s disease, Lewy body dementia, frontotemporal dementia and vascular dementia.
Modern medicine emphasizes the importance of diagnosing the specific type of dementia, understanding its progression and providing appropriate care and support. This approach has led to a more compassionate and scientifically grounded way of managing cognitive decline in the elderly.
Before the modern understanding of dementia, a number of literary works explored the theme of cognitive decline, reflecting the attitudes and beliefs of their time, as well as the emotional and social challenges senility posed.
In King Lear (1606), Shakespeare depicts the deterioration of Lear’s mental faculties, leading to erratic behavior, poor judgment and eventual madness. This decline is portrayed as a form of divine punishment and a source of profound suffering for both Lear and those around him. The play explores themes of power, identity and the vulnerability of old age, capturing early modern anxieties about the loss of control and dignity in one’s later years.
Leo Tolstoy’s The Death of Ivan Ilyich 1886) focuses on a high-ranking judge confronting the meaninglessness of his life as he faces a terminal illness. In the 19th century, old age and illness were often viewed as times of spiritual and moral reckoning. The novella delves into the inner life of a man facing mortality, revealing the existential despair and self-reflection that accompany the decline of the body and mind. It reflects the era’s concerns with the moral implications of how one lives and dies, as well as the isolation that often accompanies aging.
William Faulkner’s As I Lay Dying (1930) portrays a man’s cognitive decline through a fragmented narrative and the perspectives of multiple characters. Faulkner’s depiction of mental decline is intertwined with themes of poverty, suffering and the harsh realities of rural life in the American South, conveying a broader sense of decay and helplessness in the face of life’s challenges.
In The Old Man and the Sea (1952), Ernest Hemingway explores the physical and psychological effects of aging as the protagonist battles exhaustion, isolation and his own waning strength. The novella reflects the era’s respect for resilience, dignity and courage in the face of aging, suggesting that even in old age, individuals can retain a sense of purpose and self-worth, challenging the notion that aging necessarily leads to decline.
Gabriel García Márquez’s Love in the Time of Cholera (1985) presents a more modern view of aging, acknowledging the complexities of memory and the persistence of love and desire in old age. It suggests that aging is not simply a process of decline but a continuation of life’s journey, with its own challenges and rewards. The novel reflects a shift in attitudes toward seeing old age as a time of reflection, adaptation and continued emotional richness.
Several recent works of literature and film explore how dementia fragments and erodes a person’s sense of identity. As memories fade and cognitive functions deteriorate, characters struggle to maintain their sense of self, raising profound questions about what constitutes identity when memory is lost.
Lisa Genova’s Still Alice (2007) portrays a linguistics professor’s gradual cognitive decline and its impact on her identity, relationships and career. The novel emphasizes the fear and confusion of memory loss, the stigma surrounding dementia and the profound effect it has on family dynamics. It underscores the importance of dignity, identity and human connection, even as cognitive abilities fade.
Emma Healey’s Elizabeth is Missing (2014) is a mystery novel centered on an elderly woman with dementia who becomes obsessed with her friend’s disappearance. As her memory deteriorates, she struggles to piece together clues from both the present and her childhood, leading to revelations about her past. The novel illustrates how dementia can distort reality, blending past and present, and how those with dementia cling to memory fragments to make sense of their world.
Alice Munro’s The Bear Came Over the Mountain (1999), a short story later adapted into a film, examines the emotional pain of watching a loved one forget their shared life and how dementia can alter and redefine relationships.
Iris (2001), a biographical film about British writer and philosopher Iris Murdoch, contrasts her vibrant intellectual life with her gradual cognitive decline, as witnessed by her husband. The film highlights the tragic loss of intellectual and creative faculties that often accompanies dementia, emphasizing the stark contrast between Murdoch’s earlier achievements and her later vulnerability. It also explores the deep bond between Murdoch and her husband.
The Father (2020) presents a disorienting narrative that mirrors the confusion and unreliability of an elderly man’s memory. The film also portrays the emotional toll on family members, particularly caregivers, who must navigate the shifting landscape of their loved one’s mind.
These works illustrate dementia’s profound impact on relationships, as loved ones become unrecognizable or forgotten. They shed light on the emotional toll on caregivers, who must navigate the loss of a shared past and the shifting dynamics of their relationship with the person with dementia. These works also convey the disorientation and confusion experienced by those with dementia, often immersing the audience in the unsettling reality of a mind that can no longer reliably interpret the world.
The role of caregivers is a recurring theme, highlighting the exhaustion, guilt and grief that accompany the responsibility of caring for someone with dementia. These works explore the delicate balance between love, duty and the emotional strain of watching a loved one decline.
Furthermore, these works raise profound ethical questions about how society treats those with dementia. Issues of autonomy, dignity and decision-making power are central to the narratives, prompting reflection on how we care for and respect individuals with cognitive impairments.
While psychology and medicine focus on diagnosing and managing dementia, the humanities and arts can humanize the subjective experiences of cognitive decline and offer a richer understanding of memory, identity and loss that transcends the clinical focus of psychology and medicine, and foster a more holistic and compassionate approach to care. They can also explore the emotional and relational aspects of dementia that lie beyond the scope of traditional medical and psychological approaches.
