The Inaccurate Depiction of Alzheimer's in "The Notebook"

Media often strives to present real-world situations in fictionalized settings with the hopes of explaining phenomena in ways easily understood by audiences. This is the case with The Notebook (2004), a story recounting the life of a woman with Alzheimer’s disease. The story follows an elderly man, Duke (later revealed to be Noah), visiting his wife, Allie, and telling her the story of a young couple falling in love despite their societal differences during the 1940s. Allie is unaware that the story is her own, and that the couple in Noah’s tale is Allie and Noah themselves. Noah reads to her daily from a notebook, hoping that someday Allie will recognize the story. Alzheimer’s disease is portrayed in the movie through Allie in the “present-day” narrative. This paper will explore the cognitive impairment of Alzheimer’s disease by discussing what it is and how it relates to Allie’s situation in The Notebook.

Alzheimer’s overview

The Notebook provides a glimpse into the disease known as Alzheimer’s disease (typically referred to simply as Alzheimer’s). Alzheimer’s is “a type of dementia that causes problems with memory, thinking, and behavior” (“What is Alzheimer’s?”, 2019). The narrative of the story presents viewers with the love story, which turns out to be Allie’s story that she cannot remember due to her disease. Generally, Alzheimer’s is the cause of dementia, “a general term for memory loss and other cognitive abilities serious enough to interfere with daily life” and “accounts for 60 percent to 80 percent of dementia cases” (“What is Alzheimer’s?”, 2019). Estimates suggest that “more than 5.5 million Americans may have Alzheimer’s” (“Alzheimer’s Disease Fact Sheet,” 2016). It is a progressive disease that worsens over time. The time frame can be over a period of days, weeks, months, or years and is irreversible. During the early stages of the disease, memory loss is mild but progresses; in later stages, individuals lose the capacity to hold and partake in conversations and the ability to interact with their environment. In reality, the progression of the disease can lead to death; it is “the sixth leading cause of death in the United States,” (“What is Alzheimer’s?”, 2019) and the average life expectancy is about “four to eight years after diagnosis, but can live as long as 20 years, depending on other factors.” (Alzheimer's Association, n.d.). There is currently no cure for the disease, but there are treatments that can help stop it from progressing as quickly. These medications can temporarily reduce the progression of “symptoms and improve quality of life for those with Alzheimer's” (“What is Alzheimer’s?”, 2019).

The Notebook has many endearing qualities that make it a great love story. It engrosses the audience with intriguing twists and turns, and with its dynamic characters, this movie is sure to bring anyone to tears as well as laughing. However, this movie was chosen because of its ability to shed some light on dementia. Dementia is a relentless disease that causes memory loss and affects a patient’s independence and control over everyday life. Allie's kind of dementia is never specifically addressed in the film. Be that as it may, most spectators likely relate it to Alzheimer's dementia. “Alzheimer’s disease is the most common type of dementia” (Nall, 2017), which continuously progresses and worsens over time. The Notebook portrays Allie as having complete memory loss of her past, except in short momentary bursts at the end of the film. She does not possess the ability to remember the love of her life, kids, and grandkids. Allie's whole world has become eradicated, and she is carrying on with her life as an outsider among her friends and family. “While there is no cure for Alzheimer’s disease ('Treatments,' n.d.), there are things that can be used to try and postpone the progression of this disease. The Notebook makes you realize that Alzheimer’s is far more complicated than ones first thoughts of it. Also, this film portrays the impacts of Alzheimer's on patients as well as their caregivers. This movie conveys its message through a romantic tale yet features touch on one of the more prominent issues that patients with Alzheimer's face, memory loss.

A typical day for somebody with Alzheimer's can be challenging. Most people that develop the disease are 65 or older; however, it can develop in individuals in their 30s or 40s, while “the likelihood of developing Alzheimer’s doubles about every five years after age 65. After age 85, the risk reaches nearly 50 percent” (Rosenzweig, 2018). Thus, tasks that can already be challenging for the elderly can become even more so with Alzheimer’s. Individuals with Alzheimer’s frequently need assistance taking care of routine everyday tasks such as washing, dressing, eating, and utilizing the restroom. Noticeable symptoms in daily activities may include trouble concentrating and impaired planning. Once someone becomes diagnosed with Alzheimer’s, and it begins progressing, their world starts to change. They require extra care as the disease progresses. Once simple tasks such as bathing can cause confusion and discomfort, as they do not understand what is happening and why they have no control over what is going on during this time. Even eating is confusing for them because they may not remember the last time they ate anything or even what they ate. They are easily worn out and tired, but the brain fixates on thoughts. For example, a person with Alzheimer’s might fixate on missing car keys. His thoughts might lead him to believe the keys have been stolen, and he will spend the day searching for them. In reality, the situation is that he has not driven in years.

The health of those caring for a relative with Alzheimer’s can also suffer, as “family caregivers’ health-related quality of life deteriorated when they cared for a family member with Alzheimer’s disease” (Santrock, 2017, p. xli). Still, oftentimes the caretaker is a family member. It is important to become educated to avoid becoming discouraged. Care will increase as the disease progresses, often leading to staying in nursing homes or hospice care.

Depiction of Alzheimer’s disease in The Notebook

As a whole, Alzheimer’s is portrayed accurately through the main character, Allie, in her elderly role. The Notebook touches on learning and memory in psychology when Allie develops Alzheimer’s. Allie cannot remember anything from her past life as Noah tells her the story of how they met and fell in love. She also lives in a special care facility due to her inability to care properly for herself. Her inability to care for herself is evident from the moment the movie begins. A woman dressed in all white (the nurse) walks into the doorway and says to the woman standing to look out the window (who we later find out is Allie), “Come on, honey, let's get you ready for bed” (Harris, Johnson, & Cassavetes, 2004). However, if it was not perceived in the opening of the movie that the setting was in a special care facility, then the synopsis of the movie states more clearly that they are in an “in-care facility. Duke, a resident, has to get permission to read to a fellow resident, Ms. Hamilton, daily, as Ms. Hamilton’s health is deteriorating” ('Notebook”, 2004). A final clue that was evident in the film was a line from the movie. It was said three-fourths of the way through the film by Duke (Noah) to Allie when he walked her back to her room for dinner: “I did, with a little help from my friends on the nursing staff” (Harris, Johnson, & Cassavetes, 2004). Therefore, Allie, like many Alzheimer’s patients, must receive care from a facility for ease in her life. Comment by Tara Brackett: The Notebook addresses learning and memory in psychology when Allie's Alzheimer's starts to evolve. Allie cannot recall anything from her past life as Comment by Tara Brackett: Noah narrates the story to Allie of how they met and fell in love.

People with Alzheimer’s have difficulty remember past events due to dementia that it can cause, but they can occasionally remember events from their past. Towards the end of the movie, Allie has a moment of clarity where she remembers Noah and her role in the story. However, she soon forgets again and has a panic attack that results in nurses rushing in to sedate her. She is moved to a confined room in a different ward of the hospital after this due to additional care that is needed as the disease is progressing. It is entering a stage that she becomes a danger to herself and others, showing that the disease can be a detriment over time. Despite this, the movie struggles to demonstrate all of the needs of a person with Alzheimer’s. However, it does accurately show that sometimes the decision needs to be made to move a relative with Alzheimer’s into the care of professionals, as family members are not always the best means of support.

Allie and Noah’s lives are in review throughout the entire movie. As can be typical of a person with Alzheimer’s, Allie comprehends the story that Noah tells, but she does not realize it is the story of her life. She states in the movie, “It's beautiful. I don't know why, but it makes me feel sad” (Harris, Johnson, & Cassavetes, 2004). Her lack of ability to remember is due to a threat to her development. A psychologist named Erik Erikson developed eight stages of human development. We see one of Erikson’s stages present in The Notebook. In Erikson’s Stages of Development, he states that this is a point where adults developing in late adulthood (around 60-70 years of age until death) face a conflict in Integrity vs. Despair. As senior citizens, people look back on their lives and their accomplishments. Based on their productivity, the person can either develop a sense of integrity or fall into despair. That is, they may begin a “reflection on the past” and integrate it positively or conclude “that one’s life has not been well-spent” (Santrock, 2017, p. 591). A positive outlook can result in promoted wisdom; a negative outlook can result in despair. For Noah, he faces the conflict in Integrity vs. Despair. Noah has come to terms with his life; this results in arriving at a sense of integrity. Noah feels whole, complete, and a sense of self-satisfaction in all of his accomplishments. Noah has adapted during his life to disappointments and triumphs. However, the doctors continue to voice their opinions that Allie has little to no chance of remembering, although every once in awhile she does; however, it only lasts moments. We see this during dinner with Noah, Allie, all of a sudden, has a moment of clarity;

Allie: “I remember now. It was us. It was us. It was us.”

Noah: “Oh, my darling. Oh, my sweetheart. I love you so much. Oh, my baby.

Allie: “Noah, Noah.”

Noah: “I love you, Angel.”

Allie: “What happened to me?”

Noah: “Nothing. You just went away for a little while.”

Allie: “How much time do we have?”

Noah: “I’m not sure. Last time it was no more than five minutes” (Harris, Johnson, & Cassavetes, 2004).

That moment was fleeting. She changed and then did not remember Noah. This is the point we see despair coming from Noah. Having to bear witness to these fleeting moments of remembrance, and then progressing into an aggressive, agitated behavior are devastating to Noah. Not only that, but it puts enormous amounts of stress on him as well. Even though Allie is having fewer and shorter moments of clarity, Noah still goes back to read to her daily in hopes that she will remember. This can also cause despair.

Additionally, the movie portrays the role of a caregiver through Noah, and as discussed above, he also faces a threat to his development due to the stresses of taking care of his ailing lifelong love. Throughout the movie, Noah is pleased and filled with pride to be telling Allie about their past and desperately wants her to remember it because he has such fulfillment in it. He can look back on the past and integrate it positively, as described as a successful conflict resolution in Erikson’s theory. However, Noah is also dealing with the fact that most days, Allie does not remember him. In one instance that she does remember him, Noah assumes that he has her back permanently, but Allie quickly returns to not knowing Noah’s identity. Noah is immediately heartbroken and angered that she does not remember him. He clutches onto feelings of hopefulness whenever he reads to Allie from the notebook and faces extreme stressors when that hope is squashed. The positive feeling Noah was holding onto ends up taking a blow in his ego, another factor in affecting “Integrity vs. Despair” (“Erikson’s Stages of Development Chart”, n.d.). The stress also causes him to suffer quality of life problem, leading to him having a heart attack towards the end of the movie. As described above (Santrock, 2017, p. xli), the role of a caregiver can lead to a deteriorating quality of life.

It is a difficult movie to watch if one knows very little about Alzheimer’s. Since various individuals obtain their knowledge from popular culture, this movie can make Alzheimer’s more confusing for caregivers than it already is. It is a fictionalized portrayal but has real-world ties. Very little is shown in regards to the interactions between the caregivers and Allie. It does show, however, that confusion can lead to frustration in patients with Alzheimer’s. It also accurately shows that Alzheimer’s causes dementia, causing issues with memory, thinking, and behavior. It also accurately shows it as affecting an older person, though as mentioned earlier, it can affect people as young as 30 or 40. It vaguely shows that there is no cure, leaving the ending open-ended for interpretation. At the end of the movie, it shows Allie remembering Noah and passing away holding hands with him. That is not evidence to say that she is “cured,” as she had also remembered earlier and then forgot again. The disease is caused by “by a deficiency in acetylcholine, a brain chemical that affects memory. Also, in Alzheimer's disease, the brain shrinks and deteriorates as plaques and tangles form” (Santrock, 2017, p. 568), which is not something that can be fixed. Toward the end of the movie, Movies today can cause a sense of overwhelming feelings for their audiences through emotion. They leave you vulnerable to unrealistic versions of the truth. The movie does not do enough to show that Alzheimer’s can cause trouble in carrying out simple tasks. It also does not indicate how long Allie has had Alzheimer’s, therefore giving no factual indication about her life expectancy after her diagnosis.

One of the problems with The Notebook is the way it depicts Allie’s verbal language. With Alzheimer’s, during the later stages, language development begins to break down. The individual diagnosed cannot think about a word or misuses the word while attempting to portray something. The movie depicts a scene where Allie momentarily gets her memory back and then loses it and winds up becoming agitated and aggressive, which leads her to be sedated by the staff. Allie is given a sedative drug often used to calm dementia patients. This was an accurate portrayal of what some patients go through. However, while The Notebook does represent the fact that someone with Alzheimer’s loses their memory, it does not begin to touch on the heartache that it causes all family members. The Notebook also communicates a slanted picture of how patients are dealing with Alzheimer’s disease. However, the problem is that movies reach an enormously wider audience than the National Institute on Aging’s website does. Ultimately, Allie’s symptoms in The Notebook misrepresent the facts about late-stage Alzheimer’s. At the end of her life, Allie demonstrates traits that are synonymous with moderate Alzheimer's, instead of the more advanced late stage that the movie alludes to. Allie experiences memory loss, seen when she is unable to recall who Noah is, who her children or grandchildren are when they come to visit, although she does have moments of clarity. This symptom is indicative of a moderate case of Alzheimer’s disease. Comment by Tara Brackett: The Notebook also conveys a slanted view of how patients are managing with Alzheimer’s disease. Comment by Tara Brackett: do i need to cite this site because I mentioned it.

For the average person watching this movie, The Notebook can damage someone’s understanding of Alzheimer’s as a whole. The movie romanticizes and makes Alzheimer’s disease look glamorous, given a couple of things: first, the cushy nursing home where Allie lives. While there are some nursing homes or assisted living facilities that are like that, for the average person, that is not an option. For viewers looking for an accurate portrayal of what kind of living situation they might expect for a family member with Alzheimer’s, they might have heightened expectations.

The other romanticization of the movie revolves around the central premise of the film with Noah trying to jog Allie’s memory by reading to her from the notebook she wrote. By the end of the film, Allie remembers Noah and passes away holding hands with him. As mentioned above, there is no evidence that this was a permanent thing. However, it might give spectators false expectations that an individual with Alzheimer's can be cured, even though it is a disease with irreversible impacts.

There is undeniably more to Alzheimer’s disease than memory loss, which is what has been depicted in the film. Alzheimer’s is known vastly for its memory loss as seen in The Notebook. However, there are many more aspects to it than just memory loss. As mentioned earlier, forgetting places and names is one of many symptoms of Alzheimer’s. A majority of patients relate to a feeling of utter panic as they cannot find a connection to anything in their environment. Everything becomes depersonalized for those with Alzheimer’s. The actual disease is, unfortunately, worse than what is portrayed in the film.

Conclusion

Having read and studied about human development made understanding the context of the film easier to comprehend the emotional rollercoaster. However, having that background is not something everyone might possess. A textbook like the one from Santrock called Life-Span Development was an asset in assisting with the development of the topic of Alzheimer’s. Textbooks such as this one offer valuable information into human development and how the fundamental pieces of growing up and old are broken down into stages.

The Notebook portrays late adulthood Alzheimer’s to an audience as a minimal feature in the film, with the main premise being that it is a love story that will be remembered because of the love of a husband trying to hold on to his wife as she slips away into mental oblivion due to Alzheimer’s disease. However, endearing it was for this movie to bring to life and depict Alzheimer’s disease it displayed inaccuracies regarding the disease. In today’s society, people feel the need to identify and connect with others who are going through the same problems in life; this film is a way for people to do so. However, with its inaccuracies, it can give audiences false hope that trying to trigger memories, such as reading the story of one’s life to a loved one will help find a cure. The Notebook also minimizes the important aspects of living with Alzheimer’s disease and distorts the late stages of Alzheimer’s actual ending. Ultimately, The Notebook gives false hope to audiences around the world. Comment by Tara Brackett: In the present society we live in, individuals feel the need to identify Comment by Tara Brackett: The Notebook also minimizes the important aspects of living with Alzheimer’s disease and misrepresents the late stages of Alzheimer’s actual ending. Ultimately, The Notebook gives unrealistic hope to audiences around the world.

References

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