As the former editor of the American Journal of Public Health observed in a piece summing up AA’s first seventy-five years: “From what looks like anarchy—traditions rather than rules, maximum local autonomy and independence, and absence of centralized or layered tiers of authority—emerges consistency and stability.” That’s the power of community.

To foster an intersubjective milieu that both recognises and honours the inherent sociality of human beings is no simple feat, especially in violent societies where projection and withdrawal are the common psychological responses to perceptions of threat. Add to this mix the phenomenology of alienation - and a difficult task becomes a seemingly insurmountable one. Psychoanalyst Nina Coltart had something interesting to say about this, namely, the person who is interested only in getting better: “Psychoanalytical therapy has nothing to offer a patient who only wishes to be relieved of his suffering.

Thomas DeBaggio, a writer and horticulturist, was even able to publish two insightful memoirs about his own early-onset Alzheimer’s before the disease killed him at the age of sixty-nine. But most patients are frightened or mortified by the knowledge of what is befalling them. Some continue to be severely terrified as they lose their intellectual competences and bearings and find themselves in a world increasingly fragmented and chaotic. But the majority, I think, become calmer with time as they perhaps start to lose the sense of what they have lost and find themselves shifted into a simpler, unreflective world.

Kurt Goldstein, studying brain-damaged soldiers during World War I, was moved from his original, deficit-based point of view to a more holistic, organismal one. There were never, he believed, just deficits or releases; there were always reorganizations, and these he saw as strategies (albeit unconscious and almost automatic) by which the brain-damaged organism sought to survive, although perhaps in a more rigid and impoverished way.

Patients often lived in state hospitals for decades, and died in them—every asylum had its own graveyard. (Such lives have been reconstructed with great sensitivity by Darby Penney and Peter Stastny in their book The Lives They Left Behind.)