Gilead: A Novel

"Gilead is a great book. For a start, it’s told from the first-person perspective of a very old man and there aren’t so many books in literature that are narrated by old people. This is somebody who is very much at the end of his life and he’s writing to his much younger son. He’s had this child late and he’s old enough to be his grandfather. A lot of the book is about fathers and sons and the relationships between them and how they can be difficult. It’s also a lot about faith, so it comes from a very different perspective from the scientific work that I’m used to. It’s a remarkably empathetic and beautifully written book. It deals with a lot of the themes of old age. It deals with a lot of the anxieties about physical failings, and anxieties about legacy. It really makes you feel that you’re being put in the mind of someone who hasn’t got long and is coping with that. One of the things that comes out of the book is that this man has lived a hale and hearty life for most of his life, but has now been stricken with the disease that’s going to kill him. So his old age, in a sense, has come on quite suddenly. That raises interesting questions about what old age feels like and how much of it is disease and illness—as opposed to old age. “One of the bigger risk factors for Alzheimer’s seems to be loneliness, just sitting at home all day and not actually seeing anyone.” That’s central, of course, to the discussion of dementia—how much of it is disease and how much of it is normal ageing? In a sense, what comes out of all the books I’ve chosen is that what makes you old is the stresses, the tribulations, the diseases, the traumas that you’ve endured—rather than the actual number of years on the clock. This book plays with a lot of the themes in ageing research, only from a literary perspective, obviously. That was a slightly ironic comment but not entirely, because a lot of people do regard Alzheimer’s and dementia as an enemy. The medical or scientific view of it is that it’s a curse that has to be conquered and vanquished. I experienced it as an enemy because that’s how it felt to my family when we got struck by these brain disorders that came all at once. It really felt like we were under attack. So, there is that very natural reaction. But there’s also a sense that dementia and ageing, particularly, may not be so much about facing an enemy as coming to terms with one’s own mortality. That is quite a different perspective. One distinction that drives a lot of thinking about old age is between ‘right old age’, which is as it should be, and the ‘wrong old age’, which is old age afflicted by illness and decline and things that shouldn’t have happened. The level of trauma varies depending on the exact conditions but some dementias can be incredibly cruel and really, really horrible. I’m afraid the message is an old one. You cannot cheat fate altogether—you are going to die of something and it may well be Alzheimer’s, which is very common. Some unfortunate people have a genetic condition that makes dementia inevitable. But apart from those, for the vast majority of people, there are things that you can do to lower the risk. Get the weekly Five Books newsletter What it seems to be is a kind of accumulation of stresses, if you like, on the body and the brain. Old age is the biggest risk factor and then there are certain genes that are risk factors and then, after that, there seem to be certain environmental things that are likely to increase the risk of getting it. Just because you live a clean life and don’t breathe any polluted air and exercise and drink moderate alcohol and don’t smoke, it doesn’t mean you’re not still going to get dementia. But, all things being equal, if the whole population did that, then their risk would drop. All of that Sudoku/foreign language stuff is built on the idea that the brain is like a muscle and you use it or you lose it. It’s like with physical exercise. The research on that is suggestive but not, I would say, conclusive. That’s because it’s still not well understood how much of what contributes to what they call your ‘brain reserve’—the ability of the brain to withstand problems—is down to your genes and your early development and what happened in the womb, and how much of it is due to ongoing usage. What we do know is that there is a certain amount of evidence that keeping your brain active can help stave off things. That doesn’t necessarily mean you have to go and learn a foreign language. It means things like going out and socialising. “I have had people say to me , ‘Knowing that amyloid protein does XYZ is all very interesting but how’s that going to help?’ Well, indeed.” One of the bigger risk factors for Alzheimer’s seems to be loneliness, just sitting at home all day and not actually seeing anyone. If you talk, you’re using your brain, and when you’re socialising you’re actually doing yourself a lot of good. You don’t have to get a PhD in some science if you don’t feel like it. There are other ways. Again, there’s still a lot of research to be done on this. But, basically, the idea is that exercise increases blood flow and blood flow is very important because a lot of what goes wrong in dementia may involve problems with brain blood flow."