Dementia at the Opera: The Lion's Face

Backgrounds and Fundamentals

The Lion's Face is an opera about Alzheimer's disease, with music by the Russian composer Elena Langer, a graduate of the Moscow Tchaikovsky Conservatory and London's Royal Academy of Music, and libretto by the award-winning poet, dramatist, and novelist Glyn Maxwell.¹ The opera engages with dementia, and the treatment of and research into dementia, from the perspectives of a patient, a relative, a caregiver, and a clinician-scientist. It was premiered at the Brighton Festival in May 2010 and closed its initial run with a series of performances at the Linbury Studio of the Royal Opera House at Covent Garden, London.

The title is taken from John Bayley's memoir of the novelist Iris Murdoch, in which "lion's face" is represented (erroneously) as a clinical term, because "the features [of Alzheimer's sufferers] settle into a leonine impassivity."² In this view, the sufferer's face becomes a mask indicative of an absence. There may also be resonances of the observer's fear of an illness that, through the disintegration of memory, strikes at the continuity of personality fundamental to the human sense of identity.

The opera was commissioned by The Opera Group (London) and developed with medical input from Professor Simon Lovestone and his colleagues at the Institute of Psychiatry, King's College London, and the Biomedical Research Centre for Mental Health at the South London and Maudsley National Health Service Foundation Trust, UK. Through the Institute of Psychiatry, Elena Langer and Glyn Maxwell were given access to researchers, clinicians, and care workers, and to a particular Alzheimer's sufferer in her late fifties, with whom they discussed her condition. Public showings of sections of work in progress, including at the Royal Institution of Great Britain in 2009 and the Brighton Science Festival early in 2010, also allowed responses from the scientific and medical communities and from the general public, including people directly affected by the illness, to be fed into the work's evolution. The health care professionals involved often saw arts portrayals of psychiatrists as characteristically either godlike or demonized, and they wanted a presentation that was more neutral. Beyond this, the broad aim actuating the engagement of the scientific and medical communities was to contribute to the public understanding of Alzheimer's disease. By so doing they hoped to reduce the stigma attached to the illness that may prevent early treatment and compounds the difficulties inherent in being a caregiver, and to foster the cultural awareness that underpins the needs of research.

Scenario and Characters

Central to the opera is the Alzheimer's sufferer, Mr. D, a patient in a care home whose dementia has reached an advanced stage. While the case of Mr. D is presented specifically, he also assumes a representative status. Certain typical problems are made to arise, particularly language dysphasia (partial aphasia) and the sufferer's inability to recognize himself in a mirror (autoprosopagnosia), because he thinks of his appearance as he was when young. Mr. D is a speaking role: his speaking amid everybody else's singing is a way of representing the gulf between him and the other characters, and his alienation from what, in an operatic context, is the normal discourse. It may also help the audience to identify with Mr. D: his mode of expression is theirs.

Around Mr. D are four other characters, all individuals but all also representing typical responses to his condition, and all defined by their relation to Mr. D. They are his wife, Mrs. D; a Clinician-Scientist, for whom Mr. D is both a patient and a research subject; a Nurse, Mr. D's Caregiver; and the Caregiver's Daughter (who is in the care home illicitly because of an enforced day off school caused by a snowfall, and so has to be kept hidden by her mother). The three women are somewhat conventional figures: the daughter representing youth—neither trammeled nor informed by preconceptions, encountering and making sense of new experiences; the nurse, middle age—working, with responsibilities; the wife, old age—witnessing or experiencing ill health and...