Remains of the Brain’s Day – a Christian’s Perspective on Dementia

Dementia is one of the hardest afflictions of old age, both for the sufferer and their carers. When our bodies are sick, we can call upon mental resources to help us cope. The essential person remains the same. But when the mind is lost, it is our very self that is decaying. When Ronald Reagan announced that he had Alzheimer’s Disease (AD), he said: ‘I now begin the journey that will lead me into the sunset of my life’. Watching a relative or friend suffer from AD is a terrible experience, and for Christians it raises many questions. Why has my godly father become so aggressive? Are the outbursts of anger the real person, hidden hypocritically all these years?

There are no easy answers to these questions. But we can begin to understand a little, by knowing something of what goes on in dementia, and reminding ourselves of some basic biblical facts.

Dementia is ‘an irreversible and serious decline in cognitive performance, more than would be expected given the age or circumstances of the person’. The biggest cause of dementia is Alzheimer’s Disease, and dementia is the biggest drain on our health services. All dementias are the result of massive loss of brain cells in specific parts of the brain. Scientists are beginning to understand what causes this loss, but there are far more unanswered questions yet to be solved, and we are a long way from a cure.

The Bible is a sufficient guide to living a godly life, and therefore contains all we need to know to help someone with dementia, and perhaps even to help us should it happen to us. To my knowledge, the Bible says nothing directly on what we would call dementia (the case of Nebuchadnezzar was reversible, and was clearly a temporary judgement of God with prophetic purposes), so we must use ‘good and necessary consequence’ to try to deduce how we should react to AD.

The believer with dementia is still a child of God
One aspect of dementia is a change in personality. Someone who was once a mild-mannered, gentle saint now uses words and does things that would shock any decent person. Sometimes this is the failure of the mind to suppress erratic, sinful thoughts. In life, we (either under the Law or under the Gospel) deny (or at least should) ungodly thoughts. This requires active suppression and inhibition. As the brain deteriorates in AD, the censoring mechanisms break down. The person now no longer has the physical capacity to suppress certain actions, in the same way that a person who has lost his legs cannot walk. The bad words and bad deeds are still sinful, but the capacity to resist sin has been taken away as part of the extended dying process that we call dementia. This should not surprise us, as it is central to our belief as reformed Christians, that the sinner has lost the ability completely to stop sinning.

AD is an affliction and afflictions do not affect one’s standing with God. If an elderly person was ever a Christian, whatever behavioural changes they have, whatever deeds they do as a manifestation of AD, do not cause them to lose their salvation. It is, of course, possible that they were never converted, and pretended all their life that they were, and that the loss of inhibition that is part of AD uncovers the deception. On the other hand, all believers retain a fleshly nature which, by grace, we are to subdue. In my view, it is possible that brain decay might cause a loss of some voluntary capacity, including that part of us which has been taught to deny ungodly lusts. When we see a praying mother utter terrible words or ideas, we wonder which of these scenarios is true. However, much as it might cause us worry, we are not the final judge of such things. It is also worth remembering, that in the early stages of the disease there remains some intermittent lucidity, and the affliction of AD, like all afflictions, may be used of God to bring the person to a saving sense of need.

We have a duty to care for and respect the elderly
AD is an affliction affecting people, mostly (but not entirely) older people. We are duty-bound to respect older people: the Scripture does not qualify rising in the presence of the healthy hoar head only. We are required to love all men, especially (but not only) them of the faith. But the elderly, whether afflicted with dementia or not, deserve our particular care. The efforts of those who care for people with dementia, whether at home or in care homes, are very much to be applauded and they need much grace to continue loving those under their care.

Neither this man sinned nor his parents
We sometimes entertain the foolish thought that if someone is severely afflicted, especially in mental health, that they are being punished for something they have done. Death and disease are indeed the result of sin, both federal (i.e. in Adam) and individual. But when a person is sick, we do not know whether it is a visitation upon a specific, personal sin (whether in judgement or for loving correction), or whether it is the ‘reward’ we all inherit federally as members of Adam’s race. We therefore cannot conclude the affliction of AD reflects upon that person’s character. Rather, we should take it as a warning to ourselves, reminding us of what we all deserve as natural enemies of God. The Puritans often remarked that all sin is a form of madness, so affliction with dementia would be a just desert for all of us.

A rational response to an irrational world
Many things that are done by the mentally ill look very odd to us, but can make sense to the person given the strange world they find themselves in. If a person is suffering the delusion that there are snakes in their bed, it is perfectly rational for them to refuse to get into that bed. If someone is convinced you are reporting all their words to the Government, it is quite rational for them to refrain from talking to you. The actions of mentally ill people are often a rational response to a world that has become irrational. AD patients may accuse you of stealing from them, but that is because they have forgotten that they themselves have moved the object they have lost.

We have to remember that the forgetting that happens in dementia is different from normal forgetting. When you or I forget something, we are usually aware that we have forgotten it. Personally, I can’t remember all the calculus I learnt at school. But I am fully aware that I have forgotten it, and I perceive the gap in my memory. But with dementia, even the gap isn’t there. Now, the brain is very uncomfortable with things not making sense, and is constantly making every effort to make consistent sense of what it sees. If there is a ‘hole’ that doesn’t make sense, the brain will carefully fill around that hole without you even being aware of it. That is how so many visual illusions work. Many of the things AD patients deludedly think are actually the remains of the brain trying to make sense of what is going on – that is the brain’s job.

We very much hope that one day there will be a cure for Alzheimer’s Disease, Parkinson’s disease and other causes of dementia. The research effort into understanding dementia is increasing but has a very long way to go. Even in a sinful world we would hope to die ‘an old man, and full of years.’

Taken with permission from Perception, Winter 2010, edited by J. R. Broome.

jrbroome@talktalk.net