The Last Road Trip / A daughter wonders: Is it possible to recognize the early signs of Alzheimer’s in a narcissistic parent?

“If I die, I want you and Jorge to rent a U-Haul and drive my body to Easton. The AAA can send you a TripTik.”

My father was eighty-four years old and living in northern Florida when he made this pronouncement to me and my husband. He was widowed and in fairly good health, apart from an enlarged heart. Easton, Pennsylvania, is where his family cemetery plot is, the place where we had buried my mother five years earlier.

I wasn’t thinking about the legal and logistical complexities of transporting a dead body over state lines when he said this. I wasn’t thinking about the inevitable fumes, although that did cross my mind a few days later.

I was fixated on a phrase, the sort of telltale detail that had kept me on alert for decades as the daughter of a narcissist.

“If I die.”

The bravura of that “if.”

The revelation that, consciously or unconsciously, my octogenarian father still entertained the possibility that death might make an exception in his case.

Several comedians, including Amy Driscoll and Michael Showalter, have remarked that growing up with a narcissistic parent is ideal training for a future comic. Your formative years are spent observing, in excruciatingly detail, the behaviors of someone whose self-worth knows no limits, who assumes the world revolves around them, whose conversations are peppered with grandiose statements, and who demonstrates a Teflon-like imperviousness to facts or to the opinions and needs of those close to them.

Humor, particularly irony, becomes your healing balm. It also serves as a cloak of invisibility during so-called conversations because, as you quickly learn, narcissists don’t find many things funny. And self-deprecating humor can defuse a narcissist’s anger, if you get your timing right.

And so you laugh bitterly to yourself and share an aside with sympathetic family members, if you have any. And you develop a lifelong habit of keeping one ear out for the narcissist’s next ridiculous assertion. Round-the-clock hypervigilance is essential. It ensures you won’t relax and inadvertently revert to a state of trust. That would entail — god forbid — taking them at their word, expecting kindness and respect, not getting it, and being hurt. Staying alert to every narcissistic “tell,” no matter how small, is the bedrock of an internal surveillance system that keeps you safe and relatively sane.

I heard “If I die” and did a mental face-palm. Then I joked with my husband about my father’s protean sense of entitlement: expecting his next of kin to personally escort his corpse nearly 1,000 miles for deposit in a final resting place (a scenario reminiscent of the ancient funeral processions accompanying the pharaoh’s mummy down the banks of the Nile to the Valley of the Kings); his presumption that we, two overworked people with full-time jobs and a school-age child, would have the vacation days and inclination to embark on such a macabre road trip. The chintzy details lent The Plan a curious and uproarious pathos: The DIY U-Haul truck — or was he envisioning a more economical trailer with a hitch? — the outmoded, spiral-bound TripTik, the suggested route highlighted in neon yellow.

I was so busy registering the cacophony of feelings The Plan evoked in me, I never stopped to consider: Was the man who had concocted it in his right mind?

Alzheimer’s is a degenerative brain disorder affecting 6 million Americans, including one in three people ages 85 and older. In its early stages, patients may have difficulty remembering conversations, events or names. Confusion, poor judgement, and behavior changes often come next

Narcissistic personality disorder is a mental health condition that endows someone with an unreasonably high sense of their own importance. It can be found in 0.5% to 5% of the population; exact figures are hard to pin down because many narcissists hide their condition. Symptoms typically include requiring constant, over-the-top admiration; feeling they deserve special treatment; exaggerating achievements; denying failures; denigrating the accomplishments of others: the list goes on and on.

Unlike a certain former U.S. president, my father was not a malignant narcissist. He was rarely cruel to others, only to me, whose early writing successes he resented. What he did do, on a daily basis, was alter the truth to flatter his self-image. He bragged, he invented, he claimed he did X when he didn’t , claimed he didn’t do Y when he did. When someone pointed out his embellishments or lies, he would insist, with affronted sincerity. that he was correct or, after an awkward pause, pivot to a non sequitur.

“Did you know that Sir Francis Drake died at sea?” he would blurt out, referring to the man he claimed, without evidence, was our long-ago relative.

Or “If you take vitamin C every day, you can live twenty-five years longer.”

Or — once in conversation with an astonished endodontist — “You know, the composer Wagner liked to wear women’s underwear.”

More than one person confided in me they thought my father might be “on the spectrum.”

For fifty years, I experienced my father as a person untethered from reality. Given his peculiarities, how was I supposed to recognize the symptoms of his Alzheimer’s when they reared their Cerberus-like heads?

About two years after my father unveiled The Plan, he was diagnosed with “moderate, advancing Alzheimer’s.” Stunned, I spent months trying to unravel when his dementia had begun. Was it after my mother’s death, eight years earlier, when he started drinking in the mornings? Five years before that when he began stockpiling vitamins, filling the shelves of a bedroom closet with bottles from Puritan Pride? Was it in his late fifties when he disowned me for becoming a writer — or his sixties when he tearfully claimed that never happened?

“When did the narcissism end and the cognitive decline begin?” I scribbled on a notepad I kept on my nightstand.

It was unknowable.

My husband and I cared for my father for eighteen months after his diagnosis until he died of a heart attack in 2012. Since then, I have felt a quiet kinship with caregivers to family members with dementia. They move through the world with an invisible, ever-accumulating weight on their backs. Each day is full of hard labor and sorrow and strangeness, so much strangeness. At times, your loved one’s unhinged behavior makes you double over with laughter, but these are not anecdotes you can share at the office or on social media, no matter how cheerfully you spin the events.

I let my father eat at the dinner table with us again, and he peed in the salad bowl!

He punched me in the eye while quoting “The Wasteland”!

He says he’s dead. Jorge and I are dead. Everybody is dead. Fun times in the Upside Down!

Having a narcissistic parent kinks your sense of humor. You don’t laugh at what’s obvious or what’s witty, necessarily. You laugh at the gulf between what should be and what is. Adding dementia winds the screw another quarter turn. Irony upon irony. Tears upon tears.

Only the child of a demented narcissist would notice that ludicrous, misshapen rose blooming in the dark center of existence and smile, barely. A twitch.

I have met many family caregivers since I left the Upside Down twelve years ago. I have yet to meet someone who admitted to caring for a narcissist with dementia. I think I would like to meet them. Maybe.

We would have so much to say to each other and no urge to say it.

All we would need is some discreet, private sign, the equivalent of a Masonic handshake, so we could recognize each other. Preferably at a distance — on an open highway, say.

A nondescript sticker affixed to the car’s passenger-side front window. (I am open to design suggestions.)

Once we spotted one another, we could raise our hands in a salute/benediction/gesture of futility.

Then we could drive side by side, ignoring each other, in bleak companionability. Our budget 8’-by-4’ trailers and their complicated contents rattling behind us.

On the seat beside us, the gilded papyrus of an obsolete TripTik propelling us forward.

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Barbara Drake-Vera is a former ambassador for the Alzheimer’s Association. A journalist and teacher, she lived for seven years in Lima, Peru, where she brought her father with Alzheimer’s for an experiment in eldercare abroad. She describes that transformative experience in her new book, Melted Away: A Memoir of Climate Change and Caregiving in Peru (LSU Press, March 2024).