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Rich conversation, with valuable intersections to discussions going on in other venues.  As documented in Laura's summary above, it may well be useful to think of Alzheimer's (and other dementias?) as a progressive loss of story telling ability starting with more "elaborated stories" and extending "downward" toward primary stories.  Such a loss is consistent not only with imagery but also with many of the "inside" reports, including "can't see in my head the layout of streets," "my world, a world of confusion," "I could not always remember steps that were easy for me to remember in earlier times," and "memory"" problems generally.  Indeed it may well be that loss of memory, the most obvious feature of dementias, is actually secondary to a more general loss of story telling ability (creating patterns out of the somewhat incoherent signals reaching the story teller from the unconscious).   There is progressively neither past nor future but only the present ("I feel that I am robbed of any future because while I will live in it, I will be unlikely to remember it").  

What also struck me from this conversation is some similarities in from the inside reports to other "mental health conditions," building on our earlier discussion.   There is clear evidence of a split self here ("I tried to relax ... but it was there, like the sound of distant thunder, lurking on the horizon"), as in depression, schizophrenia, and other "disorders," and of distress caused not only by that but by concern about the reactions of others to one's condition ("we are capable of contributing to the world around us .  Please listen to your voices ...").   People are clearly being distressed by internal evidence of their own incoherence, but that discomfort is being made worse by concerns about interpersonal reactions and inadequacies. 

Could the distress be alleviated by a greater recognition/acceptance of incoherence as to some degree characteristic of all brains, and as a source of potential rather than a failing?  We presume the incoherence of infancy to be generative.  Could we do the same with that of dementias?  At least so long as there continues to be an internal recognition of incoherence there is still some story telling capability that, as in children and as in other "mental health" conditions, could be encouraged, for the benefit of the sufferer as well as the rest of us?  Might this offer a more productive approach to dealing with dementia than regarding it as loss of abilities?

The discussion of Alzheimer's linked nicely to a review of Damasio's writing about the neurobiology of self and I found it very useful to be reminded of Damasio's concepts of "proto-self," "core self," and "autobiograpical self."  And that, in turn connected to some recent development of my own ideas about the "bipartite brain."   Damasio's "proto-self" is clearly part of the "cognitive unconscious," while his "core self" and "autobiographical self" are experienced and therefore part of the conscious/story teller.  The "core self," though, is less elaborated than the "autobiographical" self, corresponding perhaps to the distinction I draw between "primary" and "elaborated" stories.  I orignally made that distinction to acknowledge the difference between experiencing something in the world and accounting for it/making sense of it, but it would seem to work equally well for distinguishing between different senses of "self."

All this connects in intriguing ways to Alzheimer's and both conceptual and therapeutic approaches to mental health issues generally.  The primary "story" can be thought of as very much like what William James described as a "blooming, buzzing confusion."  Perhaps what is at issue not only in Alzheimers but a wide variety of mental health situations is a reduced ability to influence the "stream of consciousness," to find/create elaborated stories that either distract one from it or actually smooth it out?  Does elaborated story directly impact on primary story, or must it do so indirectly by acting on the cognitive unconscious?  What about meditative practices, Csikszentmihaly's "flow state"?  Could these provide exemplars that might be of use in thinking about therapeutic practices for dementias?  for other mental health problems?