With vanishing on my mind, I crossed Central Park to the Metropolitan Museum of Art on a late autumn morning on a sober errand. Ginkgo leaves, freshly fallen, coated my path. My root-word research on vanishing—which, like vanity, comes from the Latin evanescere (“die away”) and vanus (“empty void”)—had led me to a genre of still-life painting that flourished in the Netherlands in the early seventeenth century.
The vanitas school of painting takes its name from the Latin version of an Ecclesiastes refrain (“Vanity of vanities! All is vanity”) and it involves carefully juxtaposing objects deemed symbolic of life’s brevity and the evanescence of earthly achievements. Objects such as mirrors, broken or tipped glassware, books, decaying flowers, and skulls are meant to encourage viewers to contemplate their own mortality. Jacques de Gheyn’s Vanitas Still Life, the earliest known vanitas painting, hangs in one of the Met’s seemingly less popular galleries. Most visitors pass through this corridor of dark still-life paintings on their way to lighter, more moving pieces. That autumn morning, I had Vanitas Still Life to myself.
A modest-size piece, 32 1/2 by 24 1/4″, it contains a panoply of vanitas symbols. A thin stream of vapor rises from an urn, an orange flower with browning leaves languishes in another. Dutch medals and Spanish coins glitter in the foreground. Two philosophers—Democritus, the “laughing” philosopher, and Heraclitus, the “crying” philosopher—recline in the painting’s top corners, pointing to the objects below. A large transparent bubble hovers above a human skull. From every angle, the viewer confronts images of life’s transience, but it is the skull that serves as the central reminder of human vanishing. The empty eye sockets locked my gaze, making me think—vainly—of my own future. A hollowed head, more than any other bodily remnant, symbolizes death’s totality, an unyielding force that consumes the entire person, even the ability to think. I guess there’s a reason why the sight of Yorick’s skull, not his rib cage or pelvic bone, occasions Hamlet’s famous lament.
As a condition associated with the head, dementia—like the vanitas skull—ignites an especially acute awareness of mortality, placing our very selves under death’s scrutiny. In the last decade, I have glimpsed dementia from several different angles. I have seen dementia-related deaths in my own family. I have worked with dementia sufferers day to day in my capacity as a nursing home chaplain. I recently discovered that both of my parents carry one copy of ApoE4, a gene variant strongly linked to late-onset Alzheimer’s disease. I have a 50 percent chance of having a single copy of the gene, which doubles or triples my risk of developing the disease. I have a 25 percent chance of having two copies, which elevates my risk by eight to twelve times, giving me a 51 to 68 percent chance of having Alzheimer’s by the time I am eighty-five. My particular bloodlines aside, the chance of getting Alzheimer’s disease, the most common form of dementia, is one in nine after age sixty-five and one in three after eighty-five. Nearly six million people in the United States are living with Alzheimer’s—making it the nation’s sixth leading cause of death. And yet nuanced thinking about dementia is largely absent—perhaps even nonexistent—in public discourse.
Heart disease impairs circulation. Kidney disease impairs filtration. But brain disease impairs communication. By distinctly and directly impacting our abilities to relate with ourselves and others, it confronts us with the fact of our humanness: to be human is to be limited, even in our most cherished capacities. Perhaps more than other conditions, dementia brings our fundamental lack of ultimate control over our lives, and their endings, to a head.
Rather than confirming the humanness of sufferers, dementia, curiously, is often viewed as throwing it into question. A gerontologist once told me over lunch that he begins his dementia caregiver workshops by telling participants that their loved ones remain persons throughout their illness. He reminds caregivers that, even as their relatives become more inaccessible, their “core” never leaves. I am glad for his admonition; I am also troubled that it is needed. I doubt caregivers of persons with terminal heart disease need such instruction, or caregivers of infants need reminders that, even though their babies cannot talk or use the bathroom, they remain people.
That we need reminders that persons living with dementia are “still people” elevates my curiosity and my suspicion about the peculiar burdens dementia-causing diseases bear. We seem to have placed dementia beyond the scope of ordinary human imagining, as if this condition alone reveals some nasty, shameful secret: the ease with which we all may disappear.
The skull in Vanitas Still Life, while undoubtedly grim, bears a wry, gapped grin—a grin missing four front teeth. Stripped of its flesh, our bone structure apparently discloses a faint, effortless smile. The skull’s stark, denuded presence signals gravity, but its blithe affect signals buoyancy. Perhaps this face of death reflects both the weeping Heraclitus and the laughing Democritus, pointing viewers back to Ecclesiastes: there is “a time to weep and a time to laugh.” Wisdom here comes lodged in apposition—pairs of apparent opposites, united by the word and: “a time to be born, and a time to die … a time to break down, and a time to build up … a time to cast away stones, and a time to gather stones together.” These lines in Ecclesiastes encourage readers to imagine a world in which the poles of existence create vibrant tension, in which life and death, gathering and releasing, embracing and refraining, weeping and laughing, do not negate each other but instead balance and enrich. There is aggregation and integration—even with loss, even in death.
Dementia, too, invites this kind of conjunction. There is dilution and distillation, constriction and expansion, disorder and constancy. Certain aspects of persons and their relationships fade—and other dimensions crystallize, possessing a new kind of clarity. Dementia places new constraints on communication—and relationships expand to include new ways of being and loving. Cognitive changes upset the usual patterns of one’s life—and some rhythms remain unchanged.
I heard a woman describe her spouse with dementia as “my gone but not gone husband,” and her phrase seemed to strike at the heart of dementia’s paradoxes: an acute awareness of absence, and an equal insistence on presence. Lately, I am struck by its general relevance, as I consider my own gone and not-gone self. The cells that comprise my body—all of our bodies—routinely break down or slough off, and new ones take their place. Some cells, like neurons, die and are never replaced. Paradox lives at the heart of my faith, too: the gone and not-gone ego, the gone and not-gone Jesus. The play of presence and absence infuses all of life, I think, both before and after dementia.
Maybe if we can learn to inhabit this tension, this space between opposites, then dementia and the lives it touches can rejoin the spectrum of human experience, rather than being reduced to tired tropes and burdened by outsized fears, its sufferers and caregivers made to disappear. Imagine if we received all lives—those with and without dementia—as conglomerations of the ordinary and the peculiar, the fragmented and the whole, the present and the vanishing.
Lynn Casteel Harper is a minister, chaplain, and essayist. Her work has appeared in Kenyon Review Online and Catapult magazine. She is a Barbara Deming Memorial Fund grant recipient and the winner of the 2017 Orison Anthology Award in Nonfiction. She lives in New York City and is currently the minister of older adults at the Riverside Church.
Excerpted from On Vanishing: Mortality, Dementia, and What It Means to Disappear, copyright © 2020 by Lynn Casteel Harper. Reprinted by permission of Catapult.