Post-Awareness Stage 4 is where serenity and the ability to recall singular memories gives way to confusions and horror. It's the beginning of an eventual process where all memories begin to become more fluid through entanglements, repetition and rupture (The Caretaker).
From this stage forward we can hardly talk of a melody anymore. There are a few moments in which some harmonious elements reappear, but these are few and far in between. Yet, this is exactly where the theory of melody and its flowing are most important. As the flowing of the melody is seen as the most primal expression of the temporal experience of a subject, its distortion would be the most primal expression of a distorted temporal experience as well. Now, this does not mean that listening to any kind of noise is an expression of AD, or any other form of cognitive decline. Without diving into a discussion on whether EATEOT can be considered “art” or not, the fact that Stage 4 is introduced after two hours of sounds that can definitely be considered musical, and some musical elements are retained until the very end of Stage 6, we can argue that the theory of melody is retained up until the very end.
When we are listening to a melody, the notes that have passed do not disappear – they are rather retained in an “absence that is not nothing” which flows into the note we are about to hear.
The entire melody can, in turn, be remembered, recalled and hummed, whistled, etc. The “melodies”
we hear from Stage 4 onwards, however, are not melodies that we can exactly remember, while they do flow. The Husserlian structure of retentions and protentions does remain, and is still applied when listening to these stages, but the content is so vastly different, that it has no sense which is useful in a
narrative (our past). In short; we cannot possibly remember what we’ve just listened to. Yet, even though the further retention is gone, the primary retention, which is essential for the flowing of first-personal experience, remains – suggesting an increase in flowing. If we stick to the water-related metaphors that Merleau-Ponty uses, we would no longer call this a flowing river, or fountain, but a torrent, downpour, or waterfall.
It makes sense, then, to speak of a minimal Self without a narrative Self – there is experience, but it is jumbled, discontinuous and confused. On top of this, there is research that shows that more emotional events are more easily remembered, even if they happen during the degradation in AD (Okada and Matsuo, 2012, 2). This would explain the sudden confusions that arise. A very vivid representation of this is in “H1 – Stage 4 Post Awareness Confusions”, in which the music is edited in such a way as to sound siren-like (around the 2:46:30 mark in the cited version). Many listeners have aptly called these sounds the “hell sirens”, as they sound somewhat like an air-raid siren. Comparing this to the mentioned research, stating that emotional memories are retained longer, we can make a link to Wambacq’s article in which she compares the theories of time-experience of Merleau-Ponty and Bergson.
In her “Maurice Merleau-Ponty’s Criticism of Bergson’s Theory of Time Seen Through The Work of Gilles Deleuze”, Wambacq mentions Merleau-Ponty’s discussions on aphasia, in which representation (which is central to Bergson’s theory) is seen as unimportant for memory, as in aphasia something can be remembered, without the ability to reconstruct or represent what is remembered (a patient can remember being stung by a mosquito, without being able to point out where) (Wambacq, 2011, 313). As alternative, the horizons are mentioned – just as a note in a melody is retained, so someone’s entire past is retained in this horizon, which is part of the present – and, just as the aphasiac cannot point out “where” the memory occurred, so the AD patient can no longer recall what note has just played – what memory to recall, hence the “torrent” of temporality. Wambacq gives the striking example of someone being bitten by a dog: this memory will remain with them, and influence each (present) perception of a dog (314).
This idea confuses the distinction between a narrative Self and minimal Self yet again – as we’ve argued that the narrative one tells of oneself is simply one’s past, it would be tempting to state that this narrative disappears for the Alzheimer’s patient. Now, however, we see that this is simply not the case. A memory (especially one that has emotional significance) is still retained in the horizon of past, and possibly recalled (or, rather, passively undergone) in a present perception – explaining the confusion. This allows us to, again, maintain the flowing structure of the subject that Merleau-Ponty makes so central to human being, together with a narrative. As stated, the narrative Self is also a social idea of Self, despite the narrative suffering under the patient’s decline, there is already a narrative that can (and must) be fallen back on – it is recalled wrongly by the patient, but it is still there. As we’ve mentioned Wiesing’s idea of perception earlier on, we must now find a way to empathize with this confusion. Recalling Wiesing’s limited account of perception, we must now distinguish between actual perception and delusional perception and hallucination. In short: is there any intentionality in this confusion, or must we resort to an obscure idea of “recalling without being aware of it”?
This latter idea seems an oxymoron – recalling is a self-reflective act (it is the prime example of temporal transcendence, or, depresentation), which can, therefore, by definition, not be unconscious. The concept of “flowing” can explain this. As the past is retained in every present perception, we could argue that the AD patient’s temporal flowing has actually increased. Instead of recognizing this memory as belonging to a retained past (or being part of the pre-reflective affective schema in the form of a mood or disposition), it is experienced as present. Here we can recall Sartre’s
idea of the Ego, which is a secondary structure upon a first-person perspective. Similarly, we have argued that the temporal extases of past, present and future are secondary structures upon a primordial temporal flow. In order for recollection to even happen, this flow must already exist – not being able to tell apart the extases does not necessarily mean that the flow itself is gone.
Let us complicate matters even further. As a relative, we know that this delusional perception is past – we know that the thing the patient is seeing now is something that traumatized them in their past. To stick with Wambacq’s example of being bitten by a dog once; in a healthy framework this might cause a fear of dogs. In a pathological framework, however, this fear is not simply a pre-reflective affective schema that “colours” the present perception, but takes the place of the present perception – the dog seen now is not a dog that, could, potentially, bite. Rather, it is seen as a dog that most certainly bites, as the biting dog of back then is perceived, despite it being exactly the same dog as the healthy person is seeing – the patient would be having a delusional perception. In Wiesing’s structure this would not be of importance for the continuity of experience, as it is simply not a perception. However, for the patient this distinction is inconsequential. Granted, we have just as little insight into the Other’s brain as Wiesing does, but based on the reaction of the patient (how does one react to a dog that is going to bite you?) we can argue that perception or not, it is experienced as very real, and very much part of their experiential flow.
From an empathic standpoint, then, we can recognize an intentionality – we see the patient looking at a dog, resulting in a confused (hysteric, fearful, etc.) response. That same dog (in actual perception) would not provoke such a response in healthy individuals. The patient must, therefore, be experiencing a different dog than we are, while the world is actually shared (we are looking at the same dog). From the discussions we’ve read on world-horizons and empathy, we could argue that this is always the case, but usually happens within a general, recognizable, framework. However, the experience of the dog is now vastly different. Does this warrant a switch towards radical empathy?
Essentially, we are repeating the question Nissim-Sabat posed in her article: exactly how much do we need to drop of our worldview in order to “radically” empathize with someone? How different must an experience be to count as a different kind of consciousness?
We have seen in Zahavi’s theory that there are different kinds of intentionality (imagination, perception, etc.). Arguing that the hallucination, or delusional perception of a patient is not a perception in optima forma, does not mean it is not an intentionality either. As we see a response of fear, or confusion, it is most likely that the disturbance takes place on the pre-reflective level of the habit-body – exactly what is attacked by AD. In other words, we can maintain a minimal sense of Self as Zahavi’s account shows us (a what-it-is-like-for-me-ness) and a confused narrative account of Self at the same time, even through to the later stages. In order to explain this further, we need to take a closer look at the pre-reflective aspect of the body. In this stage we have focussed mainly on the flowing of a subject, stating that this is still intact in AD, only vastly different (but not a different kind of flowing). This made us stumble upon empathy again, as we now need to figure out how to empathize with a vastly different subjectivity. In order to get a clearer idea of this, we need to take a look at what bodily aspects the disease alters. In the example of the dog, for instance, we can clearly recognize an intentionality, but we do not recognize the salience ascribed to it. We can understand why someone is fearful of a dog, but, just as Ratcliffe pointed out, these affective schema’s that dictate how we feel about things, can become radically altered in certain diseases. This is what we will focus on in Stage 5.