Big Love: The Oath

Herpes Dementia on TV

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Big Love Season 5x4: The Oath

Big Love is the soap opera about a polygamous Mormon family in Utah that aired for five seasons on HBO. In the final season of the series, one of the issues the family had to deal with was the dementia diagnosis of Bill Henrickson's mother, Lois. Although the issue of dementia had initially come up in earlier episodes, it was in "The Oath" that her mental deterioration was linked to infection with herpes dementia.

Throughout the series, Lois had a tumultuous relationship with her husband, Frank, who had numerous other wives. One of the questions that was not addressed in the episode was whether his other wives should have been informed of the potential risk to their own health. In fact, the issue wasn't even brought up. That's unfortunate, and it also made the episode seem somewhat less credible than it otherwise might have been. Given the complex and tightly interlaced sexual relationships within the Juniper Creek community, one would expect herpes to be either epidemic or largely unheard of. An isolated case of disseminated herpes seems an unlikely occurrence.

I found the choice of herpes as the source of Lois' dementia to be an interesting one. The link between herpes and dementia is still new and somewhat controversial. Syphilis would have been a more obvious choice. However, a syphilis epidemic would also have been less likely to go undetected.

Utah has required syphilis testing before marriage since the 1940s.

In some ways, it's a shame that the show did not choose to go the syphilis route, instead of working with the more stigmatized but less relevant herpes diagnosis. Doing so could have brought up some interesting questions about the importance of social hygiene laws.

That conversation would have been particularly relevant since another theme of the episode was the lack of social and government services for individuals living on the polygamous compounds. That certainly includes a lack of state marriage oversight.

In addition, if Frank and Lois had been diagnosed with syphilis infections that were not detected earlier because they didn't need to apply for a state marriage license, it might have implied that syphilis was running rampant in the compound. That, in turn, could have explained some of the aberrant behavior that was commonly seen in Juniper Creek. A medical explanation of the insanity that went on there wouldn't have been an excuse. However, t would have been quite fun to see how they dealt with it.

I am tempted to say that, given the possibility of familial transmission of herpes and not of syphilis, the show probably made the right choice in blaming Lois' dementia on herpes -- except for one thing. A doctor might well test an individual with dementia for herpes, given the attention it has been getting in the news for the past several years.

However, the association is still tentative enough that I think they would be unlikely to diagnose herpes as the cause of dementia. This seems particularly unlikely in an area as socially conservative as Mormon Utah.

Finally, It's always interesting to see how television shows address the issue of older individuals having sex. The sexual issues brought up on Big Love are frequently difficult for its audience to empathize with - husband with multiple wives, wives that range in age over 40 or 50 years, forced marriages of young women. However, it is one of the few shows in which it is made quite clear that sexual activity continues throughout a person's life.

What the episode got right:

  • Herpes infection is associated with dementia - if tentatively.
  • Scientists have proposed a link between Alzheimer's and herpes infection.
  • It is possible to have herpes for years and not know it.

What the episode got wrong:

  • Herpes isn't necessarily sexually transmitted. It can also be transmitted through casual contact.
  • It is unlikely that a doctor would diagnose herpes as the source of someone's dementia, although it might be listed as a contributing factor.

Sources:

Honjo K, van Reekum R, Verhoeff NP. (2009) "Alzheimer's disease and infection: do infectious agents contribute to the progression of Alzheimer's disease?" Alzheimers Dement. 5(4):348-60.

(1945) "News From The Field" American Journal of Public Health 35:1244-52

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