MS. DIANE REHMThanks for joining us, I'm Diane Rehm. Alice LaPlante's new novel, "Turn of Mind," is a whodunit with a twist. The suspect suffers from Alzheimer's disease. She cannot remember if she killed her best friend. It's an intriguing premise, one that strikes close to home for the author.

MS. DIANE REHMLaPlante's own mother suffers from Alzheimer's disease. She drew upon her firsthand experiences to craft the character of Dr. Jennifer White. Readers are given a moving portrait of a deteriorating mind. Do join us, call us with your questions, comments, 800-433-8850, send us your email to drshow@wamu.org, join us on Facebook or send us a tweet. Alice, good morning to you.

MS. ALICE LAPLANTEGood morning. Delighted to be here.

REHMI'm so glad you've written this novel because it is -- even though fictional, it gives us an insight to the confusion that the Alzheimer's patient feels and the sense of not knowing from minute to minute where she is, what she just did or what should she be doing. You came upon this how?

LAPLANTEWell, as you said, my mother has Alzheimer's and it's something our family has been dealing with for nearly a decade now, the fallout from that. I'd like to stress that there's -- there's nothing autobiographical about the novel in terms of my mother's character. I just took my observations and put them into fiction.

REHMHow long ago did your mother begin to show signs of Alzheimer's?

LAPLANTEProbably about a decade ago.

REHMA decade ago. And what made you first aware of the fact that she seemed to be acting differently perhaps?

LAPLANTEYou know, it creeps up, as anyone who has a loved one with Alzheimer's knows. And I can't put my finger on a specific time or place. We understood that we were at ground zero because her mother had Alzheimer's, her sister had died of it, there was Alzheimer's throughout the family. Me and my siblings joke in a very black way about what's ahead for us, so it wasn't a surprise when we started seeing signs.

REHMNow, when we meet the fictional character in your book, Dr. Jennifer White, she already has dementia. What was she like before the dementia set in?

LAPLANTEAs I see the character, she's extremely strong-willed, highly intelligent. She's an orthopedic surgeon, quite a good one. Probably I'm -- one of the first females in her field, used to plowing ahead through adversary. She's got an unconventional view of life and relationships. She's a very interesting woman and very much used to being in control and capable of taking a very clinical outlook towards people and life.

REHMAnd tell me about the murder victim and why Dr. Jennifer White is somehow implicated?

LAPLANTEWell, they're best friends. They're very -- they've known each other for decades. They've been neighbors on the same Chicago block.

REHMHer name is Amanda?

LAPLANTEHer name is Amanda. Amanda is a schoolteacher, but again, a very strong woman, also unconventional in her thinking and what I found the most interesting as I wrote the book was crafting a relationship between two very strong, unconventional women, that had its ups and downs. It's a complex relationship and there was, you know, an adversarial part of it as well as a lot of affection.

REHMSo Amanda is found murdered?

LAPLANTEThat's correct. With four of her fingers surgically amputated.

REHMAnd is that the primary reason that Dr. Jennifer White is implicated?

LAPLANTEThere's other circumstantial evidence. There's the fact that they'd -- they'd had a fight, a very loud argument, Amanda and Jennifer, the previous day. There's the fact that Jennifer cannot -- is not capable of providing an alibi for herself and no one was able to give her one. And then, of course, there's the fact she's a surgeon and the way the fingers were amputated showed a great deal of skill.

REHMJennifer is 64 years old as the novel begins. She's been forced to retire and that is because the Alzheimer's is becoming more and more apparent.

LAPLANTEThat's correct, yes.

REHMShe has an aid, Magdalena, living with her. Would you read just that one portion where she is at her Alzheimer's group, starting in the middle of page 26?

LAPLANTECertainly. "At our Alzheimer's support group today we talk about what we hate. 'Hate is a powerful emotion,' our young leader says. 'Ask a dementia patient who she loves and she sometimes draws a blank. Ask her who she hates and the memories come flooding in.' Hatred, hate, the word resonates, my stomach contracts and bile rises in my throat. I hate. I find my hands clenched into fists. Faces turn to look at me. Some men, but mostly women, a variety of races, of creeds, a united nation of the despised, of the despicable.

LAPLANTEI cannot make out their features exactly, an anonymous mob. It's becoming hard to breathe. What is that noise? It is me. Who are you staring at? Our leader comes over. Our leader is leaving the room. He returns with a youngish woman, bleach blonde hair, too much makeup.

LAPLANTEShe comes straight over to me. 'Dr. White,' the woman says, 'Jennifer, we're going home now. Shh, no, no yelling. No, please stop, stop. You're hurting me. No, don't call, I can handle this. Jennifer, come now. That's right, we're going home. Shh, it's okay. It's okay. It's me. Look at me, at me, Magdalena. That's right. We're going home.'"

REHMTough scene.

LAPLANTEYes.

REHMTough scene. The book is titled "Turn of Mind." Alice LaPlante is with me. Do join us, 800-433-8850. How much of Jennifer is there for us?

LAPLANTEInteresting question. She comes and goes. She has moments of acute awareness and then it goes away. She remembers different things at different times. Things come in and out of focus. You know who she is by the end of the book, I feel. Unfortunately, Alzheimer's, as a disease, causes a lot of personality changes. It's not just kind of a benign forgetting of your keys. There's a lot of anger and aggressive, as I tried to show in that scene, that comes out.

LAPLANTEI'm not sure if they know even, if the anger and aggression that they see in so many of these patients is the fact that the social filter is going away or whether it's the disease that's causing the agitation. So in other words, is the anger and the rage Jennifer speaking? Just unedited or is it the disease forcing her into a place that she wouldn't really go?

REHMWhat's fascinating to me is how you have interwoven the conversations that Jennifer has. Sometimes she recognizes people who are very close to her, for example, her daughter, sometimes she doesn't, for example, her son, Mark. Sometimes she looks around, she recognizes nothing, where she is, who she is and sometimes, as you say, she is acutely aware and for Magdalena, whom Jennifer describes as needing a job, as being rather destitute otherwise, she's rather disdainful in the sense that she sees her as someone she doesn't care about and yet Magdalena has to care about her.

LAPLANTEThat's a very interesting observation. I hadn't thought about it, but, yeah, the role of a caregiver, I can't imagine anything harder. It's not just the physical strain, the emotional strain. And like you said, in some cases, taking abuse and yet having to respond with care and affection and love.

REHMHave you experienced that firsthand?

LAPLANTEI'd rather not go there. I want to protect the privacy of my family.

REHMI understand. Alice LaPlante, her new novel with an individual who has Alzheimer's is titled "Turn of Mind."

REHMWelcome back. If you've just joined us, novelist Alice LaPlante has written a book. It's a novel with a central character who suffers from Alzheimer’s disease. She at times knows who she is, where she is, knows everything that's going on around her and at other times, is totally confused. The book is titled "Turn of Mind." Alice, would you read for us again? There's an extraordinarily moving scene here.

LAPLANTECertainly.

REHMSet this up for us.

LAPLANTEJennifer is still at this point living at home, but she's -- as many Alzheimer's sufferers are, she's a wanderer, an escapee. She takes off when she can when Magdalena's not watching her and that's what she's just done. And I should explain that the way the book is structured, it's in little vignettes that are separated by white space, so there's no chapters, you just come in and out of vignettes in Jennifer's mind. So we've just -- there's been no build up to this. All of a sudden, we just find ourselves in this particular place.

LAPLANTE"I'm in the middle of a street. Dirty snow has been pushed to either side, but it's still treacherous going. I have to tread carefully. There's shouting, cars everywhere, horns blaring. Someone grabs my arm, not gently, pulls me faster than my legs want to move, practically hoists me up a curb onto a cement island. I'm suddenly surrounded by people, strangers. From afar, a voice calls, a familiar one and the strangers part like the waters of the Red Sea.

LAPLANTEHere she comes, bright auburn hair shivering in a short-sleeved t-shirt that exposes her rattlesnake tattoo. 'Wait, I -- I'm her daughter. Please don't call the police,' she arrives, breathless. 'Thank you, thank you. Whoever got her out of the street, thank you.' She takes a deep breath. 'I apologize for the trouble. My mother has dementia.' She's forcing out the words and her thin frame is starting to shiver. It is bitterly cold. As the crowd begins to disperse, she turns to me, 'Mom, please don't do that. You scared us all.' 'Where am I?' 'About two blocks from home in the middle of one of the busiest intersections in the city.'

LAPLANTEShe pauses. 'It was my fault. I was putting my bag up in my old bedroom. You know, I'm spending the night again. Magdalena thought it would be best for you. We got to talking, didn't notice you'd wandered off. Where were you going?' 'To Amanda's. It's Friday, isn't it?' 'No, actually, it's Wednesday, but I understand. You were trying to find Amanda's house?' 'It's our day.' 'Yes, I understand.' She thinks for a minute, seems to make up her mind. 'I think we should go to Amanda's, see if she's in.' 'And what's your name?' 'I'm Fiona, your daughter.' 'Yes, yes, that's right. I remember now.' 'Let's go. Let's see if we can find Amanda. Look, the light is green now.'

LAPLANTEShe's holding my arm and urging me forward with purpose. Although I'm at least three inches taller than she is, I have trouble keeping up with her stride. We move past the thrift store, past the L station, around the corner of the church and suddenly, the world tilts into place again. I pause at one house, a brownstone with its short black iron fence around its yard. A tree stripped of leaves leans over the path to the front steps. 'Yes, this is our house, mom, but we're going to visit Amanda.' 'I remember,' I say. 'Three houses down, one, two, three.' 'That's right. Here you go. Let's knock on the door and see if Amanda's here. If she's not, we'll go home and have a cup of tea and do the crossword puzzle. I brought a new book.'

LAPLANTEFiona knocks loudly three times and I press on the doorbell. We wait on the porch, but nobody comes. No face appears behind the curtains of the living room windows, not that Amanda would ever peer like that. Um, despite Peter's admonition, she always flings open the door without looking always ready to face whatever life brings her. Fiona now has her back to the door, her eyes are closed, her body is shaking. Whether it's from the cold or something else, I can't tell. 'Let's go, mom,' she says. 'Clearly no one's at home.'

LAPLANTE'Strange,' I said. 'Amanda has never missed one of our Fridays.' 'Mom, please,' her voice is urgent. She pulls me down the steps so fast I stumble and nearly fall and pushes me back down the sidewalk. One, two, three, we are back in front of the brownstone. Her hand on the gate, she pauses and looks up. Her face is full of pain, but as she gazes at the house, the pain dissipates into something else. Longing."

REHMAlice LaPlante reading from her new novel "Turn of Mind." What is Jennifer thinking? Is she thinking, with the ability she still has to think, that her friend Amanda is still alive?

LAPLANTEShe is -- she forgets. She doesn't -- throughout the book, she has moments of understanding that Amanda's dead, but mostly she thinks she's still alive. And what Fiona's doing at that point is -- is doing -- making a decision that caregivers have to make all the time, which is, do you tell the truth? Do you shine them on? Do you -- and -- you know, here, let's go to her house, let's knock on the door. Well, she's not there, she'd dead, but Fiona does that to calm her mother down and it's a very common scenario.

REHMIt's a very interesting scenario that you've created about a woman who begins to wonder whether in fact she is a murderess.

LAPLANTEThat's correct. At the heart of the book is -- it's a character study of Jennifer and I think she thinks of herself as having a dark core. And when she realizes a murder has been done to -- and Amanda has been murdered, she can't help but associate that darkness with the possibility she might've been responsible.

REHMDid you write this novel for yourself or for your family?

LAPLANTEOh, for myself in the sense that I needed to write it.

REHMDo you worry for yourself that considering the heritage within your family, that this could be something that happens to you as well?

LAPLANTEI wouldn't call it worry. And this is something that writing the book has changed in my mind. I've always said to my family, my immediate family, I've got 20 years left. And they say, no, no, no. But that's how I'm living my life. And as you know, there's diagnostics to test for genes. If you have certain genes, you might get Alzheimer's. It's not a very good predictor, it's not very reliable, but there's a new test that was developed this year that involves doing a -- taking some spinal fluid that has an extraordinarily high reliability rate decades in advance of any symptoms.

LAPLANTESo it's now possible, as I understand it -- I'm not a scientist -- that someone like me in their 50s could go have this test and know that they are going to have Alzheimer's in their 70s. And of course, when the news of this broke everyone said, who would do that? There's no cure. How could you live with that? And I kind of fell into that camp. And since I wrote the book, I've changed my mind. If healthcare and insurance industries weren't what they were, I would get that test. I want to know. I want to know for myself and I want to protect my family. It's a horrible disease and it's not just for the individual suffering, but for everyone around her. And I want to spare my family as much of that as I can.

REHMTell me about your family.

LAPLANTEAgain, I promised them that I would -- that the book was not about our mother and that I wouldn't violate our family's privacy, so I want to start with that. But we're a large Irish Catholic family, there's eight kids. I'm -- six girls, two boys, I'm number two. And except for I ended up in California and one of my brothers ended up actually here in D.C., everyone else just stayed in Chicago, stayed very close to home. So they're all there.

REHMThe toll on family in your novel "Turn of Mind" is very serious. But you have a division between Fiona, the daughter, Mark, the son. Talk about that division.

LAPLANTEThey've never really gotten along because they're such different people. Fiona is just a dynamo, a very intelligent, highly ambitious. She's already a full professor of finance at the age of 24. Mark, her younger brother, is -- no, I'm sorry, her older brother is an attorney like his father and does okay, but he's rather weak in spirit and has some other problems. And so...

REHMWhat kind of a job does Fiona hold down?

LAPLANTEShe's an academic. She's a professor in economics at the University of Chicago. And like I said, Mark's a lawyer. And they just don't see eye-to-eye on anything. And then the stress of the disease has just increased their conflict.

REHMThere is also money involved.

LAPLANTEThere is money involved. There's a great deal of money involved, money that Jennifer doesn't know where it came from herself. She gets these bank statements and they puzzle her. Fiona, who took over power of attorney, financial power of attorney about a year prior to the book opening has full power to write checks, to move money around and she's, in fact, very good with money.

REHMBut Mark wants power of attorney.

LAPLANTEAnd Mark would like the power of attorney because he would like the money. It's -- so there's that thread in the book as well.

REHMThere's more than $2 million involved at least.

LAPLANTEYes.

REHMThere are doctors' bills, lawyers' bills, $50,000 moved to pay for an attorney for which Jennifer is not even aware.

LAPLANTEYeah, that's right. There's a lot of financial finagling going on and it's a little fuzzy what the situation really is. Jennifer trusts Fiona.

REHMDoes she trust Mark?

LAPLANTEAnd she does not trust Mark.

REHMAlice LaPlante, her book is titled "Turn of Mind." And you're listening to "The Diane Rehm Show." We're going to open the phones, 800-433-8850. Send us your email to drshow@wamu.org. Let's go first to Marathon, Fla. Good morning, Chris, you're on the air.

CHRISHi, Diane, I am a nursing home nurse and I've seen, of course, an awful lot of patients going through Alzheimer's. I've also taken care of some in home health. And one of the things that you were talking about was the aggression that we see. And my working theory is this, that at a certain point, they don't know where they are, they don't know who the people around them are, they don't know what you're trying to get them to do 'cause I often see this come out when we're trying to give them a bath, change their diapers, try to take them to an activity or whatever.

CHRISAnd in a sense, if you're completely surrounded by strangers in a place you don't know and they're trying to get you to do something you don't understand, the aggression is a little bit more understandable, that they're lashing out against these -- the circumstance they find themselves in. They're lashing out against the unknown and the scary features that are going on. And I don't know what the actual neurological explanation is, but that's my working hypothesis.

REHMInteresting.

LAPLANTEI think that's a very astute observation. And one of the things I try to write into the part of Jennifer, as I put myself in her mind, was just try to understand how terrifying it must be. And you're absolutely right, you know. Quite an understandable reaction to that terror would be aggression.

REHMPutting yourself into Jennifer's mind is -- had to have been a difficult task.

LAPLANTEA lot of people say that and my closest friends say, how did you do this? It must've been so difficult. And I -- it wasn't. It was very cathartic to do it. It was exciting. I enjoyed the process because I just sunk into that mindset and I was learning so much.

REHMLearning about yourself, learning about others?

LAPLANTEYeah, I think both. You know, there's the famous Flaubert quote, Madame Bovary c'est moi, Madame Bovary is me. Well, you know, every time I write or create a character, they're exploring their own internal psyche in some degree. And so there was that part of it and then there was the part, of course, of having wondered for nearly a decade what my mother might be feeling.

REHMTo Alexandria, Va. Good morning, Paul.

PAULGood morning, Diane. This is killing me 'cause it's part of my own memory, Irish Catholic Italian family. I was caregiver to both my parents that had dementia. And one January day, I was -- had to empty the trash or something. We have two locks on our door, one with a key that I had and I must have not locked the door immediately after emptying the trash and my father, who was a survivor of the Chosin Reservoir, the Chosen Few in Korea, in his bare feet walked out, went down 16 floors and was walking around the complex in his bare feet in, you know, the middle of winter and it's...

REHMMust be...

PAUL…fortunately security...

REHMYeah.

PAUL...found him and he came back with his -- he was hurt on his feet 'cause the cold...

REHMOh, sure.

PAUL...and, you know, inadequate and terrible.

REHMYeah.

PAULBut there are good things that are going on in research. And, you know, there should be more funding and we did get that into a dementia longitudinal study at Johns Hopkins.

REHMI'm glad for that, Paul, and I'm sure listening to this brings lots of feelings to the fore for a great many people. That's what good novels do. And we'll take a short break here from Alice LaPlante's novel "Turn of Mind."

REHMWelcome back. Alice LaPlante is with me, we're talking about her brand-new novel, it's titled "Turn of Mind." And the individual at the center of the book who is doing most of the talking has Alzheimer's disease. Alice LaPlante's own mother has Alzheimer's and she, Alice, is quick to point out that this is in no way a biography of her mother. In fact, not only her mother, but her grandmother, her aunt all have had Alzheimer's. And Alice is currently considering, and perhaps has already decided, to have a test whereby she can learn whether several decades down the road, she may be headed for the same thing. I'm going to go back to the phones to Linda in Williston, Ohio. Good morning to you.

LINDAGood morning and thank you. This touches me very deeply because my mother is one of eight children and at least five of them -- of her siblings, including Mama herself, have had some form of dementia. Four of them we have had diagnosed as Alzheimer's. And it's -- with that kind of numbers -- I said four, five, plus Mama -- with Mama. With those kinds of numbers, we are -- all the cousins have to be looking with terror every time we can't think of the right word or wonder if we've remembered something correctly and yet I've never heard of any type of discussion among the family members about who -- does anyone know if Grandpa was diagnosed properly? Does anyone know if this happened? Was there -- has anyone looked into research or diagnostics?

REHMWell, of course, the problem up until now has been that there has not been an accurate diagnosis until a post-mortem has been done.

LAPLANTEThat's correct. It's -- that's why you hear it -- you hear people have dementia. That's the kind of the big overall umbrella diagnosis. And to get an actual diagnosis of Alzheimer's, it involves a list of -- a check-list of things have to be in place and I can't think of them all. Diane's absolutely right, The only definitive diagnosis can come after death with a brain...

REHMBut now...

LAPLANTEBut now there's apparently this test, yeah. But, you know, you said something that was -- that I really relate to and it's obviously the fear every time you forget your cat's name, is it happening to me? But also -- and this has come up time and time again in our discussions as I tour the country. People who have it in the family talk about the lack of a social infrastructure for dealing with this disease. We're only beginning to come into terms with it. And it's -- the numbers are very, very frightening about what's ahead. But in terms of having doctors who can do the diagnosis efficiently and effectively, places who can treat our loved ones and all the way to the financial implications, which are enormous.

REHMIndeed. Thanks for calling, Linda. And to Glen Burnie, Md. Good morning, Laura.

LAURAGood morning, Diane. A wonderful show, as always.

REHMThank you.

LAURAI wanted to call because your guest was talking about tests. And three years ago my father died and he didn't die from Alzheimer's, per se. I mean, he was 97 years old, God bless him, but, you know, he wasn't the man that, you know, he was. And I wanted to see -- and I don't want to speak for Dr. Fotuhi. I'm talking about Dr. Majid Fotuhi in Baltimore, he's a noted neurologist. And I went to see him because I wanted to know. And he had me go through two sets of tests, one gross neurological, you know, where you close your eyes and touch your nose, walk on your toes, walk on your heels, that kind of thing.

REHMSure, sure.

LAURAAnd another one where you are given a bunch of words to remember and then like a half hour later, they ask you to repeat them.

REHMRight.

LAURAAnd I scored 30 out of 30 and he said, I can guarantee that you're not going to get Alzheimer's, but he said, but I cannot guarantee that you won't get demented unless you take care of yourself, eat properly, exercise and that kind of thing. And he also published a book with Will Shortz, the editor of The New York Times crossword puzzle, which he considers to be the gymnasium for the mind, doing crossword puzzles.

REHMYeah, I think a lot of people talk about crossword puzzles, other kinds of challenging exercises for the mind to try to help keep it in shape. Do you do a lot of those, Alice?

LAPLANTENo, I don't.

REHMYou don't. You don't.

LAPLANTEI should, but I don't. I read a lot. (laugh)

REHMYou read a lot.

LAPLANTEYeah.

REHMWell, I think that's part of keeping the mind informed. Let's go to Cleveland, Ohio. Good morning, Heather.

HEATHERGood morning. Thank you, Diane. I love your show.

REHMThanks.

HEATHERIt's the best on the radio. But my question has to do with gender roles and caretaking of the parents who are ill. I've seen -- I have several friends and family who have Alzheimer's or other extremely debilitative diseases. And I'm wondering -- it sounds like Mark is the bad character and Fiona is the good character, but I'm -- I don't like to simplify it that much, especially in a situation like this. In your own personal experience and in the experiences of other people that you've seen, have you noticed a difference in who winds up caregiving, the boys -- the men or the daughters?

LAPLANTEOh, boy. You know, I don't feel qualified to answer that. I know in my own family, my father is the hero. Oh, he's -- we -- oh, he's amazing. But I think a lot of times, especially 'cause women live older, they fall into the caregiving roles, but I don't have any statistics for you.

REHMI think that more often it does become the female of the family who takes on that role. But as you say, you consider your father a hero. Sounds to me as though he's taken awfully good care of your mom. There's yet another spot in the book that you might want to read. It starts in the middle of page nine.

LAPLANTEI should say that one of the things that -- I deliberately put some humor in the book and that surprises people, but it's a sort of situation where you have to laugh because the alternative is too grim. So this is what I would consider a little lighter, at least part of it. "I belong to an Alzheimer's group." This is Jennifer speaking, of course. "People come and they go. This morning, Magdalena says, 'it's an okay day, we can try to attend.' The group meets in a Methodist church on Clark, squat and gray with clapboard walls and garish primary colored stained glass windows. We gather in the fellowship lounge, a large room with windows that don't open and speckled linoleum floors baring the scuff marks of the metal folding chairs.

LAPLANTEWe're a motley crew, perhaps half a dozen of us, our minds in varying states of undress. Magdalena waits outside the door of the room with the other caregivers. They line up on benches in the dark hallway, knitting and speaking softly amongst themselves, but attentive, prepared to leap up and take their charges away at the first hint of trouble. Our leader is a young man with a social work degree. He has a kind and ineffectual face and he likes to start with introductions and a joke. 'My name is I forget and I am an I don't know what.' He refers to what we do as the two circular steps. Step one is admitting you have a problem. Step two is forgetting you have a problem.

LAPLANTEIt gets a laugh every time from some because they remember the joke from the last meeting, but from most because it's new to them no matter how many times they've heard it. Today's a good day for me. I remember it. I would even add a third step. Step three is remembering that you forget. Step three is the hardest of all. Today we discuss attitude. This is what the leader calls it. 'You've all received this extraordinarily distressing diagnosis,' he says, 'and you're all intelligent educated people. You know you are running out of time, so what you do with it is up to you. Be positive. Having Alzheimer's can be like going to a party where you just don't happen to know anyone.

LAPLANTEThink of it, every meal can be the best meal of your life. Every movie, the most enthralling you've ever seen. Have a sense of humor,' he says, 'you're a visitor from another planet and you're observing the local customs.' But what about the rest of us for whom the walls are closing in, whom change has always terrified? At 13, I stopped eating for a week because my mother bought new sheets for my bed. For us, life is now terribly dangerous, hazards lie around every corner.

LAPLANTESo you nod to all the strangers who force themselves upon you, you laugh when others laugh, look serious when they do. And when people ask, do you remember? You nod some more or you frown at first and then let your face light up in recognition. All this is necessary for survival. I'm a visitor from another planet and the natives are not friendly."

REHMAlice LaPlante reading from her novel "Turn of Mind." Is there in Jennifer a sense of shame?

LAPLANTEOh, deep shame. Deep, deep shame. I'm not sure where the root is in her character, but when she comes and goes and comes to herself after an episode and understands what has happened, she's just so mortified. She has so much personal dignity that it's -- that's very traumatic for her.

REHMShe feels as though sometimes she's being treated like a dog.

LAPLANTEYes. And again, that kinda goes with the territory of someone who comes in and out of a competent state. If you're treating them like they don't know where they are and they don't know what to do and they don't know how to eat and then they snap out of it, they're going to be insulted. It's a very volatile relationship between caregivers and patients.

REHMAnd you're listening to "The Diane Rehm Show." On that very subject, let's take a call from Severna Park, Md. Good morning, Diane.

DIANEGood morning. Mentioning volatility, I am a caregiver and works with patients that have Alzheimer's and dementia and there's so much turnover in that field because of the degree of aggression, of, you know, flat out violence perpetrated upon the caregivers. And we do our very best to be as understanding with the individual. But in this state in particular, caregivers are not allowed to have a self-defense. They're not allowed to defend themselves even when the patient is hitting them and harming them and hurting them substantially. And as a individual that experienced that recently, I didn't know if you have included that information or have references to that in your book, so what your comments would be about that.

LAPLANTEOh, boy. You know, I had no idea about the legal aspect of it. It just never occurred to me, but that's incredible. That makes it even a more difficult role. I have so much respect for caregivers like yourself.

REHMDiane, when you say that you're not permitted even to defend yourself, I have a hard time understanding that.

DIANESo did I and so did the Maryland state attorney that recently handled my case, but that is how it is here in Maryland with Maryland Department of Aging and various departments that fall under that healthcare banner for them. You just are -- you must take the abuse. You are not allowed to push the patient, strike the patient, you know, move the patient out of your way in any sort of manner and you're not able to always control that. It is totally up to the employer and they will fire you. And if you have a contract with the state, for Medicaid patients, for example, I was terminated for that very reason. Many apologies from my employer, but unfortunately, this is what happened to me.

REHMHow common is the aggression, Alice, in patients with dementia?

LAPLANTEI'm not a neurologist and it doesn't happen to everyone, but it's a common enough factor. There's even a term for it because so many of them, it happens in the late afternoon, early evening. It's called sundowning. And it's just a phenomenon that's been noticed that they get very agitated and I absolutely believe that there can be physical violence and injury to caregivers.

REHMYou know, I think we must mention that you published your first novel here in your 50s, you taught writing for 21 years and you've written books on writing. What about the rules that you set down for others that you had to follow yourself?

LAPLANTEThat's interesting. Well, let's not call them rules, let's call them conventions and techniques, but, yeah, it was -- let's just take the example of an unreliable narrator, putting -- telling a story from the point of view of someone who can't be trusted, the reader can't trust him or her, is a time honored technique and it is a technique and there's a lot of craft based tools that we have as writers to make it possible to do that. And I'll just give you one example 'cause I know...

REHMWell, someone has wondered whether you were influenced by Faulkner's "The Sound and the Fury" on that very point.

LAPLANTEYou know, he's a -- he gives -- yes, Benjy in "The Sound and the Fury." I learned from Faulkner about his mastery of getting a story told.

REHMAnd you told this story well, Alice. Congratulations.

LAPLANTEThank you so much.

REHMAlice LaPlante, the book is titled "Turn of Mind." Thanks for listening, all. I'm Diane Rehm.

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