This book calls Christians to respond to dementia in a way that offers the best care to patients, honors the inherent dignity of all people, and brings glory to God.
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About the Author
John Dunlop (MD, Johns Hopkins University) serves as an adjunct professor at Trinity International University and practices geriatrics in New Haven, Connecticut, where he is affiliated with Yale School of Medicine. Dunlop is the author of Finishing Well to the Glory of God: Strategies from a Christian Physician and Wellness for the Glory of God: Living Well After 40 with Joy and Contentment in All of Life.
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Finding Grace in the Face of Dementia
By John Dunlop
Good News PublishersCopyright © 2017 John Dunlop
All rights reserved.
God and Dementia
I hate dementia. When I saw it developing in both of my parents, it was hard to see these beautiful, loving people incapacitated by the changes in their minds, even though their dementias were not the worst cases I have known — not by far. But even while I lament this tragedy, I am still totally convinced that God is both good and strong and that dementia was in his plan for them. One of my favorite psalms puts it like this: "Once God has spoken, twice I have heard this: that power belongs to God, and that to you, O Lord, belongs steadfast love" (Ps. 62:11-12).
In his love God was able to prevent their dementias but chose not to. How am I to respond? Is he really not as good or loving as I had thought? Is he not strong enough to control dementia? I know these are valid questions to ponder; perhaps you are asking them yourself. When I confront such challenges, I have learned that I have to go back to the very basics of my faith and begin to see my struggles in the full light of Scripture. Granted, we will not find in the Bible any mention of dementia, but we do find some enduring principles that help us understand this disease and allow us respond to it in God-honoring ways.
God Has Purpose in All Things
One of those principles is that God has a purpose in all that happens. He never makes mistakes. As we face dementia in ourselves or loved ones, we can identify with the psalmist who wrote, "I cry out to God Most High, to God who fulfills his purpose for me" (Ps. 57:2). Even while recognizing that God had a purpose in what he did, the psalmist still cried out to God in his need. The more we get to know God, the more we can trust him, even when we may not understand why he does what he does. I love what Paul says: "Oh, the depth of the riches and wisdom and knowledge of God! How unsearchable are his judgments and how inscrutable his ways!" (Rom. 11:33). Once we recognize that in his infinite wisdom he has a purpose in dementia, there is no problem affirming his love and power.
Life Is Not about Us but about God
The second underlying principle we must take from Scripture is that fundamentally our lives are not all about us but about God. "In the beginning God ..." (Gen. 1:1). That is where we have to start. Before anything else, God was there. He alone exists simply because he exists. He was primary; everything else was secondary. He was Creator; everything else was created. He introduced himself to Moses as "I Am" (Ex. 3:14). He gave no explanation but in a sense simply said, "Here I am — just accept me." The apostle Paul expressed it clearly: "For from him and through him and to him are all things. To him be glory forever. Amen" (Rom. 11:36). Our universe came from him, it is daily sustained by him, and its ultimate purpose will be fulfilled in his being glorified.
This means our lives should focus on God. One of the challenges is that he allows us to enjoy so much in this life that it is easy to think that our reason for existence is to live comfortably and find happiness in every way we can. We must never discount the many blessings God pours into our earthly lives and be grateful for them. But when we focus only on the gifts and not on the giver, we are grievously wrong. Life is fundamentally about coming to know him personally and finding fulfillment and joy in nothing other than God himself. He alone can satisfy our deepest longings. If we are settling for the pleasure we get only in ourselves and in this world, we are accepting something second rate. Adopting this God-centered view of life is critical to rightly view dementia. It is not simply about dementia disrupting our comfort and happiness; this disease becomes a tool that God uses to accomplish his ultimate purpose: his honor, his glory.
Dementia Was Not Part of God's Good Creation
Seven times in Genesis 1 we are told that the world God made was good, meaning it conformed perfectly to God's character. It was filled with love, beauty, joy, righteousness, and satisfying work for our first parents. There was no human death, no disease, no pain or suffering. Most important, for our present purposes, there was no dementia.
All Humans Are Made in God's Image and Are His by Right of Creation
The high point of God's creation was humans. He created us, and so by right we all belong to him. The psalmist caught the significance of this when he wrote, "The earth is the Lord's and the fullness thereof, the world and those who dwell therein" (Ps. 24:1). Applying this truth to dementia victims means that they, too, belong to God just as much as anyone else, and we must treat them accordingly.
God made all of us with both minds and bodies, and who we are is an essential unity of these; both are equally important to our identity. There is no such thing as a half person. We cannot afford to discredit the importance of our physical bodies and emphasize our minds or do the opposite. Our bodies may get sick and not function well, but we are still persons. Our minds may get sick and not function well, but we are still persons. We will see that dementia may devastate some of our brain's abilities, such as memory and rationality, but we still have feelings and are able to enjoy human relationships. We are still whole persons who belong to God.
That each of us is God's creation and belongs to him is reason enough to treat everyone with respect. But there is an even more significant basis for doing so: each of us has been made in the image and likeness of God. That we are made in God's image is the first thing God declared about humankind and so distinguished us from all the rest of creation. Scripture doesn't say we are the exact image of God but rather that we are made in, or according to, God's image. Only Jesus is the exact image of God (Col. 1:15; Heb. 1:3). Being made in God's image conveys a special dignity to all men and women, and this dignity does not depend on how closely our character resembles God, how smart we are, or what wonderful things we do. The fact of human dignity is equally true of the Nobel laureate as of the most severe dementia sufferer who is totally dependent on others.
Sin Led to Dementia but Did Not Diminish God's Image
Our first parents were not content to live in loving relationship with their Creator and decided that merely reflecting his image was not enough for them. They wanted to be even more like God. So they disobeyed the one command God had given them. In that single act of rebellion, sin entered the human race. God's good creation began to unravel in almost every way. As a result of man's disobedience, death came alongside life, and alongside goodness came evil, alongside love came hate, and alongside health came disease, including dementia.
But even as sin disrupted so much of God's good creation, one thing it did not destroy was the image of God in all human beings. This is a key concept and worth belaboring, for it means that even those severely afflicted with dementia share equally with all of humanity in the image of God with its inherent dignity. We see this here: "Whoever sheds the blood of man, by man shall his blood be shed, for God made man in his own image" (Gen. 9:6). After the flagrant sin that led to the flood, God placed a special protection on mankind because they were "in his own image."
We get another fascinating glimpse from the New Testament, where James writes, concerning our tongues, "With it we bless our Lord and Father, and with it we curse people who are made in the likeness [image] of God" (James 3:9). Even when people are such scoundrels that we want to curse them, they still bear the image of God. Sin did not destroy the image of God nor do we get any indication in Scripture that it diminished it any more than damaging a building alters its blueprint. Martin Luther King understood the significance of this when he said, "There are no gradations in the image of God."
However, sin did damage our ability to reflect the image of God, and it did so in profound ways. Further, when sin entered the world, it compromised our ability to enjoy our lives on earth. This is seen in countless ways, but one of them is dementia and the way it wreaks havoc in the lives of its sufferers and those who love and care for them. We are right to be frustrated and even angry at dementia, leading us to cry out to God, lament the tragedy, and look for God's help to respond to it rightly.
God Uses Bad to Accomplish Good
One of the striking things the Bible teaches us about God is how he takes some of the most difficult circumstances of life and transforms them for his own purposes. We see that dramatically in the case of sin itself. God's glory is certainly seen in the marvels of his beautiful creation. But we see even more of his glory in the way he dealt with sin. In spite of our turning our backs on God, he loved us to the extent that he sent his Son to suffer and die to bring us back into relationship with him. Similarly, God takes many of the most difficult challenges of life and turns them around, enabling us to appreciate how great he is. His purpose may not be our immediate comfort but our long-term ability to find our greatest joy in him. Joni Tada, who is quadriplegic, is well known for saying of God, "Always permitting what he hates to accomplish something he loves." Pastor Tim Keller explains it clearly: "The evils of life can be justified if we recognize that the world was primarily created to be a place where people find God and grow spiritually into all they were designed to be." One of those things that God may hate, one of those evils of life, is dementia. Yet as we will see, God can use dementia to allow us to know more of his goodness and to honor him.
We Will Be Like Him
God is in the process of calling out from mankind a group of people as his own. He gives them the ability to trust him by faith and makes them his children. He chooses them not according to how good they are, for no one is good enough to merit what he gives. Instead, he chooses them to show how good he is. Then he begins the slow process of restoring them fully to his image, which they were made in. Paul writes, "Those whom he foreknew he also predestined to be conformed to the image of his Son. ... And those whom he predestined he also called, and those whom he called he also justified, and those whom he justified he also glorified" (Rom. 8:29-30). Now, here is the key point. All those he has chosen will increasingly conform to his image, and in the end all will enter into his glory. This transformation is based not on their abilities or IQ but on God's choice and plan. The apostle John put it simply: "We shall be like him" (1 John 3:2).
Robert Davis, a pastor who experienced dementia, reflected on his final destiny and wrote, "How can I stand to look at this disaster [referring to his dementia] that medical science predicts will most probably overtake me? If I were not a Christian, I do not know how I could stand it. However, since I am a Christian, I can stand it by looking beyond it — looking beyond and considering the glories of heaven where each one of these things will be gone forever and be replaced by perfection, glory, and joy."
As Christians we can confront dementia with confidence that God will accomplish his purpose and his glory. In that we can find joy and hope. We know in the future all believers, including those with dementia, will stand in his presence as whole people reflecting more of his image. Such is the destiny of those suffering from dementia, including the most severe forms of it. They will be completely restored as whole people, body and soul together, fully able to enjoy the richness of God through all eternity. That destiny is a further source of the dignity they possess even in the compromised state they live in today.
But in the meantime, one way we can be helped to honor God through the experience of dementia is by understanding more about it, which is what we'll consider next.
Heavenly Father, dementia is scary. The very thought of it terrifies me. I confess it is difficult to believe you are loving and strong while at the same time you allow this tragedy. Help me believe you have a purpose in all that you do. I want to trust you, but it will be easier if I can get a glimpse of the purpose you intend through dementia. By your Spirit, guide my thinking and my emotional responses. I pray this for my good and for your honor. Amen.CHAPTER 2
What Should We Know about Dementia?
Allow me to introduce you to Dave and Denise, two dear friends, whose story I will be sharing throughout this book. Both in their mid-sixties, they have had a good marriage for thirty-three years. They have three loving and supportive children. Dave is a medical technician, and Denise works in a high school cafeteria. They keep themselves in good health, eat wisely, and exercise on a regular schedule. Having been Christians for most of their adult lives, they love the Lord, have nurtured a personal relationship with him, and attend church regularly. They have many friends, both at church and in their neighborhood. About five years ago, Denise noted that Dave was restless, and he kept asking her to repeat what she'd said. She wasn't sure if he had a hearing problem or just wasn't paying attention. He agreed to let me check his hearing, which was fine. Knowing this, Denise wasn't totally reassured and said she still sensed something was not quite right. She commented, "Perhaps work is getting to him, or maybe this is what getting older looks like." I nodded a tentative agreement but in retrospect the correct answer should have been "not really." As time would prove, Dave was showing early signs of dementia.
The Healthy Brain
Before we can understand dementia, we must have a basic knowledge of what a healthy brain is like as it ages. That will allow us to recognize how a normal brain differs from one that is developing dementia.
Have you ever thought much about how awesome your mind is? The very fact that we can think a thought is amazing. Our brains are packed with countless nerve cells, and the chemicals that go between those cells allow one nerve cell to affect another. This enables our brains to process and record our thoughts. But we also have immaterial souls, where are thoughts originate. Together our physical brains and our immaterial souls constitute our minds. It is like the computer I am typing on. It records and processes my thoughts, but they originate from me, not from my computer. In addition to being able to think, one of the most impressive functions of our minds is that we can remember. Isn't it astounding that, somehow, recorded in our brains are experiences we had decades ago? We can recall them in an instant, allowing the experiences of the past to impact choices we make in the present. As we begin to think about the changes in our brains that occur over time, what might impress us is not that they can fail but that they ever worked in the first place.
As our brains age, they remain capable of learning new things, recording new memories, and processing vast amounts of information. Job had it right when he said, "Wisdom is with the aged, and understanding in length of days" (Job 12:12). At times we get frustrated when our brains do not work as well as we want, and as we mature we begin to forget more things. Most commonly we struggle to recall nouns and names. We look at someone and her face is familiar, but we are not sure in what context we know her and cannot immediately come up with her name. I have found that many people who have these slips think they are getting dementia. That is usually not the case. In fact, I tell seniors that I have three types of patients: those who are normal and admit they forget, those with dementia who forget they forget, and those who lie.
Excerpted from Finding Grace in the Face of Dementia by John Dunlop. Copyright © 2017 John Dunlop. Excerpted by permission of Good News Publishers.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
1 God and Dementia 21
2 What Should We Know about Dementia? 29
3 What about Diagnosis? 39
4 Can Dementia Be Prevented of Treated? 53
5 How Does It Feel to Have Dementia? 61
6 The Experience of Caregiving 71
7 Help for Caregivers 83
8 How Can We Honor God through Dementia? 101
9 Respect the Dignity of Those with Dementia 113
10 Meet the Needs of Those with Dementia 117
11 What Should the Church Do? 141
12 Grow through the Experience of Dementia 155
13 End-of-Life Issues 167
Appendix: A Letter to My Family 185
Suggested Reading 191
General Index 197
Scripture Index 205
What People are Saying About This
“This book offers needed help and hope for those who have a loved one experiencing dementia. John Dunlop’s training as a medical doctor, along with his understanding of what the Bible teaches us about our bodies and our souls, gives him a unique perspective from which to address this crucial issue.”
—Dennis Rainey, president and CEO, FamilyLife; host, FamilyLife Today; author, Stepping Up
“Finding this book is like discovering a wonderful treasure. John Dunlop has mined decades of experience as geriatrician, son of a mother with dementia, bioethics expert, and active church member to help the rest of us make sense of a condition that seems to rob people of every shred of dignity. Drawing on the glorious biblical truth of every person’s creation in the image of God, Dunlop shows that dignity cannot be lost even in the face of dementia. People entering or anticipating the experience of dementia, as well as their family, friends, and caregivers—in other words, nearly everyone—will find in this book the grace they need to cope with its challenges.”
—John F. Kilner, professor of bioethics and contemporary culture, Trinity Evangelical Divinity School; author, Why People Matter and Dignity and Destiny
“Almost thirty years ago, my mother died of complications springing from nine years of Alzheimer’s Disease. During those nine years I read several helpful books that described the stages of the disease, what to expect, and how to respond. Nowadays similar resources are found on the web. But there is nothing quite like John Dunlop’s book on dementia. Decades of experience as a geriatrician and a devout Christian combine to help other believers think through dementia—what it means, how to trust God when you see its onset (in you or in friends and relatives), and, yes, how God glorifies himself and brings strength to his people precisely in the midst of such horrendous, ravaging illness. This book will help you become a better caregiver; more importantly, it will help you become a more mature and thoughtful Christian. It may even help you become a better patient.”
—D. A. Carson, research professor of New Testament, Trinity Evangelical Divinity School; cofounder, The Gospel Coalition
“My father-in-law resided with us through his eight-year journey with Alzheimer’s. As a physician, I had taken care of patients with dementia, but then I lived with the disease. The best way to help a friend or family member dealing with this illness is to give them a copy of this book. It is an invaluable resource.”
—David Stevens, CEO, Christian Medical and Dental Associations
"Finding Grace in the Face of Dementia is a remarkably helpful book on the increasingly common phenomenon of dementia. Growing out of his medical practice as a geriatric physician and his experience as a caregiver for his parents, both of whom suffered from dementia, John Dunlop writes for those who struggle with this disease themselves, for caregivers, and for members of the body of Christ eager to lean in and love well in these difficult circumstances. This book ably and understandably covers the waterfront medically, theologically, practically, and experientially. Combining compassionate kindness, sober realism, appropriate anguish and lament, and ultimate confidence in God's love and grace, Dunlop both encourages and fortifies those who suffer and those who give care. This book rings true to my own experience with my mother, who suffered from dementia for twenty years. May this much-needed resource be used widely and mightily in the days ahead."
—Steven C. Roy, associate professor of pastoral theology, Trinity Evangelical Divinity School
“Dementia may well be the most feared diagnosis in the Western world, and this book is a timely contribution to a community in need of education and encouragement. Dunlop does not gloss over the challenges that dementia can bring but takes us by the hand and leads us sympathetically through the various aspects of the illness. Dunlop’s extensive experience allows him to contribute rich practical and spiritual wisdom for those walking this path. I highly recommend it as a guide.”
—Megan Best, palliative care practitioner; bioethicist
Most Helpful Customer Reviews
The author has real life experiences as well as medical training. However, I feel he has true compassion for the patient, and caregivers, that only someone with his understanding and beliefs can offer. He respects life and understands the value of ever person.