Me an' Algernon – grappling with (temporary) cognitive decline
tidyfirst.substack.com100 points by KentBeck 6 days ago
100 points by KentBeck 6 days ago
> When I re-read Flowers for Algernon recently I was just sad. The second half of the story, where his mind is going away, is just brutal, especially when he can remember how smart he was but knows it's gone for good.
https://news.ycombinator.com/item?id=21544149
"Von Neumann would carry on a conversation with my 3-year-old son, and the two of them would talk as equals, and I sometimes wondered if he used the same principle when he talked to the rest of us." - Edward Teller
I watched a documentary from the 80ies a long time ago. A mathematician (can't remember his name) who worked with von Neumann in Los Alamanos was interviewed. He described von Neumann's last weeks in the hospital - the cancer had already metastasized into his brain. The mathematician said something along this lines (I am citing from memory): "von Neumann was constantly visited by colleagues, who wanted to discuss their latest work with him. He tried to keep up, struggling, like in old times. But he couldn't. Try to imagine having one of the greatest minds maybe in the history of mankind. And then try to imagine losing this gift. I was terrible. I have never seen a man experience greater suffering."
Marina von Neumann (his daughter) later wrote this about his final weeks:
"After only a few minutes, my father made what seemed to be a very peculiar and frightening request from a man who was widely regarded as one of the greatest - if not the greatest - mathematician of the 20th century. He wanted me to give him two numbers, like 7 and 6 or 10 and 3, and ask him to tell me their sum. For as long as I can remember, I had always known that my father's major source of self-regard, what he felt to be the very essence of his being, was his incredible mental capacity. In this late stage of his illness, he must have been aware that this capacity was deteriorating rapidly, and the panic that caused was worse than any physical pain. In demanding that I test him on these elementary sums, he was seeking reassurance that at least a small fragment of this intellectual powers remained."
Watching my grandmother slide helplessly into the dark mental abyss of dementia and then be lost inside it for years made me realize that it is downright inhumane to not offer end of life assistance to people.
I have conflicting feelings on it
On one hand, I had a similar experience with my grandfather. He eventually couldn't even remember to speak English, he reverted to his childhood language. When we translated, he thought I was a childhood friend of his, not his grandson. It was awful
But sometimes he would be so lucid and remember everything. It was so awful thinking that "he is still in there" the idea of him choosing to end it and not have those last few times to talk.. I dunno
During one of those lucid times was the most deep and important conversation I ever had with him. He understood what was happening and it gave him the freedom (courage?) to talk about things he'd never talked to me about before. It was so important to me as a young man, I cannot imagine if he had signed an end of life form and I never got to see that side of him before he passed
Selfish of me I know. But still. Maybe this really just highlights how important it is for people to really talk to one another when they are alive
> I have conflicting feelings on it
As ardent a supporter of assisted death as I am, I really don't think there's any other way to feel about it. You illustrate exactly why these types of choices will never be easy.
Yeah, to clarify I do support it. I think reducing suffering is a noble goal and allowing people to choose not to suffer needlessly is overall a good thing
But it definitely is not cut and dry and I can see why some people are extremely resistant to the idea
Where I currently live, terminally ill nearing their end often fall in a pattern of eating and drinking less and less, to the point of having nothing (not even water). This process of dying takes 1-2 weeks(!). Longer if some liquid is still imbibed.
This is a common ending of a terminally ill process and apparently seen as humane. Though I think if anyone treated their dog like that, we'd report them for animal abuse.
I don't have good answers to most questions surrounding this topic. But I'd like to get to a point where people are treated as humanely as their pets in their final period. And I can't even tell you the current practice isn't, just that it does not at all feel that way to me.
> Where I currently live, terminally ill nearing their end often fall in a pattern of eating and drinking less and less, to the point of having nothing (not even water). This process of dying takes 1-2 weeks(!). Longer if some liquid is still imbibed.
Even just getting to this point is usually a brutal period of pain. Then you have to die like that? It's frankly barbaric.
bit ironic, all this effort to extend life but it turns out that living that long isn't always so great so we start euthanizing folks.
I'm not saying it's wrong or right (I don't have a full opinion on the matter yet) but it seems very indicative of human endeavors more generally. Like a big a cosmic joke.
There's a really big gap between 'living so long' and 'living with a lovecraftian deteriorating and debilitating disease'
> In this late stage of his illness, he must have been aware that this capacity was deteriorating rapidly, and the panic that caused was worse than any physical pain.
I watched my father go through this (due to Alzheimer’s) before he passed away. He would say “I don’t understand why I just can’t think like I used to”. It was heartbreaking. He was a brilliant mathematician before the disease put him in a mental prison. It was pure torture for him.
When I was 20 I could come up with an idea and just sit and my computer and code it over however many hours without experiencing any issues.
If I was reading a book as a teen my eyes would eventually get a little fuzzy, but we're talking margins here.
Now I'm close to 50 and a confluence of things have hit me. I figured out that I have a crippling case of ADD (who knew?) and the medication has been amazing. I really want to code more and have so many ideas and things I want (and financially speaking need) to work on, but my eyes are taking a tremendous amount of strain, so in the end a whole portion of the gains feels as if they're being wasted.
The old brain is at least still firing, when that begins to go I'm not sure what I'm going to have left.
Now keep in mind that that frustration - the absolute torture of losing who and what you are - applies to everyone going through something like this, not just the greatest minds of their time.
Makes me glad that we're starting to look at assisted dying more seriously...
why not try to cure alzheimer or other mental diseases that show up on the elderly instead?
Do you genuinely believe that this is a binary decision, or is this just anti-euthanasia rhetoric disguised as concern trolling?
Offering humane end-of-life options to people suffering today does not prohibit ongoing disease research towards potentially helping people in the future.
It's not entirely binary, but there is an obvious unpleasant tendency in e.g. Canada, to soft-push MAID onto potentially treatable patients who don't even seek medically assisted death.
I wouldn't want my government to have an option of dealing with the problem this way, and if I needed MAID, I'd just self-administer.
Yes, it's a slippery slope once a state providing assistant to suicide is law imho.
It just doesnt seem something a state should be charged with.
I doubt you can cure these diseases, you can perhaps prevent them, but to cure would mean removing their effects, and if you could remove their effects and say, bring a seriously deteriorated Von Neumann back to his previous mental heights it seems like you should be able to make anyone the equal of Von Neumann - which I agree would be a great thing to be able to do but seems to be a much further along than the words cure or prevent would indicate.
> I agree would be a great thing to be able to do but seems to be a much further along than the words cure or prevent would indicate.
If the words "cure" or "prevent" don't indicate that, why did you bring it up? :)
I think this is being needlessly pedantic. Keeping in mind that one of HN's guidelines is to respond to the strongest plausible interpretation of a comment, I think we can assume that GP meant, essentially, "learn enough about these diseases so as to detect and prevent them from causing irreparable damage"
sorry but the strongest plausible interpretation of the word cure is obviously not "prevent", it is to undo the damage.
>If the words "cure" or "prevent" don't indicate that, why did you bring it up? :)
the strongest plausible interpretation of my comment would be I brought it up for the reason I said - that if you could cure the disease you would have to be able to give anyone the capabilities the disease destroyed (because these diseases seem to destroy parts of the brain so even if you "brought back" the brain it would be a different brain with different data in it)- and that, although I did not state it, I felt that the original poster had not considered this when they expressed a wish to cure.
on edit: obviously if you have experienced minor damage you can get back to what you were before because the brain has a lot of redundancies and it can recover if decline is halted, but if you have experienced major damage you're probably not getting back and asking for a cure there seems unlikely to work.
The "disease" we're talking about here is death. Von Neumann was losing his mental capacity because he was dying. I know some in the silicon valley set think that "curing" death is both feasible and desirable but I disagree on both points.
A voice from outside SV (mine): We can extend life and prevent disease in animals and should do the same in human beings. As much as the West has exclusive access to biomedical R&D, it's an ethical imperative for the West to pursue this goal on behalf of humanity as a whole.
You invented noblesse oblige and should measure up to it.
no death is just part of life, there's no life without death.
the disease would be alzheimer, and curing it would mean probably preventing it / being able to edit the genome to nullify whatever gen is making it come up in the first place (if its genetic)
Yeah tbh english isn't my first language, and I meant more into -finding the causes- and eradicating alzheimer, aka preventing it, much like we have done with polio, or whatever.
Not really curing people already in advanced state of the maladie...
anyways, they're not mutually exclusive, but enhanching life should preceed ending it in the order of priorities imho
Ok sorry about the mistake, I just made the observation as a small aside, thinking perhaps you did mean cure as in totally revert damage.
You shouldn't apologize. You didn't make any mistake that I can see, and your comment is kind and patient.
With all due respect, you didn't even try at anything resembling full effort. There are 2, maybe 3 societies in the world, which have (or had) the capacity to try implementing a serious R&D effort to prevent the diseases of aging. The effort has been meager so far, and ultimately, compared to other major R&D directions (no, I'm not talking about AI, AI is fine), it's a testament to how much we value ourselves and our loved ones.
As an adult who already lost a few of my relatives, and will probably lose a few more: if we truly loved them, we'd have put at least 10% of GDP into eventually curing all degenerative diseases, while implementing a simple scalable cryopreservation infrastructure for those who won't be there in time.
It could be done, The West and Asia could achieve this. But didn't, due to all too well known web of aversion & coping mechanisms.
In your small-mindedness you failed humanity.
>With all due respect, you didn't even try at anything resembling full effort. There are 2, maybe 3 societies in the world, which have (or had) the capacity to try implementing a serious R&D effort to prevent the diseases of aging.
exactly who do you think I am? It sounds like you think I am some sort of avatar of one of these societies, and for some reason I am here posting on HN.
>while implementing a simple scalable cryopreservation infrastructure for those who won't be there in time.
ok, well as long as its simple.
>In your small-mindedness you failed humanity.
okey-dokey, well I can definitely see you are going through something right now, hope you get better.
There is a world of difference between removing an inhibitor and adding an enhancement.
since these diseases destroy parts of the brain not just inhibit the functioning of the brain you would need to add an enhancement and not remove an inhibitor to bring back lost functionality.
Depends very much on the disease, for my specific type of brain fog from dysautonomia (via ME/CFS and hEDS) it may feel like a gradual and permanent degradation but it is largely completely reversible and when you know what you're doing it's actually pretty easy to do so. This is only known by a very small minority of doctors so the chance a specific patient meets such a doctor is incredibly low which is why most people still think it's some great big mystery. I was able to remove the inhibitor and bounce back better than ever. I think the brain fog in my case was caused by excess IL-1B pro-inflammatory cytokines and directly targeting that with medication did result in the brain fog near permanently lifting.
It’s also likely that even if the degradation is permanent it is also likely multifaceted and one of those facets is likely to be treatable such that the impact of the degradation could be greatly reduced. I think it’s incumbent on us to try as much as possible even in the seemingly lost causes because learnings from such attempts could yield insights for those who are not lost causes.
It’s a ridiculous conflation to suggest that the inability to take a regular person and give them Von Neumann intelligence means that we can’t help Von Neumann stuffing an ailment even if a component of that ailment is clearly permanent.
>Depends very much on the disease, for my specific type of brain fog from dysautonomia (via ME/CFS and hEDS)
sorry, I thought we were talking about Alzheimer's because Alzheimer's was what was mentioned in the post I responded to but now I see it is in fact every ailment that affects the brain, and not just Alzheimer's.
>It’s also likely that even if the degradation is permanent it is also likely multifaceted and one of those facets is likely to be treatable such that the impact of the degradation could be greatly reduced.
this might be what was meant here, https://news.ycombinator.com/item?id=44277444 - when I said that the brain has a lot of redundancies and of course caught and stopped early enough then it wouldn't be such a big problem
but hey, what do I know, I didn't even know what we were talking about evidently, thanks for correcting me.
>It’s a ridiculous conflation to suggest that the inability to take a regular person and give them Von Neumann intelligence means that we can’t help Von Neumann stuffing an ailment even if a component of that ailment is clearly permanent.
OK well I guess I am taking a more stringent meaning of cure than you are, you are taking the relieve meaning, which is of course to help, but I am taking the revert meaning. I believe mine is a pretty common meaning, at least in the vernacular. I mean when they say we cure cancer they don't mean it will make the pain less intense and maybe you can live twice as long as otherwise.
Certainly I believe the pains and problems of a disease can be relieved, but in the case of Alzheimer's (sorry for going back to the disease I was discussing since you have informed me I was not discussing that but since I was, actually, discussing that I am just going to have to stick with it) it can not necessarily be reverted - it can potentially be reverted as I indicated earlier if not too much damage is done (because of redundancies), but if for example you have late stage Alzheimer's I don't believe you are going to get to cure (revert) all damages.
In such cases you can manage to stop it and rehabilitate the patient to a less damaged earlier state perhaps, but otherwise I would think there was too much damage to revert it, because if brain tissue is too damaged I suppose (perhaps again due to a naive model of how I suppose memories and knowledge are maintained in the brain) that the data that was held by these damaged sections is now unrecoverable.
on edit: removed some verbiage.
That's part of the problem, the binary classification of diseased state. This is a cultural legacy from the Germ theory vs Terrain theory and the fact that the Allies won WWII - the Germans and Japanese were big on Terrain theory. The idea of Germ theory is that the body is fine unless there is a germ and thus the cure is to remove the germ. In your example replace germ with cancer. There was also a time where it was the empiricists versus fundamentalists but academia pushed medicine into a predominately fundamentalist approach not because it's more predictive but because it's easier to defend academically. Now that we have advanced data science tools we can do empirical studies at massive scale on already collected datasets, the results of this appear when google search gives useful health results, and now with LLMs giving very helpful information. The LLM, unlike a doctor, is not trying to relate everything to the Krebs cycle because they spent so long memorizing it.
You're hung up on the binary cure or not cure. It would be like doing a machine learning problem with a binary loss function, might as well try to make it better and you'll learn things on the way that could lead to a cure i.e. you'll have a smoother gradient that'll make advancements easier.
Most doctors know next to nothing about ME/CFS and I suspect they know a similar next to nothing about Alzheimer's so when they say there are no treatments I don't believe them. It's a dysfunctional industry backed by a dysfunctional academic system combined with a dysfunctional political system. If you do the similar research that I did on ME/CFS you'll find that many of the same rules apply to Alzheimers which suggest to me that it's likely auto-immune related, I don't need to know the actual mechanism for it for me to see that empirically it presents in a way that looks like auto-immune. Then empirically it appears that GLP-1As are really good for auto-immune so transitively I highly suspect GLP-1As will helpful here and in-fact the FDA has approved a GLP-1A for the treatment of Alzheimer's so I'm not the only one who thinks this.
1. As other commenters point, many cases have intact memory and circuits for what would be considered "lost", which activate from time to time. So it's likely a question of SNR and tissue vitality (e.g. basic capillary function) for these cases.
2. You wouldn't believe what feats of neuroplasticity lie behind a few receptors properly pushed by molecular keys. We just don't have experience to describe it. Adult neuroplasticity and (disproven btw) neurogenesis is a rigid sad joke compared to what's possible.
OK maybe, although not having experience to describe it sounds somewhat worrisome for a scientific project.
where your point 1 is concerned, again, since the brain has many redundancies one can totally have brain tissue destroyed and with some slight therapy get back to normal functionality, but when Alzheimer's is too advanced I suppose you will not be able to fully revert, but maybe revert to some earlier stage - sure.
Are these mutually exclusive ideas? Can we not pursue research in this area while not forcing families to watch their loved ones slowly lose their mind and wither away?
I guess we can explore both, but I'd ask you to research how these laws are already affecting families too in new ways on places where eutanasia is already legal.
It's easy on older -about to die-, people, but what about not such clear cut cases, some families are actually against their beloved ones taking their lifes, and the state allowing it, (Parents suing their offspring, to try and not have them do it, for example)
and yes, a judge rules out on such cases, but to me, well, i dont see why the state should -sanction- taking your own life, when is something that shouldn't be natural, there's medical cases for sure, but laws sadly aren't perfect, i'd rather have no one wrongly off themselves
> I guess we can explore both, but I'd ask you to research how these laws are already affecting families too in new ways on places where eutanasia is already legal.
Can you provide some reading? Because this doesn't really mean much by itself.
> It's easy on older -about to die-, people, but what about not such clear cut cases, some families are actually against their beloved ones taking their lifes, and the state allowing it, (Parents suing their offspring, to try and not have them do it, for example)
Then those families can talk about it and the person dying can make their choice. The families who don't like it can do what they want, just like those who do want it.
> when is something that shouldn't be natural,
Almost nothing about our modern life is "natural", including most of medicine. That said, how is death unnatural?
> Almost nothing about our modern life is "natural", including most of medicine. That said, how is death unnatural?
only meant having to bear the death of your child before you, usually a parent dies first, although i guess infant mortality rates where much higher until recent times...
this recent case what i was thinking specifically https://www.elconfidencial.com/espana/2025-03-17/justicia-av...
> The young woman has been in a wheelchair for years after falling from the top of a building .
> He added that his daughter suffers from mental problems with suicidal tendencies and constant changes of heart, and therefore needed psychological treatment, not assisted death.
> "The patient's capacity to make decisions has also been verified," the ruling states, "by the attending physician and the psychologist at the Hospital Residencia . The plaintiff has not presented any evidence that could refute the conclusions of these reports. They show that Noelia retains her capacity to make all types of decisions, including, therefore, the decision to undergo euthanasia."
This is a terribly sad situation all around, but I don't see this as evidence for why euthanasia laws are bad. The best I can see is that this highlights that we shouldn't push euthanasia as a solution to every lifelong disability, but that s a social/cultural issue, not a legal one - and one that we will certainly have to adapt to as assisted dying becomes more socially accepted. There will likely be more stories where, arguably, it goes too far, but I don't think there will be an epidemic of people offing themselves for relatively minor things.
> only meant having to bear the death of your child before you
Of course this is sad, but given the context of the conversation, the other choice being watching a child lose their mind or suffer in a world that is extraordinarily hostile to disabled people, I don't think saving the parents one type of pain (while subjecting them to another) is a really great idea either.
Also, isn't it better to have a way for people to kill themselves "cleanly", rather than kill themselves at home (or worse, in public)? Presumably finding one's child like that would be far worse?
(Of course, none of this is to say that we shouldn't e.g., make the world more accessible to disabled people, or help people learn to live with their disabilities, or try to cure Alzheimer's and the like - but as said, we can do all of these things at once. In the meantime, before we cure Alzheimer's and make everyone perfectly mentally healthy, we should also deal with the harsh realities that not having done those things entails.)
I didnt link them but several similar cases around mental illness.
IMHO a state shouldn't give individuals the right to off themselves.
Nature and physics already do, providing laws and a framework around it perverses it to push that people that feels out of society to bad decisions some times
Maybe its better to have them be able to do it -cleanly- and legally, but that also means more of them do?
I don't see mental health, or disabilities, as granting ending your own life, my worry is this discourse around euthansia is actively against that view and detremines the experience of humans that are considered not optimal to society as they where a throw away toy