People with dementia often ask to go home. Some ask even if they’re still in the house they’ve lived in for years; but people in institutions can ask many times a day. Telling a person in an institution that they live here now, that this is their permanent home, is usually neither comforting nor convincing, so, to address this problem, many nursing homes and hospitals have installed fake bus stops. When a person asks to go home, an aide takes them to the bus stop, where they sit and wait for a bus that never comes. At some point, when they are tired, and have forgotten what they are doing there, they are persuaded to go back.
Some years ago, a company in Boston began marketing Simulated Presence Therapy, which involved making a prerecorded audiotape to simulate one side of a phone conversation. A relative or someone close to the patient would put together an “asset inventory” of the patient’s cherished memories, anecdotes, and subjects of special interest; a chatty script was developed from the inventory, and a tape was recorded according to the script, with pauses every now and then to allow time for replies. When the tape was ready, the patient was given headphones to listen to it and told that they were talking to the person over the phone. Because patients’ memories were short, they could listen to the same tape over and over, even daily, and find it newly comforting each time. There was a séance-like quality to these sessions: they were designed to simulate the presence of someone who was merely not there, but they could, in principle, continue even after that person was dead.
In recent years, many more of these kinds of props and simulations have been devised: not just fake bus stops but fake buses, with screens for windows, on which footage of a passing scene gives the impression of movement; one home has made a simulated beach, with heat lamps, sand on the floor, and the sound of waves. There are versions of the Chagrin Valley streetscape in many countries around the world—in the Netherlands, Italy, Canada, Australia. Many homes have rooms that re-create, with period details and vintage artifacts, a past world that their residents remember from childhood: the Dutch countryside of the nineteen-forties; small-town California in the nineteen-fifties; East Germany under Communism. All these fantasies are conceived of as a means of soothing the misery, panic, and rage that sometimes accompany dementia: to convey to people in later stages of the disease the impression that life is still as it was once, with children to take care of, and holidays at the seashore, and familiar homes to return to.
There’s a picture of me from the early ’90s: I’m 13, leaning against the railing of the Golden Gate Bridge, peering down into the water below. I look somber, possibly because my father had shared on approach to the landmark that it was, at least then, the most popular bridge in the world to jump off. Or maybe it was some other reason.
I was definitely freezing, my long legs in jean shorts exposed to the summer San Francisco air, which manages to look cold even in the photo. I would remember the unrelenting windy unpleasantness of that first trip to the city often after I moved to it more than a decade later, walking from work past tourists by the hundreds who were similarly underdressed, unable to fathom that there could be inclement weather in California.
That was the final stop on that family vacation, which was the first time I encountered the state, but it wasn’t the first discomfort during our trip. We’d gotten to the Bay Area via State Route 1, the epic and winding coastal road also known as Highway 1, my sister and I nauseated in the back seat and my mother panicking in the front as we took turns along cliff edges too fast. We had started in Los Angeles, where we had flown from Cleveland and stayed a night, we kids left at the motel while my parents went out. In the faraway unfamiliar city, noises through a door that opened directly to the outside, we were terrified.
“Pajamas are more of a fashion statement now,” says Patrick Hughes, a fashion and design historian at The New School. He adds that they’re still part of what’s considered to be “a gentleman’s wardrobe,” explaining that you’re more likely to find them in the closets of the upper-class citizenry, while the middle-class Average Joes just opt for boxers and a shirt.
Strangely enough, this is exactly how PJs started out. Originally, pajamas — or pyjamas, as they’re spelled outside the U.S. — “came from the fashion of India,” explains Hughes. During the days of the British empire, colonists observed these lightweight drawstring pants and thought they looked pretty cool, so they brought them back to England with them. Soon, among the upper class, pajamas would be paired with a matching jacket to replace the nightshirt.
In the Anthropocentric world, perhaps we will all be looking for survival in these spaces as the world we knew (both in letters and ecologies) floods and swells. Perhaps books that do something wildly new will serve as our guidebooks in more ways than one.
It is impossible not to be struck by the tenderness in Loskutoff’s writing: the sublime setting; the vivid characters, so precise and unique it seems like he dreamed them up whole and fully fledged; the intricacies of love, fear, and fatigue that resonate so strongly they left me actually breathless. But I kept coming back to a difficult question: Does Loskutoff love these people? Just when I thought he would defend them, he brought to light the ugliest part of their collective psyche. And just as I settled into this critical eye, he uncovered an aspect of their worldview that touched my heart.