The play that cures Alzheimer’s — at a price

Science in drama is not new. Arcadia, perhaps Tom Stoppard’s finest play, considers truth in the context of contemporary maths and physics. Michael Frayn’s Copenhagen is about a meeting when great physicists arrive at the most shocking — now widely accepted — interpretation of quantum theory. In novels, science has regularly been plundered, from HG Wells to Douglas Adams, for tragic or comic effect. In films, science has been used seriously — think Alex Garland’s Ex Machina — but more often as a jumping-off point for assorted space-opera mythologies.

Artists, like the rest of us, now have easier-than-ever access to science, thanks to the huge wave of popular scientific publishing that followed Richard Dawkins’s The Selfish Gene in 1976, and Stephen Hawking’s A Brief History of Time in 1988. These have injected great stories, wild ideas and, latterly, tricky moral questions into our imaginations.

Payne and his generation are taking all this a step further. But first there is the man himself and the extremely odd situation in which we find ourselves.

Payne, 34, is slightly puzzling. The writer in residence at the Donmar Warehouse has a geeky air, and the clothes of an urban hipster. He has an odd tic of going “Hmmm” or “HMMMM!” when people are talking, whether in affirmation or dissent is unclear, and he chuckles to himself at odd moments. Mind you, I think I’m also acting a bit strangely.

We are in the Donmar offices alongside Murray Shanahan (professor of cognitive robotics at Imperial College); an Apple desktop and a phone (through which Anil Seth, professor of cognitive and computational neuroscience at Sussex, communicates); and Josie Rourke (artistic director of the Donmar). Shanahan and Seth have advised Payne on his play. There are repeated failures of Seth’s internet connection, and conflicting agendas among the participants to add to the oddity of Payne’s chuckles and “Hmmm”s. In the midst of this strange huddle — quite intimate, so Seth can see us all on his screen — I find my questionings wandering in a faintly deranged manner.

Though weird science has often been staged, the subject of Payne’s play is new and very topical: Alzheimer’s. Increasing life expectancy and, perhaps, other causes of which we as yet know nothing have made this disease the presiding anxiety of the developed world. It is incurable and peculiarly brutal, as it progressively takes away the patient’s mind while leaving their physical presence intact. Harrowing as this may be, it is fertile ground for drama.

In 2014, for example, we had Florian Zeller’s hit play The Father, which used shifting characters and sets to take us inside the mind of the suffering patient. This is not a play for the faint-hearted — reading the script, I found myself wondering if there was a gas oven handy. Alzheimer’s, however, is not merely topical, it is a version of an old theme. The disintegration of identity is, after all, the subject of great plays all the way from King Lear to Who’s Afraid of Virginia Woolf?.

Rourke makes the connection between this tradition and Elegy. “Although it’s a play about the self, it’s mainly about a couple. Fundamentally, there’s a question — and it goes all the way back to the Renaissance — about what happens to the object of your love and what the nature of your love is, how far that will persist against grief. That’s as relevant to Shakespeare’s sonnets as it is to neuroscience.”

Elegy is a short three-hander — two women lovers, one with Alzheimer’s, and a doctor. Payne is vague about where the idea came from. “I had a tinyish window to write a piece, so I just jumped in, then retrospectively spoke to Murray and Anil. It was a mix of things coalescing. I read something about the mapping of the brain.”

One of the key things he learnt from the scientists is that memory is not what we think it is: a series of excisable clumps within the brain, like files on our computers.“In an earlier draft,” Payne says, “I had used a data analogy for memories, so the clinician talked in the play about memories as data files, and they got corrupted. When I spoke to Murray and Anil, they both said, ‘It doesn’t work like that.’”

The subject of Nick Payne’s play is new and very topical: Alzheimer’s

BRUCE GLIKAS/GETTY

Memories are, in fact, distributed all over the place. If you remember meeting someone, that memory will involve a mass of associations — weather, clothes, conversation, the coffee you had — linked to other incidents and associations. Memory, like the brain itself, is a garden of forking paths. This, among other things, is what makes Zeller’s play so clever: the father’s memories do not simply vanish, they break free of their moorings and fragment. This does not mean, however, that they cannot be manipulated.

“We are far from being able to do that [the surgery in Payne’s Elegy],” Shanahan says, “and I am not in the business of making predictions, but, looking just a little bit ahead, it’s entirely feasible.”

Seth goes a little further. “It has become possible to change specific memories that animals have. In humans, there has been some work showing that, using behavioural techniques, having people recall memories, then changing them, can cause selective amnesias. And there are drugs that will change the way people reconsolidate their memories. Looking ahead, there is work in the States with what are called hippocampal prostheses, which will help people lay down new memories when they have lost the ability to do so.”

In short, Elegy is not merely topical or even futuristic, it is right at the edge of science that is happening now — and, of course, an affliction that is happening now. No wonder, as Seth says of popular scientific explanation, “there is an insatiable appetite for this kind of thing”.

Rourke, the phrase-maker in our huddle, says this is all about the “futurity of the present”, which, at this particular moment, is a peculiarly urgent matter. “This is the condition of being alive, needing to think about these things. The point is not about science, the point is about subject matter and whether the artist is the right person to face it. The point I’m making about Nick is that this is part of the quality about being in your early thirties and trying to navigate the world. It’s part of everybody’s experience in a way it wasn’t 20 years ago.”

She also speaks of an “aesthetic fetish of the future”, which is all about revelling in fantasies of things to come that have no relevance or attachment to the present from which they emerge.

This is very smart. Imagined futures tend to look quaint quite quickly — most old sci-fi movies and TV shows are now watched cultishly, ironically or as exercises in style. Some, however — think of the original Invasion of the Body Snatchers — endure because they were so urgently engaged with their own present: in that case, anti-communist paranoia. We have moved from a phase in which science and technology were exciting but “out there” to one in which they are accelerating and “in here” — in our lives and, increasingly, in our minds.

Furthermore, they are increasingly pointing to a strange future, a “post-human” phase in which anatomical or neurological enhancements change us so fundamentally that we become, in effect, a different species. Elegy dramatises one aspect of this by showing how love, that most intimate and potent reality, can simply be cancelled in the name of a medical cure that seems eminently desirable, yet at the same time results in the most undesirable thing imaginable. It’s an old paradox. “We are never so defenceless against suffering as when we love,” Sigmund Freud said. But he also said: “Work and love, that’s all there is.”

In this context, I suggest to the huddle that, though the scientists may have helped Payne, he is also helping them by putting up a giant warning sign about their work. Everyone looks oddly uncomfortable with this. Payne modestly demurs and the scientists steer the conversation in the direction of that blandly unhelpful subject, “the public understanding of science”.

Payne aims at a middle way. “The play deliberately tries to present a particular version of the future where medicine has the desire to treat the illness above treating the holistic condition of the patient. And, yeah, the interventions are somewhat chilly, so I think there is an interesting thing about how medicine grapples with death and dying.”

He breaks off into a chortle, which this time, I point out, is a little oddly timed. He chortles even more. “Well, I’ve been thinking so much about death and dying, you’ve got to laugh, otherwise... I’m glad you see this as treating the science and the ethics around death and dying with respect, but also with a polite sort of question mark.”

In the end, what is at stake here, both in Alzheimer’s and in robotics and neuroscience, is the condition of the human self, the source of everything we know and make. In Alzheimer’s, the self does not vanish, as in death, but fragments — and, in doing so, raises questions about what it was in the first place.

“The self is not just one thing,” Seth says. “In dementia patients, some aspects may be intact — people still experience themselves as the centre of the subjective world and the source of their actions. There is a relevance here to how we respond to the increasing prevalence of dementia and Alzheimer’s, and we can do that as a society in a more sensitive and useful way by recognising that the self is richer than just the string of memories over time.”

Elegy is at the Donmar Warehouse, London WC2, until June 18