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Lynn Casteel Harper

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The Spiritual Implications of Dementia

Posted: 07/13/10 02:23 PM ET

The morning my grandmother suffered her life-ending stroke, my grandfather, after trying to rouse his wife of 65 years, went outside and mowed the lawn. On the morning of her funeral, he refused to shower. A few days later, passing by her picture, he stated, "I haven't seen that woman in a while."

He wasn't calloused; he was confused.

My grandfather is among the millions of people who have dementia, and my grandmother was one of the many family caregivers who predecease their sick partners. I am among the growing number of intimate bystanders who know and love someone with dementia. I also happen to work in a skilled nursing facility as the chaplain to many residents with some form of dementia.

Eloquence is irrelevant: dementia sucks really bad. Dementia defies platitudes and niceties; however, it does not defy meaning and life.

The truth is, we are all one tick away from terror and triumph, from exultation and annihilation. In a nanosecond, your carefully calculated savings can be multiplied or drained, your health decimated or restored.

We -- particularly those of us with a measure of privilege -- spend a great deal of time and energy convincing ourselves and everyone else that because we're better informed, better prepared, and generally better than most other folk, then we will avoid diminishment, dependence, death.

A dirty secret: we will make good worm food just like everyone else.

If we live long enough and if we haven't already experienced some disability of body or mind, we most certainly will. We do not choose what form our disabilities will take -- arthritis for some, Alzheimer's for others. Rain pelts the heads of the righteous and the unrighteous.

Human vulnerability is made no more terrifyingly visible than in those people with dementia. My grandfather -- the pilot, the physician, the jazz musician -- now cannot tie his own shoes. This might be you or me, tomorrow or in 20 years.

Confronted by our own mortality and limitation, we who are witnesses to persons with dementia often recoil in shame and embarrassment, yet there is another response. We can embark on the journey toward acceptance, maybe even celebration, both of oneself and of the person with dementia.

The nonlinearity of time that accompanies dementia is the source of much anguish for caregivers who bemoan, "This is not my dad!" The implication being that the person is no longer the caregiver's "real" dad or mom or spouse or friend. The "real" person is the past person. Who, then, is the person before us now? Simply the "ruined" version of the "real" person?

Dementia forces us to grapple with the reality that no one is a fixed entity -- not you, not me, not anyone. (Who among us is the same person we were at 18 as we are now?) If we consult the prophet Jonah or check out Moses' negotiations with God, we must also consider that even the Creator is not static, that even God may change.

What if we begin to conceive of God as abiding, dynamic presence rather than distant, rational ruler? A God who is just as present to the post-dementia person as to the pre-dementia person? A God whose relationship with the person changes as the person changes?

If, eternally speaking, the person is no more or less "real" today than she was 30 years ago, then perhaps the "real" problem is our inability as bystanders to offer our presence to the post-dementia person.

No doubt, opening ourselves to a person with dementia, with their puzzling and sometimes jarring responses to the world, is a herculean task. When I spend time with individuals with advanced Alzheimer's, I can expect no ego-stroking return on investment, no affirmations of a job well done.

Offering one's presence to a person with dementia means letting go of our need for rational interchanges, direct social cues, logical conclusions. It often means letting go of words altogether and entering entirely into the realm of affect and intuition.

My grandfather may not recognize me when I visit, but he can intuit care and love. He can feel my hand holding his and know, in a place beyond words, what this touch means.

In the struggle to understand what it means to be human with dementia, we need the contributions of those who regularly traffic in the spheres of the intuitive and ineffable, who understand the value of someone as transcending linear, hyper-rational formulations of identity. This is why we so desperately need the wisdom of poets and painters, dancers and drummers, sculptors and singers.

We who are people of faith must sit at the knees of our mystics, those teachers of the cloudy realm of unknowing. We need the insight of these prophets -- who point us toward different ways of knowing and experiencing the world, one another, the holy -- every bit as much as we need good doctors, drugs, and living wills.

Eve, a resident on our fourth-floor dementia unit, reaches out both arms toward me as I walk by. (She doesn't know me from Adam.) She takes and squeezes my hands hard. I ask how she is doing, but I can't understand her jumbled response. She then kisses the back of my hands, holding them to her face. "I love you," she declares. She won't remember me once I walk away. In this moment, she is -- and I am -- here. I smile. There's nothing to say.

 
The morning my grandmother suffered her life-ending stroke, my grandfather, after trying to rouse his wife of 65 years, went outside and mowed the lawn. On the morning of her funeral, he refused to s...
The morning my grandmother suffered her life-ending stroke, my grandfather, after trying to rouse his wife of 65 years, went outside and mowed the lawn. On the morning of her funeral, he refused to s...
 
 
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09:46 AM on 07/30/2010
Great article on being in the moment with dementia. The rewards are sweet.
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alineobrien
Aline
05:00 PM on 07/23/2010
Speaking as a Pagan, and also as someone who has experienced dementia in the elders of her family, I appreciate the spirit of compassion in this article. I especially appreciate such notions as "we need the contributions of those who regularly traffic in the spheres of the intuitive and ineffable, who understand the value of someone as transcending linear, hyper-rational formulations of identity. This is why we so desperately need the wisdom of poets and painters, dancers and drummers, sculptors and singers."

We need to honor these qualities more in all spheres of life, not just when someone is suffering from dementia.
09:59 AM on 07/21/2010
Won't ever understand as long as I exist where gods fit into these pictures precisely. While dementia is awful, the logic behind anyone who believes in a god that allows it to take place for some cosmic pop quiz is easily one of the most absurd notions I have come across in my existence. Not only facilitates it, but arbitrarily assigns it to humankind after intentionally creating this device for suffering. All the education in the world on the matter does not change the fact that those actually enduring it should not be viewed as some sort of holy, educational tool.
09:42 PM on 07/22/2010
One other point to your spot on observation....

More people studying the science associated with the causes of demenia instead of wasting their time with supersttious nonsense might actually help solve this one day!
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09:45 PM on 07/20/2010
I have nothing to add here except old age and god are over rated.
07:02 PM on 07/19/2010
Diagnosed with this tragic disease we with Alzheimer,s Disease (AD) are placed in the direct imminence of our vulnerability. AD has changed our lives irrevocably.

With this paradigm shift you have these choices. Deny, try to walk around, or Accept it.! Denial produces the oblivion that it has to offer. To try a way around it doesn't work any better.

Acceptance provides the fulfillment of dealing positively with events over which you have no power to change. It is through this ultimate and final actuality that you can touch the spiritual propensity the iAD has to offer.

We are not of this world in which we dwell filling space through time. one word to define life is “purposeful.” We operate with purpose, probably assigned before, tasked for here, intended for harvest hereafter.

Recently I was amongst a group talking of others. The discourse was about wealth, having, receiving wishing for it.

I wondered What value in it?

Things material are illusory. The have no inherent value. Their good the frustration upon it finding it empty.

AD removes any question.

It is ultimately terminal, devastating preliminarily, and there is no going back. It is final, you are dying in slow motion. The beauty of this is being given all the second chances of doing something good with it starting with accepting it!

It is in fact the most wonderful second chance!

Mike Donohue
My Alzheimer’s Afterthoughts! http://im-mike.blogspot.com/
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04:30 PM on 07/20/2010
Thanks, Mike. Fanned. You should have a couple of million fans.
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01:01 AM on 07/17/2010
Many years ago one of the television newsmagazine shows did a piece on dementia. Among those interviewed was a woman whose husband had developed alzheimer's disease and had to be placed in a nursing home. She related that one night she had received a call from her husband. His voice, lost and frightened, said, [as I recall], "I'm lost and don't know where I am." The woman being interviewed said she tried to reassure him by saying, "Honey, it's all right. I know where you are." His response to her still sends a shiver down my spine: "You don't understand," he said. "I'm lost in the corridors of my mind."

That interview opened for me a new way of looking at dementia: It is not that the person has changed. The consciousness that was there never leaves, but it becomes trapped in a brain and body that can no longer communicate. From the outside it looks like the elderly man or woman with dementia is simply no longer the person he or she once was. But it may well be that on the inside, that person is still present and, like the prisoner locked in solitary confinement, can no longer express what he thinks or feels.

Oliver Sacks' book and the movie, Awakenings, tends to confirm this I think.

This means that consciousness continues even when the brain deteriorates. It suggests, rather strongly, that consciousness is distinct from the brain, pointing to a conscious Soul and Beyond.
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09:33 AM on 07/17/2010
I doubt that Oliver Sacks agrees with your conclusion. As the brain deteriorates, the portions of it that no longer function contain information necessary to piece together memory,speech and logic. As each piece falls away, the remaining parts function with the remaining information available to them, proportional to their remaining capacity. To the outsider, dementia appears illogical, but to the patient the thoughts make "sense" to them. And, as the condition progresses, and less of the brain functions, less memory and logic can be accessed. The conscious is nothing more or less than a neurological communication and interaction, not a separate entity in a dualistic world. One's last thoughts will be derived from the portions of the brain that cease to live last. As prepared as one might be for a full review of one's life and sins at death, also prepare for the possibility you will rethink a lousy golf game in 1983.
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04:59 PM on 07/20/2010
This thread in Religion could turn out to be an priceless collection of insights The question of who we are in the light of what is known about AD has long awaited a public outpouring of thoughts,
and here it is, today, in front of us. What you wrote here goes to the heart of the question
of the brain as essence vs. the brain as habitat. I'll do my best from memory, a well known, startling passage from Kashmir Shaivism's Shiva Sutras, comments on what you reported::

"Citi herself, descending from the plane of pure consciousness, becomes the mind by contracting
in accordance with objects perceived. Upon recognizing this, the soul turns inward and begins the
ascent back to the plane of pure consciousness."

Something like that. At any rate, an ancient sutra, coming from a Hindu sect that may have influenced Siddhartha, all but declares that the seat of ultimate consciousness is beyond the brain,
that the brain only focuses it. Don't ask me. I'm only reporting this news in support of this post,
in support of the implications of what the dementia victim said about the state of his mind as an object in which he was lost. He was not lost to himself, so it seems. I am 70, still lucid. But we all shudder, and we all hope. The Last Question is the question asked here. Whatever gets posted here should be saved, and the most significant contributions should be published.
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12:17 AM on 07/17/2010
Dementia does have a spiritual aspect when it brings those affected to other levels of consciousness. For my Mother, Alzheimer’s allowed her a level of comfort with herself as the illness progressed and released her of rigidity and was a form of growth. Her consciousness moved back to fond memories of childhood and family in the 1930’s and 40’s and all else was forgotten, even an unhappy marriage of 47 years. As a caregiver the demands were great and time always short but it gave a glimpse of the future we all face while experiencing the consciousness of the afflicted of which I knew little. The world we see only has the meaning we assign to it. In time all washes away and even relics in a museum are futile. The medical establishment was not well suited for this journey and that is one regret I have, along with reliance on family who could not see the value of this awful horrible burden.
12:34 AM on 07/16/2010
May God bless and guide all of those who face the perpetual devastating 26 hour day associated with the care of a person with any of a number of dementias..

And may good research someday lead to a cure.... In the meantime, be sure the caretakers also takes care of themselves...
10:38 PM on 07/15/2010
What an exquisite rendering of the association with dementia most of us have or will face. Having just lost one older friend to year three and my best friend now in year one, I can't emphasize enough the power of touch that was mentioned in this article; the tactile memory of love, friendship, honor and caring that exist within each touch, each embrace, each refusal to let go.

God bless.
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Cindbird
Using my head for something other than a hat rack.
08:26 PM on 07/15/2010
My father-in-law had dementia for the last 4 years of his life. He often thought I was his deceased wife and my sons, his grandsons., were actually my husband and his brother. However, dementia can also open a door to the past life of the person. I don't mean past life as in reincarnation. I mean the past memories of the patient. Memories which may have been lost before the dementia come back and the person has almost total recall. If we can sit with the person and allow them to just talk, listen to the memories pour out of their mind, we can learn so much about the person. Then when the point comes that they no longer can participate in life, we can still connect with the spark of humanity within. The simple act of holding a hand, rubbing their shoulder, this connects on a spiritual level. It returns, just for a second, the essential humanity with lies buried within.
05:43 PM on 07/15/2010
My parents are 88 and 80 and both have Alzheimers. Dad is clueless to his state by now though he still knows us, but Mom feels herself slipping away and is flustered when she can't say what she means.

Thank you for the insights that they are no less "real" today than ever and that I can be a loving, affirming presence to them even when the day comes that they see me as a stranger.

That said, as a "believer," I hope for a time when, in the fullness of our personalities and wit and love, we are reunited in the nearer presence of God.
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TheModernBunny
09:21 AM on 07/15/2010
"If we consult the prophet Jonah or check out Moses' negotiations with God, we must also consider that even the Creator is not static, that even God may change."

I think perhaps He does change. That He grows with time, just as we do. It would explain a lot if He did. Thanks you very much for your insight.
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StephenJK
All your consciousness are belong to us
06:25 AM on 07/17/2010
If there is anything true about the nature of the Universe (and of God) and reality is that it is a fractal so great in breadth, scope and complexity. Repeating patterns of ultimate unpredictablity. As "time" passes the complexities grow and become more and more beautiful. From spiral galaxies to you and I, the fractal continues to blossom and fold into itself revealing the awesomeness of all that is. In this, nothing remains the same. EVERYTHING, including all of us, is, A) unique and B) completely dynamic. From a blade of grass, to the spiral galaxies, all are in a constant state of flux. This is the awesomeness.
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Devon Chambers
05:25 AM on 07/15/2010
With dementia and really any mental illness there is always two victims; the actual person suffering fro m the disability and the caretaker (most often family members.) It may seem selfish but your life halts to a stop for the foreseeable future when you're having to deal with somebody with dementia. It has to be one of the most frustrating things in the world to deal with; living with it daily and volunteering to be around people with it from time to time are two completely different things.
06:53 PM on 07/15/2010
Yeah...somebody finally says it well. I stated earlier that it is one of the hardest jobs in the world to be a caregiver and can lead to an early death of the caregiver. I stated that there was research to back it up. The moderator would not publish it. This is not a spiritual issue. It is a horrible way to die.
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TobusRex
New Mexico
04:37 AM on 07/15/2010
Losing one's mind may seem a blessing, but it's more than a loss of intellect...it's a loss of identity. Frankly, it's the worst fate imaginable.
08:28 PM on 07/15/2010
This article reminds me of a dear old friend of mine who spent her last years in demetia. I would visit her twice a year 500 km away, and phone her once or twice a week at her nursing home. She never lost her identity: she was her pure loving self to the last. She'd blow me kisses like she always did, and she'd say "I love you" on the phone like she always did. At the time, I felt so sorry for her confusion with regard to things, places and persons - but in hindsight I realize the spiritual lesson: we are pure love. That's our identity, to some degree here, and more so in the life to come.
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capitaldysfunction
White male never voted Republican
02:28 AM on 07/15/2010
Although I haven't experienced it, I suspect the diminishing returns of being a caregiver are grossly underestimated. It sounds callous and unloving, but the sick and demented should be removed from your life to enable your life to continue.
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Ascoli
05:24 AM on 07/15/2010
You cannot be serious.
You cannot be so cruel.
You cannot be so unloving.
My My
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12:26 PM on 07/15/2010
I was going to comment directly to his post, but will hold my tongue.

Thank you for channeling my thoughts*
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capitaldysfunction
White male never voted Republican
09:31 PM on 07/20/2010
Next I pull the plug on you, Ascoli
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zlohcuc
"Serving millions from atop the Allegheny"
09:04 AM on 07/15/2010
Sound theoreticly but the game is already rigged by HCI...the costs for care are astronomical, many would be giving up their financial independence to institutionalize their afflicted friends and relatives. It's difficult to see this play out repeatedly in the lives of people that you love and care about.
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capitaldysfunction
White male never voted Republican
10:54 PM on 07/15/2010
Money is always the central focus of these decisions with most people. Suze Orman always recommends Long Term Care insurance. Thanks for recognizing I wasn't talking about taking these people out for their last walk in the woods.