A Sense of Doubt blog post #4040 - Did Alzheimer's Affect Terry Pratchett's Discworld?
This recent video from Rebecca Watson, whom I follow, caught my eye.
I needed a quick share as I am busy this week.
This video is worth your time, but if you'd rather not watch, the full transcript is reprinted below.
Even though I do not always agree with her, Watson is very worth following with a subscription on You Tube or even a Patreon subscription. The links below will guide you to either or both.
Thanks for tuning in.
Watson video
https://www.patreon.com/posts/did-alzheimers-152181726
Did Alzheimer's Impact Terry Pratchett's Discworld?
Rebecca Watson
I have a variety of techniques I use to deal with the ongoing collapse of everything, most of them different kinds of drugs. But I also have healthy habits, like reading, and when it comes to reading purely for pleasure, I find myself turning back again and again to Terry Pratchett’s Discworld series.
If you aren’t familiar, “Discworld” is a sprawling collection of stories that blend fantasy, adventure, and satire, often with recurring characters popping up here and there. There are guides online to help people decide what order to read them in, with some focusing on starting with the best bangers and others that focus on following one character through the years. When I started reading them a few years ago, I took the completely insane tactic of reading them in the order that they were published and not really thinking too much about them. So far, I have enjoyed this approach and highly recommend it to others.
Because I’m pretty much always in the middle of a Discworld novel, I perked up to recently see an entire scientific study about that series: “Detecting Dementia Using Lexical Analysis: Terry Pratchett’s Discworld Tells a More Personal Story,” published last month in Brain Sciences.
Now, this is going to get a little sad but it’s old news to most: Pratchett published 41 Discworld novels (and even more one-offs) between 1983 and 2015. In 2007 at the age of 59, he announced that he had been diagnosed with a rare form of early-onset Alzheimer's disease. He died in 2015 at the age of 66 from complications of that disease.
Alzheimer’s and other kinds of dementia can be difficult to diagnose before symptoms become very obvious and life-altering, which leads to worse outcomes for patients who don’t catch it early enough for interventions. And so, a lot of research has been done to figure out new ways to detect dementia as early as possible. One of these research avenues involves identifying very subtle changes in the way a person uses language, and so back in 2005 neuroscientists decided to examine the works of novelist Iris Murdoch to see if they could detect changes in her writing throughout the span of her 40-year career. Murdoch’s final novel was published in 1995 and received uncharacteristically negative reviews. Shortly thereafter, she was diagnosed with Alzheimer’s and died in 1999 at the age of 79. The researchers compared that last novel to her first novel as well as one she wrote at the height of her career, and found that “Whilst there were few disparities at the levels of overall structure and syntax, measures of lexical diversity and the lexical characteristics of these three texts varied markedly and in a consistent fashion.” Her later work displayed a marked decrease in unique word choices relative to the overall word count.
Building on that, in 2011 linguists performed a more robust analysis of Murdoch’s novels and compared them to those of Agatha Christie, who was suspected of having Alzheimer’s, and PD James, who did not experience any cognitive decline over her 94 years. Their results supported the earlier study, and further they seemed to be able to detect a more “impoverished” vocabulary in Murdoch’s novels a full thirty years before her death. They also felt that they had convincing evidence Christie did, in fact, suffer from Alzheimer’s.
So now, it’s not surprising that some researchers would want to perform a similar examination of Terry Pratchett, considering how many novels he produced, especially in the same world, over many decades. They chose 33 out of the 41 Discworld novels, excluding those that were very short or written for young adults, and looked for patterns in the vocabulary used.
They found a “significant decrease in lexical diversity across all word classes” beginning after the publication of The Last Continent in 1998, the 22nd book in the series–9 and a half years before his diagnosis.
So there we go! Pretty good evidence that it may be possible to diagnose Alzheimer’s early using a careful examination of a history of the patient’s writings. Right? Well, no, it’s not quite that simple.
First, let me point out some criticisms I’ve seen a lot about this study, as articulated by Marc Burrows, who wrote a biography of Terry Pratchett:
“First,” Burrows writes on Facebook, “the point where this supposed “decline” begins is just before the strongest run of his entire career — a decade of book after book that includes Night Watch and Nation, two of the finest novels Sir Terry ever wrote. To argue that his writing was already deteriorating years before those books appeared just doesn’t stand up.”
Okay, that is not what this study or any of the previous studies have shown. Yes, Murdoch’s final novel was panned but these studies do not have anything to say about the quality of the authors’ work. In fact, they are specifically looking for very subtle changes in word choice that literally require an algorithm to identify. Pratchett could very well have been using less diverse language while continuing to knock it out of the park when it comes to character development, storyline, and humor.
Burrows goes on, “Second, there’s a far simpler explanation for a drop in adjective use: he was getting better. At this point Sir Terry was writing at an astonishing rate — often two or three novels a year. His prose was getting cleaner and more disciplined. He was learning, bit by bit, not to let vocabulary get in the way of character, narrative and theme. That's mastery, not decline. Unless the argument is that Alzheimer’s made him a better writer, which feels… off.”
That is absolutely true, and it actually negates his first point: you do not necessarily need a unique array of words in order to produce a great novel. Yes. Correct. And Pratchett very well may have made a conscious effort to change up his style. So why didn’t the researchers consider that? Simple: they did. In the discussion section of their paper, they include a lengthy list of reasons why this is not a slam dunk case of a decline in cognition: “Age-related changes in writing style are expected, and it is possible that some of the observed changes represent natural stylistic evolution rather than disease-related decline.”
They also point out that after his diagnosis, Pratchett’s language may have changed due to related factors like stress, or having less time to write.
Burrow’s third point is “the big one — Sir Terry had posterior cortical atrophy (PCA), a very rare form of Alzheimer’s that affects visual and spatial processing first. It isn’t a language-led illness in its early stages, and it often doesn’t touch memory or vocabulary for a long time. That’s one reason it’s so hard to diagnose. It doesn't work like other forms of dementia.
“When language problems do show up in PCA, they usually come via visual impairment — difficulty reading, scanning text, processing what’s on the page, that sort of thing. Many of you will have seen the heartbreaking footage of Terry trying to read from Nation onstage at the Discworld con and complaining of "shadows" on the page. It can slow access to words, but it doesn’t shrink vocabulary in this neat, statistical way. Terry himself talked about this a lot. He took great pride in being able to rattle off long lists of words when he was being tested, while being unable to copy simple pictures.
Even later on, when writing genuinely became a struggle, Rob Wilkins has been very clear that the issues were about keeping the shape of a story in his head and the character voices distinct— not about choosing words. And yet the articles making these claims don't mention PCA at all, which is extraordinary when you’re citing scientific research and talking about the effects of a disease. They lump all forms of alzheimers together.”
That’s also a great point: why did the authors lump all forms of Alzheimer’s together? Simple: they didn’t. I’ll give Burrows a break here and assume that he was ONLY reading some popular press about the study instead of reading the study itself (which is available in full for free), but if that’s the case it’s really better to actually point to those articles and criticize them and not the study itself. Because the authors do repeatedly point out that Pratchett had PCA: they cite research that found “that in addition to the well reported degradation of vision, literacy and numeracy, PCA is characterised by progressive oral language dysfunction with prominent word retrieval difficulties.”
And then we’re back to that discussion section, where the authors state plainly that “while PCA and Alzheimer’s disease share some common features and PCA is thought to be in most cases caused by Alzheimer’s disease, they are distinct conditions with different clinical presentations. It is possible that the linguistic markers of PCA may differ from those of Alzheimer’s disease. For example, PCA often causes severe reading impairments and “pure alexia,” which disrupts the writer’s ability to visually scan and review their own text. Writers unable to effectively read their drafts may struggle to detect unwanted lexical repetitions and potentially may contribute to the observed decline in lexical richness.”
So I’m not impressed by these quite common criticisms of the study, seeing as one is just wrong and the others are freely stated by the study authors as limitations. The authors also point out that they could only judge the books based upon their publishing date, with no way to know exactly when in his life Pratchett actually wrote the books. They also point out that unlike the 2011 study, they didn’t have a control author with no known problems with cognition.
Essentially, this was just another case study to add to the data.
That said, I will point out some critical thoughts I had about the idea that research like this will allow earlier detection of conditions like Alzheimer’s. While all of the writers discussed were diagnosed with Alzheimer’s or strongly suspected by experts to have had it, these changes in vocabulary do not point to Alzheimer’s specifically: they point to cognitive decline, and that can mean about a zillion different diseases. Alzheimer’s, sure, but also Huntington’s disease, Parkinson’s, dementia with Lewy bodies, depression, concussion, or medication side effects. Even if we had a nice little private algorithm running in our email outboxes that can detect declining cognition long before we notice it ourselves, that would be a real “well what the fuck now” situation. There would need to be a serious discussion about whether or not it makes sense to then run every test possible to try to narrow it down immediately, or whether you just have to wait and see what happens, terrified every time you walk into a room and forget what you were going there for.
I’ve talked in the past about the seemingly paradoxical problem of elective full body MRIs and gene sequencing: sometimes more information is actually worse for us, if it stresses us out and puts us through procedures that end up being useless. Sometimes ignorance really is bliss.
So, it’s an interesting study just for the sake of scientific inquiry, but I’m not sure it should give anyone a lot of hope for a way to easily detect early Alzheimer’s in the near future. And also, the takeaway absolutely is NOT “study pinpoints when Discworld fell off.” I haven’t even made it to the fan-favorite “golden age” yet but I’m fairly certain that Terry Pratchett could craft an entertaining story with a toddler’s vocabulary so I’m not worried about it.
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- Bloggery committed by chris tower - 2603.10 - 10:10
- Days ago: MOM = 3904 days ago & DAD = 558 days ago
- New note - On 1807.06, I ceased daily transmission of my Hey Mom feature after three years of daily conversations. I post Hey Mom blog entries on special occasions. I post the days since ("Days Ago") count on my blog each day, and now I have a second count for Days since my Dad died on August 28, 2024. I am now in the same time zone as Google! So, when I post at 10:10 a.m. PDT to coincide with the time of Mom's death, I am now actually posting late, so it's really 1:10 p.m. EDT. But I will continue to use the time stamp of 10:10 a.m. to remember the time of her death and sometimes 13:40 EDT for the time of Dad's death. The blog entry numbering in the title has changed to reflect total Sense of Doubt posts since I began the blog on 0705.04, which include Hey Mom posts, Daily Bowie posts, and Sense of Doubt posts. Hey Mom posts will still be numbered sequentially. New Hey Mom posts will use the same format as all the other Hey Mom posts; all other posts will feature this format seen here.











